International Journal of Impotence Research最新文献

Recto-urethral fistulas represent a rare and challenging condition, occurring either congenitally or due to various prostatic and pelvic interventions such as radical prostatectomy and radiation therapies. This condition often manifests with symptoms such as pneumaturia, fecaluria, and urinary tract infections. Despite its rarity, this condition presents significant clinical management challenges due to the lack of consensus on standardized treatment protocols, particularly in patients with a history of irradiation. This study aims to systematically review the available literature on the efficacy and safety of primary surgical repair of adult-acquired recto-urethral fistulas. We conducted a comprehensive bibliographic search of MEDLINE, Scopus, and Web of Science Core Collection databases in August 2024, following the PRISMA guidelines. A total of 10 studies, covering over 500 patients, were included in our review. The most common surgical approach used was the transperineal technique with gracilis muscle flap interposition. Findings indicate higher complication rates and diminished healing in irradiated patients compared to non-irradiated counterparts. Although transperineal approaches generally resulted in high success rates irradiated individuals frequently required additional surgeries or definitive urinary diversion. Further research is required to establish evidence-based guidelines for optimal management, particularly for complex cases involving radiation-induced recto-urethral fistulas.

Simultaneous stress urinary incontinence (SUI) and erectile dysfunction (ED) are commonly caused by prostate surgery. Penile prosthesis is the gold standard for erectile dysfunction refractory to conservative therapies, fixed male sling and artificial urinary sphincter are recommended in mild and moderate/severe stress urinary incontinence respectively. The implantation of these devices can be simultaneous or delayed. This systematic review analyzes articles on simultaneous implantation of penile prosthesis and anti-incontinence devices. We search on Pubmed/Medline and Scopus: "penile prosthesis" AND "artificial urinary sphincter", "male sling", "Mini-Juppette", "ATOMS", "ProACT", "urethral bulking", "Advance", "Virtue". We have included 21 studies, mostly retrospective. The size of study cohorts is relatively small (2-65 patients) and the main cause of stress urinary incontinence and erectile dysfunction was radical prostatectomy. The average operating time appeared longer (57-218 min), although without evidence of intraoperative complications and an average hospital stay of 1-3 days. The average follow up of the studies ranged from 1 month to 94 months. Studies expressed different outcomes measurements, that could not allow a cumulative analysis. The overall continence outcomes were encouraging, with social continence rates (no more than 1 pad/day) ranging from 72 to 100%. The overall satisfaction for the inflatable penile prosthesis was high (84-100%). The postoperative complication rate did not show an augmented risk for double implants. All studies did not report any technical or surgical implant obstacles in synchronous versus metachronous implantation.

Over the years, numerous non-surgical and surgical treatment options have been explored for Peyronie's disease. Current options may result in incomplete correction of the deformity, which can be bothersome to the patient. This is a two-center case series of three patients who had previously undergone treatment for Peyronie's disease. Patient 1 underwent plication with extratunical grafting. Patient 2 underwent a series of Xiaflex® injections and then subsequent surgical plication for residual curvature. Patient 3 underwent a series of Xiaflex® injections. The Himplant® subcutaneous silicone penile prosthesis was placed in a standardized manner through a scrotal incision in all cases to mask residual penile deformities and enhance penile girth after Peyronie's disease treatment. Patients were contacted and asked 18 questions regarding satisfaction and erectile function with the responses recorded. This pilot study presents findings of high patient satisfaction, increases in flaccid penile length and girth, and an acceptable profile of adverse events following Himplant® placement. Based on our limited experience, we would consider offering Himplant® implantation when residual curvature is <40° and the penile indentation does not cause instability/buckling during penetrative sexual activity. Further research and larger studies are warranted to validate these findings and assess long-term outcomes and patient-reported satisfaction.

Vein ligation for veno-occlusive erectile dysfunction is being abandoned due to the recurrence rate. Among the reasons for failure is inability to ligate the deep system of veins; the internal pudendal vein. The vein exits the pelvis in the gluteal region, from the lesser sciatic foramen to the greater sciatic foramen, coursing over the ischial spine and sacro-spinous ligament, under the gluteus maximus. This work aims to verify feasibility of the first surgical procedure to ligate the internal pudendal vein through the gluteal approach. This cadaveric study involved five formalin-fixed cadavers. A surface anatomical landmark was designed to identify the ischial spine, at the intersection of two lines: a vertical line from posterior superior iliac spine to ischial tuberosity, and a horizontal line extending from sacro-coccygeal joint, laterally. An incision is cut encompassing the target point. Subcutaneous fat is dissected down to the gluteus maximus, which is split along the direction of its fibers. The vein can be found crossing over the ischial spine. "Shaeer's Vein Ligation - I" appears to be surgically feasible. A protocol for a surgical study is registered at clinicaltrials.gov, and is open for participation.

The need to enhance the quality of life and functionality of patients with a number of diseases, such as congenital abnormalities, traumas, and gender incongruence, has contributed to a significant development in the field of male genital reconstructive surgery. This article highlights the roots of penile reconstructive surgeries over history, emphasizing innovative achievements that have shaped modern practices. Critical advancements that have improved surgical accuracy and post-operative care are examined, including new imaging modalities, penile prosthesis implantation, and complete phallic reconstruction. In terms of future improvements in genital reconstructive surgery, the combination of tissue engineering and microsurgery offers the potential to further improve the field.

Congenital penile curvature is a rare condition identified by an abnormal penile curvature present from birth. Surgical intervention is currently the most effective treatment and is generally deferred until after puberty; however, early correction is recommended by some due to its impact on psychosexual development. This systematic review aims to evaluate the literature on surgical techniques for congenital penile curvature correction, focusing on their efficacy, safety, and patient-reported outcomes. Conducted in accordance with PRISMA guidelines and registered with PROSPERO (ID: CRD42024526737), the review includes 59 studies meeting inclusion criteria. The findings indicate that numerous surgical techniques have been documented over the past decades, predominantly focusing on shortening procedures such as Nesbit, Yachia, tunica albuginea plication, and Essed-Schröder. These historically utilized methods remain effective for correcting congenital penile curvature, but they may result in side effects like penile shortening and erectile dysfunction. The review emphasizes the necessity for well-designed studies to better compare the benefits of various surgical techniques.

Neurovascular bundle mobilization (NVBm) requires experience to avoid injury of the dorsal nerves and arteries of the penis. This work described Shaeer's Hydro-Inflation Technique for Neurovascular Bundle Mobilization (S-NVBm), whereby infiltration of the neurovascular bundle with saline is performed to increase safety and speed of NVBm. S-NVBm was performed in 50 cases: 21 cases of corporal rotation for congenital curvature, and 29 cases of penile prosthesis implantation with slitting of the tunica albuginea for correction of Peyronie's disease deformity (S-NVBm group). A matching group was operated upon with "classic" NVBm, without hydro-inflation (C-NVBm group, n = 32). In S-NVBm cases, hydro-inflation of Buck's fascia was performed prior to NVBm using 80% saline and 20% xylocaine (without adrenaline). The mixture was injected into Buck's fascia with the blunt nozzle of a 20 ml syringe, superficially applied to the surface. Average duration for NVBm in the S-NVBm group was 3.5 min ± 1.4 (range 1.2-7), compared to a duration of 7.3 ± 2 (range 4-11.2) in the C-NVBm group (p < 0.001); a 51.8% difference. No arterial injury was witnessed with S-NVBm group, compared to 1 case of minor unilateral arterial injury in the C-NVBm group. Sensitivity score was 10.2% higher in the S-NVBm group (mean 4.7 ± 0.5, range 3-5) compared to a mean of 4.3 ± 1 (range 2-5) in the C-NVBm group (p < 0.001). Biosthesiometry detected a mild sensory deficit in 1/50 cases of the S-NVBm group (2%) compared to 3/32 in the C-NVBm group (9.4%). Average post-operative pain score was 46% lower (2.5 ± 1.4, range 1-6) in the S-NVBm group compared to 4.6 ± 1.3 (range 2-7) in the C-NVBm group(p < 0.001). The findings herein demonstrate that Hydro-Inflation technique allows mobilization of the neurovascular bundle in a shorter time, with less post-operative pain, and with a lower risk for sensory deficit.

Adult Acquired Buried Penis (AABP) is a pathological condition necessitating surgical correction, ranging from simple to complex procedures involving the utilization of full-thickness (FTSG) or split-thickness (STSG) skin grafts especially in cases of substantial viable penile skin loss. In this retrospective study, we aimed to compare the surgical, functional, and patient-reported outcomes (PROs) of graft types that were utilized to treat AABP among 39 patients at a single center between November 2017 and May 2023. Among these patients, 22 needed skin grafts, with 9 undergoing FTSG and the remainder receiving STSG. Lichen Sclerosus (LS) was the primary cause (54.6%) of AABP requiring skin grafts. Patients primarily presented with voiding (63.6%) and sexual (27.3%) dysfunction. The STSG group had a lower mean age (64.7 ± 11.6) than the FTSG group (66.7 ± 11.6; P = 0.015), with no significant differences in BMI (p = 0.643). Complex repairs (Santucci grade ≥3) were performed in 81.0% of cases, with 88.9% in the FTSG group and 75.0% in the STSG group. Operative times were similar (160.2 ± 31.7 vs 161.5 ± 50.3, p = 0.945). No significant differences in preoperative penis length were found between the FTSG and STSG groups (P = 0.918). Postoperative complications occurred in 36.4% of patients, with severe complications (Clavien grade ≥3) in 9.1%. General postoperative complications and recurrence rates did not significantly differ between groups (P = 0.397 and 0.375; respectively). Functional outcomes, evaluated using the International Index of Erectile Function and the International Prostate Symptom Score, improved significantly in both groups after surgical procedures (P < 0.001 for all). Patient-reported satisfaction for the operation was 81.3% calculated by ad-hoc questionnaire. In conclusion, no discernible differences in outcomes were observed between STSG and FTSG. Larger comparative studies with extended follow-up periods and validated questionnaires are warranted for confirmation. Physicians should consider specialized centers for AABP surgical repair due to its intricacies.