Penile Implant Surgery: Contemporary Challenges and Controversies 3030823628, 9783030823627

Penile implants have been an effective treatment for erectile dysfunction (ED) for more than 40 years. However, there is

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Table of contents :
Preface
Contents
Contributors
Chapter 1: Patient and Device Selection
Patient Selection
Modifiable Risk Factors
Smoking
Diabetes Mellitus (DM)
Obesity
Pre-existing Basic Infection Screening
Fungal Infection in the Groin
Nasal Swab Testing for Staphylococcus aureus
Urine Culture
Age
HIV Status
Solid Organ Transplantation (SOT)
Neurological Impairment
Simultaneous Artificial Urinary Sphincter (AUS) Implantation
Revision Surgery
Counselling
Patient and Partner Involvement
Consent Form
Device Selection
The Following Are the List of Currently Available PP Models of Two Major Companies
Approach
Reservoirs
The Following Are Some of the Tips in Choosing the Right Device (PP) in Specific Clinical Scenarios
References
Chapter 2: Critical Analysis of Maneuvers to Reduce Infection in Penile Implant Surgery
Introduction
Risk Factors Clearly Associated with Penile Prosthesis Infection
Biofilm, Complete Implant Removal, and Culture Sensitivity
Quick Preoperative Considerations
Revision Washout
Antibiotic-Coated Implant
Prevention of Hematoma Formation
Suction Drain
Mummy Wrap
Minimization of Device Skin Contact (“No Touch”)
Strict Operative Sterile Technique
Future Research, Ideas, and Advancements
References
Chapter 3: Strategies for Optimal Pain Control in the Penile Implant Patient
Introduction
Literature Challenges
Preoperative Strategies
Education and Patient History
Pre-op Medication: Acetaminophen, NSAID/COX-2, and Gabapentin/Pregabalin
Intraoperative Strategies
Local Anesthesia
Surgical Technique
Alternative Approaches
Postoperative Strategies
Multimodal Analgesia
Limitations
Summary
Conclusions
References
Chapter 4: Perioperative Management of Antithrombotic Therapy in Penile Implant Surgery
Introduction
Periprocedural Evaluation
Antiplatelet Therapy
Aspirin
Indications/Prevalence
Mechanism of Action
Perioperative Management of Aspirin
ADP Receptor Inhibitors (Clopidogrel, Prasugrel, Ticagrelor)
Indications/Prevalence
Antithrombotic Mechanism of Action
Perioperative Management of ADP Receptor Inhibitors
Anticoagulation Therapy
Warfarin
Indications/Prevalence
Mechanism of Action
Perioperative Management of Warfarin
Direct Thrombin Inhibitor (Dabigatran)
Indications/Prevalence
Mechanism of Action
Perioperative Management of Dabigatran
Direct Factor Xa Inhibitors (Apixaban, Rivaroxaban)
Indications/Prevalence
Mechanism of Action
Perioperative Management of Direct Factor Xa Inhibitors
Perioperative Management
Conclusion
References
Chapter 5: Management of Residual Curvature in Men with Peyronie’s Disease Following Penile Prosthesis Implantation
Introduction
Etiology of PD
Anatomy and Pathophysiology
Surgical Indications for Inflatable Penile Prosthesis (IPP) in PD
Intraoperative Methods for Correction of Residual Curvature
Manual Modeling
Technique
Complications
Summary
Plication
Technique
Complications and Considerations
Plaque Incision or Partial Excision and Grafting (PIG/PEG)
Technique
Scratch Technique
Technique
Postoperative Management
Length Restoration
Sliding Technique
Technique
Complications and Considerations
Modified Sliding Technique (MoST)
Technique
Postoperative Management
Multiple-Slit Technique (MuST)
Technique
Postoperative Management
Outcomes
Postoperative Techniques for Straightening
Home Manual Modeling
Penile Traction Therapy and Vacuum Erection Devices
Residual Curvature Algorithm
Conclusions
References
Chapter 6: Considerations on Inflatable Penile Prosthesis Reservoir Placement
Introduction
Preoperative Considerations
Surgical Technique
Intraoperative Complications
Bladder Injury
Bowel Injury
Vascular Injury
Postoperative Complications
Infection
Organ and Tissue Damage
Herniation
Mechanical Failure
Leakage
Auto-Inflation
Tubing Torsion
Palpability
Explantation of IPP
Conclusion
References
Chapter 7: The Hostile Penis: Managing the Patient with Corporal Fibrosis
Introduction
Prevention
Preoperative Management
History
Physical Exam
Imaging
Patient Counseling
Operative Management
Surgical Instruments and Equipment
Retraction
Scissors
Cavernotomes
Narrow-Base Inflatable Penile Prosthesis
Operative Technique
Patient Positioning and Preparation
Incision
Penoscrotal Dissection and Corporotomy Creation
Corporal Dilation +/− Excavation
Selection of Cylinder Length
Cylinder Insertion
Corporotomy Closure
Reservoir Insertion and Fill
Tubing Passage and Connection
Pump Insertion
Drain Insertion
Postoperative Care
Management of Selected Complications
Injury to the Ventral Corpus Spongiosum +/− Urethra
Proximal (Crural) Perforation
Distal Urethral Perforation
Distal Crossover
Infection
Supersonic Transformer (SST) Deformity and Intrinsic Glanular Hypermobility (IGH)
Distal or Lateral Extrusion
Conclusions
References
Chapter 8: Considerations in the Management of Visceral and Vascular Injury During Penile Implant Surgery
Introduction
Anatomy
Normal Anatomy
Altered Anatomy
Post-prostatectomy
Post-cystectomy
Radiation
Renal Transplant
Inguinal Hernia Repair
Reservoir Placement
Traditional Reservoir Placement
Alternate Reservoir Placement
Posterior to Transversalis Fascia (PTF)
Anterior to the Transversalis Fascia (ATF)
High Submuscular (HSM)
Trans-Fascial Placement of HSM
Intraperitoneal
Epigastric
Lateral Retroperitoneal
Preperitoneal
Scrotal
Subcutaneous
Reservoir Removal
Traditional Reservoir Removal
Alternative Reservoir Removal
Intraoperative Injuries
Bladder Injuries
Vascular Injury
Bowel Injuries
Conclusion
References
Chapter 9: The Role of Penile Lengthening Procedures at the Time of Penile Implant Surgery
Introduction
PPI Procedures That Maximize Corporal Length
Cavernosal Sparing PPI Insertion without Dilatation
Subcoronal Incision with Circumferential Penile Degloving
Surgical Techniques That Determine a Real Penile Shaft Lengthening
Penile Prosthesis Implantation with Simultaneous Tunica Albuginea (TA) Incisions
PPI and Circumferential Grafting or Sliding Technique
Penile Prosthesis Implantation and MUST
Egydio’s Tunica Expansion Procedure (TEP): The Last Innovation in Lengthening Strategies
Surgical Techniques That Improved Perceived Penile Length
Prepubic V-Y Plasty
Suspensory Ligament Division
Apronectomy or Suprapubic Lipectomy
Ventral Phalloplasty (VP) or Scrotoplasty
Discussion and Conclusion
References
Chapter 10: Implant Surgery in Patient with a Neophallus
Rationale for Prostheses in Phalloplasty
Phalloplasty Techniques
History of Prostheses in Phalloplasty
Timing for Placement of Prostheses
Penile Implant: Surgical Technique
Approach: Cis-males
Approach: Trans-males
Pubis Dissection and Proximal Fixation: Trans-males
Phallus Dilatation
Choosing a Prosthesis and the Number of Cylinders
Sock and Cap Formation
Insertion of the Implant
Post-operative Care
Future Outlook
Testicular Prosthesis
Patient Satisfaction
Implant Survival
Summary
References
Chapter 11: The Approach to Prevention and Management of Device Extrusion and Erosion
Introduction
Corporal Dilation
Impending Cylinder Erosion
Repairs with Distal Counter-incision
Repairs Without Counter-incision
Complete Cylinder Erosion
Management of Complete Erosion
Delayed Replacement After Complete Distal Erosion
Erosion of Prosthetic Reservoir
Pump-Related Erosion
Conclusion
References
Chapter 12: Management of Long-Term Complications of Penile Implant Surgery
The “Sticky” Pump
History
The Problem
Differential Diagnosis
Studies
Management
SST Deformity: What Is True, What Is a Myth?
Definition and Cause
Incidence
The Problem
Differential Diagnosis
Management
Delayed Urethral Injury or Erosion
Definition and Cause
Prevention
Management
Glans Denervation or Devascularization
Definition and Cause of Glans Devascularization
Management
Penile Shortening
Introduction
Etiology
Incidence
Strategies to Preserve Length
Chronic Pain Syndrome
Definition and Cause
Differential Diagnosis
Management
Complications Associated with IPP Reservoirs
References
Chapter 13: Intraoperative Complications of Penile Prosthesis Surgery
Introduction
Intraoperative Complications
Urethral Injury
How to Deal with the Complication
Corporal Crossover
How to Deal with the Complication
Proximal or Crural Perforation
How to Deal with the Complication
Injuries Related to Reservoir Insertion
How to Deal with the Complication
Complications During Closure of the Wound
Conclusion
References
Chapter 14: Medicolegal Impacts of Penile Implant Surgery
Introduction
Considerations in Pre- and Postoperative Counseling
Medical Malpractice in Urology
Legal Proceedings
Clinical Considerations and Recommendations
Common Complaints Leading to Litigation After Penile Prosthesis Implantation
Informed Consent
Surgical Technique and Decision-Making
Infection
Conclusion
References
Index
Recommend Papers

Penile Implant Surgery: Contemporary Challenges and Controversies
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Citation preview

Penile Implant Surgery Contemporary Challenges and Controversies Eduardo P. Miranda John P. Mulhall Editors

123

Penile Implant Surgery

Eduardo P. Miranda  •  John P. Mulhall Editors

Penile Implant Surgery Contemporary Challenges and Controversies

Editors Eduardo P. Miranda Urology Division Universidade Federal do Ceará Fortaleza, Ceará, Brazil

John P. Mulhall Urology Service Memorial Sloan Kettering Cancer Center New York, NY, USA

ISBN 978-3-030-82362-7    ISBN 978-3-030-82363-4 (eBook) https://doi.org/10.1007/978-3-030-82363-4 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface

For decades penile implants have been considered the most effective treatment for severe and medication-refractory erectile dysfunction. There remains great interest in this treatment modality as the number of procedures is expected to increase over time with our aging population globally. However, implant surgery is associated with the potential for complications, and a high level of expertise is required to identify and manage these problems during and after surgery. This book provides a comprehensive and illustrated resource to the most salient aspects of penile implant surgery, ranging from indications to long-term complications. Having an international authorship of world authorities, ​chapters are aimed to address common concerns, such as patient and device selection, key steps in operative technique, pain control, management of residual penile deformity, and prevention and management of infection. It also provides a step-by-step guide for specific scenarios such as penile fibrosis and neophalloplasty. Rarely discussed issues such as lengthening procedures, operating on anticoagulated patients, and medicolegal aspects are also discussed. Penile Implant Surgery: Contemporary Challenges and Controversies is intended for both beginners and the most advanced audience, which includes, but is not limited to, residents and fully trained urologists, fellows, and practitioners in sexual medicine and reconstructive urology. Ceará, Brazil New York, NY, USA

Eduardo P. Miranda John P. Mulhall

v

Contents

1 Patient and Device Selection ������������������������������������������������������������������    1 Pramod Krishnappa, Esaú Fernández-Pascual, and Juan Ignacio Martinez-Salamanca 2 Critical Analysis of Maneuvers to Reduce Infection in Penile Implant Surgery ��������������������������������������������������������������������������������������   17 Karina Evelyn Sidabutar, Jared J. Wallen, and Gerard D. Henry 3 Strategies for Optimal Pain Control in the Penile Implant Patient������   37 Bruno C. G. Nascimento, Eduardo P. Miranda, and John P. Mulhall 4 Perioperative Management of Antithrombotic Therapy in Penile Implant Surgery����������������������������������������������������������������������������   49 Kevin J. Hebert, David Y. Yang, and Tobias S. Köhler 5 Management of Residual Curvature in Men with Peyronie’s Disease Following Penile Prosthesis Implantation����������������������������������������������   61 Eiftu Haile, Petar Bajic, and Laurence A. Levine 6 Considerations on Inflatable Penile Prosthesis Reservoir Placement��������������������������������������������������������������������������������   79 Brian Dick, Michael Polchert, Ayman Soubra, and Wayne J. G. Hellstrom 7 The Hostile Penis: Managing the Patient with Corporal Fibrosis������   97 Benjamin M. Dropkin, Nathan A. Chertack, Samantha W. Nealon, Gregory A. Joice, and Allen F. Morey 8 Considerations in the Management of Visceral and Vascular Injury During Penile Implant Surgery��������������������������������������������������  125 Kristina Buscaino, Raul E. Fernandez-Crespo, and Rafael Carrion 9 The Role of Penile Lengthening Procedures at the Time of Penile Implant Surgery ����������������������������������������������������������������������  155 Mirko Preto and Giulio Garaffa vii

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Contents

10 Implant Surgery in Patient with a Neophallus��������������������������������������  165 Gideon A. Blecher, Nim Christopher, and David J. Ralph 11 The Approach to Prevention and Management of Device Extrusion and Erosion����������������������������������������������������������������������������  187 Jonathan Clavell-Hernández and Run Wang 12 Management of Long-Term Complications of Penile Implant Surgery ��������������������������������������������������������������������������������������  207 Daniar Osmonov and Ahmed M. Ragheb 13 Intraoperative Complications of Penile Prosthesis Surgery����������������  237 Hussain M. Alnajjar and Asif Muneer 14 Medicolegal Impacts of Penile Implant Surgery����������������������������������  247 Caleb Natale, Gabe Leinwand, Michael Polchert, and Wayne J. G. Hellstrom Index������������������������������������������������������������������������������������������������������������������  259

Contributors

Hussain M. Alnajjar  Institute of Andrology, University College London Hospital, London, UK Division of Surgery and Interventional Science, UCL, London, UK Petar  Bajic  Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA Gideon A. Blecher  The Alfred Hospital, Melbourne, VIC, Australia Department of Surgery, Monash University, Melbourne, VIC, Australia Kristina  Buscaino  Morsani College of Medicine, University of South Florida, Tampa, FL, USA Rafael  Carrion  Morsani College of Medicine, University of South Florida, Tampa, FL, USA Nathan  A.  Chertack, MD  Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA Nim Christopher  University College London Hospitals & St Peter’s Andrology, London, UK Jonathan Clavell-Hernández  St Joseph Medical Center, Houston, TX, USA McGovern Medical School at Houston, University of Texas Health Science Center, Houston, TX, USA Brian Dick  Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA Benjamin M. Dropkin, MD  Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA Raul  E.  Fernandez-Crespo  Morsani College of Medicine, University of South Florida, Tampa, FL, USA

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x

Contributors

Esaú  Fernández-Pascual  Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain Department of Urology, Hospital Universitario La Paz, Madrid, Spain Giulio  Garaffa  The Institute of Urology, University College London Hospitals, London, UK Eiftu  Haile  Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA Kevin J. Hebert  Mayo Clinic, Rochester, MN, USA Wayne  J.  G.  Hellstrom  Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA Gerard D. Henry  WK Advanced Urology, Bossier City, Louisiana, USA Gregory A. Joice, MD  Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA Tobias S. Köhler  Mayo Clinic, Rochester, MN, USA Pramod Krishnappa  Andrology Division, Department of Urology, NU Hospitals, Bangalore, India Gabe Leinwand  Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA Laurence  A.  Levine  Division of Urology, Rush University Medical Center, Chicago, IL, USA Juan  Ignacio  Martinez-Salamanca  Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain Department of Urology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain Eduardo P. Miranda  Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA Division of Urology, Federal University of Ceara, Fortaleza, Brazil Allen F. Morey, MD  Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA John  P.  Mulhall  Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA Asif  Muneer  Institute of Andrology, University College London Hospital, London, UK Division of Surgery and Interventional Science, UCL, London, UK Bruno  C. G. Nascimento  Sexual & Reproductive Medicine Program, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

Contributors

xi

Sexual Medicine Group, Division of Urology, Hospital das Clinicas – University of Sao Paulo Medical School, Sao Paulo, Brazil Caleb Natale  Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA Samantha W. Nealon, MD  Department of Urology, University of South Florida, Tampa, FL, USA Daniar Osmonov  University Medical Center Schleswig Holstein, Kiel, Germany Michael Polchert  Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA Mirko  Preto  A.O.U.  Città della Salute e della Scienza di Torino  – Clinica Urologica – Presidio Molinette, Torino, Italy Ahmed  M.  Ragheb  Department of Urology, Beni-Suef University, Beni Suef, Egypt Bedaya Fertility & IVF Hospitals, Cairo, Egypt IHUN, Cairo, Egypt David  J.  Ralph  University College London Hospitals & St Peter’s Andrology, London, UK Karina Evelyn Sidabutar  Regional Urology, Jakarta, Indonesia Ayman  Soubra  Department of Urology, Tulane University School of Medicine, New Orleans, LA, USA Jared J. Wallen  YOU & WEE Urologic Surgery and Wellness, Sarasota, FL, USA Run  Wang  McGovern Medical School at Houston, University of Texas Health Science Center, Houston, TX, USA University of Texas MD Anderson Cancer Center, Houston, TX, USA David Y. Yang  Mayo Clinic, Rochester, MN, USA

Chapter 1

Patient and Device Selection Pramod Krishnappa, Esaú Fernández-Pascual, and Juan Ignacio Martinez-Salamanca

Penile prosthesis (PP) has become the standard of care in the management of refractory erectile dysfunction (ED). The success of a surgery is half completed even before the start of the surgery if one knows how to select the patients and devices diligently. There are several aspects which need to be considered before doing the PP surgery to maximise the patient-partner satisfaction and to be medicolegally safe. Patients should be given a realistic overview of the entire procedure, outcomes and possible complications so that they know what to expect following the surgery. A legal database review published in 2014 by Sunaryo et al. [1] about PP malpractice litigation revealed that 42% of cases (17/40) led to indemnity payment to the plaintiff with a mean settlement of US$335,000 and a mean indemnity award of US$831,050. The other important and alarming findings were error in surgical decision-­making (48% of cases), informed consent (31%) and postoperative infection (31%) which were the top three reasons for above claim. A detailed preoperative discussion about the entire surgical procedure and taking signature on a detailed informed consent form is of major importance. This chapter gives a detailed outline of the issues that need to be resolved before attempting a PP surgery to make the outcomes better for the patient and also for the treating doctor. P. Krishnappa Andrology Division, Department of Urology, NU Hospitals, Bangalore, India E. Fernández-Pascual Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain Department of Urology, Hospital Universitario La Paz, Madrid, Spain J. I. Martinez-Salamanca (*) Lyx Institute of Urology, Universidad Francisco de Vitoria, Madrid, Spain Department of Urology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain © The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 E. P. Miranda, J. P. Mulhall (eds.), Penile Implant Surgery, https://doi.org/10.1007/978-3-030-82363-4_1

1

2

P. Krishnappa et al.

Patient Selection Modifiable Risk Factors Identifying risk factors of the patient is a top priority as some of these can be optimised before the planned PP surgery. Smoking There is level 1 evidence to say that smoking increases surgical site infections (SSI) [2]. As there is no published data on the adverse effects of smoking in PP surgery outcomes, we have derived established conclusions from other surgical specialities. Smokers with 11 or more pack-years had significantly increased deep surgical-site infection (p