Current management of penile implant infections, device reliability, and optimizing cosmetic outcome.

Penile implants hold a major position in the treatment algorithm for patients with erectile dysfunction who find medications and vacuum erection devices ineffective or unsatisfactory. As with any surgical procedure, adverse events may occur. The infection rate associated with implant placement has been lowered to the range of 1 % or less due to multifactorial improvements including no-touch techniques, the use of antibiotic-coated devices, and improved quality measures in the operating room. Urologists have been proactive in employing techniques and procedures which minimize loss of erectile length, hence enhancing patient satisfaction. Flat reservoirs have been developed and techniques of placing these to avoid problems in the space of Retzius have reduced complication rates as well. Device reliability has improved to the point that penile implants are among the most durable mechanical surgical products that contribute to patient and partner satisfaction, which is by far the greatest among all the treatments of erectile dysfunction.

Detection of Medication Taking Using a Wrist-Worn Commercially Available Wearable Device.

PURPOSE: Medication nonadherence is a persistent and costly problem across health care. Measures of medication adherence are ineffective. Methods such as self-report, prescription claims data, or smart pill bottles have been used to monitor medication adherence, but these are subject to recall bias, lack real-time feedback, and are often expensive. METHODS: We proposed a method for monitoring medication adherence using a commercially available wearable device. Passively collected motion data were analyzed on the basis of the Movelet algorithm, a dictionary learning framework that builds person-specific chapters of movements from short frames of elemental activities within the movements. We adapted and extended the Movelet method to construct a within-patient prediction model that identifies medication-taking behaviors. RESULTS: Using 15 activity features recorded from wrist-worn wearable devices of 10 patients with breast cancer on endocrine therapy, we demonstrated that medication-taking behavior can be predicted in a controlled clinical environment with a median accuracy of 85%. CONCLUSION: These results in a patient-specific population are exemplar of the potential to measure real-time medication adherence using a wrist-worn commercially available wearable device.

Review: Alternative Placement of Penile Prosthesis Reservoir and AUS Pressure Regulating Balloon.

INTRODUCTION: Ectopic placement of prosthetic balloons and reservoirs in urological surgery has gained popularity, and early experience suggests that such placement is safe and efficacious. We review the artificial urinary sphincter (AUS) pressure regulating balloon (PRB) and inflatable penile prosthesis (IPP) reservoir placement and the factors relating to ectopic vs. traditional paravesical placement of these devices. METHODS: Articles from peer-reviewed journals, abstracts, and surgeons' series of outcomes form the basis for this review. Relevant mechanical function of devices and pertinent anatomy is reviewed. MAIN OUTCOME MEASURES: To review the current data regarding ectopic and conventional reservoir placement for the AUS and IPP. RESULTS: Traditional and ectopic placements of the AUS PRB and IPP reservoir have been shown to be safe and effective. There are well-documented risks associated with both traditional and ectopic approaches, and these risks must be weighed in the context of a specific clinical scenario and surgeon comfort. CONCLUSION: Traditional and ectopic placement of prosthetic balloons and reservoirs should be guided by patient characteristics and surgeon experience. Our early experience is in agreement with that of others in that ectopic placement of these devices appears to be a viable alternative in the appropriately selected patient and may be a technically easy procedure to learn for the experienced prosthetic surgeon. Reznicek DG, Bryson R, and Kramer AC. REVIEW: Alternative placement of penile prosthesis reservoir and AUS pressure regulating balloon. Sex Med Rev 2015;3:48-55.