Technological Advances in Penile Implant Surgery

BackgroundDuring the last century, surgical management of erectile dysfunction has evolved from an experimental concept to a core treatment modality with widespread use among the men's health community. Over time, innovations in materials, mechanical design elements, device coatings, and surgical technique have provided patients with low-risk, reliable, and reproducible erectile function with high satisfaction rates.AimTo provide a foundation for future innovation by improving understanding of historical penile prosthetics and the rationale behind incremental technological improvements for the contemporary Men's Health physician.MethodsLiterature review was conducted to generate a comprehensive review of historical technological innovations in penile implant surgery. Companies with FDA approved penile prosthetics in use in the United States were contacted for information regarding technological innovations in the past and future devices in development. A separate literature review was performed to identify any significant future device design elements being tested, even in the ex vivo setting, which may have future clinical applications.OutcomesTechnological innovations in penile implant surgery were described.ResultsCurrent options for the prosthetic surgeon include malleable penile prostheses (MPP), self-contained (2-piece) inflatable penile prostheses, and multicomponent (3-piece) inflatable penile prostheses. Current MPPs consist of a synthetic coated solid core which allow for manipulation of the penis for concealability while maintaining sufficient axial rigidity to achieve penetration when desired. Multi-component (3-Piece) IPPs currently include the Coloplast Titan and Boston Scientific/AMS 700 which consist of a fluid reservoir, intrascrotal pump, and intracavernosal cylinders. The devices have undergone numerous design updates to the cylinders, pump, reservoir, tubing, and external coatings to increase reliability and decrease short- and long-term complications.Clinical ImplicationsFuture innovations in penile prosthetic surgery seek to broaden the indications and applicability to the transgender community and improve both safety and functionality for patient and partner.Strengths & LimitationsThe review is limited primarily to penile prosthetics approved for current or historical clinical use in the United States and may not be representative of the global prosthetic environment. Additionally, the research and development of future innovations, particularly those provided by device manufacturers, is likely limited by non-disclosure to maintain a competitive advantage.ConclusionsPenile prosthetic surgery will undoubtedly remain integral to the treatment of erectile dysfunction, and education regarding the current state of technological innovation will empower the prosthetic surgeon and biomedical engineering community to improve contemporary patient care and drive the development of the next generation of implantable penile prosthetics.Barnard JT, Cakir OO, Ralph D, et al. Technological Advances in Penile Implant Surgery. J Sex Med 2021;18:1158–1166.     

充气式加温毯的不同使用方式在婴幼儿颅面重建术中保温效果的比较

【】 目的 探讨充气式加温毯不同使用方式应用于婴幼儿颅面重建术的保温效果。 方法 选择择期全身麻醉下行颅面重建术患儿50例,随机分为两组,铺垫式组(A组)和覆盖式组(B组),每组25例。记录围手术期患儿的肛温(T)、MAP、HR,术中的出血量,手术结束时PT、 APTT、TT,术后的自主呼吸恢复时间、拔管时间、完全清醒时间、苏醒期的不良反应。 结果 与T0时比较：A组患儿在T2和T3时的MAP、HR和T均明显降低(P<0．05);与A组相比,B组患儿在T2和T3时的MAP、HR和T均明显升高(P<0．05);与A组相比,B组患儿的术中出血量明显减少(P<0．05);B组患儿的PT、APTT、TT均明显低于A组(P<0．05);与A组相比,B组患儿手术结束后到呼吸恢复时间、手术结束后到拔管时间、手术结束后到送回病房的时间均明显减少 (P<0．05);与A组相比,B组患儿术后寒颤和苏醒延迟发生率明显降低(P<0．05)。 结论 覆盖式使用充气式加温毯更能有效地预防婴幼儿颅面重建术中低体温的发生。     

‘A reservoir within a reservoir’ – An unusual complication associated with a defunctioned inflatable penile prosthesis reservoir

INTRODUCTION

Inflatable penile prostheses (IPP) have been a successful method of treating men with erectile dysfunction since the early 1970s. IPP are comprised of two intracorporal cylinders, a scrotal pump and a fluid reservoir.

PRESENTATION OF CASE

We present a case of a retained reservoir in a sixty eight year old gentlemen presenting with a cystic abdominal mass and bothersome LUTS, 15 years after the removal of the penile components of a three-piece penile prosthesis. Percutaneous drainage of the cyst was performed, with four litres of purulent fluid evacuated. A midline laparotomy was required to remove the reservoir and drain the collection completely.

DISCUSSION

Inflammatory reaction and subsequent erosion of an IPP reservoir is an infrequent but severe complication of IPP insertion, replacement or infection. Infection remains the primary indication for penile prosthesis removal and in this setting removal of the reservoir is routine. A thorough literature search has identified that in the non-infective setting, the routine removal of the original reservoir is not standard practice during three-component IPP replacement. In patients with a history of IPP presenting with new LUTS, reservoir erosion should be considered in the differential diagnosis and investigation with cystoscopy and computed tomography included early in the investigatory armament of the urologist.

CONCLUSION

It is our belief that a defunctionalized reservoir serves no purpose; rather it can only cause trouble in the future. Consequently, at our institution we do not leave defunctionalized reservoirs in situ.     

Clinicopathologic correlations in pseudocapsule formation after breast augmentation

In 2,000 patients who underwent augmentation mammoplasties with different types of prostheses, the thickness of the pseudocapsules around gel-filled implants was greater than that of the pseudocapsules forming around inflatable implants. This observation was corroborated by an independent histologic study. Deposition of liquid silicone into the pseudocapsules as well as the adjacent brest tissue and migration into capillaries was demonstrated. Until an impermeable shell or a non-transgressive gel can be manufactured, gel-filled implants should not be used.     

Inflation osteoplasty: in vitro evaluation of a new technique for reducing depressed intra-articular fractures of the tibial plateau and distal radius

Background

Anatomic reduction of intra-articular fractures of the tibial plateau and distal radius can be difficult to achieve. Treatment goals are centered on restoring the native anatomy and articular congruency. Several surgeons in the USA have begun using an inflatable bone tamp to reduce these fracture patterns. The concept is built on the success of the tamp in kyphoplasty of the spine, but it has yet to be tested in the lab for use in the extremities. We performed an investigation into the safety and efficacy of using an inflatable bone tamp for intra-articular fracture reduction of the tibial plateau and distal radius.

Materials and methods

Paired cadaveric specimens were obtained for a total of six proximal tibias and six distal radii. Intra-articular depression-type fractures were created in all specimens. The inflatable bone tamp was then used to reduce the depression. For comparison, the tibias were fractured on the medial and lateral side and a conventional metal tamp was used on the contralateral side of the balloon. Fine-cut micro-computed tomography (CT) scans were performed on all intact specimens, which were then fractured, and again after fracture reduction. CT data was used to measure the amount of restoration of the normal anatomy and to compare the effectiveness of the balloon to conventional methods.

Results

The inflatable bone tamp was equivalent to conventional methods in large, minimally displaced fracture fragments and proved superior when comminution was present at the articular surface. No instances of overreduction or penetration into the joint were encountered with the balloon, whereas this was a common occurrence with conventional metal tamps. The inflatable tamp was successful in reducing all distal radius fractures without complication.

Conclusion

Anatomic reduction of impacted articular fractures should be the goal of any treating surgeon. In our cadaveric models, we have shown the inflatable bone tamp to be safe and effective in reducing depressed articular fractures around the tibial plateau and distal radius. The balloon offers the advantage of being minimally invasive and creating a symmetric, contained defect to hold bone filler for subchondral support.     

充气式保温机在婴儿先天性心脏病手术中的应用效果观察

目的 探讨充气式保温机在婴儿先天性心脏病(先心病)手术中的应用效果.方法 将同一外科组的71例心脏病患儿随机分为实验组(36例)和对照组(35例).患儿进人手术室即开始监测肛温,两组降温阶段均采用降低室温的方法.在保温和升温阶段,对照组采用调节室温、添加被服等常规保暖方式,而实验组则在调节室温、被服保暖方式的基础上使用充气式保温机.结果 围手术保温阶段,尤其是改良超滤阶段,对照组体温波动大,实验组体温保持平稳.实验组在苏醒、住ICU时间上少于对照组,术后1h胸腔-心包引流量少于对照组,差异有显著意义(P＜0.05).结论 充气式保温毯作用于体表,在围手术期可以保持患儿体温恒定,有效预防室颤、心跳停搏、出血等现象发生.     

Inflatable Penile Prosthesis in the Ambulatory Surgical Setting: Outcomes From a Large Urological Group Practice

BackgroundThe definitive treatment for erectile dysfunction is the surgical implantation of a penile prosthesis, of which the most common type is the 3-piece inflatable penile prosthesis (IPP) device. IPP surgery in outpatient freestanding ambulatory surgical centers (ASC) is becoming more prevalent as payers and health systems alike look to reduce healthcare costs.AimTo evaluate IPP surgical outcomes in an ASC as compared to contemporaneously-performed hospital surgeries.MethodsA database of all patients undergoing IPP implantation by practitioners in the largest private community urology group practice in the United States, from January 1, 2013 to August 1, 2019, was prospectively compiled and retrospectively reviewed. Cohorts of patients having IPP implantation performed in the hospital vs ASC setting were compared.Main Outcome MeasureThe primary outcome measure was to compare surgical data (procedural and surgical times, need for hospital transfer from ASC) and outcomes (risk for device infection, erosion, and need for surgical revision) between ASC and hospital-based surgery groups.ResultsA total of 923 patients were included for this analysis, with 674 (73%) having ASC-based surgery and 249 (27%) hospital-based, by a total of 33 surgeons. Median procedural (99.5 vs 120 minutes, P < .001) and surgical (68 vs 75 minutes, P < .001) times were significantly shorter in the ASC. While the risk for device erosion and need for surgical revision were similar between groups, there was no higher risk for prosthetic infection when surgery was performed in the ASC (1.7% vs 4.4% [hospital], P = .02), corroborated by logistic regression analysis (odds ratio 0.39, P = .03). The risk for postoperative transfer of an ASC patient to the hospital was low (0.45%). The primary reason for mandated hospital-based surgery was medical (51.4%), though requirement as a result of insurance directive (39.7%) was substantial.Clinical ImplicationsIPP implantation in the ASC is safe, has similar outcomes compared to hospital-based surgery with a low risk for need for subsequent hospital transfer.Strengths & LimitationsThe strengths of this study include the large patient population in this analysis as well as the real-world nature of our practice. Limitations include the retrospective nature of the review as well as the potential for residual confounding.ConclusionASC-based IPP implantation is safe, with shorter surgical and procedural times compared to those cases performed in the hospital setting, with similar functional outcomes. These data suggest no added benefit to hospital-based surgery in terms of prosthetic infection risk.Weinberg AC, Siegelbaum MH, Lerner BD, et al. Inflatable Penile Prosthesis in the Ambulatory Surgical Setting: Outcomes From a Large Urological Group Practice. J Sex Med 2020;17:1025–1032.     

气垫床不同充气程度及不同翻身间隔时间预防压疮的效果观察

目的探讨气垫床不同充气程度配合不同翻身间隔时间预防压疮的效果。方法选择在本科住院的压疮高危患者160例随机分为A、B、C、D四组,各40例,A、B组患者应用充气程度为80%的气垫床,分别每2h、4h翻身1次,C、D组患者应用充气程度为100%的气垫床,分别每2h、4h翻身1次,观察、评估患者的皮肤变化及压疮发生情况。结果 A、B、C、D四组Ⅰ期压疮的发生数分别为1例、0例、6例、4例,A组和C组、B组和D组的压疮发生率比较,差异有统计学意义(P0.05);A组与B组、C组和D组的压疮发生率比较,差异无统计学意义(P0.05)。结论应用充气程度为80%的气垫床预防压疮的效果优于充气程度为100%的气垫床,且翻身间隔时间可延长至4h。