Tips and tricks in the management of inflatable penile prosthesis infection: A review.

OBJECTIVE: To review the management of inflatable penile prosthesis (IPP) infection.Methods: The 'gold-standard' treatment for medication-refractory erectile dysfunction is the IPP, wherein the most dreaded complication is infection. To prevent and manage an infected IPP requires a strict protocol during the pre-, intra-, and postoperative course. A variety of techniques and antibiotics are used in conjunction with IPP implantation to prevent contamination. This modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review of the literature examines the current practices by leading urologists in the management of IPP infection, as well as provides insights for improved patient outcomes. RESULTS: : Patient selection is important to reduce IPP infections, and those with risk factors need to be optimised prior to surgery. Proper antibiotic prophylaxis includes pre-, intra-, and postoperative administration. As most infections derive from normal skin flora, every measure must be taken to sterilise the skin and avoid direct device skin contact. Up to 3% of virgin IPPs develop infections and this number increases to 18% in revision cases. Antibiotic coverage depends on the presenting microbe, which can vary significantly between patients. CONCLUSIONS: : A greater success in IPP implantation can be attributed to appropriate prophylaxis, field sterilisation, and surgical technique. For those implants that do become infected, often erectile function can be preserved by immediate antibiotic coverage combined with salvage procedures.

Changing Trends in Management Following Artificial Urinary Sphincter Surgery for Male Stress Urinary Incontinence: An Analysis of the National Surgical Quality Improvement Program Database.

OBJECTIVE: To characterize the safety and practice patterns of artificial urinary sphincter (AUS) placement on a population level. Increasingly AUS implantation has shifted to be an outpatient surgery; however, there is a lack of large-scale research evaluating factors associated with early (≤ 24 hours) versus late (>24 hours) discharges and complications in men following AUS placement. We utilized the National Surgical Quality Improvement Program (NSQIP) database to identify and compare factors and outcomes associated with each approach. METHODS: NSQIP database was queried for men undergoing AUS placement between 2007 and 2016. Patients were classified as either early discharge (ED ≤ 24 hours) and late discharge (LD > 24 hours). Baseline demographics, operating time, and complications were compared between the 2 groups. Multivariate logistic regression evaluated factors associated with discharge timing and 30-day complications. RESULTS: A total of 1176 patients were identified and were classified as ED in 232 and LD in 944 patients. Operative time was shorter in ED (83 minutes) compared to LD (95 minutes, P < .001). Hypertension was more prevalent among LD patients (60.3% vs 69.1% for ED and LD respectively, P < .001). The 30-day complication rate was similar in both groups (ED: 4.3% vs LD: 3.4%, P = .498). Multivariable analysis revealed that surgery after 2012 was associated with ED (OR = 3.66, P < .001). CONCLUSION: At the national level, there are no differences in postoperative morbidity between early and late discharges. There is a trend toward more ED, specifically after 2012. A prospective study on the feasibility and safety of outpatient AUS is needed.

Review of Management Options for Active-Phase Peyronie's Disease.

INTRODUCTION: Peyronie's disease (PD) is a fibrotic disorder that leads to plaque formation in ∼3-9% of adult men. Connective tissue buildup results in plaque formation, penile curvature and shortening, and in some cases, pain. In the active phase of PD, penile pain is a common symptom, often accompanied by progression in curvature. Treatment options for PD include oral drugs, topical cream, intralesional injections, traction, and shock wave therapy. This article reviews the different treatment options for active-phase PD. AIM: To provide a comprehensive review of the current evidence-based treatments, focusing on active-phase PD. METHODS: A PubMed database search was performed for studies on conservative therapy. We reviewed current clinical practices and trials for the treatment of active-phase PD and assessed their applicability as treatment options. MAIN OUTCOME MEASURE: Define the most recent and effective therapies for the improvement in penile curvature in men presenting with acute PD. RESULTS: A number of trials have resulted in significant benefits in the treatment of PD. Many of the oral therapies studied improved patient outcomes, but the data are insufficient. Similarly, there is no approved topical therapy by guidelines. The best options are intralesional injections of collagenase Clostridium histolyticum (CCh) and interferon-α2b. Shock wave therapy is not recommended for treatment of curvature, but has been shown to improve pain. Traction therapy may have a role in improving PD curve and penile length. CONCLUSION: PD remains a challenge for urologists. Evidence suggests that, for oral therapy, a combination of drugs produces better results. Shock wave therapy is still unproven. Intralesional therapy delivers the best evidence for improvement in the active phase. CCh is the only FDA-approved treatment option available. Penile traction therapy may improve patient outcomes. Brimley SC, Yafi FA, Greenberg J, et al. Review of Management Options for Active-Phase Peyronie's Disease. Sex Med Rev 2019;7:329-337.