Search

Background A successful penile prosthesis implantation (PPI) surgery can be defined by outcomes beyond the absence of complications. Aim To introduce the concept of failure to cure (FTC) in the context of PPI to more accurately gauge postoperative outcomes after PPI. Methods Consecutive patients from our sexual function registry who underwent PPI from January 2011 to December 2013 were analyzed. Demographics, previous treatment of erectile dysfunction, comorbidities, social history, postoperative problems (POPs), and surgical outcomes were tabulated. Patients completed the International Index of Erection Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaires. We defined a complication, according to the Clavien-Dindo classification, as any deviation from the ideal postoperative course that is not inherent in the procedure and does not constitute an FTC. FTC was defined as a POP that was not a complication. The χ2 tests, t-tests, or Wilcoxon rank-sum tests were used. Outcomes Patient-reported and objective outcomes after PPI. Results Our enrollment consisted of 185 patients, and we contacted 124 (67%). Of these, 16 (12.9%) had a POP requiring reoperation. Eight patients developed surgical complications (three infections, four erosions, and one chronic pain). Eight patients had FTC (four malpositions and four malfunctions). Factors that correlated with POPs were previous PPI, body mass index higher than 30 kg/m2, and previous treatment with intracorporal injections (P < .05 for all comparisons). Patients who had POPs scored significantly lower on the IIEF erectile function and intercourse satisfaction domains (P < .05 for the two comparisons), but not on the orgasmic function, sexual desire, and overall satisfaction domains (P > .05 for all comparisons). Clinical Implications POPs after PPI surgery can be more accurately categorized using the Clavien-Dindo classification of surgical complications to more clearly distinguish surgical complications from FTC. Strengths and Limitations Limitations of our study include its retrospective approach. Our series included a large proportion of patients treated for prostate cancer, which limits the generalizability of our findings. We also had a relatively short median follow-up time of 27 months. Conclusions Patient-reported outcome assessments can vary greatly from what physicians determine to be successful PPI. An assessment of POPs encompasses more than just complication rates; it also reflects FTC. Even when POPs occur, patients can still derive satisfaction if they are correctively managed. Factors that possibly predispose to POPs include previous PPI surgery, body mass index greater than 30 kg/m2, and history of intracorporal injections.

Introduction Penile prosthesis infections remain challenging despite advancements in surgical technique, device improvements, and adoption of antibiotic prophylaxis guidelines. Aim To investigate penile prosthesis infection microbiology to consider which changes in practice could decrease infection rates, to evaluate current antibiotic prophylaxis guidelines, and to develop a proposed algorithm for penile prosthesis infections. Methods This retrospective institutional review board–exempt multi-institutional study from 25 centers reviewed intraoperative cultures obtained at explantation or Mulcahy salvage of infected three-piece inflatable penile prostheses (IPPs). Antibiotic usage was recorded at implantation, admission for infection, and explantation or salvage surgery. Cultures were obtained from purulent material in the implant space and from the biofilm on the device. Main Outcome Measures Intraoperative culture data from infected IPPs. Results Two hundred twenty-seven intraoperative cultures (2002–2016) were obtained at salvage or explantation. No culture growth occurred in 33% of cases and gram-positive and gram-negative organisms were found in 73% and 39% of positive cultures, respectively. Candida species (11.1%), anaerobes (10.5%) and methicillin-resistant Staphylococcus aureus (9.2%) constituted nearly one third of 153 positive cultures. Multi-organism infections occurred in 25% of positive cultures. Antibiotic regimens at initial implantation were generally consistent with American Urological Association (AUA) and European Association of Urology (EAU) guidelines. However, the micro-organisms identified in this study were covered by these guidelines in only 62% to 86% of cases. Antibiotic selection at admissions for infection and salvage or explantation varied widely compared with those at IPP implantation. Conclusion This study documents a high incidence of anaerobic, Candida, and methicillin-resistant S aureus infections. In addition, approximately one third of infected penile prosthesis cases had negative cultures. Micro-organisms identified in this study were not covered by the AUA and EAU antibiotic guidelines in at least 14% to 38% of cases. These findings suggest broadening antibiotic prophylaxis guidelines and creating a management algorithm for IPP infections might lower infection rates and improve salvage success.

ICT in education plays a role in encouraging and improving the creativity and critical thinking of students. In the Philippines, public high schools suffer from slow and intermittent internet connection which can negatively affect the quality of education that the students get. With the help of Software Defined Networking and Network Function Virtualization, we propose a local caching system to alleviate the effects of the aforementioned problem. This solution is remotely configurable and automatically scaling which lessens the need for a network administrator to maintain the system. The local caching system can operate between two modes, Hot and Cold. The system's two modes are tested and compared with each other. Experimental results show that the Hot mode reacts 42 seconds faster to changes in the internet connection while the Cold mode reacts slower but uses fewer resources overall. The automatic scaling is also tested and the results show that our system uses half the number of cores compared to an overprovisioned setup when the load is low.

Introduction Inflatable penile prosthesis (IPP) surgery has been performed for more than 40 years. IPP infection rates have decreased owing to advances in manufacturing and surgical technique but have remained a devastating complication. Aims To describe the pathophysiology of infections, examine evidence associating clinical risk factors with IPP infection, assess the benefit of techniques aimed at preventing and managing infection, and discuss future directions. Methods PubMed and Google Scholar were searched for studies relating to IPP infections. Main Outcome Measures A comprehensive review of the literature on IPP infections focusing on predisposing factors and ways to prevent and treat. Results There are two types of IPP infections: those caused by coagulase-negative Staphylococcus species, which present mildly, and those caused by organisms that are more virulent and systemically toxic. Biofilm on devices protects bacteria from immunologic responses and antibiotics. Much research has targeted biofilm. Spinal cord injury, IPP revision, and longer operative times predispose to IPP infection. Other factors, such as diabetes, immunosuppression, and concomitant surgeries, lack sufficient evidence to determine conclusively. Methods that decrease infections include using infused prostheses and adhering to surgical techniques that avoid prolonged wound exposure. Techniques that might prevent IPP infection but lack definitive evidence are using postoperative antibiotics past 24 hours, shaving with clippers, and prepping with chlorhexidine-alcohol. Different treatments for IPP infections exist. Antibiotics should be followed by explantation if no improvement occurs. Device replacement can be immediate or delayed depending on infection severity and other variables such as erosion. Various techniques are proposed to prevent corporal fibrosis after IPP removal. Conclusion We reviewed studies to determine true risk factors and the techniques that have true impact on infection prevention. Newer studies focusing on prevention and disruption of biofilm will be key in advancing the best outcomes.

Analysis of radionuclides in radioactive waste is performed according to a number of operating protocols which are usually time-consuming and difficult to implement. The use of micro devices for liquid-liquid extraction of radionuclides is promising, since small amounts of materials are needed. In this work, a plug flow modelling approach for the liquid-liquid extraction in microdevices is presented. A multi-component chemical process based on the PUREX-TRUEX waste management treatment is analysed. We evaluate the performance of the coupled micro-units as a function of channel size, superficial mixture velocity, and initial loading. The results show that it is possible to use the model in an optimisation based design procedure for microfluidic devices.

Introduction Penile prosthesis implantation is believed to provide a high level of patient satisfaction. The International Index of Erectile Function and the Erectile Dysfunction Inventory of Treatment Satisfaction are two validated questionnaires that have been used to assess this outcome. The lack of a tool specifically validated for patients undergoing penile prosthesis surgery has led to the use of heterogeneous methods to assess patient satisfaction. Aim To review the assessment of patient satisfaction with penile prosthesis surgery according to several factors. Methods A literature review was performed through PubMed from January 2000 through February 2016 addressing patient satisfaction after penile prosthesis surgery. Main Outcome Measures Patient satisfaction according to the characteristics of penile prosthesis devices and different clinical contexts. Results Forty-eight articles were selected. Of these, 66.2% used non-validated questionnaires to assess patient satisfaction. Device characteristics, patient comorbidities, and partner profile are potential factors that can determine patient satisfaction. Conclusion Patient satisfaction is a meaningful outcome of penile prosthesis surgery modulated by different conditions. The rigor of this assessment in the literature is limited. The validation of a scale designed for patients with penile prosthesis surgery is needed to optimize clinical practice. Akakpo W, Pineda MA, Burnett AL. Critical Analysis of Satisfaction Assessment After Penile Prosthesis Surgery. Sex Med Rev 2017;5:244–251.

The percentage of patients who had achieved continence in the control group were: 13%, 35%, 50%, 62% and 82% at the 1-, 6-, 12-, 24- and 52-week follow-up, respectively. The percentage of patients who had achieved continence in the anterior reconstruction group were 27%, 59%, 77%, 86%, and 91%, respectively. The total reconstruction group had continence rates of 38%, 83%, 91%, and 97% at 1, 6, 12, and 24 weeks, respectively. At all the follow-up intervals the continence rate was significantly less in the control group than in the anterior reconstruction group and the total reconstruction group ( P < 0.01).

Between 800,000 to 1 million transrectal ultrasound (TRUS)-guided prostate biopsies are performed in the United States each year [1]. Despite the potential benefit of undergoing TRUS biopsy (i.e., diagnosing prostate cancer at an early, treatable stage), the procedure is associated with a wide variety of minor and major complications. Prior to the actual procedure patients can suffer from anxiety and the anxiety may persist for weeks afterwards [2]. The source of the anxiety ranges from worrying about the discomfort of the procedure to the fear of being diagnosed with cancer. The physical consequences from a biopsy procedure include anal pain and discomfort from the insertion of the rectal sonogram probe, as well as pain from the needle punctures for both the anesthetic injection and tissue sampling [3]. Some of the more common complications are relatively mild, usually requiring nothing more than observation and reassurance, and mostly consist of blood in the semen, urine, or per rectum [4–7]. Other, less common, minor complications include irritative voiding symptoms such as dysuria and frequency [8]. Erectile dysfunction has also been documented, sometimes afflicting patients before the procedure, but also occurring after the biopsy and lasting for weeks in some cases [2, 9].