Development and validation of 3-dimensional simulators for penile prosthesis surgery.

BACKGROUND: The acquisition of skills in penile prosthesis surgery has many limitations mainly due to the absence of simulators and models for training. Three-dimensional (3D) printed models can be utilized for surgical simulations, as they provide an opportunity to practice before entering the operating room and provide better understanding of the surgical approach. AIM: This study aimed to evaluate and validate a 3D model of human male genitalia for penile prosthesis surgery. METHODS: This study included 3 evaluation and validation stages. The first stage involved verification of the 3D prototype model for anatomic landmarks compared with a cadaveric pelvis. The second stage involved validation of the improved model for anatomic accuracy and teaching purposes with the Rochester evaluation score. The third stage comprised validation of the suitability of the 3D prototype model as a surgical simulator and for skill acquisition. The third stage was performed at 3 centers using a modified version of a pre-existing, validated questionnaire and correlated with the Rochester evaluation score. OUTCOME: We sought to determine the suitability of 3D model for training in penile prosthesis surgery in comparison with the available cadaveric model. RESULTS: The evaluation revealed a high Pearson correlation coefficient (0.86) between questions of the Rochester evaluation score and modified validated questionnaire. The 3D model scored 4.33 ± 0.57 (on a Likert scale from 1 to 5) regarding replication of the relevant human anatomy for the penile prosthesis surgery procedure. The 3D model scored 4.33 ± 0.57 (on a Likert scale from 1 to 5) regarding its ability to improve technical skills, teach and practice the procedure, and assess a surgeon's ability. Furthermore, the experts stated that compared with the cadaver, the 3D model presented greater ethical suitability, reduced costs, and easier accessibility. CLINICAL IMPLICATIONS: A validated 3D model is a suitable alternative for penile prosthesis surgery training. STRENGTHS AND LIMITATIONS: This is the first validated 3D hydrogel model for penile prosthesis surgery teaching and training that experts consider suitable for skill acquisition. Because specific validated guidelines and questionnaires for the validation and verifications of 3D simulators for penile surgery are not available, a modified questionnaire was used. CONCLUSION: The current 3D model for penile prosthesis surgery shows promising results regarding anatomic properties and suitability to train surgeons to perform penile implant surgery. The possibility of having an ethical, easy-to-use model with lower costs and limited consequences for the environment is encouraging for further development of the models.

Phenomenological and existential contributions to the study of erectile dysfunction.

The current medical approach to erectile dysfunction (ED) consists of physiological, psychological and social components. This paper proposes an additional framework for thinking about ED based on phenomenology, by focusing on the theory of sexual projection. This framework will be complementary to the current medical approach to ED. Our phenomenological analysis of ED provides philosophical depth and illuminates overlooked aspects in the study of ED. Mainly by appealing to Merleau-Ponty's Phenomenology of Perception, we suggest considering an additional etiology of ED in terms of a weakening of a function of sexual projection. We argue that sexual projection can be problematized through cognitive interferences, changes in the 'intentional arc', and modifications in the subject's 'body schema'. Our approach further highlights the importance of considering the 'existential situation' of patients with ED. We close by reflecting briefly on some of the implications of this phenomenological framework for diagnosis and treatment of ED.

Management of priapism in the newborn.

We report a case of priapism in a newborn and the results of a review of the publications on neonatal priapism. A preterm newborn developed idiopathic priapism on the first day after birth. The priapism disappeared after 4 days of observation. Periods with normal penile erection were reported at follow-up after 20 months. The results of the literature review also advocate management by observation alone.