Search

Introduction: Prior studies evaluating the efficacy of penile prostheses (PP) and intracavernosal injections (ICI) have focused predominantly on sexual function, not psychosocial health. We utilized the freelisting technique and the Self-Esteem and Relationship (SEAR) questionnaire to evaluate the impact of PP and ICI treatments on psychosocial functioning., Materials and Methods: IRB-approval was obtained to perform an evaluation of patients who underwent PP or ICI treatment for erectile dysfunction (ED). Using a modified freelisting approach, participants were asked to give three one-word responses to questions about sexual function and relationships. Participants also completed the SEAR questionnaire and results were calculated based on the previously described formulas., Results: Fifty patients agreed to participate in the study (25 ICI, 25 PP). In the freelisting portion of the study, PP patients had more positive responses than ICI patients in 2 out of 3 questions. The freelisting study also identified important areas of concern for ED patients such as self-esteem, confidence, and treatment reliability. PP patients reported numerically higher SEAR total scores than ICI patients (63.9 vs. 53.9, p = 0.12), especially in confidence with duration of (p = 0.003), satisfaction with sexual performance (p = 0.06), and confidence with sexual performance (p = 0.02). SEAR confidence domain (p = 0.83), self-esteem subscale (p = 0.68), and overall relationship sub-scales (p = 0.90) were similar between PP and ICI patients., Conclusions: PP appears to have a stronger psychosocial impact compared to ICI; however, both PP and ICI patients continue to struggle with self-esteem, confidence, and treatment reliability. Further patient counseling before and after treatment may help to address these concerns and improve patient satisfaction.

The implantation of penile protheses for the surgical treatment of erectile dysfunction has risen in popularity over the past several decades. Considerable advances have been made in surgical protocol and device design, specifically targeting infection prevention. Despite these efforts, device infection remains a critical problem, which causes significant physical and emotional burden to the patient. The aim of this review is to broaden the discussion of best practices by not only examining practices in urology, but additionally delving into the field of orthopedic surgery to identify techniques and approaches that may be applied to penile prothesis surgery., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: To compare the frequency and severity of erectile dysfunction (ED) among pelvic fracture patients with and without urethral injuries and to identify potential risk factors for ED in the setting of pelvic fracture injury., Materials and Methods: A retrospective review was conducted of male patients treated for pelvic fractures with and without urethral injuries at a Level 1 trauma center between 2005 and 2016. The International Index of Erectile Function (IIEF-5) questionnaire was administered to patients by telephone to assess post-injury ED. Additional questions about pre-injury ED, post-injury symptoms, and past medical history were reviewed., Results: Fifty patients (42%, n = 118) responded to the IIEF-5 questionnaire: 29 with pelvic fractures alone and 21 with PFUIs. We observed a numerical increase in frequency of new onset ED in patients with pelvic fracture urethral injuries (PFUIs) (n = 12, 57%) compared with patients with pelvic fractures alone (n = 11, 38%) (P = .3). Patients with PFUIs reported lower IIEF-5 scores (ie worse ED) than patients with pelvic fractures alone (13 versus 18, P = .05). There were no significant differences in potential risk factors between the 2 groups on univariate analyses., Conclusion: ED was more severe following PFUI than pelvic fracture alone. We suspect that urethral injury is not the direct cause of ED, but rather a surrogate for extensive pelvic injury and risk for neurovascular injury. A larger prospective analysis is warranted to clarify this hypothesis and to further stratify risk factors for developing ED in pelvic fracture patients with and without urethral injuries., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To present a novel algorithm for definitive reconstruction of penile curvature in men undergoing inflatable penile prosthesis (IPP) surgery as an alternative to manual penile modeling and grafting procedures., Methods: Patients with erectile dysfunction and concomitant penile curvature undergoing IPP placement were divided into 2 treatment groups: (1) group 1, penile deformity known preoperatively, and (2) group 2, penile curvature recognized intraoperatively after IPP placement. Group 1 patients underwent penile plication after artificial erection and immediately before IPP insertion via the same penoscrotal incision, whereas group 2 patients were treated with a Yachia (Heineke-Mikulicz) corporoplasty over the intact cylinders. Patients completed postoperative Patient Global Impression of Improvement (PGI-I) questionnaires assessing overall satisfaction., Results: Among 405 men receiving IPP at our institution from 2007 to 2014, 30 patients received synchronous correction of penile curvature (7%). Group 1 included 23 of 30 (77%) patients, and 7 of 30 (23%) were in group 2. Overall mean initial curvature was 36°, and all patients were corrected to < 10°. Average operative times were 18 minutes longer compared with patients who underwent IPP placement alone (82 vs 64 minutes, P <.05). At an average follow-up of 13 months (range 7-32), 19 of 20 (95%) group 1 and 6 of 7 (86%) group 2 patients who completed surveys reported an improved overall condition. No patient reported chronic pain, recurrent deformity, or device malfunction., Conclusion: Penile curvature can be safely and reliably corrected at the time of IPP placement, regardless of whether the deformity was identified preoperatively., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: Twenty to thirty percent of patients with Peyronie's disease (PD) have erectile dysfunction (ED) refractory to medical therapy and may benefit from a combined procedure addressing both conditions., Aim: The aim of this study was to show the efficacy of inflatable penile prosthesis (IPP) insertion and synchronous penile plication for correcting penile curvature and ED in patients with PD., Methods: A retrospective review was performed of all patients who underwent IPP insertion with synchronous penile plication at our tertiary care center between 2010 and 2013. All patients received an intraoperative saline intracorporal injection to induce an artificial erection. After the tunica albuginea was exposed via a standard transverse scrotal incision over the proximal penile shaft, the incision was retracted distally and/or laterally as needed for plication suture placement. Plication sutures were placed in parallel opposite the angle of greatest curvature. The incision was returned proximally to the standard penoscrotal junction for IPP insertion. Demographic and surgical data were collected from the patients' medical records. Patient satisfaction was assessed postoperatively using a nonvalidated questionnaire., Main Outcome Measures: The focus of this study was surgical outcomes, both technical and patient-reported satisfaction., Results: Eighteen patients with a mean age of 63 years underwent IPP insertion with synchronous penile plication. Patients presented with dorsal (n = 11), lateral (n = 2), and biplanar curvature (n = 5). Mean preoperative curvature was 39 degrees (range 30-60) and was corrected on average to <5 degrees (range <5-12) using a median of four plication sutures (range 3-6). Among 15 patients completing a postoperative satisfaction survey at a mean of 11 months, all reported improvement in their overall condition and penile curvature; one with biplanar deformity reported minor residual curvature. None reported continued pain or required suture release., Conclusions: IPP insertion with synchronous penile plication for the correction of ED and PD is effective and results in high patient satisfaction., (© 2014 International Society for Sexual Medicine.)