Penile Prosthesis Implantation and Timing Disparities After Radical Prostatectomy: Results From a Statewide Claims Database

BackgroundMany patients with erectile dysfunction (ED) after radical prostatectomy (RP) improve with conservative therapy but some do not; penile prosthesis implantation rates have been sparsely reported, and have used nonrepresentative data sets.AimTo characterize rates and timing of penile prosthesis implantation after RP and to identify predictors of implantation using a more representative data set.MethodsThe Healthcare Cost and Utilization Project State Inpatient and State Ambulatory Surgery databases for Florida from 2006 to 2015 were used. Patients undergoing RP (2006–2012) were tracked longitudinally for penile prosthesis implantation. Patient and clinical data were analyzed using multivariable logistic regression.OutcomesThe primary outcome was risk-adjusted predictors of prosthesis implantation, and the secondary outcome was predictors of the highest quartile of time between RP and penile prosthesis.ResultsOf 29,288 men who had RP, 1,449 (4.9%) patients underwent subsequent prosthesis. The mean time from RP to prosthesis was 2.6 years (median: 2.1; interquartile range [IQR]: 1.2–3.5). Adjusted predictors of prosthesis implantation included open RP (odds ratio [OR]: 1.5, P < .01), African American race (OR: 1.7, P < .01) or Hispanic ethnicity (OR: 3.2, P < .01), and Medicare (OR: 1.4, P < .01) insurance. Oler patients (age >70 years; OR: 0.7, P < .01) and those from the highest income quartile relative to the lowest (OR: 0.8, P < .05) were less likely to be implanted. Adjusted predictors of longer RP-to-implantation time (highest quartile: median: 4.7 years; IQR: 3.9–6.0 years) included open RP (OR: 1.78, P < .01), laparoscopic RP (OR: 4.67, P < .01), Medicaid (OR: 3.03, P < .05), private insurance (OR: 2.57, P < .01), and being in the highest income quartile (OR: 2.52, P < .01).Clinical ImplicationsThese findings suggest ED treatment healthcare disparities meriting further investigation; upfront counseling on all ED treatment modalities and close monitoring for conservative treatment failure may reduce lost quality of life years.Strengths & LimitationsThis study is limited by its use of administrative data, which relies on accurate coding and lacks data on ED questionnaires/prior treatments, patient-level cost, and oncologic outcomes. Quartile-based analysis of income and time between RP and prosthesis limits the conclusions that can be drawn.ConclusionLess than 5% of post-RP patients undergo penile prosthesis implantation, with open RP, Medicare, African American race, and Hispanic ethnicity predicting post-RP implantation; living in the wealthiest residential areas predicts lower likelihood of implantation compared to the least wealthy areas. Patients with the longest time between RP and prosthesis are more likely to live in the wealthiest areas or have undergone open/laparoscopic RP relative to robotic RP.Bajic P, Patel PM, Nelson MH, et al. Penile Prosthesis Implantation and Timing Disparities After Radical Prostatectomy: Results From a Statewide Claims Database. J Sex Med 2020;17:1175–1181.     

Exacerbation of occult femoral hernia during laparoscopic prostatectomy.

Laparoscopic prostatectomy has been accepted as an appropriate treatment for prostate cancer because of the shorter hospital stay and quicker recovery. We present a rare complication of groin hernia with incarceration and necrosis of small bowel following laparoscopic prostatectomy. Occult hernias and small fascia defects may not always be apparent pre-operatively, but extension of pneumoperitoneal insufflation to extraperitoneal compartments should alert the surgeon to the possible presence of such a defect.     

经尿道非接触式激光前列腺切除技术的应用与改进

１９９３年１１月至１９９６年５月应用改进的经尿道非接触式激光治疗前列腺增生１２０例，并对病人进行术前术后的症状评分，尿动力学，残余尿检查，随访病人１－２４个月，结果显示病人无论是症状评分，还是尿流率，残余尿等各项指标均有明显的改善，此种手术具有简单，安全，副作用小，术后恢复快，治疗效果好等优点。     

The use of ultrasound in automated prostatectomy

A new way of applying transurethral ultrasound scanning in the common surgical procedure of the transurethral resection of the prostate is described. The scanning is incorporated as part of a robotic procedure for surgery, so that the overall time spent in an operation can be further shortened, and a safe and accurate operation can be achieved. The prostate dimensions obtained pre-operatively by the transrectal method and those obtained operatively are compared. A robotic system, which was developed specifically to remove prostatic adenoma automatically, is discussed. The system, called a motorised frame, is briefly described, together with its predecessor, a manual frame, in relation to ultrasound measurements. Sizing of the prostate pre-operatively using transrectal ultrasound methods is discussed, using both the manual and the motorised frame. The shortcomins of transrectal ultrasound for use in a robotic procedure are highlighted.     

改良Madigan术切除前列腺中叶增生

目的：改良Madigan术式治疗前列腺中叶增生。方法：对22例前列腺增生患者采用了先行耻骨后保留尿道切除膀胱颈以远的腺体;再经膀胱入路,在突入膀胱腔内的增生中叶腺体的前壁作远离尿道内口2cm的弧形切口,直视下分离膀胱颈和尿道后壁的粘膜,完整切除腺体,直视下修剪并缝合固定粘膜,将膀胱与腺窝隔离,同时处理膀胱内的其它病变。结果：本组22例手术顺利,出院时测最大尿流率14．0－24．5ml/s,IPSS平均4．5分,B超测定剩余尿≤20ml。术后21例随访3－30个月,最大尿流率未降低,无尿道狭窄,排尿通畅。结论：我们在实际操作过程中达到切除全部增生腺体,完整保留了尿道组织,直视下修剪并缝合固定膀胱后唇粘膜,将膀胱与腺窝隔离,同时处理了膀胱内的其它病变,操作方便,无后顾之忧。     

前列腺增生症术后排尿困难的原因探讨及预防

为了探讨前列腺增生症术后排尿困难的原因及预防方法,对前列腺切除术后27例仍有排尿困难的临床资料进行了分析。结果显示:尿道狭窄14例,尿道内口闭锁2例,膀胱逼尿肌功能紊乱2例,腺体残留3例,后唇瓣膜2例,输尿管间嵴肥厚1例,后尿道狭窄合并结石1例,膀胱颈水肿,前列腺癌1例。由此可见,尿道狭窄是术后排尿困难的主要原因,小前列腺增生或前列腺增生伴炎症宜采用TURP+膀胱颈内切开治疗以减少尿道狭窄。     

Anatomy and physiology of the male urethral sphincter and its preservation in prostatic surgery

Radical prostatectomy is commonly used in the management of localized prostate cancer. Urinary incontinence after prostatectomy is of great concern to many patients. Improved understanding of the anatomy of the external urethral sphincter complex has resulted in a statistically significant decrease in the incidence of postprostatectomy incontinence. Most recent anatomic studies have described the external urethral sphincter complex as consisting of an intrinsic rhabdosphincter surrounding the smooth musculature of the urethra and an extrinsic sphincter incorporating the levator ani muscle and the pelvic floor. Both form a condensed striated muscle ring around the membranous urethra. Preservation of as much as possible of the normal anatomy of the sphincter mechanism and its nerve supply results in an excellent return to continence after radical prostatectomy. Received: 26 February 1999 / Accepted: 20 May 1999     

四磨汤对前列腺摘除术后胃肠功能的影响

目的 观察四磨汤口服液在前列腺摘除术后对胃肠功能恢复的治疗疗效.方法 60例前列腺摘除术后患者随机分为治疗组（常规治疗加用四磨汤口服液）和对照组（常规治疗）,比较两组术后肠鸣音恢复时间和肛门排气时间.结果 两组患者术后肠鸣音恢复时间和肛门排气时间比较,治疗组明显短于对照组（P＜0.05）.结论 前列腺摘除术后在常规治疗基础上,加用四磨汤口服液,胃肠功能恢复快,为临床上前列腺摘除术后患者可早期进食提供了治疗方法.     

前列腺增生症术后排尿困难的原因与防治(附26例分析)

目的 分析各种常见前列腺切除术后排尿困难的原因，为预防和治疗提供依据。方法 回顾分析26例前列腺切除术后发生梗阻患者的资料。耻骨上前列腺切除术后排尿困难22例，TURP术后4例。患者均有不同程度的排尿困难、尿线变细，12例呈滴沥状排尿，5例发生急性尿潴留。结果 膀胱颈挛缩6例(23％)．后尿道狭窄6例(23％)，腺体残留或复发4例(15．4％)，膀胱颈水肿3例(11．6％)，血块或脱落组织堵塞2例(7．7％)．逼尿肌无力2例(7．7％)，输尿管间嵴肥厚2例(7．7％)，前尿道狭窄1例(3．9％)。除2例逼尿肌无力者分别行自家清洁导尿和永久性膀胱造瘘外，余经处理均愈。结论前列腺增生症术后排尿困难的原因较多，主要是手术操作及术前、术后处理不当所致。一旦发生，则可根据不同原因采取不同方法治疗，效果较佳。