SILDENAFIL CITRATE AFTER RADICAL RETROPUBIC PROSTATECTOMY

PURPOSE: Erectile dysfunction continues to be a significant problem for men after radical retropubic prostatectomy despite nerve sparing techniques. Sildenafil citrate (Viagra) has proved effective for erectile dysfunction in many men. We determine the efficacy of sildenafil in men with erectile dysfunction after radical retropubic prostatectomy and examine variables that may impact the response to treatment. MATERIALS AND METHODS: A total of 84 men were prescribed sildenafil after radical retropubic prostatectomy and asked to complete a series of questionnaires, including the International Index of Erectile Function (IIEF), on erectile function before and after sildenafil administration. The importance of factors, such as patient age, time since surgery, degree of cavernous nerve sparing, preoperative prostate specific antigen, Gleason score, clinical and pathological stage, and baseline postoperative erectile function, was examined. RESULTS: Of the 84 patients 45 (53%) had improved erections and 34 (40%) had improved ability for intercourse while taking sildenafil. Mean IIEF score for the erectile function domain increased from 9 to 14 (p <0.001). Orgasmic function (p = 0.004) and intercourse satisfaction (p = 0.009) also significantly improved. The degree of nerve sparing and baseline postoperative erectile dysfunction had a significant impact on the ability of sildenafil to improve erectile function (p = 0.010 and p <0.001, respectively) and total IIEF questionnaire responses (p = 0.031 and p <0.001, respectively). Age and pathological stage also appeared to have a significant effect. CONCLUSIONS: Sildenafil improved erectile function and the ability to have intercourse in more than half of men after radical retropubic prostatectomy. Baseline postoperative erectile function, which is dependent on the degree of nerve sparing technique, significantly impacts the likelihood that patients will respond to sildenafil.     

Hardware preservation after sternal wound infection in a lung transplant recipient

Sternal wound infections can result in significant morbidity and mortality. Managing these complications is particularly challenging when infected hardware is involved. Traditional thinking mandates removal of infected hardware, yet this hardware is often essential to chest wall stability in the early postoperative period. Here, we present a case of an infected transverse sternotomy wound involving hardware in a lung transplant patient whose treatment included successful hardware preservation. Our experience and other experiences reported in the literature highlight the alternatives in the management of this complication.     

Balloon-assisted deployment prevents endograft misalignment during hybrid aortic arch repair

Misaligned deployment refers to eccentric flaring of the bare stent portion of the endograft that causes proximal device retroflexion resulting in suboptimal graft placement. A 71-year-old woman with 6.8-cm distal aortic arch aneurysm underwent hybrid repair with combination of open aortic arch debranching and subsequent thoracic endovascular aortic repair. During endograft deployment, misaligned opening occurred; this was corrected by using a balloon-assisted graft deployment. Follow up imaging continues to demonstrate complete aneurysm exclusion. Misaligned deployment is a clinical challenge; we hereby present a previously undescribed technique to accommodate this limitation of the current endograft technology.