Penile rehabilitation after inflatable penile prosthesis(IPP)implantation for the treatment of erectile dysfunction includes leaving the device partially inflated so as to preserve the penile length and to maintain he...Penile rehabilitation after inflatable penile prosthesis(IPP)implantation for the treatment of erectile dysfunction includes leaving the device partially inflated so as to preserve the penile length and to maintain hemostasis.With a partially inflated device,the penis becomes more sensitive and more susceptible to unintended insults during the immediate postoperative management.The“Wang Collar,”a device intended to protect the penis in the early postoperative period,is hereby described.Three hundred and forty-eight patients had the 44Wang Collar"included as part of their post-1 PP management from August 2014 to February 2019.The protective collar,devised from a polystyrene cup with the bottom removed,is secured with a tape over the previously dressed and partially inflated penis.In order to evaluate the effectiveness of this device,we conducted surveys on the perioperative staff at three different institutions.The“Wang Collar”has been found to be beneficial in the early postoperative care of patients.Based on the answers to our questionnaire,the perioperative personnel found this device to be highly protective,especially when transporting the patient after IPP surgery,easy to work with,and almost never bothersome or irritative to the patient.We present a novel penile device after IPP placement,which we have found to improve patient satisfaction in the postoperative period.In addition,it eases the care of the patient by the perioperative staff.It is now our routine to use this device after IPP surgery.Further research is necessary to evaluate whether this device can decrease postoperative wound complications.展开更多
Inflatable penile prosthesis(IPP)implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy.The standard placement of the reservoir in the space of Retzius...Inflatable penile prosthesis(IPP)implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy.The standard placement of the reservoir in the space of Retzius(SOR)may be contraindicated in patients with prior pelvic or abdominal surgery due to altered anatomy and increased risk of complications.This has led to the development of alternative ectopic reservoir placement techniques.In this narrative review,we summarize the literature on various ectopic reservoir approaches,including low and high submuscular placements,submuscular techniques with counter incisions or transfascial fixation,midline submuscular placement,subcutaneous placement,and lateral retroperitoneal approaches.We describe the surgical methods,outcomes,and complication rates associated with each technique.While most methods demonstrate low complication and revision rates,direct comparisons remain limited due to heterogeneity and lack of prospective data.This review highlights the importance of individualized technique selection based on prior surgical history,body habitus,and surgeon experience.As ectopic placement becomes more widely adopted,familiarity with multiple approaches is essential for prosthetic surgeons.展开更多
Background:Patients with inflatable penile prostheses(IPP)may experience erosions after years of use or after indwelling Foley catheter placement.IPP erosions should be managed as an infection with the entire IPP remo...Background:Patients with inflatable penile prostheses(IPP)may experience erosions after years of use or after indwelling Foley catheter placement.IPP erosions should be managed as an infection with the entire IPP removed.Replacing IPPs in erosion patients can be challenging due to extensive scarring development.Using proper graft materials may be necessary to close and reinforce the corporal defect after difficult corporal dilation or significant scar removal for the long‐term success of IPP reimplantation.Case Presentation:Herein we report a patient with a history of IPP placement in 2007 for erectile dysfunction and Peyronie's disease,presenting in 2018 with dysuria and a feeling of IPP displacement following Foley catheter placement for coronary artery bypass graft surgery.The left cylinder of the IPP was observed by physical examination and a defect near the fossa navicularis was discovered during office cystoscopy.A complete explantation of IPP was then performed.Reimplantation of the IPP was performed in 2021 which required excision of corporal scar tissue and repair of a left distal corporal defect using a Tutoplast®pericardium allograft.The procedure was successful with proper IPP position and good function without any penile deformity.Conclusion:The use of graft materials in the management of corporeal defects should be considered in the setting of complex IPP revision.The Tutoplast®pericardium allograft reinforcement can provide long‐term durability,flexibility,and a lower risk of infection.展开更多
Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass optical head-mounted display to train urology reside...Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a lO-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.展开更多
Understanding the methods and rationale for managing erectile function in cis-and trans-male patients after neophallus reconstruction is of clinical value to the practicing urologists who encounter such patients.We de...Understanding the methods and rationale for managing erectile function in cis-and trans-male patients after neophallus reconstruction is of clinical value to the practicing urologists who encounter such patients.We describe a brief overview of the urologist’s role in the management of sexual function.This communication focuses on pre-and post-construction of a neophallus,considerations for surgical techniques that are largely dependent on whether the patient is cis-or transgender,the traditional method of placing of inflatable penile prosthesis in a neophallus,and in conjunction with the management of complications post implantation.This manuscript is both a review of the current literature in the field,as well as an overview of experience gained from managing a cohort of patients over the years.Additionally,we discuss novel advances that aim to decrease the risk of complications,including distal erosion of the cylinders of the penile prostheses and the proximal dislodgement of cylinders in these unique patients.展开更多
文摘Penile rehabilitation after inflatable penile prosthesis(IPP)implantation for the treatment of erectile dysfunction includes leaving the device partially inflated so as to preserve the penile length and to maintain hemostasis.With a partially inflated device,the penis becomes more sensitive and more susceptible to unintended insults during the immediate postoperative management.The“Wang Collar,”a device intended to protect the penis in the early postoperative period,is hereby described.Three hundred and forty-eight patients had the 44Wang Collar"included as part of their post-1 PP management from August 2014 to February 2019.The protective collar,devised from a polystyrene cup with the bottom removed,is secured with a tape over the previously dressed and partially inflated penis.In order to evaluate the effectiveness of this device,we conducted surveys on the perioperative staff at three different institutions.The“Wang Collar”has been found to be beneficial in the early postoperative care of patients.Based on the answers to our questionnaire,the perioperative personnel found this device to be highly protective,especially when transporting the patient after IPP surgery,easy to work with,and almost never bothersome or irritative to the patient.We present a novel penile device after IPP placement,which we have found to improve patient satisfaction in the postoperative period.In addition,it eases the care of the patient by the perioperative staff.It is now our routine to use this device after IPP surgery.Further research is necessary to evaluate whether this device can decrease postoperative wound complications.
文摘Inflatable penile prosthesis(IPP)implantation is the gold standard treatment for patients with erectile dysfunction who are refractory to medical therapy.The standard placement of the reservoir in the space of Retzius(SOR)may be contraindicated in patients with prior pelvic or abdominal surgery due to altered anatomy and increased risk of complications.This has led to the development of alternative ectopic reservoir placement techniques.In this narrative review,we summarize the literature on various ectopic reservoir approaches,including low and high submuscular placements,submuscular techniques with counter incisions or transfascial fixation,midline submuscular placement,subcutaneous placement,and lateral retroperitoneal approaches.We describe the surgical methods,outcomes,and complication rates associated with each technique.While most methods demonstrate low complication and revision rates,direct comparisons remain limited due to heterogeneity and lack of prospective data.This review highlights the importance of individualized technique selection based on prior surgical history,body habitus,and surgeon experience.As ectopic placement becomes more widely adopted,familiarity with multiple approaches is essential for prosthetic surgeons.
文摘Background:Patients with inflatable penile prostheses(IPP)may experience erosions after years of use or after indwelling Foley catheter placement.IPP erosions should be managed as an infection with the entire IPP removed.Replacing IPPs in erosion patients can be challenging due to extensive scarring development.Using proper graft materials may be necessary to close and reinforce the corporal defect after difficult corporal dilation or significant scar removal for the long‐term success of IPP reimplantation.Case Presentation:Herein we report a patient with a history of IPP placement in 2007 for erectile dysfunction and Peyronie's disease,presenting in 2018 with dysuria and a feeling of IPP displacement following Foley catheter placement for coronary artery bypass graft surgery.The left cylinder of the IPP was observed by physical examination and a defect near the fossa navicularis was discovered during office cystoscopy.A complete explantation of IPP was then performed.Reimplantation of the IPP was performed in 2021 which required excision of corporal scar tissue and repair of a left distal corporal defect using a Tutoplast®pericardium allograft.The procedure was successful with proper IPP position and good function without any penile deformity.Conclusion:The use of graft materials in the management of corporeal defects should be considered in the setting of complex IPP revision.The Tutoplast®pericardium allograft reinforcement can provide long‐term durability,flexibility,and a lower risk of infection.
文摘Augmented reality is widely used in aeronautics and is a developing concept within surgery. In this pilot study, we developed an application for use on Google Glass optical head-mounted display to train urology residents in how to place an inflatable penile prosthesis. We use the phrase Augmented Reality Assisted Surgery to describe this novel application of augmented reality in the setting of surgery. The application demonstrates the steps of the surgical procedure of inflatable penile prosthesis placement. It also contains software that allows for detection of interest points using a camera feed from the optical head-mounted display to enable faculty to interact with residents during placement of the penile prosthesis. Urology trainees and faculty who volunteered to take part in the study were given time to experience the technology in the operative or perioperative setting and asked to complete a feedback survey. From 30 total participants using a lO-point scale, educational usefulness was rated 8.6, ease of navigation was rated 7.6, likelihood to use was rated 7.4, and distraction in operating room was rated 4.9. When stratified between trainees and faculty, trainees found the technology more educationally useful, and less distracting. Overall, 81% of the participants want this technology in their residency program, and 93% see this technology in the operating room in the future. Further development of this technology is warranted before full release, and further studies are necessary to better characterize the effectiveness of Augmented Reality Assisted Surgery in urologic surgical training.
文摘Understanding the methods and rationale for managing erectile function in cis-and trans-male patients after neophallus reconstruction is of clinical value to the practicing urologists who encounter such patients.We describe a brief overview of the urologist’s role in the management of sexual function.This communication focuses on pre-and post-construction of a neophallus,considerations for surgical techniques that are largely dependent on whether the patient is cis-or transgender,the traditional method of placing of inflatable penile prosthesis in a neophallus,and in conjunction with the management of complications post implantation.This manuscript is both a review of the current literature in the field,as well as an overview of experience gained from managing a cohort of patients over the years.Additionally,we discuss novel advances that aim to decrease the risk of complications,including distal erosion of the cylinders of the penile prostheses and the proximal dislodgement of cylinders in these unique patients.
