Challenging Ethical Scenarios in the Surgical Treatment of Erectile Dysfunction: A Survey of High-Volume Penile Prosthesis Surgeons

Mohan, Charan; Sonntag, Elizabeth; Ehlers, Mark; Akerman, Jason; Hayon, Solomon; Figler, Bradley D.; Coward, R. Matthew

doi:10.1016/j.urology.2020.10.053

Cited by 5 publications

(2 citation statements)

References 26 publications

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“…Mohan et al reported survey results of how experienced prosthetic surgeons would approach several challenging clinical scenarios, including two patients with possible cognitive impairment—the first is a patient with Down Syndrome and the second is a non-verbal patient following a stroke ( 47 ). The authors report that providers are half as likely to offer an IPP to patients in these clinical scenarios as they would be to the baseline 50 years old male with medication-refractory ED ( 47 ). However, having a better understanding of the patient’s autonomy, including cognitive capacity to understand their surgery, resulted in higher odds of the provider offering IPP ( 47 ).…”

Section: Discussionmentioning

confidence: 99%

“…The authors report that providers are half as likely to offer an IPP to patients in these clinical scenarios as they would be to the baseline 50 years old male with medication-refractory ED ( 47 ). However, having a better understanding of the patient’s autonomy, including cognitive capacity to understand their surgery, resulted in higher odds of the provider offering IPP ( 47 ). The authors stress the importance of balancing the biomedical ethical principles (autonomy, nonmaleficence, beneficence and justice) during surgical planning ( 48 ); in the scenario of a patient with MCI, autonomy may be the key principle.…”

Section: Discussionmentioning

confidence: 99%

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The impact of cognitive impairment in urologic implants: a narrative review

Bryk,

Zillioux,

Kennady

et al. 2023

Transl Androl Urol

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Background and Objective With the general population aging and thus more patients developing bothersome erectile dysfunction, stress urinary incontinence and overactive bladder, there will likely be a higher demand for three common interactive implants in urology, the penile prosthesis, artificial urinary sphincter (AUS) and sacral neuromodulation (SNM). Further, the prevalence of mild and major neurocognitive disorders (also known as mild cognitive impairment and dementia, respectively) is expected to increase. While the aforementioned urologic implants have excellent short and long term outcomes, there are also known device issues such as malfunction or misuse that may require surgical removal and/or revision. The objective of this narrative review is to describe the association of cognitive impairment and urologic implants. Methods We performed a search on PubMed between the years 1975–2023 for English language articles that reported on any type or severity of cognitive impairment and its association with penile prosthesis, AUS and/or SNM. While peer-reviewed published manuscripts were prioritized, abstracts that fit our search criteria were also included. Key Content and Findings Data assessing outcomes of patients with cognitive impairment who undergo placement of a urologic implant are limited. There is an association between AUS failure or misuse with cognitive impairment. SNM is efficacious in this population in the short term. In patients who develop dementia, an inflatable penile prosthesis can be deflated via in-office needle puncture and an AUS can be deactivated. The Memory Alteration Test, Quick Screen for Mild Cognitive Impairment and the Saint Louis University Mental Status Examination are relatively quick screening tests with good sensitivity and specificity for mild cognitive impairment. Conclusions While data on the association between urologic implants and cognitive impairment are sparse, there are tools that urologists can use to screen patients for cognitive impairment. With screening, urologists can provide appropriate preoperative counseling (including recommending against implantation) and can provide closer postoperative monitoring. Further study is required to assess which patients should be excluded from device implantation and how to properly assess for cognitive impairment in a manner that is both beneficial for the patient and convenient and efficient for a urologist.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The impact of cognitive impairment in urologic implants: a narrative review

Bryk,

Zillioux,

Kennady

et al. 2023

Transl Androl Urol

View full text Add to dashboard Cite

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Ethical Dilemmas in Penile Implant Surgery

Mohan

Coward

2021

The Journal of Sexual Medicine

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The Dilemma of Penile Prosthesis Implantation in Sex Offenders

Zhang

DeWitt-Foy

Jankowski

et al. 2021

The Journal of Sexual Medicine

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Background Penile prosthesis surgeons face an ethical dilemma when confronted with a sex offender who seeks surgical management of erectile dysfunction. Aim To provide practice guidelines to screen and manage patients with a history of sexual violence prior to surgery. Methods Three urologists with expertise in penile prosthesis surgery and 1 medical bioethicist were asked to contribute their opinions and provide recommendations to address this controversial topic. Outcomes Expert opinion supported by analysis of available literature and institutional experience. RESULTS The authors review current United States legislation, published literature on sex offender registration, and institutional data on the prevalence of sex offenders among men seeking penile prosthesis placement. Within a context established by medical bioethical principles, the authors propose a practice guideline for screening sex offenders prior to penile implantation surgery and referral for trained psychological evaluation prior to surgical management. Strengths & Limitations Strengths: multidisciplinary approach in data acquisition including bioethical and legal review. Limitations: Lack of available evidence regarding recidivism risk in sex offenders who undergo penile prosthesis placement. CONCLUSION Sex offenders exist among the population of patients seeking surgical placement of a penile prosthesis. A standardized practice guideline for management of this population should be employed with the intention to reduce future harm.

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Challenging Ethical Scenarios in the Surgical Treatment of Erectile Dysfunction: A Survey of High-Volume Penile Prosthesis Surgeons

Cited by 5 publications

References 26 publications

The impact of cognitive impairment in urologic implants: a narrative review

The impact of cognitive impairment in urologic implants: a narrative review

Ethical Dilemmas in Penile Implant Surgery

The Dilemma of Penile Prosthesis Implantation in Sex Offenders

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