Corporal fibrosis is known to result from prolonged priapism; however, the impact of the timing of penile prosthesis placement after priapism on complication rates is poorly understood.
We sought to ...evaluate the impact of timing of inflatable penile prosthesis (IPP) placement on complications in men with a history of ischemic priapism.
We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 10 experienced implantation surgeons. We defined early placement as ≤6 months from priapism to IPP. We identified a 1:1 propensity-matched group of men without a history of priapism and compared complication rates between men who had early placement, late placement, and no history of priapism.
Our primary outcome was postoperative noninfectious complications, and secondary outcomes included intraoperative complications and postoperative infection.
A total of 124 men were included in the study with a mean age of 50.3 ± 12.7 years. A total of 62 had a history of priapism and 62 were matched control subjects. The median duration of priapism was 37 (range, 3-168) hours and the median time from ischemic priapism to IPP placement was 15 months (range, 3 days to 23 years). Fifteen (24%) men underwent early (≤6 months) IPP placement at a median time of 2 months (range, 3 days to 6 months) following the ischemic priapism event. The remaining 47 (76%) underwent placement >6 months following priapism at a median time of 31.5 months (range, 7 months to 23 years). The complication rate in the delayed placement group was 40.5% compared with 0% in the early placement group and control group. Cylinder-related complications such as migration or leak accounted for 8 (57%) of 14 of the postoperative noninfectious complications. Full-sized cylinders were used in all patients who had a cylinder related complication.
Priapism patients should be referred to prosthetic experts early to decrease complication rates in those needing an IPP.
This is a multicenter study from experienced prosthetic urologists but is limited by the retrospective nature and small number of patients in the early placement group.
IPP complication rates are high in men with a history of ischemic priapism, especially when implantation is delayed beyond 6 months.
Orgasm-associated incontinence, climacturia, is one of the lesser studied radical prostatectomy (RP) complications. Little is known about patient bother related to this condition, specifically, its ...prevalence and predictors.
To ascertain the prevalence and predictors of patient bother associated with climacturia.
Patients presenting for the evaluation of sexual dysfunction after RP at a single center were queried on various domains of sexual dysfunction. This included orgasmic dysfunction and sexual incontinence (including climacturia and arousal incontinence). Patients were specifically asked about the frequency and amount of climacturia. In addition, questions addressed patient bother and the perceived bother of their partners. Descriptive statistics were used for patient characteristics. A t-test was used for comparing the frequency of patient and partner bother, and the Pearson correlation test compared relationships between bother and predictors. Multivariable analysis was conducted to define predictors of climacturia-associated bother.
The main outcome measures was the prevalence and predictors of climacturia-associated patient bother and perceived partner bother.
Climacturia was reported by 23% of 3,207 consecutive men analyzed. Bother of any degree was experienced by 45% of these patients, and 14% reported partner bother related to this condition. Patient bother was associated with perceived partner bother (P < .001) and inversely correlated with relationship duration (P < .001). The overall frequency and quantity of climacturia were also predictive (P < .001 for both). In the adjusted model, all of these factors remained significant.
Given the prevalence of this condition and the bother associated with it, this complication should be discussed with patients preoperatively.
Strengths include a large study population and specific questions on climacturia-associated bother. Limitations include the fact that it is a single-center study and no direct partner questioning occurred.
Climacturia and its associated bother are common after RP. The predictors of patient bother include perceived partner bother, shorter relationship duration, and increasing frequency and quantity of climacturia. Salter CA, Bach PV, Miranda E, et al. Bother Associated With Climacturia After Radical Prostatectomy: Prevalence and Predictors. J Sex Med 2020;17:731-736.
Objective To understand the role of Advanced Practice Providers (APPs) in urologic procedural care and its change over time. As the population ages and the urologic workforce struggles to meet ...patient access demands, the role of APPs in the provision of all aspects of urologic care is increasing. However, little is currently known about their role in procedural care. Materials and Methods Commonly performed urologic procedures were linked to Current Procedural Terminology (CPT) codes from 1994 to 2012. National Medicare Part B beneficiary claims frequency was identified using Physician Supplier Procedure Summary Master Files. Trends were studied for APPs, urologists, and all other providers nationally across numerous procedures spanning complexity, acuity, and technical skill set requirements. Results Between 1994 and 2012, annual Medicare claims for urologic procedures by APPs increased dramatically. Cystoscopy increased from 24 to 1820 (+7483%), transrectal prostate biopsy from 17 to 834 (+4806%), complex Foley catheter placement from 471 to 2929 (+522%), urodynamics testing from 41 to 9358 (+22,727%), and renal ultrasound from 18 to 4500 (+24,900%) Conclusion We found dramatic growth in the provision of urologic procedural care by APPs over the past 2 decades. These data reinforce the known expansion of the APP role in urology and support the timeliness of ongoing collaborative multidisciplinary educational efforts to address unmet needs in education, training, and guideline formation to maximize access to urologic procedural services.
Variations in climate have been associated with a greater risk of surgical site infections, urinary tract infections, and changes in the skin microbiome; however, limited data exist on the impact of ...climate on inflatable penile prosthesis (IPP) infections.
We sought to evaluate the impact of climate on the risk of IPP infections in a large international, multicenter cohort.
We performed a multi-institutional, retrospective study of patients undergoing IPP surgery. We then evaluated whether the month or season, during which surgery was performed, affected device infections. Implant infections were defined as infections requiring device explantation. A univariate logistic regression analysis was undertaken.
Our primary outcome was implant infection.
A total of 5289 patients with a mean age of 62.2 ± 10.8 years received IPP placement. There was a fairly even distribution of implants performed in each season. A total of 103 (1.9%) infections were recorded. There were 32 (31.1%) IPP infections in patients who underwent surgery in the summer, followed by 28 (27.2%) in the winter, 26 (25.2%) in the spring, and 17 (16.5%) in the fall. No statistically significant differences were recorded in terms of season (P = .19) and month (P = .29). The mean daily temperature (P = .43), dew point (P = .43), and humidity (P = .92) at the time of IPP placement was not associated with infection.
These findings provide reassurance to prosthetic urologists that infection reduction strategies do not need to be tailored to local climate.
Climate data were not directly recorded for each hospital, but rather based on the monthly averages in the city where the surgery was performed.
The climate at time of IPP placement and time of year of surgery is not associated with IPP infection risk.
An Update on Non-Ischemic Priapism Ingram, Amanda R; Stillings, Stephanie A; Jenkins, Lawrence C
Sexual medicine reviews
8, Številka:
1
Journal Article
Recenzirano
Non-ischemic or high-flow priapism is derived from unregulated arterial inflow within the penis, which is significantly less common and, therefore, less well characterized than ischemic or low-flow ...priapism.
We collected the most recent available data and summarized the findings.
All literature related to non-ischemic priapism from 2000-2018 from several databases was reviewed, and 105 articles, including any relevant referenced articles, were ultimately included.
We evaluated modality success rates, need for repeat procedures, and effects on erectile function.
237 cases of non-ischemic priapism were evaluated. Approximately 27% of patients underwent observation or medical management as the first treatment modality, whereas 73% underwent intervention without observation or medical management beforehand. Angiographic embolization with temporary agents was the most common intervention and generally resulted in both moderate resolution of non-ischemic priapism and moderate preservation of baseline erectile function. Patients who underwent embolization with permanent agents experienced higher rates of resolution, as well as lower rates of erectile dysfunction (ED).
Most of the literature is in the form of case reports and small case series, thus limiting the quality and quantity of evidence available to draw decisive conclusions. However, from the available data, it is reasonable to presume that patients can undergo a trial of conservative management, then pursue embolization first with temporary agents. The analysis of the data demonstrated ED rates were higher with temporary agents than permanent agents. The literature quotes ED rates as low as 5% when using temporary agents and 39% with permanent agents. Our results were, in fact, the opposite, with higher ED rates when using temporary agents vs permanent (17-33% vs 8-17%). Further studies are required to better characterize the success and outcomes of angioembolization. Ingram AR, Stillings SA, Jenkins LC. An Update on Non-Ischemic Priapism. Sex Med Rev 2020;8:140-149.
The New Business of ED Therapy Jenkins, Lawrence C.; Mulhall, John P.
Journal of sexual medicine,
December 2015, 2015-Dec, 2015-12-01, 20151201, Letnik:
12, Številka:
12
Journal Article
Anophthalmia and microphthalmia (A/M) are rare birth defects affecting up to 2 per 10,000 live births. These conditions are manifested by the absence of an eye or reduced eye volumes within the orbit ...leading to vision loss. Although clinical case series suggest a strong genetic component in A/M, few systematic investigations have been conducted on potential genetic contributions owing to low population prevalence. To overcome this challenge, we utilized DNA samples and data collected as part of the National Birth Defects Prevention Study (NBDPS). The NBDPS employed multi‐center ascertainment of infants affected by A/M. We performed exome sequencing on 67 family trios and identified numerous genes affected by rare deleterious nonsense and missense variants in this cohort, including de novo variants. We identified 9 nonsense changes and 86 missense variants that are absent from the reference human population (Genome Aggregation Database), and we suggest that these are high priority candidate genes for A/M. We also performed literature curation, single cell transcriptome comparisons, and molecular pathway analysis on the candidate genes and performed protein structure modeling to determine the potential pathogenic variant consequences on PAX6 in this disease.
Sexual function after colorectal surgery is a largely ignored topic. In patients being treated for colon and rectal cancers, the risk of sexual dysfunction after surgery is high and is influenced by ...multiple factors.
To examine the factors involved with sexual dysfunction after colorectal surgery and review gender-specific sexual complaints most reported on in the literature.
A comprehensive review of peer-reviewed publications on the topic was performed through a PubMed search. Key search terms and phrases included colorectal surgery, sexual dysfunction, risk factors, cancer, erectile dysfunction, dyspareunia, and counseling.
The main outcome measures were gender-specific sexual complaints after colorectal surgery and risk factors involved.
The type of excision and surgical technique strongly influences sexual dysfunction risk, where newer nerve-preserving techniques seem to be associated with better sexual outcomes in contrast to more extensive surgeries. Adjunctive radiotherapy negatively affects sexual health when combined with surgical resection. The most common postoperative sexual complaints reported by men include erectile dysfunction, ejaculatory dysfunction, and dysorgasmia, whereas for women dyspareunia and poor lubrication are common.
Sexual morbidity after treatment for colorectal cancer is common and inadequately addressed by healthcare providers in the preoperative setting. Towe M, Huynh LM, El-Khatib F, et al. A Review of Male and Female Sexual Function Following Colorectal Surgery. Sex Med Rev 2019;7:422-429.
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