Current devices, outcomes, and pain management considerations in penile implant surgery: an updated review of the literature.

Penile prosthesis surgery is a definitive treatment for erectile dysfunction (ED). The two categories of penile prosthesis are endorsed by professional guidelines, inflatable penile prosthesis (IPP) and malleable penile prosthesis (MPP). Each modality of penile prosthesis offers distinct advantages and incorporates specific design features, allowing for personalized device selection that aligns with individual needs and preferences. While the overall complication rate of penile implant surgery remains low, surgeons should maintain a high index of suspicion for complications in the perioperative time period. Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain. Finally, the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.

Decreased Opioid Prescription With Low Pain Scores After Urethroplasty: Using a Simplified, Multimodal, Opioid Minimization Pain Protocol.

OBJECTIVE: To implement a simplified, opioid-minimized, multimodal pain management (MPM) protocol and assess its effectiveness of reducing opioid dispersion while maintaining low postoperative complications, patient-reported pain, and patient-reported interference with quality of life (QOL) for men undergoing urethroplasty. METHODS: Ninety-five men at a single academic center from October 2020 to October 2023 received a urethroplasty. We retrospectively reviewed the prior standard pain management (SPM) cohort before August 2021, then prospectively studied the MPM cohort after August 2021. For the SPM cohort, we collected postoperative day (POD) 1 pain scores from our Electronic Medical Record (EMR). For the MPM cohort, we obtained a validated pain and QOL assessment in the early postoperative period. The SPM cohort's POD 1 pain scores were compared with the MPM cohort's POD 2 pain scores. Opioid dispensation records were queried from the Prescription Monitoring Program. RESULTS: Seventy-five morphine milligram equivalent fewer opioids in the MPM cohort were prescribed than the SPM cohort (0 (interquartile range [IQR]: 0-0) vs 75 (IQR:0-150), P < .001, respectively). Patients with opioid discharge prescriptions fell from 50% in the SPM cohort to 11% in the MPM cohort (P < .001). Early postoperative pain scores remained low and showed no significant difference between the cohorts. Pain's interference with QOL measures remained low. Complications were rare across both cohorts. CONCLUSION: This simplified, multimodal analgesia protocol effectively decreases postoperative pain and opioid dispersion without affecting QOL outcomes after urethroplasty. This pain regimen can be easily adopted to decrease the use of postoperative opioids in men undergoing urethroplasty.

Queen presence mediates the relationship between collective behaviour and disease susceptibility in ant colonies.

The success of social living can be explained, in part, by a group's ability to execute collective behaviours unachievable by solitary individuals. However, groups vary in their ability to execute these complex behaviours, often because they vary in their phenotypic composition. Group membership changes over time due to mortality or emigration, potentially leaving groups vulnerable to ecological challenges in times of flux. In some societies, the loss of important individuals (e.g. leaders, elites and queens) may have an especially detrimental effect on groups' ability to deal with these challenges. Here, we test whether the removal of queens in colonies of the acorn ant Temnothorax curvispinosus alters their ability to execute important collective behaviours and survive outbreaks of a generalist entomopathogen. We employed a split-colony design where one half of a colony was maintained with its queen, while the other half was separated from the queen. We then tested these subcolonies' performance in a series of collective behaviour assays and finally exposed colonies to the entomopathogenic fungus Metarhizium robertsii by exposing two individuals from the colony and then sealing them back into the nest. We found that queenright subcolonies outperformed their queenless counterparts in nearly all collective behaviours. Queenless subcolonies were also more vulnerable to mortality from disease. However, queenless groups that displayed more interactions with brood experienced greater survivorship, a trend not present in queenright subcolonies. Queenless subcolonies that engage in more brood interactions may have had more resources available to cope with two physiological challenges (ovarian development after queen loss and immune activation after pathogen exposure). Our results indicate that queen presence can play an integral role in colony behaviour, survivorship and their relationship. They also suggest that interactions between workers and brood are integral to colonies survival. Overall, a social group's history of social reorganization may have strong consequences on their collective behaviours and their vulnerability to disease outbreaks.