High Patient Satisfaction after Inflatable Penile Prostheses Implantation Correlates with Female Partner Satisfaction

IntroductionPatient and female partner satisfaction after implantation of an inflatable penile prosthesis (IPP) assessed by objective means, and the correlation between the partners, is important for determining postoperative sexual life.AimThe primary goal was to evaluate patients' erectile function and patients' and their partners' satisfaction after IPP implantation. A secondary aim was to investigate potential determinative factors of satisfaction according to device characteristics, demographics, and cause of erectile dysfunction (ED).MethodsNinety patients, who underwent IPP implantation as an alternative to refractory or undesirable medical treatment for ED, were evaluated. Patients who could not or refused to participate, or were out of a relationship, were excluded. The 69 remaining patients were evaluated for their pre‐ and postoperative erectile function and posttreatment satisfaction for themselves and their partners.Main Outcome MeasuresPreoperative and postoperative scores on the International Index of Erectile Function Questionnaire–five items (IIEF‐5) were compared. The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) was given to males and their female partners. Patient demographics, etiology of ED, and implant characteristics were correlated also with patients' EDITS scores.ResultsMean IIEF‐5 scores demonstrated a significant improvement after IPP implantation: from 8.88 ± 3.75 to 20.97 ± 4.37 (P < 0.001). The mean patients' EDITS score was 75.48 ± 20.54, whereas mean female partners' score was 70.00 ± 22.92, highlighting high posttreatment satisfaction for both. Regression analysis suggested a direct linear correlation of satisfaction between the sexual partners as a degree of satisfaction. There were no statistically significant differences according to level of education or implant characteristics. Concerning the etiology of ED, no conclusions could be made.ConclusionsOvercoming previous limitations in determining post‐IPP implantation satisfaction, our study reiterates high rates of patient and partner satisfaction. Of particular note, patient satisfaction appears independent of prosthesis type and cylinder length. Vakalopoulos I, Kampantais S, Ioannidis S, Laskaridis L, Dimopoulos P, Toutziaris C, Koptsis M, Henry GD, and Katsikas V. High patient satisfaction after inflatable penile prostheses implantation correlates with female partner satisfaction. J Sex Med 2013;10:2774–2781.     

Development of Penile Hydrocele Following Placement of Inflatable Penile Prosthesis: A Rare Entity

IntroductionThe development of a penile hydrocele following the placement of an inflatable penile prosthesis (IPP) for erectile dysfunction has never been documented. We herein report an unusual complication of penile hydrocele formation that developed following placement of an IPP for erectile dysfunction.MethodsThe penile hydrocele was successfully repaired by excision of the hydrocele sac.ResultsSuccessful surgical repair of a penile hydrocele was accomplished following placement of an IPP without removal of any implant components. The penile implant was functional at the end of the procedure as well as at all scheduled follow‐up appointments.ConclusionsWith advances in both surgical techniques and improved devise technology, high volume penile implanters encounter fewer IPP‐related complications such as infectious or mechanical complications. We herein report for the first time a rare complication of penile hydrocele development after IPP placement that was treated successfully with surgical excision of the hydrocele sac. Urologists who perform these types of procedures should be aware of this unusual complication and know that it is curable with prompt diagnosis and meticulous surgical repair. Raheem OA, Cohen SD, Chandrasekaran B, and Goldstein I. Development of penile hydrocele following placement of inflatable penile prosthesis: A rare entity. J Sex Med 2015;12:270–273.     

Simultaneous Total Corporal Reconstruction and Implantation of a Penile Prosthesis in Patients with Erectile Dysfunction and Severe Fibrosis of the Corpora Cavernosa

IntroductionImplantation of a penile prosthesis in severely scarred corporal bodies represents a great challenge as fibrosis can compromise dilatation and subsequent closure of the corpora cavernosa and limit size, type, and function of the device.AimThe aim of this study is to report our experience of simultaneous corporeal reconstruction and penile prosthesis implantation in patients with severe penile contracture consequence of diffuse fibrosis.MethodsBetween March 2006 and February 2010, 18 patients with severe penile contracture and coporeal fibrosis underwent simultaneous corporeal reconstruction and placement of a penile prosthesis.Main Outcome MeasuresSurgical outcome and complications have been recorded during postoperative follow‐up. Patients' satisfaction has been assessed 6 months postoperatively with the administration of the modified Erectile Dysfunction Index of Treatment Satisfaction questionnaire.ResultsAlthough the dilatation of the corpora was extremely difficult due to the severe fibrosis, a penile prosthesis has been implanted in all patients. A malleable penile prosthesis has been inserted in four patients and a three‐piece inflatable device in the remainder. After an average follow‐up of 26 months (range 6–36), revision surgery was required in four patients (elective exchange to three‐piece inflatable device in three patients and upsizing of the implant in one patient). Although all patients were able to achieve penetrative sexual intercourse, four patients were partially dissatisfied because of significant penile shortening.ConclusionIn expert hands, simultaneous penile prosthesis implantation and corporal reconstruction of severely scarred corpora yield satisfactory results. Patients must be warned that complication rate in presence of severe fibrosis is significantly higher than in virgin cases and that downsized cylinders might be required due to the contracture of the tunica albuginea. Sansalone S, Garaffa G, Djinovic R, Antonini G, Vespasiani G, Ieria FP, Cimino S, Loreto C, and Ralph DJ. Simultaneous total corporal reconstruction and implantation of a penile prosthesis in patients with erectile dysfunction and severe fibrosis of the corpora cavernosa. J Sex Med 2012;9:1954–1961.     

Erosion of Inflatable Penile Prosthesis Reservoir into Neobladder

IntroductionErosion of the reservoir into surrounding tissues is a rare complication after inflatable penile prosthesis (IPP) implantation.AimTo present a new case and a review of the literature including discussion of pathogenesis, risk factors, and management options.MethodsWe present the case of a 75-year-old male who underwent placement of an IPP for postoperative erectile dysfunction with a history of bladder cancer requiring radical cystoprostatectomy and Studer neobladder. Six years after IPP placement, he presented with recurrent febrile urinary tract infection that seemed to be precipitated by cycling of his penile prosthesis. Cystoscopy and cross-sectional computed tomography imaging demonstrated erosion of the inflatable penile prosthesis reservoir into the neobladder.ResultsPatient underwent open removal of the IPP reservoir and cystorrhaphy with a plan for future prefascial reimplantation of an IPP reservoir.ConclusionsIn patients with a history of abdomino-pelvic surgery or radiation therapy, the retroperitoneal space may be extremely fibrotic and the transversalis fascia may have thickened. Potential intraoperative complications as well as reservoir erosion may be avoided by using a two-piece device or ectopic reservoir placement. Management options for reservoir erosion include explantation of the entire device as well as reservoir removal with salvage of remaining components. Tran CN, Boncher N, Montague DK, and Angermeier KW. Erosion of inflatable penile prosthesis reservoir into neobladder. J Sex Med 2013;10:2343–2346.     

Prospective Evaluation of Postoperative Penile Rehabilitation: Penile Length/Girth Maintenance 1 Year Following Coloplast Titan Inflatable Penile Prosthesis

IntroductionThe 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.AimOur goal was to assess results using the Coloplast Titan IPP, with NLMT, and postoperative rehabilitation.MethodsAfter 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 MeasurePenile length measurements after implantation compared with 12 months postimplantation.ResultsPenile 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.ConclusionThis 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. Henry GD, Carrion R, Jennermann C, and Wang R. Prospective evaluation of postoperative penile rehabilitation: Penile length/girth maintenance 1 year following coloplast titan inflatable penile prosthesis. J Sex Med 2015;12:1298–1304.     

A Survey of Patients with Inflatable Penile Prostheses: Assessment of Timing and Frequency of Intercourse and Analysis of Implant Durability

IntroductionThis study was conducted to determine how long after inflatable penile prosthesis (IPP) surgery patients attempt sexual intercourse and the frequency of subsequent relations. We also examined survival-related factors for the AMS 700 CX, Mentor Alpha 1, and Mentor Alpha Narrow Base.AimsThe aim was to survey men who received IPPs and collect information about their return to sexual function and frequency of use, and to assess the resilience of their devices.MethodsPhase I involved retrospective chart review of 1,298 virgin IPP surgeries performed by one surgical team from January 1992 to December 1998. Phase II included 330 subjects selected by stratified, systematic, random sampling from phase I patients. Data were collected by computer-assisted telephone interview, using a 27-question survey. All patients had been instructed to wait 4 weeks before using the implant and were taught how to inflate/deflate their prostheses at the 4-week postsurgical visits.Main Outcome MeasuresThe survey examines the length of time after surgery for men to resume sexual function. In the same study, information was garnered about mechanical durability of the device.ResultsAmong phase I subjects, the 5-year survival rate was 83% (N = 1,069) for IPP revision for any reason. Of the 330 phase II subjects, 248 (75%) were successfully contacted; 199 (80%) responded to the full survey and 49 (20%) responded to selected parts of the survey. Sexual intercourse was resumed postoperatively at 1–4 weeks for 41% (78/190), at 5–6 weeks for 31% (59/190), at 7–8 weeks for 16% (30/190), and at >8 weeks for 12% (23/190) of the patients. More than 60% of patients reported using their IPP at least once weekly.ConclusionsThe three-piece IPP has excellent 5-year survival rates. Most patients return to sexual activity relatively quickly, with high frequency of usage of their prostheses. Henry GD, Brinkman MJ, Mead SF, Delk JR II, Cleves MA, Jennermann C, Wilson SK, and Kramer AC. A survey of patients with inflatable penile prostheses: Assessment of timing and frequency of intercourse and analysis of implant durability. J Sex Med 2012;9:1715–1721.     

Sexual Rehabilitation and Penile Pain Associated with Intracavernous Alprostadil after Radical Prostatectomy

IntroductionIntracavernous alprostadil injection (IAI) is widely used for sexual rehabilitation (SR) after radical prostatectomy (RP). However, the rate of spontaneous erection recovery with IAI remains unclear, and IAI causes pain that may hinder SR.AimsTo assess SR in IAI users after RP and to evaluate the course and impact on SR of postinjection penile pain.MethodsWe prospectively studied 87 patients who underwent nerve‐sparing laparoscopic RP, reported normal preoperative erectile function, and used IAI for 12 months. Patients started with 2.5 µg alprostadil and were advised to increase the dose gradually until erection hardness allowed vaginal penetration.Main Outcome MeasuresAt 6 and 12 months, the International Index of Erectile Function (IIEF‐15) and Erection Hardness Score (EHS) were determined with and without IAI, and injection‐related penile pain was assessed using a numeric rating scale. Correlations linking penile pain, IIEF‐15, and EHS scores were evaluated.ResultsThe mean alprostadil dose was 8.1 µg after 6 months and 9.9 µg after 12 months. With/without IAI, mean IIEF‐15 scores for erectile and orgasmic function and mean EHS score were 14.6/4.6, 4.1/2.1, and 2.5/0.4, respectively, after 6 months; and 17.2/5.4, 4.9/2.6, and 2.7/0.9 after 12 months. Pain scores were 3.2 ± 2.5/10 and 2.5 ± 2.5/10 after 6 and 12 months, respectively. Pain intensity correlated with erectile function (r = ?0.23), intercourse satisfaction (r = ?0.23), and overall satisfaction (r = ?0.24) after 6 months but not after 12 months. Follow‐up was short and only patients who used IAI for 12 months were included.ConclusionsIn patients who were willing and able to use IAI, erectile function improved after 1 year but remained below preoperative levels. The adverse impact of pain on SR was significant during the first 6 months and diminished over time. These data may help to counsel IAI users with painful erections. Yiou R, Cunin P, de la Taille A, Salomon L, Binhas M, Lingombet O, Paul M, and Abbou C. Sexual rehabilitation and penile pain associated with intracavernous alprostadil after radical prostatectomy.     

Simultaneous penile lengthening and penile prosthesis implantation in patients with Peyronie's disease, refractory erectile dysfunction, and severe penile shortening

IntroductionDue to loss of length, patients who had penile prosthesis implantation for Peyronie's disease (PD) show a statistically significant reduction in their levels of satisfaction when compared with the general implant population.AimThe aim of this study is to report our experience of penile lengthening with circumferential graft during penile prosthesis implantation in patients with PD and severe penile shortening.MethodsBetween March 2006 and February 2008, 23 patients with PD, refractory erectile dysfunction, and severe penile shortening underwent penile lengthening with circumferential graft and concomitant implantation of an inflatable penile prosthesis.Main Outcome MeasuresSurgical outcome and complications have been recorded during postoperative follow‐up. Patients' satisfaction has been assessed 6 months postoperatively with the administration of the modified Erectile Dysfunction Index of Treatment Satisfaction (EDITS) questionnaire.ResultsAfter an average follow‐up of 22 months (range 6–36), 20 patients attended all the postoperative follow‐up visits and returned the EDITS questionnaire. An average length gain of 2.8 cm (range 2.2–4.5) was recorded, and all patients were able to cycle the device and engage in penetrative sexual intercourse. Patient recorded complications included diminished glans sensitivity in four (20%) and persistent dorsal curvature of less than 15° in three (15%). Overall, 18 patients (90%) were satisfied with the cosmetic and functional result of surgery.ConclusionPenile lengthening with circumferential graft during penile prosthesis implantation in patients with PD represents a safe and reproducible technique that yields higher satisfaction rates than penile prosthesis implantation alone in patients with severe penile shortening. Sansalone S, Garaffa G, Djinovic R, Egydio P, Vespasiani G, Miano R, Loreto C, and Ralph DJ. Simultaneous penile lengthening and penile prosthesis implantation in patients with Peyronie's disease, refractory erectile dysfunction, and severe penile shortening. J Sex Med 2012;9:316–321.     

Favorable female sexual function is associated with patient satisfaction after inflatable penile prosthesis implantation

IntroductionThe interrelationship between male and female sexual function suggests that partner outcomes after inflatable penile prosthesis (IPP) implantation must be assessed.AimWe examined predictors of patient and partner satisfaction, and the relationship between patient satisfaction and female sexual function, after IPP implantation.MethodsWe designed a questionnaire (scored 1–5) assessing satisfaction with various domains related to the IPP (e.g., overall satisfaction and satisfaction related to: length, width, ease of use, and partner perception). Scores ≥3 were classified as satisfied. The Female Sexual Function Index (FSFI) was administered to the female partners of patients that underwent an IPP.Main Outcome MeasuresIndependent samples Students' t‐test was used to compare various FSFI domain scores in relation to male and female satisfaction. Analysis of variance test was used to assess linear regression correlation between various continuous variables.Results45 men and 32 partners with a mean follow‐up of 2.2 years were contacted. Overall satisfaction for men and women was 3.60 and 3.62 (out of 5), respectively. Partner FSFI scores were higher, respectively, in men with higher implant satisfaction than those with lower implant satisfaction (25.09 ± 6.79 vs. 13.67 ± 12.70, P < 0.001). Regression analysis suggests a direct correlation between FSFI scores and the degree of patient (r = 0.50, r² = 0.23; P = 0.001) and partner (r = 0.70 r² = 0.50; P < 0.001) satisfaction with the IPP.ConclusionPatient satisfaction after IPP implantation implies favorable partner sexual function compared to that of unsatisfied patients. The correlation observed suggests that patients not satisfied with their IPP are likely to have female partners at high risk for female sexual dysfunction. Further interventions may be needed to improve patient and partner sexual function, particularly unsatisfied men and their female partners. Moskovic DJ, Gittens P, Avila D, Chandrashekar A, Khera M, and Lipshultz LI. Favorable female sexual function is associated with patient satisfaction after inflatable penile prosthesis implantation. J Sex Med 2011;8:1996–2001.     

The Relationship between Resting Heart Rate Variability and Erectile Tumescence among Men with Normal Erectile Function

IntroductionIndividuals with erectile dysfunction (ED) have been shown to display lower heart rate variability (HRV), suggesting dysregulation of cardiac autonomic function. No studies have explored whether HRV is predictive of erectile response among men with clinically normal erectile function.AimThe study aims to examine associations between resting HRV and objective measures of genital response (i.e., resting penile circumference; erectile tumescence) and self‐reported sexual function.MethodsThe sample comprised 59 male community volunteers (mean age = 20.15 years; SD = 2.52) selected from the control conditions of two previously published studies. Participants reported erectile function in the normal range (scoring ≥ 26 on the International Index of Erectile Function [IIEF]) and had no history of cardiovascular disease or myocardial infarct. During a laboratory visit, self‐report, anthropometric, cardiovascular, and electrocardiographic data were assessed, as well as resting penile circumference and erectile tumescence in response to viewing an erotic film.Main Outcome MeasuresResting penile responses, erectile tumescence (circumferential change via penile plethysmography), self‐reported sexual function per the IIEF, and both time‐domain (standard deviation of beat‐to‐beat [NN] intervals, square root of the mean squared difference of successive NN intervals, and percent of NN intervals for which successive heartbeat intervals differed by at least 50 msec [pNN50]) and frequency‐domain (low frequency [LF], high frequency [HF], LF/HF ratio) parameters of HRV were assessed.ResultsHigher‐resting HF power and lower‐resting LF/HF ratio were associated with greater erectile tumescence. There were marginally significant positive associations between mean NN interval and pNN50 and penile tumescence. HRV was not associated with self‐reported sexual function or with resting penile circumference.ConclusionsResults suggested that, among men without ED, relatively elevated parasympathetic tone was predictive of larger erectile tumescence. Limited variance in sexual function scores may have accounted for the lack of association between HRV and IIEF scores. Harte CB. The relationship between resting heart rate variability and erectile tumescence among men with normal erectile function. J Sex Med 2013;10:1961–1968.     

Comparison between AMS 700™ CX and Coloplast™ Titan Inflatable Penile Prosthesis for Peyronie's Disease Treatment and Remodeling: Clinical Outcomes and Patient Satisfaction

IntroductionThe implantation of inflatable penile prosthesis (IPP) with simultaneous manual penile remodeling allows for men to undergo a single procedure aimed at correcting both the penile deformity/curvature and erectile dysfunction (ED).AimTo evaluate the clinical outcomes and patient satisfaction in men with Peyronie's disease (PD) and ED who underwent AMS 700? CX and the newer Coloplast? Titan inflatable penile prosthesis (IPP) implant.Main Outcome MeasuresPatient demographics, type of IPP, clinical outcomes, post-implant sexual characteristics, and overall patient satisfaction.MethodsA single-center retrospective review of clinical database and prospective telephone survey were conducted in all men with PD who underwent IPP between January 2006 and November 2010.ResultsA total of 138 patients with an average age of 57.7 (32 to 80) underwent AMS 700 CX (88 patients) and Coloplast Titans (50 patients) IPP implantation during the 5-year period. The majority of patients (91%) had only one IPP implantation. The IPP clinical outcomes include eight (6%) revision surgery for device malfunction and three (2%) device explantation for prosthesis infection. While there was no statistically significance in device survival between the two devices, the trend favored AMS 700 CX over Titan (5-year Kaplan-Meier estimates of mechanical survival were 91% vs. 87%, P > 0.05) and both IPPs provided similar penile straightening without the need for revision surgery. Most men (79%) reported great satisfaction following CX or Titan implants with greater than two thirds of men reported greater self-confidence and 82% of patients would undergo the same operation again.ConclusionsAMS 700? CX and Coloplast? Titan IPP implantation and penile remodeling appeared to provide permanent penile straightening and high patient satisfaction without an increase risk of revision surgery. Chung E, Solomon M, DeYoung L, and Brock GB. Comparison between AMS 700? CX and Coloplast? Titan inflatable penile prosthesis for Peyronie's disease treatment and remodeling: Clinical outcomes and patient satisfaction. J Sex Med 2013;10:2855–2860.     

ORIGINAL RESEARCH—SURGERY: Anatomical Radical Retropubic Prostatectomy in Patients with a Preexisting Three-Piece Inflatable Prosthesis: A Series of Case Reports

IntroductionOnly few reports addressed the outcome of patients submitted to anatomical radical retropubic prostatectomy (RRP) with an indwelling inflatable penile prosthesis (IPP).AimTo assess the feasibility and safety of RRP in patients with clinically localized prostate cancer and a previously implanted with an IPP.Main Outcome MeasuresWe evaluated the surgical parameters and the follow-up functional results in this particular patient population.MethodsFour patients previously submitted to IPP implant for severe erectile dysfunction underwent RRP for organ-confined prostate cancer. Patients' charts were carefully reviewed to investigate pre- and perioperative details. Patients were evaluated by the International Index of Erectile Function (IIEF) preoperatively and at 6 months postoperatively. Patients were then contacted to assess long-term functional and oncological outcome.ResultsThe outcome of the procedures was comparable to a normal population in terms of operating time, estimated blood loss, hospitalization time, and pathological outcome. No injury to the preexisting penile implant was reported. Continence was obtained in 3 (75%) patients at catheter removal, and in 1 (25%) patient at the 1-month follow-up. No major intra- and postoperative complications were reported. All patients were able to use their prosthesis after RRP. No statistical difference in pre- and post-RRP EF domain scores was found.ConclusionThe presence of an IPP in patients with prostate cancer is not a contraindication to perform an anatomical RRP. Surgery can be performed safely without injuring the implant and the clinical outcome in these patients is satisfactory. Postoperative implant use is not affected by RRP. Deho' F, Salonia A, Briganti A, Zanni G, Gallina A, Rokkas K, Guazzoni G, Rigatti P, and Montorsi F. Anatomical radical retropubic prostatectomy in patients with a preexisting three-piece inflatable prosthesis: A series of case reports. J Sex Med 2009;6:578–583.     

Comparison of Penile Size and Erectile Function after High-intensity Focused Ultrasound and Targeted Cryoablation for Localized Prostate Cancer: A Prospective Pilot Study

IntroductionErectile dysfunction (ED) represents a common quality-of-life issue of any treatment used for prostate cancer, including high-intensity focused ultrasound (HIFU) and targeted cryoablation of the prostate (TCAP). There is a paucity of comparative studies regarding the difference in the erectile function and penile size of patients undergoing HIFU or TCAP.AimThe aim of this study is to compare the erectile function and penile size of patients undergoing HIFU or TCAP.MethodsPatients with a preoperative erectile function domain of the International Index of Erectile Function (IIEF-EF) score ≥26 were prospectively included. All patients were preoperatively evaluated by IIEF-EF and penile color Doppler ultrasound. Penile length and circumference were measured in flaccidity and at maximum erection. At 6, 12, 18, 24, 36 months after surgery, patients were assessed with the same protocol.Main Outcome MeasuresIIEF-EF score, penile color Doppler ultrasound, penile length, and circumference at different time points.ResultsThere were 55 patients in the HIFU group and 47 in the TCAP group. At each time point, there were significant differences in mean IIEF-EF scores and penile color Doppler results between the two groups. At 36 months, TCAP patients experienced lower erectile function recovery rate compared with HIFU patients (TCAP = 46.8%; HIFU = 65.5%; P = 0.021). No significant decreases in penile length and circumference were found in the two groups (all P values ≥0.05).ConclusionsOur data demonstrate TCAP caused significantly decreased erectile function than HIFU. We found no change in penile size after HIFU or TCAP. The option of HIFU may be more attractive to the patient who wants to avoid ED afterward, to maintain their quality of life. Li L-Y, Lin Z, Yang M, Gao X, Xia T-L, and Ding T. Comparison of penile size and erectile function after high-intensity focused ultrasound and targeted cryoablation for localized prostate cancer: A prospective pilot study.     

Radical Cystectomy in Patients with Preexisting Three‐Piece Inflatable Penile Prosthesis

IntroductionRadical cystectomy with urinary diversion is the treatment of choice for muscle‐invasive, and certain populations with non‐invasive, urothelial carcinoma of the bladder. There have not been any reports to date on patients undergoing this surgery who have had previous placement of an inflatable penile prosthesis.AimTo present the outcomes of four patients with pre‐existing inflatable penile prostheses (IPP) with reservoirs within the space of Retzius who were subsequently treated with radical cystectomy for bladder cancer management.MethodsAfter obtaining institutional review board approval, the demographic, clinical, and pathologic data were reviewed in the Johns Hopkins Cystectomy Database for patients who underwent radical cystectomy for bladder cancer from 1994 to 2012. A case series of four patients is presented who had a preexisting IPP and their post‐operative course and long‐term outcomes are reviewed.ResultsAll four patients had radical cystectomy and ileal conduit urinary diversion with no intra‐operative or post‐operative complications. One patient was not sexually active and therefore had the reservoir explanted and not replaced. The other three patients had the reservoir removed prior to bladder extirpation and the tubing capped, with reservoir replacement in the pseudocapsule at the termination of the procedure. In one patient an omental flap was used to ensure separation between the reservoir and ileal conduit. The devices were all functional intra‐operatively and on follow‐up.ConclusionsAs erectile dysfunction is more commonly being diagnosed and treated with IPP insertion at younger ages, surgeons will increasingly encounter pre‐placed abdominal reservoirs when performing pelvic surgery. This case series of four patients undergoing radical cystectomy with prior‐placed IPPs reveals that the functionality of the IPP can be preserved while still performing oncologically sound extirpative procedures. Segal RL, Readal N, Pieororazio PM, Kutlu O, Schoenberg M, and Bivalacqua TJ. Radical cystectomy in patients with preexisting three‐piece inflatable penile prosthesis. J Sex Med **;**:**–**.     

Intraoperative Cavernous Nerve Stimulation and Laser-Doppler Flowmetry during Radical Prostatectomy

IntroductionErectile dysfunction is a common side effect following radical prostatectomy mainly due to damage of the pelvic autonomic nerve fibers (cavernous nerves). Intraoperative electrical stimulation of the cavernous nerves while measuring changes in penile girth has previously been shown to provide the surgeon with feedback of nerve integrity.AimTo test the feasibility of recording changes in glans penis blood flow by Laser Doppler flowmetry from cavernous nerve stimulation.MethodsFifteen patients with localized prostate cancer undergoing radical prostatectomy had electrical stimulation of the proximal and distal parts of the neurovascular bundles after prostate removal. The stimulation consisted of 30–40 seconds biphasic constant current (10–30 mA) with 0.5 millisecond pulse duration.Main Outcome MeasuresStimulus induced changes in penile blood flow was recorded from a Laser Doppler probe attached to the glans penis. Changes in penile girth were simultaneously recorded from a mercury-in rubber strain gauge. Erectile function was evaluated three months after surgery.ResultsTen patients had stimulus induced increase in Laser Doppler flow unilaterally (N = 7) or bilaterally (N = 3). Out of 10 patients, 6 reported some preserved erectile function postoperatively at 3 months follow-up (indicating 6 true and 4 false positives). Three patients had no Doppler response from stimulation and had no postoperative erectile function postoperatively (indicating three true negatives). Two patients were excluded from the study due to bad signal quality in the Laser Doppler signal. In the majority of patients, stimulation produced increase in penile girth sensed by the strain gauge.ConclusionThis preliminary report provides evidence that Laser Doppler Flowmetry is able to detect increased penile blood flow from intraoperative electrical stimulation of the neurovascular bundles. However, further improvement in the recording technique is required. Laser Doppler Flowmetry may also be feasible to confirm autonomic nerve sparing in women undergoing pelvic surgery. Axelson HW, Johansson E, and Bill-Axelson A. Intraoperative cavernous nerve stimulation and Laser-Doppler flowmetry during radical prostatectomy. J Sex Med 2013;10:2842–2848     

Recovery of Erectile Function after Nerve‐Sparing Laparoscopic Radical Prostatectomy in Japanese Patients Undergoing Both Subjective and Objective Assessments

IntroductionThe sexual potency rate following a radical prostatectomy can vary. In Japanese patients, sexual activity after nerve‐sparing prostatectomy seems especially unfavorable. Most studies have assessed potency status subjectively using questionnaires.AimsThe aim of this study is to evaluate the recovery of potency in Japanese patients after nerve‐sparing laparoscopic prostatectomy (nsLRP) both subjectively and objectively.MethodsTwenty‐seven patients operated on with nsLRP (bilateral sparing in four patients, unilateral in 23 patients) were enrolled. The mean age of the patients was 60.1 years. Seventeen of 27 patients used type 5 phosphodiesterase inhibitors on demand at least 3 months after surgery.Main Outcome MeasuresSubjective erectile function was examined by the International Index of Erectile Function (IIEF)‐15 and by the Erection Hardness Score (EHS) questionnaires before and at 3, 6, and 12 months after surgery. Objective erectile function, with measurement of rigidity and tumescence of the penis, was evaluated by RigiScan‐Plus as the erectile response to audio‐visual stimulation.ResultsIIEF erectile function domain, IIEF‐total, and EHS scores decreased significantly after surgery; they were almost half of pretreatment levels at 12 months after surgery. On the other hand, penile rigidity and tumescence measured by RigiScan also decreased significantly 3 months after surgery. However, these values gradually improved, and head nearly recovered at 12 months after surgery. At 12 months after surgery, recovery rates of penile rigidity and tumescence from baseline were rigidity 92.6% at tip and 96.3% at base, with tumescence of 87% at tip and 76% at base.ConclusionsDiscrepancies were found between results of subjective and objective assessments of erectile function. From an objective viewpoint, the recovery of erectile function in Japanese patients after nsLRP was not bad. Taniguchi H, Kawa G, Kinoshita H, and Matsuda T. Recovery of erectile function after nerve‐sparing laparoscopic radical prostatectomy in Japanese patients undergoing both subjective and objective assessments. J Sex Med 2012;9:1948–1953.     

Inflatable Penile Prosthesis Placement in Men with Peyronie's Disease and Drug-resistant Erectile Dysfunction: A Single-Center Study

IntroductionErectile dysfunction (ED) frequently accompanies Peyronie's disease (PD) and changes the therapeutic approach.AimTo evaluate a single-center experience with inflatable penile prostheses (IPP) in men with medication refractory ED and PD.MethodsNinety men underwent placement of an IPP with straightening maneuvers as necessary to address their deformity and ED.Main Outcome MeasuresPreoperative assessment included International Index of Erectile Function-erectile function domain (IIEF-EF) and duplex ultrasound to confirm ED and measure erect deformity. Postoperative assessment included a modified Erectile Dysfunction Index of Treatment Satisfaction (EDITS) questionnaire, as well as office visits at 1, 6, and every 12 months thereafter.ResultsComplete chart review was performed with mean follow-up of 49 months. Mean preoperative IIEF-EF score was 11. Full rigidity was not obtained in any patient during duplex ultrasound. Mean curvature at maximum erection was 53°. There were seven mechanical failures requiring device replacement, two revision surgeries for pump or reservoir malposition, one infected device, and two corporoplasties for distal tunica erosion. Postoperative office assessment revealed a functionally straight (i.e., <20°) erect penis and a properly positioned as well as operational device in all patients. The modified EDITS questionnaire was returned by 56 (62%). Overall, 84% of patients were satisfied with their outcome, yet only 73% were satisfied with their straightness. Patient perceived postoperative curvature correction stabilized quickly and was complete by 3 months in 84% of patients. Satisfaction with ease of inflation, deflation, and concealability was 84%, 71%, and 91%, respectively. Coital activity was reported by 91% of men in this group.ConclusionIn men with PD and ED, IPP placement allowed reliable and satisfactory coitus for the great majority of men. Mechanical failure was 7%. Men with PD undergoing IPP placement should be counseled regarding potential penile length loss and residual curvature, neither of which appeared to interfere with coitus but may reduce satisfaction. Levine LA, Benson J, and Hoover C. Inflatable penile prosthesis placement in men with Peyronie's disease and drug-resistant erectile dysfunction: A single-center study.     

Erectile Function and Sexual Satisfaction: The Importance of Asking About Sexual Desire

IntroductionErectile function, libido, and sexual bother are incompletely correlated: a man may or may not be satisfied for a given level of erectile function; similarly, 2 men may have the same erectile function and different levels of sexual desire.AimTo explore the relationship between erectile function, sexual satisfaction and sexual desire.MethodsWe examined the Spearman correlation among erectile function (International Index of Erectile Function [IIEF-6]), sexual desire, and sexual bother in 3,944 questionnaires completed by patients after radical prostatectomy as part of routine care. IIEF-6 scores were adjusted if a patient indicated that the reason for not having intercourse was other than lack of ability of confidence (eg, lack of partner).Main Outcome MeasurePatient-reported outcome instruments.ResultsMedian age at surgery and preoperative IIEF-6 were 63 years and 26, respectively. Among questionnaires completed after surgery, there was moderate correlation among the IIEF-6 score and both sexual desire (Spearman rho: 0.41) and sexual bother (Spearman rho: 0.30). In men who reported high or moderate bother relating to sexual function, there was a narrow distribution of erectile function scores, with most men reporting poor function (median IIEF-6: 6, interquartile range 3, 11). For men who reported small or no problem with sexual function, the distribution of erectile function scores was wide, and particularly bimodal as a function of sexual desire. Among patients with high desire, the correlation between sexual bother and erectile function was 0.61 (ie, the poorer is your function, the greater you are bothered), whereas it was -0.081 among patients with low desire, meaning that some men are not bothered by poor erections.Clinical ImplicationsWe provided useful insights to help physicians during sexual counselling after surgery for prostate cancer.Strength & LimitationsThe study included a large number of patients and provides evidence for implementation of patient-reported outcome insturments. Limitations include the retrospective nature of our data.ConclusionSexual desire helps explain the moderate correlation between erectile function and sexual bother. Sexual desire and bother questions should be incorporated in patient-reported outcome instruments for male sexual function.Bravi CA, Tin A, Montorsi F, et al. Erectile Function and Sexual Satisfaction: The Importance of Asking About Sexual Desire. J Sex Med 2020;17:349–352.     

Erectile function and sexual satisfaction before and after penile prosthesis implantation in radical prostatectomy patients: a comparison with patients with vasculogenic erectile dysfunction

IntroductionPatients with erectile dysfunction (ED) after radical prostatectomy (RP) may benefit from penile prosthesis (PP) implantation after failure of less invasive treatments.AimTo assess surgical outcomes and satisfaction after PP implantation in RP patients and compare the results with those in patients with vasculogenic ED (controls).MethodsA database of 415 consecutive PPs (January 1996–December 2008) was used to collate data on preimplantation ED treatments, surgical complications, satisfaction, and International Index of Erectile Function (IIEF) scores before and 3 months after implantation. The results for 90 post-RP implants (79 primary, 11 secondary) and 131 implants for vasculogenic ED were compared.Main Outcome MeasuresThe main outcome measures of this study are intra- and postoperative complications and IIEF domain scores.ResultsMean follow-up of RP patients was 37.6 ± 26.8 months. Mean interval between RP and PP implantation was 31.5 ± 28.7 months. Nearly all primary implants (96.2%) were inflatable (3-piece, 70.1%; 2-piece, 24.1%). There was no significant difference between groups in terms of rates of infection (1.1%), mechanical failure (3.3%), and other surgical complications requiring revision surgery (migration, auto-inflation) (4.4%). For primary implants, the mean preimplantation IIEF score (all items) was significantly lower in RP patients than in controls (14.7 ± 5.9 vs. 22.6 ± 10.8, P = 0.003), chiefly because of significantly lower scores for erectile function, intercourse satisfaction, and orgasmic function. After PP implantation in RP patients, the scores for all domains improved, but the total score remained significantly lower than in controls (63.1 ± 7.0 vs. 68.5 ± 6.9, P = 0.005). The orgasmic function score was significantly lower (P < 0.001). Overall satisfaction rate was 86.1% in RP patients and 90.7% in controls (P = 0.3).Conclusions. PP implantation after RP is associated with low morbidity and high satisfaction. It improves the scores for all IIEF domains and, in particular, erectile function. Fibrosis of the retropubic space may require a second incision for reservoir placement or implantation of a 2-piece PP. Menard J, Tremeaux J-C, Faix A, Pierrevelcin J, and Staerman F. Erectile function and sexual satisfaction before and after penile prosthesis implantation in radical prostatectomy patients: A comparison with patients with vasculogenic erectile dysfunction. J Sex Med **;**:**–**.     

High Patient Satisfaction of Inflatable Penile Prosthesis Insertion with Synchronous Penile Plication for Erectile Dysfunction and Peyronie's Disease

IntroductionTwenty 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.AimThe 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.MethodsA 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 MeasuresThe focus of this study was surgical outcomes, both technical and patient-reported satisfaction.ResultsEighteen 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.ConclusionsIPP insertion with synchronous penile plication for the correction of ED and PD is effective and results in high patient satisfaction. Chung PH, Scott JF, and Morey AF. High patient satisfaction of inflatable penile prosthesis insertion with synchronous penile plication for erectile dysfunction and Peyronie's disease. J Sex Med 2014;11:1593–1598.