Search

Explantation of an inflatable penile prosthesis (IPP) reservoir in the setting of acute infection can be challenging. We identified three such cases of infection and simultaneous extraction of multiple reservoirs among patients with the most recent prosthetic surgeries performed between March 2016 and November 2018. These cases were reviewed with particular emphasis on preoperative and operative management. All three patients underwent successful simultaneous explantation of all retained hardware with subsequent clinical improvement in their clinical status. Prior to surgery, none of the patients were aware of the presence of more than one reservoir. All three patients recovered well post operatively. A subset of prosthetics patients have undergone multiple implant procedures at various sites. Due to the importance of retrieving all foreign material in the setting of acute infection, the authors advocate for a low threshold to obtain cross-sectional imaging to identify the tissue plane and laterality of any retained components, with particular emphasis on creating an operative plan for reservoir retrieval.

Penile prosthesis placement is the gold standard for the treatment of erectile dysfunction (ED) refractory to medical therapy; however, limited data exist on the long-term outcomes of these devices.A PubMed search focused on long-term outcomes of penile prosthetics was performed. Studies with a follow-up of less than 5 years were excluded. Included studies were arranged chronologically by implant date to identify trends in device lifetime. Data were further scrutinized to separate device failure secondary to mechanical malfunction from device failure secondary to infection.Limited data prevent accurate 15-year predictions for modern prosthetics. The 5- and 10-year overall survival of modern prosthetics is estimated to be 90.4% and 86.6%, respectively. Infection rates are estimated to be 1.5% and 1.8% at 8 and 10 years, respectively. While great strides have been made in device design, there is still potential for advancement in both infection rate reduction and mechanical improvement. The combination of increased collaboration between implanting urologists and engineers from prosthetic device companies and improved, prospectively collected data will usher prosthetic urology into its next era.

The global population is collectively getting older, and age is directly correlated with erectile dysfunction (ED). With the advent of effective oral agents and wide availability of the Internet, a larger portion of the population is becoming aware of the different treatment options for men with ED. The penile prosthesis is a definitive and effective treatment for ED which has been available for just over half a century.

An Institutional Quality and Safety Initiative to reduce postoperative urinary retention (POUR) and improve patient safety indicators (PSIs) was undertaken after a nurse driven protocol for catheter removal lead to an increase in POUR. The aim of this study was to identify the number of risk factors present in patients with POUR while examining the prevalence of those risk factors individually.A retrospective review of our institution's surgical database was performed to identify 500 consecutive cases of POUR between July 1, 2013 and July 1, 2014. POUR was defined as the inability to void postoperatively with bladder scan volumes greater than 450 mL and subsequent need for catheterization with an output greater than 450 mL. These records were individually reviewed for 15 known independent risk factors for urinary retention. Patients with incomplete records or preoperative baseline urinary retention requiring catheterization were excluded.Of the 500 consecutive patients with POUR, 288 (57.6%) were male and 212 (42.4%) were female. At the time of voiding trial, all 500 patients with POUR (100%) had at least one perioperative risk factor identified and over 75% had six or more (mean 6.88, median 7, range 1-12).Multiple perioperative risk factors are present in the vast majority of patients with POUR. Many of the risk factors are modifiable and represent an opportunity for intervention. This could ultimately lead to a risk profile which could be used to optimize timing of postoperative voiding trials, thus improving patient care (improve PSIs and patient comfort, reduce trauma) while maintaining low rates of CAUTI.