When compared to a malleable prosthesis, a 3-piece inflatable type offers patients a superior erection quality that most closely resembles a natural erection. During the operation of replacing a patient’s malleable prosthesis for a 3-piece inflatable device, an extended corportomy (> 3cm) is required for successful removal of the malleable device, given its girth and inability to deflate. Unfortunately, a long corporotomy poses multiple potential risks: (1) It requires exposing a longer segment of corpora cavernosa resulting in excessive dissection that could worsen post-operative pain and edema. (2) Its closure lengthens the operative time and increases the risk of inadvertent needle puncture injury to the inflatable prosthesis. (3) Given a more challenging corporotomy closure, there is an increased risk of a scrotal hematoma and its associated complications from corporeal leakage. Due to concerns associated with a large corportomy, we investigate the outcomes of a novel technique of malleable prosthesis incision prior to its explantation, which enables Urologists to safely remove the prosthesis while maintaining a small corporotomy size (< 1cm).

To determine whether adding rear tip extenders affect penile prosthesis cylinder stiffness. A penile model simulating two corpora cavernosa in which Rear Tip Extenders (RTE) of varying lengths could be added to a penile prosthesis cylinder was created using a 3D printer. The cylinders were attached to a pressure monitor and inflated to 15 psi (103 kPa) (see Figure 1). An Instron machine was used to apply 200g of force at exactly the same distance from the cylinder base where it is secured to the pelvic model (see Figure 2) for various cylinder lengths. The cylinder deflection was measured using a ruler. For each cylinder length, deflection was measured with varying lengths of RTE. In a previous abstract, we defined the Rigidity Factor (RF) as the ratio of the live inflatable cylinder length divided by the total cylinder length (inflatable plus non-inflatable). All Titan® cylinders have a non-inflatable rear of 5cm. A correlation between the RF and cylinder stiffness is established by measuring the change in cylinder deflection as RTE’s are added to the cylinder.

To determine whether high volume IPP surgeons use less rear-tip extenders (RTE) than mid to low volume surgeons. Manufacturer-tabulated patient information forms (PIFs) reported to Coloplast Corp. (Coloplast) from January 1, 2012 to April 5, 2015 were reviewed. Coloplast obtains PIF forms on a voluntary basis only. Low volume was defined as surgeons performing 0-10 IPPs per year, mid volume 11-49 and high volume > 50 per year. Data were analyzed using Pearson's chi-squared test. A total of 24,180 PIFs with relevant data were received during the study period. 51% of implants were placed by low volume surgeons, 22% by mid volume surgeons, and 27% by high volume surgeons. RTEs were used in 68% (16,354/24,180) of penile implants. There was a statistical significant difference in the use of RTEs amongst surgeons of different volume (p = < 0.001). RTEs were used in 73% of surgeries performed by low volume surgeons, 68% of surgeries performed by mid volume surgeons, and only in 58% of surgeries performed by high volume surgeons, see table.

To determine whether rear tip extenders affect erectile quality in inflatable penile prosthesis. A penile model simulating two corpora cavernosa in which inflatable cylinders of varying lengths could be inserted was created using a 3D printer. The cylinders were attached to a pressure monitor and inflated to 15 psi (see Figure 1). A 200g weight was then uniformly placed on the tip of the cylinders at the same distance from the pelvic model and the deflection measured using a ruler (see Figures 2 & 3). Cylinders of varying lengths with Rear Tip Extenders (RTE) needed to total 22cm were used. In order to quantify the relative amount of inflatable cylinder to rear tip, the previously described Rigidity Factor (RF) index was used, defined as the live inflatable cylinder length divided by the total prosthesis length (22cm for all measurements in this case). All Titan ® cylinders have a non-inflatable rear of 5cm. Therefore the rigidity factor for each cylinder size is (total cylinder length - 5cm)/22cm.

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Surgical Therapy I1 Apr 2015PD26-02 A REVIEW OF MICROORGANISMS ISOLATED AT SALVAGE OR EXPLANT OF IPPS: ARE WE COVERING THE CORRECT BUGS? Martin Gross, Francois Eid, Christopher Yang, Ross Simon, Daniel Martinez, Rafael Carrion, Paul Perito, Nelson Bennett, Laurence Levine, Jason Greenfield, and Ricardo Munarriz Martin GrossMartin Gross More articles by this author , Francois EidFrancois Eid More articles by this author , Christopher YangChristopher Yang More articles by this author , Ross SimonRoss Simon More articles by this author , Daniel MartinezDaniel Martinez More articles by this author , Rafael CarrionRafael Carrion More articles by this author , Paul PeritoPaul Perito More articles by this author , Nelson BennettNelson Bennett More articles by this author , Laurence LevineLaurence Levine More articles by this author , Jason GreenfieldJason Greenfield More articles by this author , and Ricardo MunarrizRicardo Munarriz More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1078AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Current AUA guidelines regarding IPP implantation dictate that the standard of care is to use antibiotics that cover Gram-positive and Gram-negative organisms. Surgical prophylaxis with aminoglycosides, vancomycin, cephalosporins, and fluoroquinolones is recommended. These guidelines are intended to prevent infection with skin flora (the most likely cause of infection per the literature) and urinary tract flora. A review of organisms cultured during IPP salvage or explant at our institutions indicates that fungi and anaerobes are prevalent isolates. These organisms are not covered by the recommended antibiotic regimens. METHODS This is a retrospective multi-institution study of 65 patients with IPPs who presented with infections. These patients underwent either prosthesis explant or Mulcahy salvage procedure with device replacement. Patients' operative notes and charts were extensively reviewed to compile study data. Antibiotics were recorded at implantation, immediately prior to infection-related surgery, and during infection-related surgery. RESULTS Between 2002 and 2014 65 patients presented with IPP infection. Antibiotic regimens for all patients at implantation were consistent with current AUA guidelines. Intraoperative cultures were obtained at the time of either salvage or explant. 42 patients had at least one organism cultured from their wound at time of salvage or explant. 5 had more than one organism. Coagulase negative staph was the most commonly cultured organism, and was present in 20 isolates (31%). Candida albicans was the second most commonly cultured organism, and was present in 8 isolates (12%). Other cultured organisms included expected Gram-positive and Gram-negative flora: MRSA (5 patients, 8% of all cultures), group B strep (5, 8%), prevotella bivia (2, 3%), enterococcus (2, 3%), pseudomonas (2, 3%), staph epidermidis (1, 1.5%), and klebsiella (1, 1.5%). Anaerobes, including peptostreptococcus, clostridium innocuum, bacteroides tectus, and lactobacillus acidophilus, were individually cultured once, occurring at a rate of 1.5% each. CONCLUSIONS Intraoperative cultures obtained from infected IPPs in this sample show an unexpected rate of microorganisms that are not covered by current AUA recommended antibiotic regimens. Candida was present in 12% of cultures, and anaerobes were present in four total cultures, for a combined prevalence of 6%. Further correlation with data from other providers may verify if this trend indicates a need to broaden antifungal and antibiotic coverage at implantation, salvage, or explant. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e566 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Martin Gross More articles by this author Francois Eid More articles by this author Christopher Yang More articles by this author Ross Simon More articles by this author Daniel Martinez More articles by this author Rafael Carrion More articles by this author Paul Perito More articles by this author Nelson Bennett More articles by this author Laurence Levine More articles by this author Jason Greenfield More articles by this author Ricardo Munarriz More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Inflatable penile prosthesis (IPP) remains the gold standard for the surgical treatment of refractory erectile dysfunction; however, current literature to aid surgeons on how best to counsel patients on their postoperative inflated penile length is lacking. The aim of this study was to identify preoperative parameters that could better predict postoperative penile length following insertion of an IPP. Twenty men were enrolled in a prospective study examining penile lengths before and after IPP surgery. Patients with Peyronie’s disease were excluded from this analysis. Baseline preoperative characteristics, including body mass index, history of hypertension, diabetes, Sexual Health Inventory for Men scores and/or prior radical prostatectomy were recorded. All patients underwent implantation with a three-piece inflatable Coloplast penile prosthesis. We compared stretched penile length to pharmacologically induced erect lengths. Postoperatively, we measured inflated penile lengths at 6 weeks and assessed patients’ perception of penile size at 12 weeks. The median (±interquartile range) stretched penile length and pharmacologically induced erect penile length was 15 (±3) and 14.25 (±2) cm, respectively (P=0.5). Median post-prosthesis penile length (13.5±2.13 cm) was smaller than preoperative pharmacologically induced length (P=0.02) and preoperative stretched penile length (P=0.01). The majority of patients (70%) had a decrease in penile length (median loss 0.5±1.5 cm); however, this loss was perceptible by 43% of men. Stretched penile length and pharmacologically induced erect penile length were equally good predictors of postoperative inflated length (Spearman’s correlation 0.8 and 0.9, respectively). Pharmacologically induced erect penile length and stretched penile lengths are equal predictors of post-prosthesis penile length. The majority of men will experience some decrease in penile length following prosthesis implantation; however <50% report a subjective loss of penile length.

You have accessJournal of UrologyDiscussed Poster, Tuesday, May 24, 2005, 1:00 - 5:00 pm1 Apr 20051266: A Multi-Center Study: Safety, Efficacy and Patient Satisfaction Results of the Two-Piece Ambicor™ Inflatable Penile Prosthesis (IPP) Laurence A. Levine, Keith O'Reilly, Ronald F. Tutrone, David G. McLeod, Ronald W. Lewis, Gerald H. Jordan, Marc Siegelbaum, Claire C. Yang, Charles M. Feinstein, J. Francois Eid, Wayne J.G. Hellstrom, George T. Ho, Abraham Morgentaler, Arnold Melman, Robert Hackler, and Stewart W. McCallum Laurence A. LevineLaurence A. Levine More articles by this author , Keith O'ReillyKeith O'Reilly More articles by this author , Ronald F. TutroneRonald F. Tutrone More articles by this author , David G. McLeodDavid G. McLeod More articles by this author , Ronald W. LewisRonald W. Lewis More articles by this author , Gerald H. JordanGerald H. Jordan More articles by this author , Marc SiegelbaumMarc Siegelbaum More articles by this author , Claire C. YangClaire C. Yang More articles by this author , Charles M. FeinsteinCharles M. Feinstein More articles by this author , J. Francois EidJ. Francois Eid More articles by this author , Wayne J.G. HellstromWayne J.G. Hellstrom More articles by this author , George T. HoGeorge T. Ho More articles by this author , Abraham MorgentalerAbraham Morgentaler More articles by this author , Arnold MelmanArnold Melman More articles by this author , Robert HacklerRobert Hackler More articles by this author , and Stewart W. McCallumStewart W. McCallum More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)35411-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1266: A Multi-Center Study: Safety, Efficacy and Patient Satisfaction Results of the Two-Piece Ambicor™ Inflatable Penile Prosthesis (IPP)." The Journal of Urology, 173(4S), p. 343 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 173Issue 4SApril 2005Page: 343 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Laurence A. Levine More articles by this author Keith O'Reilly More articles by this author Ronald F. Tutrone More articles by this author David G. McLeod More articles by this author Ronald W. Lewis More articles by this author Gerald H. Jordan More articles by this author Marc Siegelbaum More articles by this author Claire C. Yang More articles by this author Charles M. Feinstein More articles by this author J. Francois Eid More articles by this author Wayne J.G. Hellstrom More articles by this author George T. Ho More articles by this author Abraham Morgentaler More articles by this author Arnold Melman More articles by this author Robert Hackler More articles by this author Stewart W. McCallum More articles by this author Expand All Advertisement PDF DownloadLoading ...