Initial safety outcomes for the Rigicon Infla10® inflatable penile prosthesis.

OBJECTIVE: To analyse data from patient information forms (PIFs) submitted to the manufacturer of a new three-piece inflatable penile prosthesis (IPP), the Rigicon Infla10®, to summarize early outcomes. METHODS: A retrospective review of PIFs from 319 patients implanted with the IPP between 6 January 2019 and 31 December 2021 was performed to assess device durability and rates of reoperation for infection, mechanical failure or medical reasons. RESULTS: The mean ± sd (range) follow-up was 21.2 ± 11 (5-36) months and the mean ± sd patient age was 58.5 ± 8.7 years. Of the total, 4.4% of devices required removal or revision. Complications included mechanical failure (2.5%) and component migration (0.7%). No infections were observed in this series. One patient (0.4%) required revision for inadequate straightening of Peyronie's disease. Three patients (0.9%) requested device removal because of dissatisfaction. A total of 95.6% of the Rigicon Infla10 devices were free from explant or revision 21 months after the original implant date. Kaplan-Meier analysis showed the rates of cumulative survival of the device at 12, 24, 36 months were 95.6%, 94.7% and 93.7%, respectively. CONCLUSIONS: The vast majority of the early Rigicon Infla10 IPPs implanted prior to January 2022 were included in this retrospective analysis of volunteered PIFs. These early results demonstrate initial durability from reoperation equivalent to that of other contemporary devices.

Penile Implant Instrument Innovations.

PURPOSE OF REVIEW: Numerous innovations have been made since the first inflatable penile prosthesis was introduced in 1973-not just of the implant apparatus itself, but crucially also in the surgical instruments used for prosthetic surgery. Starting with Dr. Furlow's revolutionary inserter tool, advancements were quickly made in dilators, retractors, and cavernotomes. RECENT FINDINGS: More recent innovations have been made in inserter tools, forceps, needle holders, clamps, and disposable instruments. Leading companies Boston Scientific and Coloplast have contributed significantly to the evolution of IPP surgical placement, and companies such as Uramix and Rigicon are developing a wide array of new specialized tools. We aim to summarize the instruments needed for IPP placement, with a focus on describing the variety of instrument innovations since Dr. Brantley Scott designed and placed the first IPP.

Extended Reality-Assisted Surgery as a Surgical Training Tool: Pilot Study Presenting First HoloLens-Assisted Complex Penile Revision Surgery.

BACKGROUND: Extended reality-assisted urologic surgery (XRAS) is a novel technology that superimposes a computer-generated image on the physician's field to integrate common elements of the surgical process in more advanced detail. An extended reality (XR) interface is generated using optical head-mounted display (OHMD) devices. AIM: To present the first case of HoloLens-assisted complex penile revision surgery. METHODS: We describe our pilot study of HoloLens-assisted penile revision surgery and present a thorough review of the literature regarding XRAS technology and innovative OHMD devices. OUTCOMES: The ability of XRAS technology to superimpose a computer-generated image of the patient and integrate common elements of the surgical planning process with long-distance experts. RESULTS: XRAS is a feasible technology for application in complex penile surgical planning processes. CLINICAL TRANSLATION: XRAS and OHMD devices are novel technologies applicable to urological surgical training and planning. STRENGTHS AND LIMITATIONS: Evidence suggests that the potential use of OHMD devices is safe and beneficial for surgeons. We intend to pioneer HoloLens technology in the surgical planning process of a malfunctioning penile implant due to herniation of the cylinder. This novel technology has not been used in prosthetic surgery, and current data about XRAS are limited. CONCLUSION: OHMD devices are effective in the operative setting. Herein, we successfully demonstrated the integration of Microsoft HoloLens 2 into a penile surgical planning process for the first time. Further development and studies for this technology are necessary to better characterize the XRAS as a training and surgical planning tool. Quesada-Olarte J, Carrion RE, Fernandez-Crespo R, et al. Extended Reality-Assisted Surgery as a Surgical Training Tool: Pilot Study Presenting First HoloLens-Assisted Complex Penile Revision Surgery. J Sex Med 2022;19:1580-1586.

"Pumpology": the Realistic Issues Associated with Pump Placement in Prosthetic Surgery.

PURPOSE OF REVIEW: The goal of this paper was to discuss the issues and/or overt complications associated with the 3-piece inflatable penile prosthesis (3-IPP) pump. We also addressed how to resolve such issues with or without surgical intervention. RECENT FINDINGS: Numerous modifications of the 3-IPP pump have been introduced with multiple techniques to place the pump. These are largely dependent on the approach to place the 3-IPP. Pump issues may inevitably occur, and there are numerous special maneuvers that can be performed to resolve pump issues. It is important for urologists to know maneuvers for pump malfunctions to prevent unnecessary surgical procedures and pump revision. Several studies are reviewed regarding pump issues and patient satisfaction; however, a more structured prospective research project is warranted to further evaluate these issues.

Current Status for Semirigid Penile Prosthetic Devices.

PURPOSE OF REVIEW: The goal of this paper was to evaluate the current use of semirigid penile prosthesis (SRPP), surgical techniques for insertion of SRPP, and how to prevent and approach surgical complications. RECENT FINDINGS: SRPP is a valid option for those who are refractory to medical therapy for erectile dysfunction (ED) and even more appropriate for specific subsets of patient populations. It is important for urologists to know which patient population SRPP is preferred for. Several studies have shown good patient outcomes and patient satisfaction with those who underwent SRPP.

Distal Biologic Cap for Impending Distal Erosion.

INTRODUCTION: Management for distal impending erosion can be difficult and has been previously managed with counter incisions which can lead to unsightly scars and increased infection risk. AIM: To demonstrate a novel technique in management of impending erosion. METHODS: We retrospectively reviewed patients who underwent placement of a distal biologic cap for impending erosion. MAIN OUTCOME MEASURE: The main outcome was thesuccessful placement of inflatable penile prosthesis through a single incision. RESULTS: All patients who underwent this procedure are functional and have had no evidence of recurrence. CLINICAL IMPLICATIONS: A simple approach to manage impending distal erosion. STRENGTH & LIMITATIONS: Limitations include small sample size and short duration of follow-up. CONCLUSION: The distal biologic cap is a simple alternative technique to treat distal impending erosion of an inflatable penile prosthesis and can be performed safely without the need for additional incisions on the penis and with a minimal increase in operative times. Karpman E, DiGiorgio L, Carrion RE. Distal Biologic Cap for Impending Distal Erosion. J Sex Med 2020;17:551-555.

Suprapubic Fat Pad Excision with Simultaneous Placement of Inflatable Penile Prosthesis.

INTRODUCTION: Many men suffering from erectile dysfunction are overweight with generous suprapubic fat pads, which often contribute to a decrease in visible exophytic phallic length. AIM: To present a novel surgical concept of suprapubic fat pad excision with a concomitant placement of inflatable penile prosthesis. METHODS: A transverse incision begins slightly medial to the anterior superior iliac spine, with the superior edge crossing transversely to the contralateral anterior superior iliac spine. The inferior border is incised in a curvilinear fashion, with the medial apex being approximately 1 cm above the base of the penis. Dissection is carried down to the lower abdominal anterior fascia, which leads to excision of the suprapubic fat pad. Using this same exposure, the inflatable penile prosthesis (IPP) is placed via an infrapubic approach. The wound is reapproximated in multiple layers, and 2 drains are placed, 1 subcutaneous in the area of the fat pad excision and the other in the scrotum around the pump. MAIN OUTCOME MEASURES: Primary outcomes included penile implant functionality, ability to engage in sexual activity, and cosmetic satisfaction. RESULTS: A total of 8 patients have undergone suprapubic fat pad excision with simultaneous placement of IPP at our institution. Average body mass index of our patient cohort was 36.6. 1 patient developed prosthetic infection after inadvertent removal of his drains in the immediate postoperative period. At last follow-up, all other patients have excellent cosmetic and functional outcomes. CLINICAL IMPLICATIONS: This technique can lead to higher patient satisfaction with their penile implant, enhanced sexual performance, and improved quality of life for patients with concurrent erectile dysfunction and significant suprapubic fat pad. STRENGTHS & LIMITATIONS: This unique technique has never been previously described. It allows placement of IPP in the setting of fat pad excision without any additional incisions. Limitations include the small patient population and relatively short follow-up. CONCLUSIONS: Suprapubic fat pad excision is a safe and reproducible technique that can be performed simultaneously with the placement of an IPP in appropriately selected patients. Patients must be counseled appropriately on the expectations of surgeries and the theoretical increased risk of postoperative complications, such as infection. Baumgarten AS, Beilan JA, Shah BB, et al. Suprapubic Fat Pad Excision with Simultaneous Placement of Inflatable Penile Prosthesis J Sex Med 2019;16:333-337.

Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses.

BACKGROUND: Fungal infections of inflatable penile prostheses (IPPs) are inadequately understood in the literature. AIM: To review a multi-institution database of IPP infections to examine for common patient and surgical factors related to IPP fungal infections. METHODS: This is a retrospective Institutional Review Board-approved analysis of 217 patients at 26 institutions who underwent salvage or device explant between 2001 and 2018. Patient data were compiled after an extensive record review. OUTCOMES: 26 patients (12%) with fungal infections were identified. RESULTS: 23 of 26 patients (83%) with a fungal IPP infection were either diabetic or overweight. 15 patients had undergone primary IPP implantation, and the other 11 had previously undergone an average of 1.7 IPP-related surgeries (range 1-3; median 2). The average age at implantation was 63 years (range 31-92; median 63). 18 of the 26 patients with fungal infection had diabetes (69%), with a mean hemoglobin A1c (HbA1c) value of 8.4 (range 5.8-13.3; median 7.5). Twenty-two patients (85%) were overweight or obese. The mean body mass index for all patients was 30.1 kg/m2 (range 23.7-45 kg/m2; median 28.4 kg/m2), and that for diabetic patients was 30.8 kg/m2 (range 24.1-45 kg/m2, median 29.7 kg/m2). Ninety-one percent of implants were placed with intravenous antibiotics, consistent with current American Urological Association guidelines: an aminoglycoside plus first- or second-generation cephalosporin or vancomycin or ampicillin/sulbactam or piperacillin/tazobactam. 65% (17 of 26) of infected IPPs had only fungal growth in culture. No patient had concomitant immunosuppressive disease or recent antibiotic exposure before IPP implantation. CLINICAL IMPLICATIONS: More than two-thirds of the fungal infections occurred in diabetic patients and 85% occurred in overweight or obese patients, suggesting that antifungal prophylaxis may be appropriate in these patients. STRENGTHS & LIMITATIONS: This is the largest series of fungal infections reported to date in the penile prosthesis literature. The overall number of such cases, however, remains small. CONCLUSION: Fungal infections represent 12% of all penile prosthesis infections in our series and were seen mostly in diabetic or overweight patients, who may benefit from antifungal prophylaxis. Gross MS, Reinstatler L, Henry GD, et al. Multicenter Investigation of Fungal Infections of Inflatable Penile Prostheses. J Sex Med 2019;16:1100-1105.

Biomechanical Comparison of Inflatable Penile Implants: A Cadaveric Pilot Study.

BACKGROUND: Throughout the last decade there has been a growing interest in the biomechanical differences between inflatable penile prostheses (IPPs) and their significance with regard to the patient experience. AIM: To present our findings assessing the biomechanical properties of IPPs with and without rear tip extenders (RTEs). METHODS: This is a biomechanical study of the 3 most commonly used IPPs (AMS CX, AMS LGX, and Coloplast Titan) as assessed by column compression, modified cantilever deflection, and 3-point bending methods. The IPPs were surgically placed into 3 fresh cadavers via an infrapubic technique by a single large-volume implanter. A biomechanical evaluation of the properties of each IPP inside the fibroelastic tunica albuginea was assessed in blinded testing, and analyses were based on industry standard methods for assessment. OUTCOMES: Maximum axial load; kink formation; horizontal stiffness; and resistance to 3-point flexure testing were measured. RESULTS: At maximum inflation, all 3 implants had similar performance. Differences appear to be most affected by fill pressures. In fact, only the AMS LGX at less than maximum inflation (LTMI) was unable to consistently withstand the roughly 0.9 kg (2 lbs) of pressure for column load testing mimicking vaginal intromission. The Coloplast Titan showed slightly better rigidity than the AMS LGX and CX devices in horizontal load testing, and, with 3-point flexure testing, the CX showed the best rigidity in the shortest phallus (A). Overall, the Titan showed slightly better rigidity in the longest phallus (C) and the phallus with mild Peyronie's disease (B). CLINICAL TRANSLATIONS: Penile implants with circumferential expansion had higher rigidity on biomechanical testing and should be considered in a patient's decision during selection of a penile implant. STRENGTHS AND LIMITATIONS: Strengths include blinding of the biomechanical testing and analyses, surgical procedures performed by a highly experienced surgeon, and that this is the "closest to" in vivo evaluation (inside the tunica albuginea) of penile implant function and properties to date. Weaknesses are that this study was performed in cadavers and not in live patients. It also has a small sample size, including the use of only 3 cadavers, and there was no correlation of performance to patient satisfaction. CONCLUSION: The results of this study support the conclusion that all devices are capable of functionally restoring erectile capacity. However, we observed that, in general, the 2 circumferentially expanding penile prosthesis showed greater resistance in biomechanical testing when compared with longitudinal and circumferential expanding devices. This should be considered as a guide during device selection for a patient undergoing penile prosthesis. Wallen JJ, Barrera EV, Ge L, et al. Biomechanical Comparison of Inflatable Penile Implants: A Cadaveric Pilot Study. J Sex Med 2018;15:1034-1040.

V-Neck Technique: A Novel Improvement to the Infra-Pubic Placement of an Inflatable Penile Implant.

BACKGROUND: Infra-pubic placement of an inflatable penile prosthesis (IPP) has a well-known configuration deformity from contralateral tubing that crosses the corporal bodies, resulting in tubing visibility and irritation under the penile skin. AIM: To present a novel step to eliminate this tubing crossover deformity. METHODS: The V-neck technique was applied to five patients, two of whom underwent suprapubic fat pad excision with simultaneous infra-pubic IPP placement and three patients who underwent only infra-pubic IPP placement. The technique added an additional 1 minute of procedure time. The reservoir was placed on one (ipsilateral) side into the space of Retzius. OUTCOMES: Primary outcome measurements were esthetic appeal at follow-up, immediate postoperative complications, and difficulty of implementation of the technique. RESULTS: The technique included the following steps. (i) The standard infra-pubic approach, as popularized by Perito (J Sex Med 2008;5:27-30), was used to place the reservoir and cylinders. The ipsilateral and contralateral cylinders and the reservoir were clamped and unconnected. (ii) Finger dissection was used to create a sub-phallic window and a U-shaped aortic clamp was used to pass the contralateral tubing. (iii) After passing the green tubing through the window, all connections were performed in the usual fashion. Tubing crossover was eliminated, as was passage of the right and left cylinder tubes down their respective gutters. Postoperative follow-up at 2 weeks showed no visible tubing. CLINICAL IMPLICATIONS: This simple maneuver could help prevent the discomfort of tubing crossover deformity commonly seen after infra-pubic placement of an IPP. STRENGTHS AND LIMITATIONS: This unique maneuver can be applied to all infra-pubically placed IPPs. Limitations include the small patient population and short follow-up. Whether this maneuver will make revision surgery more difficult is unclear. CONCLUSION: This technique is a novel step to infra-pubic IPP placement that adds minimal operative time and could eliminate visible tubing. Shah BB, Baumgarten AS, Morgan K, et al. V-Neck Technique: A Novel Improvement to the Infra-Pubic Placement of an Inflatable Penile Implant. J Sex Med 2017;14:870-875.

Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis.

INTRODUCTION: Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. AIM: To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. METHODS: This retrospective institutional review board-exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. MAIN OUTCOME MEASURES: Intraoperative culture data from infected IPPs. RESULTS: Two hundred twenty-seven intraoperative cultures (2002-2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. CONCLUSION: This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success. Gross MS, Phillips EA, Carrasquillo RJ, et al. Multicenter Investigation of the Micro-Organisms Involved in Penile Prosthesis Infection: An Analysis of the Efficacy of the AUA and EAU Guidelines for Penile Prosthesis Prophylaxis. J Sex Med 2017;14:455-463.

The Malleable Implant Salvage Technique: Infection Outcomes after Mulcahy Salvage Procedure and Replacement of Infected Inflatable Penile Prosthesis with Malleable Prosthesis.

PURPOSE: Since its introduction in 1996 Mulcahy salvage has significantly improved outcomes for the removal and replacement of infected inflatable penile prostheses. Long-term followup data of Mulcahy salvage show an infection-free rate of 82%. A multicenter retrospective analysis of the malleable implant salvage technique was conducted to assess infection outcomes and the feasibility of conversion from malleable device back to inflatable penile prosthesis. MATERIALS AND METHODS: This is a retrospective, institutional review board exempt, multi-institution study of 58 patients who underwent Mulcahy salvage with inflatable penile prosthesis removal and replacement with malleable prosthesis. Patient operative notes and charts were extensively reviewed to compile study data. RESULTS: Between 2002 and 2014 a total of 58 patients underwent infected inflatable penile prosthesis removal and replacement with a malleable prosthesis via Mulcahy salvage. Of these patients 54 (93%) have remained infection-free postoperatively. Average patient age was 56.4 years and average operative time was 148 minutes. Postoperative followup (as of May 2015) ranged from 1 month to 84 months. Of the 54 patients 37 retained the malleable prosthesis and 17 (31%) subsequently underwent replacement with an inflatable penile prosthesis. This occurred on average 6.7 months after Mulcahy salvage. Four patients had persistent infection after Mulcahy salvage with the malleable prosthesis and underwent explantation. CONCLUSIONS: This retrospective analysis of Mulcahy salvage procedure and replacement of inflatable penile prosthesis with malleable prosthesis shows a high infection-free rate. Additionally, 17 of the 54 patients who remained infection-free were able to successfully undergo subsequent removal of the malleable prosthesis and replacement with an inflatable penile prosthesis. Further prospective studies are needed to compare salvage with malleable vs inflatable penile prosthesis.

Longitudinal and Horizontal Load Testing of Inflatable Penile Implant Cylinders of Two Manufacturers: An Ex Vivo Demonstration of Inflated Rigidity.

INTRODUCTION: Since the inception of the inflatable penile prosthesis, a new era has been ushered in for the management of erectile dysfunction. Despite multiple innovations to improve function and reliability, there are no current data comparing the biomechanical properties of these devices. AIM: To compare the resistance of the Coloplast Titan (Minneapolis, MN, USA) with that of the AMS 700 LGX (Minnetonka, MN, USA) penile prosthesis cylinders to longitudinal (penetration) and horizontal (gravity) forces. METHODS: We compared two cylinder sizes from each company: the Coloplast Titan (18 and 22 cm) and the AMS 700 LGX (18 and 21 cm). To evaluate axial rigidity, which simulates forces during penetration, we performed a longitudinal load compression test to determine the load required to cause the cylinder to kink. To test horizontal rigidity, which simulates the horizontal forces exerted by gravity, we performed a modified cantilever test and measured the degrees of bend for each device. All devices were tested at 10, 15, and 20 PSI to simulate in vivo pressures. MAIN OUTCOME MEASURES: The main outcome measurement for the longitudinal load test (penetration) was the force required for the inflated cylinder to bend, thereby affecting its rigidity. The main outcome for the horizontal rigidity test (gravity) was the angle of displacement, in which a smaller angle represents a more horizontally rigid device. RESULTS: Longitudinal column testing (penetration) demonstrated that less force was required for the AMS device to kink compared with the Coloplast implant across all three fill pressures tested. The Coloplast Titan also had a smaller angle of displacement at the modified cantilever test (gravity) compared with the AMS implant across all fill pressures. CONCLUSION: The Coloplast Titan demonstrated greater resistance to longitudinal (penetration) and horizontal (gravity) forces in this study. The AMS device was very sensitive to fill pressures. In contrast, the Coloplast Titan's ability to resist these forces was less dependent on the device fill pressure.

Testosterone Therapy after Radiation Therapy for Low, Intermediate and High Risk Prostate Cancer.

PURPOSE: Limited literature exists regarding the safety of testosterone therapy in men treated for prostate cancer. We present multi-institutional data on testosterone therapy in hypogonadal men with prostate cancer treated with radiation therapy. MATERIALS AND METHODS: We retrospectively reviewed the records of hypogonadal men treated with testosterone therapy after radiation therapy for prostate cancer at 4 institutions. Serum testosterone, free testosterone, estradiol, sex hormone-binding globulin, prostate specific antigen, prostate specific antigen velocity and prostate biopsy findings were analyzed. RESULTS: A total of 98 men were treated with radiation therapy. Median age was 70.0 years (range 63.0 to 74.3) at initiation of testosterone therapy. Median baseline testosterone was 209 ng/dl (range 152 to 263) and median baseline prostate specific antigen was 0.08 ng/ml (range 0.00 to 0.33). In the cohort the tumor Gleason score was 5 in 3 men (3.1%), 6 in 44 (44.9%), 7 in 28 (28.6%), 8 in 7 (7.1%) and 9 in 4 (4.1%). Median followup was 40.8 months (range 1.5 to 147). Serum testosterone increased to a median of 420 ng/dl (range 231 to 711) during followup (p <0.001). Overall a nonsignificant increase in mean prostate specific antigen was observed from 0.08 ng/ml at baseline to 0.09 ng/ml (p = 0.05). Among patients at high risk prostate specific antigen increased from 0.10 to 0.36 ng/ml (p = 0.018). Six men (6.1%) met criteria for biochemical recurrence. CONCLUSIONS: Testosterone therapy in men following radiation therapy for prostate cancer was associated with a minor increase in serum prostate specific antigen and a low rate of biochemical recurrence.

Adjuvant Maneuvers for Residual Curvature Correction During Penile Prosthesis Implantation in Men with Peyronie's Disease.

INTRODUCTION: The surgical treatment of comorbid erectile dysfunction and Peyronie's disease has long included the implantation of an inflatable penile prosthesis as well as a number of adjuvant maneuvers to address residual curvature after prosthesis placement. AIM: To review the various surgical options for addressing curvature after prosthesis placement, with specific attention paid to an original article by Wilson et al. reporting on modeling over a penile prosthesis for the management of Peyronie's disease. METHODS: A literature review was performed analyzing articles reporting the management of penile curvature in patients undergoing implantation of an inflatable penile prosthesis. MAIN OUTCOME MEASURES: Reported improvement in Peyronie's deformity as well as the complication rate associated with the various surgical techniques described. RESULTS: Modeling is a well-established treatment modality among patients with Peyronie's disease undergoing penile prosthesis implantation. A variety of other adjuvant maneuvers to address residual curvature when modeling alone is insufficient has been presented in the literature. CONCLUSIONS: Over 20 years of experience with modeling over a penile prosthesis have proven the efficacy and safety of this treatment option, providing the surgeon a simple initial step for the management of residual curvature after penile implantation which allows for the use of additional adjuvant maneuvers in those with significant deformities.

Prospective evaluation of postoperative penile rehabilitation: penile length/girth maintenance 1 year following Coloplast Titan inflatable penile prosthesis.

INTRODUCTION: The most prevalent long-term complaint after successful inflatable penile prosthesis (IPP) surgery is reduction of penile length. The purpose of this study was to evaluate penile measurements in patients whose implantation experience included the aggressive new length measurement technique (NLMT) coupled with postoperative IPP rehabilitation (daily inflation) of the implant for 1 year. Moreover, we aimed to document objective data concerning dimensional changes of the phallus over time. Postoperative IPP rehabilitation has been discussed and presented at meetings, but no multi-institutional prospective data have been published. AIM: Our goal was to assess results using the Coloplast Titan IPP, with NLMT, and postoperative rehabilitation. METHODS: After IRB approval, we conducted a prospective, three-center study of 40 patients who underwent IPP placement, with NLMT for end organ failure erectile dysfunction with the Coloplast Titan IPP. The patient was instructed to inflate daily for 6 months and then inflate maximally for 1-2 hours daily for 6-12 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. MAIN OUTCOME MEASURE: Penile length measurements after implantation compared with 12 months postimplantation. RESULTS: Penile measurement changes were statistically significantly improved at 12 months as compared with immediately postoperative and at 6 months. A total of 64.5% of subjects were satisfied with their length at 1 year, and 74.2% had perceived penile length that was longer (29%) or the same (45.2%) as prior to the surgery; 61.3% and 16.1% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared with prior to IPP surgery. All but two subjects (93.4%) were satisfied with the overall function and dimensions of their IPP. CONCLUSION: This study suggests using the Coloplast Titan IPP with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol may help optimize patient satisfaction and erectile penile measurements.

The reduction corporoplasty: the answer to the improbable urologic question "can you make my penis smaller?".

INTRODUCTION: Aneurysmal dilatation of the corpora cavernosa can occur because of recurrent priapism in the setting of sickle cell disease. AIM: We present the first case of a successful implementation of the reduction corporoplasty technique for treatment of a phallus that was "too large for intercourse." METHODS: We describe the presentation of a 17-year-old male with a history of sickle cell disease with a phallus "too large for intercourse." Patient reported normal erectile function and response with masturbation but also reported inability to penetrate his partner due to the enlarged and disfigured morphology. He had three priapismic episodes since the age of 10 that progressively led to an aneurysmal morphologic deformity of his phallus. Evaluation included a magnetic resonance imaging, which revealed true aneurysmal dilatation of bilateral corpora cavernosa in the middle and distal portions, and diffusely hyperplastic tunica. MAIN OUTCOME MEASURE: The main outcome measure is the successful management of phallic disfiguration. RESULTS: Reduction corporoplasty was performed, and the patient reported intact erectile function without aneurysmal recurrence. CONCLUSIONS: Patients with significant corporal aneurysmal defects secondary to recurrent priapism can be successfully managed with reduction corporoplasty.

Partial Priapism Treated with Pentoxifylline.

MAIN FINDINGS: A 26-year-old man suffering from partial priapism was successfully treated with a regimen including pentoxifylline, a nonspecific phosphodiesterase inhibitor that is often used to conservatively treat Peyronie's disease. CASE HYPOTHESIS: Partial priapism is an extremely rare urological condition that is characterized by thrombosis within the proximal segment of a single corpus cavernosum. There have only been 36 reported cases to date. Although several factors have been associated with this unusual disorder, such as trauma or bicycle riding, the etiology is still not completely understood. Treatment is usually conservative and consists of a non-steroidal anti-inflammatory and anti-thrombotic. Promising future implications: This case report supports the utilization of pentoxifylline in patients with partial priapism due to its anti-fibrogenic and anti-thrombotic properties.

Reduction corporoplasty.

OBJECTIVE: Here we present the first video demonstration of reduction corporoplasty in the management of phallic disfigurement in a 17 year old man with a history sickle cell disease and priapism. INTRODUCTION: Surgical management of aneurysmal dilation of the corpora has yet to be defined in the literature. MATERIALS AND METHODS: We preformed bilateral elliptical incisions over the lateral corpora as management of aneurysmal dilation of the corpora to correct phallic disfigurement. RESULTS: The patient tolerated the procedure well and has resolution of his corporal disfigurement. CONCLUSIONS: Reduction corporoplasty using bilateral lateral elliptical incisions in the management of aneurysmal dilation of the corpora is a safe an feasible operation in the management of phallic disfigurement.