Effect of operative local anesthesia on postoperative pain outcomes of inflatable penile prosthesis: prospective comparison of two medications.

Few studies have examined the roles of dorsal penile nerve block (DPNB) and penile ring block (PRB) in surgery of inflatable penile prosthesis (IPP) placement. We sought to compare the postoperative pain outcomes of two different medications used in DPNB plus PRB. We thus carried out a prospective study of patients with erectile dysfunction who underwent "de novo" IPP placement between January 2013 and June 2013. Patients were divided to one of three groups: 1-DPNB plus PRB with bupivacaine injection; 2-DPNB plus PRB with ropivacaine injection and, 3-Control group without DPNB or PRB injection. Postoperative pain score and pain medication usage were recorded 2 h postoperatively, and every 24 h, for a week. The Visual Analog Scale (VAS) was used as pain scale measurement. A total of 131 patients were included in this study: 40 to bupivacaine, 47 to ropivacaine, and the rest were controls. Two hours postoperatively, mean VAS was significantly different (p < 0.0001) between medicated patients and the control group, however, no significant differences were observed between medication groups. Mean VAS was not significantly different among the groups from post-surgical day 2 thru 7. In conclusion, DPNB plus PRB during IPP provided effective analgesia in the immediate post-operative recovery.

Experience With Prophylactic Gentamicin During Penile Prosthesis Surgery: A Retrospective Comparison of Two Different Doses.

BACKGROUND: Gentamicin has been determined to be active against a wide range of bacterial infections and has been commonly used as a preoperative antibiotic for inflatable penile prosthesis (IPP) implantation. However, the best dosing regimen to produce the safest optimal prophylactic effect remains to be determined. AIM: To compare low- and high-dose gentamicin as prophylaxis during IPP implantation. METHODS: We retrospectively analyzed two groups of patients who underwent IPP placement from April 14, 2012 through April 13, 2016. Group 1 was composed of 490 patients who underwent IPP placement from April 14, 2012 through April 13, 2014 and received a low dose of preoperative gentamicin at 80 mg every 8 hours for 1 day. Group 2 was composed of 407 patients who underwent IPP placement from April 14, 2014 through April 13, 2016 and received a single high dose of preoperative gentamicin at 5 mg/kg. We compared the infection rates of IPP and any gentamicin-related toxicities. The same surgeon performed all procedures. All patients received additional vancomycin 1 g before incision and at 12 hours postoperatively. OUTCOME: Demographic data and IPP infection rate were compared and potential toxicities from the higher dose of gentamicin were closely monitored. RESULTS: There were no significant differences in mean age, mean body mass index, and mean interval for IPP placement and IPP infection between the two groups. No toxicity was seen with the higher gentamicin dose. Six cases in group 1 (five de novo cases and one redo case, infection rate = 1.22%) and three cases in group 2 (two de novo cases and one redo case, infection rate = 0.74%) were found to have IPP infection. The infection rate in group 2 appeared to be lower than that in group 1, although a significant statistical difference was not achieved (P = .057). CLINICAL IMPLICATIONS: These findings would help guide urologists in choosing an optimal preoperative gentamicin dose for IPP surgery. STRENGTHS AND LIMITATIONS: This is the first study to report on the usage of high-dose preoperative gentamicin for IPP surgery but with limitations as a retrospective study. CONCLUSIONS: Although not achieving a statistical difference, there was a trend for patients receiving a higher dose of preoperative gentamicin to have a lower IPP infection rate. No toxicity was encountered from the 5-mg/kg gentamicin dose. We recommend following prophylactic high-dose gentamicin guidelines. Xie D, Gheiler V, Lopez I, et al. Experience With Prophylactic Gentamicin During Penile Prosthesis Surgery: A Retrospective Comparison of Two Different Doses. J Sex Med 2017;14:1160-1164.

A prospective evaluation of penile measures and glans penis sensory changes after penile prosthetic surgery.

BACKGROUND: With better designed devices and lower infection rates, satisfaction with inflatable penile prosthesis (IPP) placement is increasingly high. However, dissatisfaction is still present and there is disagreement regarding length and sensation changes after the IPP placement. The aim of this study was to evaluate changes in penile length, girth and sensitivity after IPP placement. METHODS: From August 2012 to January 2013 all patients undergoing "de novo" IPP surgery were invited to participate in this study. Eighty six patients met inclusion criteria while 62 agreed to participate in this observational study. A week before surgery, penile length and circumference, and glans/elbow biothesiometer readings were recorded 15 minutes after Trimix induced erection. Same measures were taken at postoperative week 6 and month 6. RESULTS: Amperage from Glans biothesiometer readings showed statistically significant shorter readings than elbow biothesiometer preoperatively, 6 weeks and 6 months after surgery (P<0.001 each). No significant sensory difference in the glans penis after IPP was noted. However, compared to preoperative Trimix induced erections, penile length and circumference were greater after IPP placement (P=0.04 and P=0.001, respectively). CONCLUSIONS: We observed statistically significant increase in penile length and girth after IPP placement without significant changes in sensory conduction.

Infection control professionals' information-seeking preferences.

OBJECTIVES: The aims of this study were to: 1) establish whether infection control professionals (ICPs) who had access to and utilised medical librarian services for evidence-based medicine (EBM) research perceived this assistance to be useful and 2) to establish whether ICPs who used electronic or hard copy resources for EBM research perceived that those resources had a significant impact on their work. METHODS: Convenience sampling was used to collect quantitative data via a questionnaire. Study participants were members of South-west and Western chapters of the Association for Professionals in Infection Control and Epidemiology. There were 264 questionnaires distributed in this study; 179 participants completed the questionnaire. The response rate for eligible respondents was 59.5% (157). RESULTS: Results indicated 56.7% (51) of the ICPs with librarian access reported requesting assistance from their work facility librarian. In reference to locating infection control information, 77.9% (95), 87.3% (124) and 93.3% (138) of ICPs found textbooks, journals and the Internet 'very useful' or 'useful', respectively. CONCLUSION: Study results indicated ICPs who used the assistance of medical librarians and/or hard copy or electronic resources for EBM research perceived such sources to be valuable for obtaining infection control information.

Factors that influence physician assistant program graduates to choose rural medicine practice.

PURPOSE: A shortage of primary care, rural practitioners exists in the United States. The increasing number of physician assistants (PA) in the workforce could be an important resource in improving access to primary care services for rural patients, yet little is known about the specific factors influencing a PA to choose to practice rural medicine. The purpose of this study is to examine the factors that influence PA program graduates to choose rural medicine. METHODS: This descriptive study was conducted by electronic survey. Participants were recruited from the membership of the Texas Academy of Physician Assistants (TAPA). Main outcome measures were the correlations between rural clerkships, rural background, and rural practice. Participants were also queried regarding 16 additional factors that might influence practice choice. RESULTS: A relationship exists between rural background and rural practice choice (chi2(4) = 16.08, P = .003). Correlation also was identified between completion of rural clerkships and rural practice choice (chi2(1) = 10.67, P= .001). Factors found to have the most influence on PAs to choose rural practice were (1) desire to serve the needs of the community; (2) type of practice; and (3) supervising physician characteristics. CONCLUSIONS: PAs with a rural background and those that completed rural clerkships have a greater propensity toward rural practice after graduation. It is possible, for programs with an interest or a mission of increasing the number of their graduates who choose rural practice, that knowledge of factors that influence their graduates' practice choices may prove beneficial.

Using pictograms for communication.

The U.S. Navy sponsors annual Pacific Partnership deployments to provide humanitarian and disaster relief training for the U.S. military, partner nations, nongovernmental organizations, and host nations. Communication between these groups and the local populations receiving medical care is problematic in that sufficient numbers of capable translators are often unavailable or vastly undertrained with respect to medical terminology and practice. In addition, should Pacific Partnership respond to a real disaster, adequate numbers of translators will likely be unavailable as a result of the disaster itself. Consequently, medical providers will require alternate methods of communication previously tested for efficacy and validity. One such method is the use of pictograms designed to represent common medical maladies. To determine whether pictograms meet the 85% congruence level required by the American National Standards Institute, 36 images were provided to English-speaking physician assistants and nurse practitioners for interpretation with three images repeated within the array to assess internal validity of the questionnaire. Of the 33 distinct images, 26 (79%) reached 85% congruence showing that validated images may be a method of communication in circumstances where medical providers and patients speak discordant languages.