Satisfaction assessment study in patients (and their partners) with/without Peyronie's disease and penile prosthesis implantation.

INTRODUCTION AND OBJECTIVE: Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. However, patients with coexistent Peyronie's disease (PD) and refractory erectile dysfunction and/or severe deformities may show different results. The aim of our study was to assess and to compare the level of satisfaction, with an inflatable penile prosthesis (IPP), in men with/without coexistent PD. MATERIAL AND METHODS: A survey study based on a five-item satisfaction questionnaire was submitted to all those live patients implanted in the period 1992-2022 at our center (n = 570) and their partners. Ninety-two percent of implants were inflatable devices. Surgeries were mainly performed by two surgeons. The main outcome measure used was the level of patient and partner satisfaction with sexual intercourse after IPP. RESULTS: Of the 570 eligible patients, 479 (84%) completed the survey (393 Non-PD: GROUP 1; 70 non-complex PD-Group 2; 16 complex PD). Eighty-six per cent of patients in Group 1 reported satisfactory sexual intercourse (very or moderately satisfied). Non-complex PD implanted patients (Group 2) reported a global 81% satisfactory sexual intercourse (very or moderately satisfied) (p > 0.05). However, when we evaluated the PD subgroup of patients with severe PD who require incision/excision/grafting at the time of implant (Group 3: n = 20), only 61% reported satisfactory sexual intercourse (p < 0.01) with predominance of moderately satisfied patients over very satisfied: 78% vs. 22%). Additionally, 84% (Group 1), 80% (Group 2) and 54% (Group 3) of partners reported satisfactory intercourses, respectively (p < 0.01). Overall, 84% of Group 1 implants and 79% of Group 2 reported that they would undergo the procedure again if the IPP failed (p > 0.05; ns). Only 50% of Group 3 patients would do it again. With regard to cosmetic aspects, 48% of the Group 3 implant reported penile shortness or soft glans as the main causes of their dissatisfaction. Only 2.4% of total PP patients expressed difficulty in manipulating the device. CONCLUSION: The presence of PD alone may not impact PP patient and partner satisfaction, but patients with more severe baseline deformity who require incision/grafting may be less satisfied with outcomes including penile length and glans sensation.

Revisión sistemática de la implantación de prótesis de pene en cirugía mayor ambulatoria / Systematic review of the implantation of penile prosthesis in major ambulatory surgery

Introducción y objetivo La implantación de prótesis deZ pene (PP) es una alternativa eficaz para la disfunción eréctil. Aunque inicialmente la cirugía de PP se realizaba en régimen hospitalario, existe una tendencia creciente a realizar el implante de PP en un modelo de cirugía mayor ambulatoria (CMA). El objetivo de este estudio es realizar una revisión sistemática de la literatura para identificar la evidencia disponible sobre la implantación de PP en el marco de la CMA en comparación con el procedimiento realizado en régimen hospitalario. Material y métodos Se realizó una búsqueda en las bases de datos electrónicas PubMed, EMBASE, Cochrane Library y MEDES y en los suplementos no indexados de los congresos científicos para identificar artículos relacionados con la implantación quirúrgica de PP en CMA hasta febrero de 2021. Los términos de búsqueda incluyeron prótesis de pene, disfunción eréctil, cirugía ambulatoria, atención ambulatoria y cirugía. Resultados Entre las 171 publicaciones obtenidas (51 en PubMed, 73 en EMBASE, 3 en Cochrane, 2 mediante MEDES y 42 mediante búsqueda manual), se seleccionaron finalmente 5 estudios. No hubo diferencias significativas entre la CMA y el régimen hospitalario en términos del tipo de dispositivo, el abordaje quirúrgico o la ubicación del reservorio. Las tasas de complicaciones observadas en ambos grupos fueron similares. La implantación de PP en régimen de CMA supuso un menor coste que la cirugía en régimen hospitalario y se asoció con tasas aceptables de satisfacción de los pacientes y un adecuado control del dolor. Conclusiones Los estudios demostraron que la implantación de PP en régimen de CMA puede lograr resultados similares en términos de seguridad y satisfacción a la implantación de PP en el régimen hospitalario, pudiendo también reducir los costes y mejorar la eficiencia. Esta investigación podría ayudar a los responsables de la toma de decisiones a extender la cirugía de PP al régimen ambulatorio (AU)

Introduction and objective Penile prosthesis (PP) implantation is an effective option for erectile dysfunction. Although initially PP surgery was carried out in an inpatient setting, there is a growing trend to implant PP in a major ambulatory surgery (MAS). This study aimed to perform a systematic review of the literature to identify available evidence of the implantation of PP under MAS setting and go carry out a comparison between MAS and inpatient procedures. Material and methods PubMed, EMBASE, Cochrane Library and MEDES electronic databases and non-indexed supplements for scientific congresses were searched to identify articles related to the surgical implantation of PP in MAS up to February 2021. Key search terms included penile prosthesis, erectile dysfunction, ambulatory surgery, ambulatory care, and surgery. Results Among 171 publications retrieved (51 PubMed, 73 EMBASE, 3 Cochrane, 2 using MEDES and 42 manual searching), 5 studies were finally selected. There were no significant differences between MAS or inpatient setting in terms of the type of device, surgical approach, or location of reservoir. Complication rates observed in both groups were similar. Implantation of PP in MAS was less expensive than inpatient surgery and was associated with acceptable patient satisfaction rates and adequate pain control. Conclusions Studies demonstrated that outpatient PP surgery can achieve similar outcomes in terms of safety and satisfaction to implantation of PP in the inpatient setting, while it could reduce costs and improve the efficiency. This research could provide support decision makers to extend PP surgery into the ambulatory setting (AU)

Systematic review of the implantation of penile prosthesis in major ambulatory surgery.

INTRODUCTION AND OBJECTIVE: Penile prosthesis (PP) implantation is an effective option for erectile dysfunction. Although initially PP surgery was carried out in an inpatient setting, there is a growing trend to implant PP as a major ambulatory surgery (MAS). This study aimed to perform a systematic review of the literature to identify available evidence of the implantation of PP under MAS setting and go carry out a comparison between MAS and inpatient procedures. MATERIAL AND METHODS: PubMed, EMBASE, Cochrane Library and MEDES electronic databases and non-indexed supplements for scientific congresses were searched to identify articles related to the surgical implantation of PP in MAS up to February 2021. Key search terms included penile prosthesis, erectile dysfunction, ambulatory surgery, ambulatory care, and surgery. RESULTS: Among 171 publications retrieved (51 PubMed, 73 EMBASE, 3 Cochrane, 2 using MEDES and 42 manual searching), 5 studies were finally selected. There were no significant differences between MAS or inpatient setting in terms of the type of device, surgical approach, or location of reservoir. Complication rates observed in both groups were similar. Implantation of PP in MAS was less expensive than inpatient surgery and was associated with acceptable patient satisfaction rates and adequate pain control. CONCLUSIONS: Studies demonstrated that outpatient PP surgery can achieve similar outcomes in terms of safety and satisfaction to implantation of PP in the inpatient setting, while it could reduce costs and improve the efficiency. This research could support decision makers to extend PP surgery into the ambulatory setting.

Inflatable penile prosthesis reservoir placement—Are we ready for a paradigm change? / Colocación de reservorio para prótesis de pene inflables: ¿estamos preparados para un cambio de paradigma?

In 2002, Steve Wilson pioneered new procedures for alternative placement of reservoirs for inflatable prostheses in patients who have suffered damage to the space of Retzius following pelvic surgery or obliteration of the transversalis fascia by mesh hernia repair. Since then, surgical techniques and tools for ectopic reservoir placement have gradually gained acceptance to minimize palpability, and the risk of visceral and vascular lesions for high risk patients has been all but eliminated. Lockout valves and high submuscular placement techniques are now recommended, and reports of vascular, bowel or bladder injuries are uncommonly rare. While surgeons continue their search for safer and more effective placement methods, new skills and instruments are constantly being introduced to make recommendations to minimize complications and provide safety and functionality. Additional studies and comparisons of techniques are needed to achieve a consensus of best practice for reservoir placement solutions. (AU)

En 2002, Steve Wilson fue el precursor de nuevos procedimientos para la colocación alternativa de reservorios para prótesis inflables en los pacientes que habían sufrido daños en el espacio de Retzius tras cirugía pélvica u obliteración de la fascia transversalis por reparación de hernia con malla. Desde entonces, han ido ganando aceptación las técnicas y herramientas quirúrgicas para colocación de reservorio ectópico, a fin de minimizar la palpabilidad, habiéndose eliminado prácticamente el riesgo de lesiones viscerales y vasculares para pacientes de alto riesgo. Hoy en día se recomiendan las válvulas de bloqueo y las técnicas de colocación submuscular alta, siendo excepcionalmente raros los informes sobre lesiones a nivel vascular, intestinal o en la vejiga. A pesar de que los cirujanos siguen investigando en busca de métodos de colocación más seguros y efectivos, se están introduciendo constantemente nuevas competencias e instrumentos en aras de realizar recomendaciones para minimizar las complicaciones y aportar seguridad y funcionalidad. Son necesarios más estudios y comparaciones sobre técnicas para lograr un consenso acerca de la mejor práctica sobre soluciones de colocación de reservorios. (AU)

Inflatable penile prosthesis reservoir placement-Are we ready for a paradigm change?

In 2002, Steve Wilson pioneered new procedures for alternative placement of reservoirs for inflatable prostheses in patients who have suffered damage to the space of Retzius following pelvic surgery or obliteration of the transversalis fascia by mesh hernia repair. Since then, surgical techniques and tools for ectopic reservoir placement have gradually gained acceptance to minimize palpability, and the risk of visceral and vascular lesions for high risk patients has been all but eliminated. Lockout valves and high submuscular placement techniques are now recommended, and reports of vascular, bowel or bladder injuries are uncommonly rare. While surgeons continue their search for safer and more effective placement methods, new skills and instruments are constantly being introduced to make recommendations to minimize complications and provide safety and functionality. Additional studies and comparisons of techniques are needed to achieve a consensus of best practice for reservoir placement solutions.

Implante de prótesis de pene en la era COVID. Seguimiento tras la cirugía y manejo de complicaciones / Penile prosthesis implantation in the covid era. post-surgery follow up and management of complications

Objetivos: Establecer unas recomendaciones lo más seguras posibles con respecto a la implantación de prótesis peneanas, su seguimiento tras la cirugía y manejo de las posibles complicaciones durante las diferentes fases de la pandemia por la COVID-19.Material y métodos: Diseñamos una revisión narrativa crítica de los estudios que investigan el impacto de la COVID-19 en la práctica de la urología y en la implantología de prótesis de pene. Se realizó una búsqueda exhaustiva en la base de datos MEDLINE. Se utilizaron diferentes combinaciones de las siguientes palabras clave según un protocolo de texto libre: SARS-CoV-2, COVID19, COVID Urology, COVID19 surgery, penile prostheses. Fueron incluidos trabajos en idioma inglés y español, publicados hasta septiembre de 2020.Resultados: La cirugía del implante de la prótesis de pene es una cirugía electiva que siempre debería diferirse para cuando se pueda hacer en máximas condiciones de seguridad. Sin embargo, este tipo de cirugía puede conllevar en ocasiones complicaciones que deben resolverse de manera urgente, o preferente incluso dentro de la situación de pandemia por la COVID-19.Conclusiones: En la situación actual es importante desarrollar estrategias compartidas para evitar el daño colateral potencial de la pandemia de COVID-19 para nuestros pacientes. En el caso de la cirugía de la prótesis de pene ha de primar la seguridad del paciente, posponiéndola para evitar riesgos innecesarios o minimizando estos riesgos con todas las medidas necesarias. (AU)

Objectives: To provide recommendations regarding surgery, follow-up, and management of possible complications related to penile prostheses implantation, during the COVID-19 pandemic.Material and methods: We designed a critical narrative review of the studies investigating the impact of COVID-19 on urology practice and on penile prosthetic implantology. A comprehensive search in the MEDLINE database was performed. Different combinations of the following keywords were used according to a free-text protocol:: “SARS-CoV-2”, “COVID19“, “COVID Urology”, “COVID19 surgery”, “penile prostheses”. Papers in English and Spanish language, published until September 2020 were included in the review.Results: Penile prosthesis implantation is an elective surgery which should always be deferred when it cannot be performed in maximum safety conditions. However, it may lead to complications wich must be resolved urgently even within the COVID-19 Era.Conclusions: Currently, it is mandatory to develop shared strategies to avoid potential COVID-19-related complications for surgical patients. Penile prosthesis implantation should be deferred to avoid unnecessary risks and all preventive measures should be taken to minimize the risks in the event of non-delayable surgery. (AU)

[Penile prosthesis implantation in the covid era. post-surgery follow up and management of complications]. / Implante de prótesis de pene en la era COVID. Seguimiento tras la cirugía y manejo de complicaciones.

OBJECTIVES: To provide recommendations regarding surgery, follow-up, and management of possible complications related to penile prostheses implantation, during the COVID-19 pandemic. MATERIAL AND METHODS: We designed a critical narrative review of the studies investigating the impact of COVID-19 on urology practice and on penile prosthetic implantology. A comprehensive search in the MEDLINE database was performed. Different combinations of the following keywords were used according to a free-text protocol:: "SARS-CoV-2", "COVID19", "COVID Urology", "COVID19 surgery", "penile prostheses". Papers in English and Spanish language, published until September 2020 were included in the review. RESULTS: Penile prosthesis implantation is an elective surgery which should always be deferred when it cannot be performed in maximum safety conditions. However, it may lead to complications wich must be resolved urgently even within the COVID-19 Era. CONCLUSIONS: Currently, it is mandatory to develop shared strategies to avoid potential COVID-19-related complications for surgical patients. Penile prosthesis implantation should be deferred to avoid unnecessary risks and all preventive measures should be taken to minimize the risks in the event of non-delayable surgery.

Superficial glans ischemia after penile prosthesis successfully treated by conservative treatment.

Glandular ischemia is an extremely uncommon dreaded postoperative complication of inflatable penile prosthesis surgery that may lead to penile gangrene and organ loss, whose incidence is difficult to determine. We report the case of a 56-year-old male admitted to our department with complaints of cold and painful glans penis after penile implant one month before. A color Doppler examination revealed the normal intracavernosal arteries with no vascularity in the superficial glans tissues. Due to the mild severity of the ischemia, conservative management was suggested, and consisted of oral pentoxifylline and hyperbaric therapy for 10 days, achieving a significant improvement at 4 months of follow-up.

Do candidates for penile implant prefer their doctors or another implanted patient as their information source? Results of a pilot study.

INTRODUCTION: Erectile dysfunction incidence is about 19-26 cases for every 1000 men/year, requiring about 20,000 penile implants/year. There is high demand for information on the part of patients, however, there is a lack of evidence about the sources of information prior to penile implant and the figure of the Expert Patient (EP) has never been described in this area. AIMS: To evaluate the sources of information used by candidates for penile implant as well as to describe the role of the EP as an information source. METHODS: Pilot study of candidates for penile prosthesis. Patients already implanted attending for exchange or reallocation surgery were excluded. Each patient had an interview with an EP, and commercial documentation was given. Each source of information was evaluated in a face-to-face interview. SPSS™ version 20.0 was used. MAIN OUTCOME MEASURES: The EP was evaluated by the International Index of Erectile Function, the Generalized Anxiety Disorder 7 questionnaire, and the Erectile Dysfunction Inventory of Treatment Satisfaction. Each source of information was evaluated by a non-validated 6-section questionnaire. RESULTS: Ten patients were included. Mean age was 60±10.3 years. Medical interview with the urologist resulted in a global value and truthfulness score of 9.2±.9 and 9.8±.4, respectively. Commercial information had a global score of 8.5±.9 and a truthfulness score of 8.6±.6, while the internet had 6.8±.8 points for global value and 7.2±1 for truthfulness. The global score of the EP was 8.7±1.2 points and their veracity scored 9.6±.5 points. CONCLUSIONS: The urologist remains the main source of information for patients with erectile dysfunction candidates for penile prosthesis implant. However, the EP is an alternative and could be a key pillar in presurgical counselling.

[Andrology and penile cancer. Recommendations during COVID-19 pandemia.] / Andrología y cáncer de pene. Recomendaciones durante la pandemia COVID-19.

PURPOSE: The COVID-19 pandemic which has affected Spain since the beginning of 2020 compels us to determine recomendations for the practice of Andrology in present times. MATERIALS AND METHODS: A web search is carried out in English and Spanish and a joint proposal is defined by experts in Andrology from different regions of Spain. RESULTS: Most diagnostic and therapeutic procedures in Andrology can be safey postponed during the COVID-19 pandemic. Online consultations and outpatient surgeries must be encouraged. Andrologic emergencies and penile cancer management should be considered high priority, and should be diagnosed and treated promptly even in the most severe phases of the pandemic.

INTRODUCCIÓN: La pandemia COVID-19 que ha afectado a España desde comienzos de 2020 obliga a definir unas recomendaciones para la práctica de la Andrología en la actualidad.MATERIAL Y MÉTODOS: Se realiza una búsqueda web en inglés y español y se define una propuesta conjunta por parte de expertos en Andrología de distintas regiones de España.RESULTADOS: La mayor parte de los procedimientos diagnósticos y terapéuticos en Andrología pueden ser demorados con seguridad durante la pandemia COVID-19. Se debe fomentar la consulta telemática y la cirugía ambulatoria. Las urgencias andrológicas y el manejo del cáncer de pene deben considerarse una prioridad alta, diagnosticándose y tratándose con brevedadi ncluso en las fases más severas de la pandemia.

Penile prosthesis surgery: Indications and penoscrotal approach. / Implante de prótesis peneana: indicaciones y abordaje penoescrotal.

Inflatable penile prosthesis was developed in 1973 as a definitive treatment for erectile dysfunction. Since then these prosthetic devices underwent huge modifications, and scientific and technologic advances were accomplished, improving reliability, longevity and the surgical outcomes. Surgical implantation of a penile prosthesis may be considered in patients with erectile dysfunction who do not respond to pharmacotherapy or who prefer a permanent solution to their problem. According to the 2019 EAU Guidelines, regardless of the indication, prosthesis implantation has one of the highest satisfaction rates (92-100% in patients and 91-95% in partners) among the treatment options for erectile dysfunction based on appropriate consultation. The penoscrotal handling is the most common approach accounting for >80% of inflatable penile prosthesis placed worldwide. Most frequent complaints and dissatisfaction with inflatable penile prosthesis are related to technical issues or poor surgical outcomes such as the final length of the penis. There is an urgent need to improve the patient awareness in inflatable penile prosthesis in the preoperative arena, including the high expectation management, and an effort to select the proper patients for definitive treatment.

Intraoperative and postoperative complications of penile implant surgery. Diagnosis and treatment. / Complicaciones intraoperatorias y postoperatorias de la cirugía de prótesis de pene. Diagnóstico y tratamiento.

We describe the most frequent complications associated with penile implant surgery, paying special attention to their practical management. We have analyzed preoperative complications and postoperative complications separately. The intraoperative include perforation of the corpora cavernosa during dilation, cylinder cross-over or cross-placement and urethral injury during implantation. The most frequent postoperative complications are mechanical failure, cylinder erosion and prosthesis infection. We emphasize on rescue surgery and reimplantation techniques in cavernous tissue fibrosis.

Three-piece inflatable penile prosthesis: Ectopic reservoir placement. / Prótesis de pene inflable de 3 componentes: emplazamiento ectópico del reservorio.

INTRODUCTION: The complications associated to the placement of the reservoir are infrequent but potentially serious. Therefore, technical alternatives have been developed for the performance of the procedure in different locations (ectopic). The aim of this review is to revise the evidence available on the different options for the ectopic placement of the reservoir. MATERIAL AND METHOD: Narrative review based on a bibliographical search limited to PubMed- indexed relevant manuscripts, in Spanish or English, for the period 2000-2019, using «penile prosthesis¼, «ectopic reservoir¼, radical prostatectomy¼, «radical cystectomy¼, «pelvic radiotherapy¼, and «renal transplantation¼ as key words. Non original articles and reviews were not considered eligible. A total of 11 manuscripts were included. RESULTS: Pelvic alterations after surgery and/or radiotherapy increase the difficulty in the placement of the prosthesis reservoir. In order to minimize the risk of complications, different modifications have been performed on the devices, and technical innovations have been developed for the submuscular placement of the reservoir. The available evidence regarding the functionality and complications of these techniques is limited to single institution, low volume, and retrospective series with short follow-up periods. The functionality seems to be adequate using the adapted devices. The complications are infrequent and mild in severity. CONCLUSIONS: Although the available evidence is still limited, the ectopic placement of the reservoir may be considered a safe, effective, and reproducible technique. In addition, it may result particularly useful in cases of altered pelvic anatomy.

Organization of the operating room and specific instruments for the implant of penile prosthesis. / Organización del quirófano e instrumental específico para el implante de prótesis de pene.

After more than 1600 penile implant surgeries, we can affirm the need for a procedure protocol of the steps prior to this type of surgery, and the importance of carefully control the preparation for the surgical act. The instruments that must be available for surgery include elements that have been specifically designed for this type of intervention, such as the Cavernotomo dilators (Rossello®) or the Furlow. These are essential for penile implant surgeries in the usual practice, especially in complex cases or when complications arise. We should avoid complications as much as we can, or at least we should be able to minimize, address and resolve them with effective organization and adequate instruments. Undoubtedly, the surgeon's skills and experience are one of the key components for success, but the great importance of an adequately performed and rigorously applied protocol by all team members should not be underestimated. The objective of this article is to explain the basis of the details of this procedure in a clear and realistic way.

Enlargement of length and girth associated with implantation of penile prostheses. / Implante de prótesis con reconstrucción y agrandamiento de pene en el mismo acto quirúrgico.

INTRODUCTION: Reduction in penile size is due to numerous conditions including Peyronie's disease, previous penile surgeries, diabetes, trauma, erectile dysfunction, pelvic surgery, and aging. Elasticity of the tunica albuginea is adversely affected by any of the above. Fibrosis then triggers progressive erectile dysfunction OBJECTIVES: When a penile prosthesis is indicated, it is important to determine whether the penis has already diminished in size prior to insertion of the implant. Because a prosthesis only provides axial rigidity and is not associated with the enlargement of the penis, reflection of strategies to simultaneously enlarge the size of the penis while implanting a device is recommended. MATERIAL AND METHODS: A systematic review of current scientific literature regarding procedures and tactics currently available for penile implants and enlargement was conducted. RESULTS: The literature demonstrates that the evolution of penile implant surgery, accompanied by consideration of enlargement, has evolved through 5 fundamental techniques: Incision with Grafting; Sliding with Grafting; Modified Sliding without Grafting (MoST); Multiple Slit without Grafting (MUST); and the Egydio Paradigm for Tunica Expansion Procedures (TEP), a further evolution of previous strategies to achieve state of the art penile implantation accompanied by maximum penile enlargement. Evolving technology of tunica expansion procedures has led to diminution of the size of tunica defects and avoidance of grafts to prevent bulging and indentation, while developing solutions to preserve the strength of the tunica albuginea for firm positioning of the cylinders in the interior of the corpora cavernosa. CONCLUSIONS: The evolution of these techniques is the transformation of larger tunica defects into smaller ones. While grafts are often used to reinforce the penile structure due to large defects, multiple incisions of the tunica albuginea are gaining popularity to promote girth and length enlargement without grafts and without the loss of tunica strength necessary to support the cylinders inside the corpora.

Complex Peyronie's disease cases: surgery with or without penile prosthesis placement. / Casos complejos. Enfermedad de Peyronie: cirugía sin/con implante de prótesis de pene.

INTRODUCTION AND OBJECTIVE: Surgery is the treatment of choice for patients with Peyronie's disease presenting difficulty in penetration or erectile dysfunction without adequate response to therapy. Several techniques have been described, and urologists must be aware of their possible complications and sequelae in order to offer the patient the best possible alternative. PATIENTS AND METHODS: Three complex cases of patients with Peyronie's disease are presented. The first case exposes a complication after penile plication for the treatment of a major dorsal curve. The second case refers to difficult anal penetration secondary to a problem of erection direction after plaque incision surgery with oral mucosa grafting. The last case is a patient with a late post-operative complication of a three-piece prosthesis placement with plaque incision and equine collagen patch. RESULTS: Surgical options for each case are detailed and discussed. After patients were informed, the decision was taken in a consensual manner. CONCLUSIONS: Surgery for Peyronie's disease requires the urologist's consideration of the functional, aesthetic and psychological spheres. A systematic approach to all of these avoids complications, sequels and improves results.

Analysis of satisfaction and surgical outcomes of a major ambulatory surgery program for penile implant. / Análisis de satisfacción y resultados quirúrgicos de un programa de cirugía mayor ambulatoria para el implante de prótesis de pene.

INTRODUCTION AND OBJECTIVE: Penile prosthesis (PP) surgery is performed in many institutions as an inpatient procedure. We have recently initiated a major ambulatory surgery (MAS) program, thus reducing the hospital stay. The objective of this study was to assess the feasibility, complications and satisfaction of the implantation of outpatient surgery PP program in our hospital. MATERIAL AND METHODS: Retrospective observational study evaluating the results and satisfaction of PP implanted as an outpatient procedure in Bellvitge University Hospital during 2018. RESULTS: During 2018 we implanted 49 PP: 27 (55%) inpatient surgeries vs. 22 (45%) outpatient surgeries. Of these 22, 2 (9%) were second implants. All patients underwent both general anesthesia and crural, proximal dorsal nerve and transversus abdominis plane block (TAP). Complication rates between inpatient and outpatient procedures were similar, 2 (7%) and 1 (5%), respectively, without reporting infections or requiring PP removal. Postoperatively, a satisfaction telephone survey was conducted in 19 (86%) patients: 16 (84%) considered the time of hospital stay as appropriate, 15 (79%) would have preferred to be operated again in an outpatient care setting and 15 (79%) would recommend it. The patients' main concerns were related to being at home with no medical assistance at home and about coming back the next day for drainage removal. All patients reported well-controlled pain without requiring opioid intake in any case. CONCLUSIONS: In our series, PP implantation in an ambulatory care setting is feasible and safe. Although there are some aspects that should be improved, the program showed acceptable satisfaction rates and an adequate postoperative pain control, neither raising the administration of opioids, nor increasing complications and re-admission rates.

Infrapubic surgical approach for penile prosthesis surgery: Indications and technique. / Cirugía de prótesis peneana: indicaciones y técnica infrapúbica.

CONTEXT: Penile prosthesis surgery is currently the most effective treatment for erectile dysfunction when medical treatment is ineffective or contraindicated. Among the surgical approaches described in the literature, the scrotal, infrapubic and subcoronal are the most common in the daily clinical practice. OBJECTIVES: The main objectives were to describe the infrapubic surgical technique evaluating its indications and complications, as well as comparing its advantages and disadvantages with the penoscrotal approach. ACQUISITION AND SYNTHESIS OF THE EVIDENCE: A literature review from 1983 until current date was carried out in Medline (PubMed and Cochrane Library databases) following PRISMA standards. Sixteen studies were included: 4 prospective, 4 retrospective, one systematic review, one randomized trial, one original article, 5 expert opinion/surgical technique descriptive paper. DISCUSSION: According to the literature reviewed, although the penoscrotal approach is the most applied, the infrapubic approach showed a shorter operative time and a tendency for an earlier recovery of sexual activity after surgery. Complications are rare, having similar rates to the penoscrotal approach; no cases of glans hypoesthesia have been reported and peri-prosthetic infection rates were less than 3%. Satisfaction rates of infrapubic penile prosthesis were higher than 80%. CONCLUSIONS: Penile prosthesis implantation requires of a profound knowledge of the different surgical approaches in order to best adapt each technique based on each individualized case. The infrapubic approach, even if it is not the most used, is as feasible and reliable as the penoscrotal approach. The infrapubic approach is effective and safe, with high level of both, patients and partners' satisfaction.

Clinical guidelines on erectile dysfunction surgery: EAU-AUA perspectives. / Visión global de las guías clínicas en cirugía de la disfunción eréctil: EUA-AUA.

INTRODUCTION: The implantation of a penile prosthesis is considered a third-line treatment and is indicated in patients who do not respond adequately to pharmacotherapy or require definitive treatment. Currently, the most used devices are 3-component penile prostheses, which presently account for more than 90% of the implants used. MATERIAL AND METHODS: We reviewed the evidence and the recommendations of the clinical practice guidelines regarding surgery in patients with erectile dysfunction. RESULTS: The recommendations of the clinical practice guidelines on surgery in patients with erectile dysfunction are summarized as follows: men with erectile dysfunction should be informed about the option of penile prosthesis implant treatment, commenting on the benefits, risks and consequences; men with erectile dysfunction who have agreed to receive penile prosthesis should be advised on post-surgical expectations; penile prosthesis implants should not be performed in patients with systemic, cutaneous or urinary tract infection; in young men with erectile dysfunction and focal penile or pelvic arterial obstruction who do not have generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction can be considered; in men with erectile dysfunction, penile venous surgery is not recommended. CONCLUSIONS: The use of penile prostheses offers high satisfaction rates to both the patient and his partner. However, it is crucial to adequately inform and warn patients about possible complications and consequences.

[Adjuvant surgical maneuvers in penile prostheses implant to improve their aesthetic and functional outcomes]. / Maniobras quirúrgicas adyuvantes en el implante de prótesis de pene para mejorar su resultado estético y funcional.

Penile prosthetic surgery is the definitive treatment for those patients with erectile dysfunction refractory to medical treatment. Although it associates satisfaction rates>90%, it is known that men with Peyronie's disease, body mass index>30kg/m2 or those previously operated on radical prostatectomy have lower satisfaction rates than the general population. The main reasons for dissatisfaction are the subjective loss of penile length and glans' flaccidity. Given such circumstance, several adjuvant surgical techniques have been described to improve aesthetic and functional outcomes after the implant. In our review, we wanted to investigate the different maneuvers used in patients with Peyronie's disease, those used to avoid the reduction of penile length and those used to avoid the floppy glans syndrome.