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.     

男科学组织工程研究前景

利用组织工程技术进行细胞移植的设想 ,已经为男科领域的组织再建工作提供了许多可能。为改善、修复或替代现有组织的功能 ,组织工程的应用研究 ,已经在睾丸间质细胞、睾丸假体、阴茎海绵体、阴茎假体等方面开展。虽然大多数再建工作仍然停留在实验阶段 ,但是有些技术也被用于临床 ,并取得满意的结果。本文简要地综述了组织工程在男科学的应用     

新生儿阴茎长度及其相关因素的探讨

本文测定了208名生后5天内的新生儿阴茎长度,并对新生儿阴茎长度与胎龄、出生体重、出生身长的关系进行了探讨。结果为(1)成熟儿阴茎长度平均值±1SD为33.8±3.7mm,正常范围为26.4～41.2mm(平均值±2SD);(2)适于胎龄儿和小于胎龄儿阴茎长度与胎龄、出生体重、出生身长呈明显正相关;(3)大于胎龄儿阴茎长度平均值±1SD为34.6±3.2mm,正常范围与成熟儿相同。新生儿阴茎正常值的确定有助于小阴茎畸形的诊断和疗效的判断。     

肩胛皮瓣再造阴茎

目的：探索一种新的阴茎再造手术方式。方法：应用肩胛皮瓣游离移植和银丝棒硅胶阴茎假体置入行阴茎再造。结果：自2000年3月起，已在临床应用6例，术后皮瓣全部成活。经随访6－12个月，阴茎形态和功能良好，结论：此手术方法设计合理，术后形态功能良好，供区无明显继发畸形，是一种较好的阴茎再造方法。     

Primary and secondary malignancies of the penis: ultrasound features

Cancer of the penis is a rare neoplasm in developed countries but worldwide represents a significant health problem. In this study, the ultrasonographic features of primary and secondary malignant lesions of the penis are described. Squamous cell carcinoma usually presents as a hypoechoic lesion with heterogeneous appearance. Invasions of the corpora cavernosa and the corpus spongiosum are appreciable. B-cell lymphoma presents as a well-vascularized mass, a plaque, or ulcers in the penile skin. Penile metastases result from hematogenous or lymphatic spreading of distant tumors or, more frequently, as penile infiltration by tumors from adjacent organs. Diffuse corporeal or nodular involvement can result. 1Award-winning poster at the 10th European Symposium on Urogenital Radiology; Uppsala, Sweden, September 4•7, 2003.     

An in vitro study of nonadrenergic-noncholinergic activity on the cavernous tissue of mouse

The relaxant effects of electrical field stimulation (EFS) and exogenously applied acetylcholine (ACh) or acidified NaNO₂ (a-NaNO₂) were investigated in the isolated mouse corpus cavernosum precontracted with phenylephrine hydrochloride (PE). Tetrodotoxin (TTX) blocked the relaxant effects of EFS completely, whereas it had no effect on the responses to ACh or a-NaNO₂. Guanethidine and indomethacin failed to affect the electrically or ACh-induced relaxations. Atropine completely blocked the effect of ACh; however, it caused a slight reduction in the relaxation evoked by EFS.N ^G- Nitro-l-arginine (l-NOARG) reduced the effects of EFS and ACh significantly, but it was ineffective on the relaxations induced by a-NaNO₂. The inhibitory action ofl-NOARG was partly restored byl-arginine, but not byd-arginine. Methylene blue (MB) and hydroxocobalamin (HC) exhibited significant inhibition on the relaxations evoked by EFS, ACh and a-NaNO₂. Hydroquinone (HQ) reduced relaxation due to a-NaNO₂, but did not affect that of EFS and ACh. Our findings suggest that EFS-induced relaxations of mouse cavernosal tissue are mediated by a transmitter which probably resembles an organic nitrate.     

一种拥有自主知识产权的国产可膨胀阴茎假体

勃起功能障碍是常见的男性疾病，部分ED患者在非手术治疗无效后，最终将植入阴茎假体进行治疗，且可获得满意的效果。本文简述这种疾病现状及其治疗方法，介绍一种拥有自主知识产权的国产阴茎假体的特征及其临床应用情况。     

阴囊皮瓣修复阴茎缺损的临床应用

目的探讨阴囊皮瓣修复阴茎大部分缺损的临床效果。方法对由不同原因引起阴茎缺损的17例患者，采用阴囊皮瓣进行修复。在阴囊根部两侧阴囊前动脉之间的无血管区剥离一腔隙，将延长后的阴茎海绵体经腔隙转移至阴囊皮瓣的下方，以包绕海绵体创面，皮瓣缝合后瘢痕在阴茎腹侧。结果切口均Ⅰ期愈合。术后随访患者1～9年，未出现皮瓣坏死现象，阴茎的外观及功能恢复较好。结论阴囊皮瓣的血运丰富、组织柔软、弹性好、伸缩性强，而且此手术切口隐蔽，是修复阴茎缺损较理想的皮瓣。     

No colocalization of immunoreactivities for VIP and neuronal NOS, and a differential relation to cGMP-immunoreactivity in bovine penile smooth muscle

The distribution of immunoreactivity (IR) for the neuropeptide vasoactive intestinal polypeptide (VIP) and neuronal nitric oxide synthase (nNOS) in the bovine retractor penis muscle (RP) and penile artery (PA) was studied by using two different methods. The distribution of these immunoreactivities was also compared with that of the immunoreactivity for cyclic guanosine monophosphate (cGMP). In both tissues the nerve fibers and terminals immunoreactive for VIP had a distribution that was completely different from that of the nerve fibers and terminals immunoreactive for nNOS. This contrasts with the previous observations in penile smooth muscle of other species. In the RP, as well as in the PA, many of the VIP-IR fibers were also immunoreactive for neurofilaments (NF), whereas the nNOS-IR fibers were consistently devoid of NF-IR. Stimulation with sodium nitroprusside, a nitric oxide donor, considerably increased cGMP-IR in the smooth muscle cells in both RP and PA, and in several nerve fibers in PA. Many of these cGMP-IR nerve fibers exhibited nNOS-IR, whereas none of them was immunoreactive for VIP. Our results suggest that the degree of coexistence of VIP-IR and nNOS-IR in the nerve fibers and terminals innervating penile smooth muscle show wide species differences. They also suggest that the mechanisms by which VIP could be involved in neurogenic penile erection may vary between species.