Search

The spouses and partners of patients undergoing implantation of an inflatable penile prosthesis (IPP) are often active participants in the perioperative process. Many urologists encourage partner involvement for penile implant patients, but there is little information on whether this influences their post-operative course. This study seeks to determine whether preoperative partner attendance at clinic appointments is associated with deviation from a standard postoperative care pathway for patients undergoing primary IPP placement. This is a retrospective study conducted using data obtained from primary IPPs performed by a single surgeon between October 2016 and January 2021. A standardized postoperative course was used, including planned follow-up visits at 2 weeks (for wound check and device deflation) and 6 weeks (for device teaching). Patient characteristics, including demographics, partner involvement, and the number of follow-up visits were obtained from the medical record. Logistic regression modeling was performed to determine the influence of partner involvement on planned postoperative scheduled visits. During the study period, n = 170 primary IPP patients were identified and 147 (67%) of these patients had partners. Partners were involved in all perioperative visits for 92 patients (54%). Unplanned follow up visits were seen for 58 patients (34%) between 0-6 weeks and for 28 patients (17%) after 6 weeks postoperatively. Partner involvement was associated with a reduced odds of additional follow up visits, both at 0-6 weeks (unadj: OR 0.43, 95% CI 0.23-0.83; adj: OR 0.40, 95% CI 0.20-0.79) and after 6 weeks (unadj: OR 0.32, 95% CI 0.13-0.76; adj: OR 0.33, 95% CI 0.13-0.81), both in unadjusted analysis and when adjusted for obesity and presence of complications. Clavien-Dindo complications were identified in 29 patients (17%) intraoperatively or postoperatively. Mean surgical time was 69 minutes (SD = 19). Mean patient age was 62 years (SD = 9). Comorbidities included obesity (52%), diabetes (37%), hyperlipidemia (72%), and hypertension (84%). Partner involvement equated to a 2.5 fold decrease in the odds of unplanned postoperative visits among primary IPP patients. Though the mechanism of this reduction is unclear, having partners attend perioperative visits is easily implemented, low cost, and minimal risk. We would recommend that urologists routinely encourage patients considering insertion of a penile prosthesis involve their partners in perioperative visits. Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast [ABSTRACT FROM AUTHOR]

An association between congenital bilateral absence of the vas deferens (CBAVD), normal renal anatomy and cystic fibrosis (CF) gene mutations is well established (CF/CBAVD). We postulate that unilateral renal agenesis (URA) and CBAVD (URA/CBAVD) may have a non-CF mutation-mediated genetic basis that leads to abnormal development of the entire mesonephric duct at a very early stage in embryo development (≤7 weeks). The physical, laboratory and radiographic findings of men with URA/CBAVD (n = 17) and CF/CBAVD (n = 97) were compared; the fertilization and pregnancy rates in the URA/CBAVD population calculated, and the incidence of renal agenesis in immediate family members and offspring of men with URA/CBAVD analysed. No statistical differences could be identified within any of the above comparisons. The fertilization rate for the URA/CBAVD group was 58.2 ± 26.3%. Eight infants and two fetuses had normal renal anatomy, while one terminated male fetus had bilateral renal and vasal agenesis. Thirty first-order relatives had normal renal units. Anatomical expression of the reproductive ductal derivatives in men with URA/CBAVD and CF/CBAVD was similar, but the phenotypic outcome of the renal portion of the mesonephric duct was different. The potential for transmission of this fatal anomaly reinforces the need for prenatal ultrasounds with all pregnancies involving URA/CBAVD men. [ABSTRACT FROM PUBLISHER]

Purpose: Patients with priapism often develop permanent erectile dysfunction and personal sexual distress. This report is intended to help educate the public by reviewing the varied definitions and classifications of priapism and limited literature reports of pathophysiology, diagnosis and treatment outcomes of priapism. The AUA priapism guidelines committee is responsible for creating consensus as to appropriate individual patient management of priapism by physicians. Materials and methods: A multidisciplinary panel, consisting of 19 thought leaders in priapism, was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease to address pertinent issues concerning the role of the urologist, primary care providers and other health care professionals in the education of the public regarding management of men with priapism. The panel utilized a modified Delphi method and built upon the peer review literature on priapism. Results: The Thought Leader Panel recommended adoption of the definition of priapism as a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is stressed to be an important medical condition that requires evaluation and may require emergency management. The classification system is categorized into ischemic and non-ischemic priapism. Essential elements of the ischemic classification are the inclusion of: (i) clinical characteristics of pain and rigidity; (ii) diagnostic characteristics of absence of cavernosal arterial blood flow; (iii) pathophysiological characteristics of a closed compartment syndrome; (iv) a time limit of 4 h prior to emergent medical care; and (v) a description of the potential consequences of delayed treatment. Essential elements of the non-ischemic classification are the inclusion of: (i) clinical characteristics of absence of pain and presence of partial rigidity; (ii) diagnostic and pathophysiological characteristics of... [ABSTRACT FROM AUTHOR]

Presents several studies related to sexual functions. Effects of sex steroid hormones on nitric oxide synthase and arginase activity in the vagina; Unidentified neurotransmitter in the vaginal wall; Development of a model of female genital sexual response elicited by stimulation of the clitoris.

Presents studies related to erectile dysfunction. Comparison between vardenafil and sildenafil in facilitating pelvic nerve-mediated penile erection in a rabbit model; Restoration of erectile function in aged rats by gene transfer of prepro-calcitonin gene related peptide; Morphological characteristics of rat vagina.

Erectile dysfunction (ED) is a common and costly urologic condition with increasing prevalence as men age. Thus, penile prosthesis placement for the treatment of ED in Medicare beneficiaries is likely dependent on where these patients seek urologic care. [Extracted from the article]

Penile prostheses (PPs) are a safe, effective, and satisfactory treatment option for patients with erectile dysfunction refractory to medical therapy. Most respondents believe that the current infection rates are accurate (71.3%) and self-reported an estimated PP infection rate of <1% (43.3%) or 1-3% (46.0%). Penile prosthesis infections are managed by a salvage procedure using malleable prosthesis (66.9%), 3-piece inflatable penile prosthesis (IPP) (31.7%), or a 2-piece IPP (1.4%). [Extracted from the article]

Penile prosthesis is a safe and effective treatment option in the management of severe vasculogenic ED. We have adopted its use to provide prolonged focal antibiotic exposure around the penile prosthesis pump, a location that is susceptible to the majority of penile prosthesis infections. The aim of the study is to determine whether vancomycin paste can be safely used intraoperatively as an additional step for infection prevention during penile prosthesis placement. [Extracted from the article]

Sexual medicine is a dynamic field with continual advancements in treatment options for commonly encountered conditions. The purpose of this study was to evaluate changes in online search behavior for three common sexual medicine conditions: erectile dysfunction, Peryronie's disease, and male hypogonadism. For male hypogonadism, searches for "testosterone injection" ( 0.42, p <0.01), "testosterone pill" ( 0.27, p <0.01), "testosterone cypionate" ( 0.43, p<0.01), and "testosterone replacement therapy" ( 0.27, p<0.01) increased, while "testosterone gel" ( 0.004, p=0.85) remained unchanged. [Extracted from the article]

Corporal fibrosis can make the insertion of a penile prosthesis very challenging and is associated with high complication rates. The aim of this study was to investigate the outcomes and complications of penile prosthesis placement in patients with corporal fibrosis. [Extracted from the article]

A lack of uniformity exists for insurance payer coverage for all categories of penile prostheses (PP). Member benefit plans were reviewed for the largest domestic health insurers and policy language was reviewed if PP coverage was provided. Insurance coverage criteria for PP placement varies by state and plan, however coverage is provided for PP implantation in most cases. [Extracted from the article]

Constraints on surgical resident training (work-hour mandates and shorter training programs) and the availability of expert surgical educators may limit the acquisition of prosthetic surgical skills. This full-immersion and biodegradable penile prosthesis simulation model offers comprehensive full-task training that is cost-effective and may improve patient safety by increasing surgical training exposure. [Extracted from the article]