Repair of penile prosthesis-induced impending erosion using xenograft during simultaneous inflatable penile prosthesis replacement.

BACKGROUND: Penile prosthesis (PP)-induced impending erosion is a rare complication that has not been well characterized. AIM: This study evaluates the role of prosthesis sizing and of the safety of xenograft windsock repair (AlloDerm, Tutoplast, ArthroFLEX) of impending erosion. METHODS: This was a retrospective review of xenograft use during inflatable penile prosthesis (IPP) replacement. Patient demographics, prior PP characteristics, and xenograft-augmented IPP characteristics were obtained. Paired-samples t tests were used to compare the PP cylinder size, rear tip extender size, and calculated PP length between the most recent prior PP and the xenograft-augmented IPP. Complications and follow-up data were obtained. OUTCOMES: The primary outcome was comparing the corporal body and device measurements between the PP presenting with impending erosion and the implanted xenograft-augmented IPP. The secondary outcome was evaluating the incidence of subsequent explantation. RESULTS: A total of 24 patients underwent xenograft repair with simultaneous IPP replacement from 2012 to 2022. The median number of prior PP was 1 (interquartile range, 1-2.75). The median time between the most recent prior PP and xenograft-augmented IPP placement was 21 (interquartile range, 14-79) months. The prior PP was significantly longer at the time of explantation compared with the measured corporal body length in both the left (21.4 cm vs 20.1 cm; P < .01) and right (21.4 cm vs 20.1 cm; P < .01) sides. However, there was no significant difference in length between the xenograft-augmented IPP length at the time of implantation and measured corporal body length in both the left (20.1 cm vs 20.0 cm; P = .67) and right (20.2 cm vs 20.1 cm; P = .56) sides. A total of 16 (66.7%) cases required bilateral xenograft corporal body use. Only 1 (4.2%) patient had an IPP infection requiring explantation within 90 days of xenograft-augmented IPP placement. A total of 2 (8.3%) patients had device malfunction and 1 (4.2%) patient had impending erosion recurrence requiring removal/replacement of their initial xenograft-augmented IPP in a median time of 56 months from placement. CLINICAL IMPLICATIONS: PP oversizing may increase risk of PP-induced impending erosion, which is a delayed process. STRENGTHS AND LIMITATIONS: This is the largest retrospective study of xenograft use during IPP replacement for impending erosion but does not have a control cohort. This study is limited by its retrospective nature, limited follow-up, and absence of a treatment comparison. CONCLUSION: PP-induced impending erosion may be due to PP oversizing but can be successfully repaired with xenograft windsock during simultaneous IPP replacement.

Rear Tip Extenders and Penile Prosthesis Rigidity: A Laboratory Study of Coloplast Prostheses.

BACKGROUND: Rear tip extenders (RTEs) are used commonly in penile prostheses, but their effect on erectile rigidity has not been extensively studied. AIM: To determine whether RTEs affect erectile rigidity in inflatable penile prostheses and determine what length of RTE should be used for a given corporal length-in this case, 22 cm. METHODS: To assess the effect of RTEs on erectile rigidity, we created a penile model simulating 2 corpora cavernosa that accommodated cylinders of varying lengths. Once the cylinders were inflated, a 200-g weight was then uniformly placed on the tip of the cylinders and deflection was measured using a ruler. Measurements were repeated for varying cylinder/RTE lengths to total 22 cm of overall corporal length. OUTCOMES: Differences in rigidity and angular deflection based on RTE length were assessed. RESULTS: Increasing the length of RTEs increased the deflection in our model, indicative of decreased axial rigidity. CLINICAL TRANSLATIONS: The current work implies that having additional RTEs may decrease penile rigidity and in turn, patient satisfaction. STRENGTHS AND LIMITATIONS: Though assessing effect of RTEs on erectile rigidity is novel, the exact ability of our model to predict in-vivo behavior is unknown. CONCLUSION: An inflatable penile prosthesis represents a heterogeneous beam given that it is composed of a non-inflatable rear combined to an inflatable cylinder. In this model greater bending deflection was associated with more RTE length. Greater RTE length decreases the size of the inflatable device that can be implanted. The erect penis is subject to axial stress and bending deflection. Though further work is needed, these data support the notion that maximizing inflatable length by minimizing RTEs will improve overall erectile rigidity dynamics. Thirumavalavan N, Cordon BH, Gross MS, et al. Rear Tip Extenders and Penile Prosthesis Rigidity: A Laboratory Study of Coloplast Prostheses. J Sex Med 2018;15:1030-1033.

Intracavernosal Prostaglandin Injection Prior to Circumcision Allows More Precise Removal of Foreskin.

OBJECTIVES: The study aims to evaluate the outcomes of adult circumcision with the use of intracavernosal injection (ICI) of prostaglandin to induce an erection at time of operation. METHODS: Twenty patients undergoing circumcision received ICI with prostaglandin prior to surgery. Demographics of all patients along with outcomes and complications at 2-week and 3-month follow-up were recorded. RESULTS: No complications were evident at 2-week and 3-month follow-up. All 20 patients were satisfied with cosmetic result. CONCLUSIONS: Circumcisions performed with ICI is a novel technique that allows accurate removal of foreskin and can be safely applied to current surgical technique for improved cosmetic results.

Safety and efficacy of Rezum™ in erectile dysfunction patients with and without an inflatable penile prosthesis[[es]]Seguridad y eficacia del sistema Rezum® en pacientes con disfunción eréctil con y sin prótesis de pene inflable.

PURPOSE: This study evaluates the safety and efficacy of Rezum™ in erectile dysfunction (ED) patients with and without an inflatable penile prosthesis (IPP). MATERIALS AND METHODS: This was a retrospective review of ED patients who underwent Rezum™ by a single surgeon over 12 months. Patient age, presence of IPP, number of benign prostatic hyperplasia medications, International Prostate Symptom Score (IPSS), IPSS Quality of Life Index (QOL), uroflowmetry maximum flow rate (Qmax), and uroflowmetry average flow rate (Qavg) before and after Rezum™ were obtained. Independent two-sample T-tests were used to compare preoperative and postoperative characteristics between patients with and without an IPP. Linear regression was performed to identify factors associated with postoperative Qmax or Qavg. RESULTS: A total of 17 patients with ED who underwent Rezum™ were identified, including 11 patients with an IPP. The median follow-up after Rezum™ was 65 days. There were no significant differences in baseline demographics and clinical characteristics between patients with and without an IPP. Postoperative Qmax (10.9 mL/s vs 9.8 mL/s, p = 0.04) and Qavg (7.5 mL/s vs 6.0 mL/s, p = 0.03) were significantly higher in patients with an IPP compared to patients without an IPP. There were no factors associated with postoperative Qmax or Qavg on linear regression. Two patients without an IPP went into urinary retention, while no complications occurred in IPP patients. CONCLUSION: Rezum™ is a safe and effective procedure to perform in ED patients, particularly those with an IPP. IPP patients may experience greater increase in uroflowmetry rate compared to ED patients without an IPP.

Retained needles during intracavernosal self-injection for erectile dysfunction treatment: a case report and systematic literature review.

Introduction: Although the breakage and entrapment of the needles inside the penis during intracavernosal self-injection for erectile dysfunction treatment is a rare complication, when it happens, it can cause significant distress and anxiety to the patients who experience it. Aims: Our work aims to report a case of retained penile needle and to compare it with similar cases in the literature to define the risk factors and the best practice to prevent and treat this complication. Methods: We are reporting successful surgical removal of a deeply retained penile needle with the aid of intraoperative fluoroscopy after an unsuccessful attempt of ultrasound-guided removal in the emergency room. We searched the PubMed and Embase databases for similar cases and compared the findings across all the cases. Results: In our case, the needle was initially superficial; however, excessive manipulation in the emergency room resulted in deep displacement into the corpus cavernosum. We were able to successfully localize the needle using intraoperative fluoroscopic guidance. The needle was then surgically removed via a small skin incision with minimal dissection of cavernosal tissue. We identified 15 reported cases of retained penile needles in the literature and performed a comprehensive comparison among all the cases. It is critical to search for specialized treatment with a urologist to avoid great damage due to erroneous manipulation of the corpora cavernosa. Conclusion: Selecting patients with good manual dexterity is essential to avoid breakage and entrapment of penile needles during intracavernosal self-injection for erectile dysfunction treatment. The management of retained penile needles should be individualized depending on the clinical picture at the time of presentation. It is critical to avoid excessive manipulation as it can push the needle deeper into the penis and make the extraction more demanding.

New Advancements in Inflatable Penile Prosthesis.

INTRODUCTION: Inflatable penile prosthesis (IPP) technology is a mainstay in the treatment of erectile dysfunction refractory to medical management. Technological advancements in the design of 3-piece IPPs have been improved to optimize concealability and surgical placement since the 1980s. Recent advancements over the past 10 years include pump, reservoir, tubing, and cylinder updates. OBJECTIVES: This review examines the latest updates in IPP technology, reviews recent relevant research, and is based on over 32 years of experience performing IPP surgery in addition to concurrent postoperative management. METHODS: A literature review was conducted for studies published over the last 10 years through March 2020 with an emphasis on technical updates of IPP, specifically the pump, reservoir, tubing, and cylinder, and their functional outcomes. Anti-infective coating and transgender innovations, in addition to postoperative management, are also reviewed. RESULTS: Technological advancements include a flat reservoir designed for improved discreteness and a prosthesis with optimized tubing length, a one-touch deflatable 3-piece system, narrow-base cylinders, a 0° angle design between the cylinders and tubing to aid in cylinder placement, a soft molding cylinder tip redesign that better mimics human anatomy, and a 3-piece IPP specifically designed for neophallus use. Furthermore, the Food and Drug Administration approved the submuscular reservoir placement. CONCLUSION: Penile prosthesis has evolved over time to improve functional outcomes, ease of use, and minimize postoperative complications and pain. Penile prosthesis implantation continues to be a life-changing procedure for patients and it is imperative for surgeons to be up-to-date on the latest developments and research in order to provide the best functional outcomes for those they take care of. Dinerman BF, Telis L, Eid JF. New Advancements in Inflatable Penile Prosthesis. Sex Med Rev 2021;9:507-514.

What is new for inflatable penile prostheses?

PURPOSE OF REVIEW: Although the first inflatable penile prosthesis was introduced over 30 years ago for the treatment of erectile dysfunction, technological innovations have continually improved these penile implants since that time. This review will highlight outcomes reported in peer-reviewed literature during the past 5 years related to several recent advancements in three-piece inflatable penile prosthesis technology of interest to surgeons who implant these devices. RECENT FINDINGS: Research findings reported during the past 5 years have been related to improvements in cylinder and pump design to provide more reliable performance with good device concealment and a normal look and feel, to ease inflation and deflation, and to reduce infection complications with inflatable prostheses. SUMMARY: It is important for all physicians, who implant life-changing penile prosthetics, to understand the most recent advances in technology in order to best serve their patients.

The Rear Tip Extender for Inflatable Penile Prostheses: Introduction of "Rigidity Factor" and Review of the Literature.

INTRODUCTION: Rear tip extenders (RTEs) are often used in penile prosthesis surgery, and their value and use have varied with the evolution of penile prostheses. AIM: To review the literature addressing RTEs and to introduce a new term, rigidity factor, which quantifies the ratio of inflatable to non-inflatable component of the cylinders. METHODS: The urologic literature was reviewed for all mention of RTEs. In addition, literature regarding penile prostheses was explored for mention of RTEs. MAIN OUTCOME MEASURE: A search on PubMed for "rear tip extender" resulted in 17 publications. These publications were reviewed, and references were also explored for related publications. RESULTS: The history of the development of RTEs, complications associated with the use of RTEs, and current practices in the use of RTEs are all discussed. In addition, recent publications regarding RTEs were examined in detail. RTEs were introduced in the 1980s to improve mechanical survival of prostheses. They were thought to decrease input tubing wear. Although the trend recently has been to place more rear tips, evidence has surfaced suggesting a link to increased need for reoperation with additional RTEs. In addition, we believe that increased length of RTEs can decrease erectile quality. Rigidity factor, defined as the ratio of the live (inflatable) portion of cylinder to the total cylinder length, can be used to quantify the effect of RTE on erectile strength. However, the effects of RTEs on biomechanical properties of the penis when fully inflated are still not fully understood. CONCLUSION: The use of RTEs is a relatively underexplored area of penile prosthesis placement. Further laboratory and in vivo work will allow for a better understanding of the optimal role of RTEs in penile prosthesis surgery. Thirumavalavan N, Cordon BH, Gross MS, et al. The Rear Tip Extender for Inflatable Penile Prostheses: Introduction of "Rigidity Factor" and Review of the Literature. Sex Med Rev 2019;7:516-520.