Single Dilation in Primary Inflatable Penile Prosthesis Placement Is Associated With Fewer Corporal Complications Than Sequential Dilation.

OBJECTIVE: To assess the difference in outcomes between single dilation (SingD) and sequential dilation (SeqD) in primary penile implantation, hypothesizing that patients who undergo SeqD had higher rates of noninfectious complications. METHODS: We performed a multicenter, retrospective study of men undergoing primary inflatable penile prosthesis placement. Intraoperative complications and postoperative noninfectious outcomes were assessed between the two groups. Multivariable analysis was performed to identify predictors of complications. RESULTS: A total of 3293 patients met inclusion criteria. After matching, there were 379 patients who underwent SingD and 379 patients who underwent SeqD. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length (20 cm with interquartile range [IQR] 18-21 cm vs 20 cm with IQR 18-20 cm respectively, P = .4). On multivariable analysis, SeqD (OR 5.23 with IQR 2.74-10, P < .001) and older age (OR 1.04 with IQR 1.01-1.06, P = .007) were predictive of postoperative noninfectious complications. There was no significant difference in intraoperative complications between patients who underwent SingD vs SeqD, nor was there any difference in cylinder length. SeqD and older age were predictive of postoperative noninfectious complications. CONCLUSION: During inflatable penile prosthesis placement in the uncomplicated patient without fibrosis, SingD is a safe technique to utilize during implantation that will minimize postoperative adverse events, and promote device longevity without loss of cylinder length.

Optimal Modeling: an Updated Method for Safely and Effectively Eliminating Curvature During Penile Prosthesis Implantation.

OBJECTIVES: To assess outcomes of a variant of traditional modeling ("optimal modeling," OM) in patients with residual curvature following prosthesis implantation. METHODS: We performed a retrospective review of all patients who underwent penile implant insertion. Patients with >30° of residual curvature after cylinder placement and inflation underwent OM and were compared 1:1 to a demographically-matched cohort who received implantation without ancillary straightening. Optimal modeling was performed by forcibly bending the erect penis in the direction opposite the point of maximal curvature while maintaining glanular pressure to prevent urethral injury. This was performed for 90-second intervals for as many cycles as necessary to achieve <15° curvature. RESULTS: Eighty patients were included in the final analysis; 40 (50.0%) underwent optimal modeling while 40 (50.0%) did not need additional straightening following surgery. The mean premodeling curvature was 47.8° (range 30°-90°) while post-modeling curvature improved to a mean of 10.6° (range 0°-30°, P < .001); 87.5% of patients had <15° of residual curvature. Patients in the OM cohort experienced longer operative times (82.7 vs 75.8 min, P = .15). No patient in either group experienced an intraoperative or postoperative complication at a mean follow-up of 29.9 months. CONCLUSION: Although many prosthetic urologists forego manual modeling in cases of moderate-severe penile curvature, our contemporary series shows it to be both safe and effective. OM may preclude the need for more time-consuming and complex surgical procedures.

A minute ostracod (Crustacea: Cytheromatidae) from the Miocene Solimões Formation (western Amazonia, Brazil): evidence for marine incursions?

A huge wetland (the 'Pebas system') covered western Amazonia during the Miocene, hosting a highly diverse and endemic aquatic fauna. One of the most contentious issues concerns the existence, potential pathways and effects of marine incursions on this ecosystem. Palaeontological evidences (body fossils) are rare. The finding of a new, presumably marine ostracod species (Pellucistoma curupira sp. nov.) in the upper middle Miocene Solimões Formation initiated a taxonomic, ecological and biogeographical review of the genus Pellucistoma. We demonstrate that this marine (sublittoral, euhaline), subtropical-tropical taxon is biogeographically confined to the Americas. The biogeographical distribution of Pellucistoma largely depends on geographical, thermal and osmotic barriers (e.g. land bridges, deep and/or cold waters, sea currents, salinity). We assume an Oligocene/early Miocene, Caribbean origin for Pellucistoma and outline the dispersal of hitherto known species up to the Holocene. Pellucistoma curupira sp. nov. is dwarfed in comparison to all other species of this genus and extremely thin-shelled. This is probably related to poorly oxygenated waters and, in particular, to strongly reduced salinity. The associated ostracod fauna (dominated by the eurypotent Cyprideis and a few, also stunted ostracods of possibly marine ancestry) supports this claim. Geochemical analyses (δ18O, δ13C) on co-occurring ostracod valves (Cyprideis spp.) yielded very light values, indicative of a freshwater setting. These observations point to a successful adaptation of P. curupira sp. nov. to freshwater conditions and therefore do not signify the presence of marine water. Pellucistoma curupira sp. nov. shows closest affinities to Caribbean species. We hypothesize that Pellucistoma reached northern South America (Llanos Basin) during marine incursions in the early Miocene. While larger animals of marine origin (e.g. fishes, dolphins, manatees) migrated actively into the Pebas wetland via fluvial connections, small biota (e.g. P. curupira sp. nov.) were phoretically freighted and developed freshwater tolerance over long timescales. http://zoobank.org/urn:lsid:zoobank.org:pub:886C6476-393D-4323-8C0E-06BB8BD02FD9.

On the Miocene Cyprideis species flock (Ostracoda; Crustacea) of Western Amazonia (Solimões Formation): Refining taxonomy on species level.

The Miocene mega-wetland of western Amazonia holds a diverse, largely endemic ostracod fauna. Among them, especially the genus Cyprideis experienced a remarkable radiation. Micropalaeontologic investigations of a 400 m long sediment core (~62 km SW Benjamin Constant, Amazonia, Brazil) permitted a taxonomic revision of about two-thirds of hitherto described Cyprideis species. We evaluate the diagnostic value of shell characters and provide an extensive illustration of the intraspecific variability of species. Based on comparative morphology, the 20 recorded Cyprideis species are arranged in groups and subgroups. The "smooth" group comprises C. amazonica, C. kotzianae, C. kroemmelbeini, C. machadoi, C. multiradiata, C. olivencai, C. paralela and C. simplex; the "ornate" group C. curucae nom. nov., C. cyrtoma, C. aff. graciosa, C. inversa, C. ituiae n. sp., C. matorae n. sp., C. minipunctata, C. munoztorresi nom. nov., C. pebasae, C. reticulopunctata, C. schedogymnos and C. sulcosigmoidalis. Five species have been revalidated, two renamed, two synonymised and two are new descriptions. Along with 10 further formally established species, for which a review is pending, Cyprideis keeps at least 30 endemic species in that region during Miocene times. Up to 12 Cyprideis species have been found to occur sympatrically, representing >90% of the entire ostracod fauna. Ostracod index species enable a biostratigraphic allocation of the well succession to the Cyprideis minipunctata to Cyprideis cyrtoma biozones, corresponding to a late Middle to early Late Miocene age (late Serravallian-early Tortonian).

Ostracods (Crustacea) and their palaeoenvironmental implication for the Solimões Formation (Late Miocene; Western Amazonia/Brazil).

Western Amazonia's landscape and biota were shaped by an enormous wetland during the Miocene epoch. Among the most discussed topics of this ecosystem range the question on the transitory influx of marine waters. Inter alia the occurrence of typically brackish water associated ostracods is repeatedly consulted to infer elevated salinities or even marine ingressions. The taxonomical investigation of ostracod faunas derived from the upper part of the Solimões Formation (Eirunepé; W-Brazil) documents a moderately diverse assemblage (19 species). A wealth of freshwater ostracods (mainly Cytheridella, Penthesilenula) was found co-occurring with taxa (chiefly Cyprideis) usually related to marginal marine settings today. The observed faunal compositions as well as constantly very light δ18O- and δ13C-values obtained by measuring both, the freshwater and brackish water ostracod group, refer to entirely freshwater conditions. These results corroborate with previous sedimentological and palaeontological observations, which proposed a fluvial depositional system for this part of western Amazonia during the Late Miocene. We demonstrate that some endemic, "brackish" water ostracods (i.e., Cyprideis) have been effectively adapted to freshwater conditions. Thus, their occurrence is no univocal evidence for the influence of brackish or marine waters in western Amazonia during the Miocene.

Late Miocene sedimentary environments in south-western Amazonia (Solimões Formation; Brazil).

In Miocene times a vast wetland existed in Western Amazonia. Whereas the general development of this amazing ecosystem is well established, many questions remain open on sedimentary environments, stratigraphical correlations as well as its palaeogeographical configuration. Several outcrops located in a barely studied region around Eirunepé (SW Amazonas state, Brazil) were investigated to obtain basic sedimentological data. The observed deposits belong to the upper part of the Solimões Formation and are biostratigraphically dated to the Late Miocene. Vertically as well as laterally highly variable fine-grained clastic successions were recorded. Based on the lithofacies assemblages, these sediments represent fluvial deposits, possibly of an anastomosing river system. Sand bodies formed within active channels and dominant overbank fines are described (levees, crevasse splays/channels/deltas, abandoned channels, backswamps, floodplain paleosols). Lacustrine environments are restricted to local floodplain ponds/lakes. The mollusc and ostracod content as well as very light δ18O and δ13C values, measured on ostracod valves, refer to exclusively freshwater conditions. Based on palaeontological and geological results the existence of a long-lived lake ("Lake Pebas") or any influx of marine waters can be excluded for that region during the Late Miocene.