Medical pre-operative considerations for patients undergoing penile implantation

Masterson, Thomas A.; Palmer, Joseph; Dubin, Justin M.; Ramasamy, Ranjith

doi:10.21037/tau.2017.03.85

Cited by 13 publications

(7 citation statements)

References 40 publications

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“…In general, it is recommended that in elective, higher-risk procedures, medications like warfarin or clopidogrel be stopped at least 5 days preoperatively while NOACs be discontinued 2-5 days prior. Anticoagulation/antiplatelet guidelines for prosthetic surgery do not exist beyond stating therapies can be resumed based on clinician gestalt 42 . Furthermore, the AUA guidelines on the surgical management of ED do not provide clarity in labelling implant surgery as either a low or high-risk procedure for hemorrhagic complications 41 .…”

Section: Discussionmentioning

confidence: 99%

Defining the Incidence and Management of Postoperative Scrotal Hematoma after Primary and Complex Three-piece Inflatable Penile Prosthesis Surgery

Simhan

Braun

Swerdloff³

et al. 2022

Preprint

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Background: Scrotal hematoma is a challenging complication of penile prosthesis surgery. We characterize the risk of hematoma formation with implementation of standardized techniques to mitigate hematomas and assess for any associated factors in a large multi-institutional penile implant cohort. Materials and Methods: A retrospective review from February 2018 to December 2020 of all patients who underwent inflatable penile prosthesis (IPP)implantation at 2 high volume implant centers was conducted. Cases were defined as ‘complex’ if they involved revision, salvage with removal/replacement, or were performed with concurrent penile, scrotal or intra-abdominal surgeries. The incidence of scrotal hematoma among primary and complex IPP recipients was measured and modifiable and innate risk factors associated with hematoma formation within the two cohorts were tracked. Results: Of 246 men who underwent IPP, 194 (78.9%) patients underwent primary implantation and 52 (21.1%) were complex. Although patients in the complex group had comparable drain outputs to non-hematoma patients on POD0 (66.8cc vs 49.6, p=0.488) and POD1 (20.0cc vs 40.3, p=0.114), hematomas in the complex group had a higher propensity for OR evacuation (p=0.03). Difference in duration of temporary device inflation between 2 and 4 weeks did not contribute to hematoma formation. Postoperative hematoma formation in complex cases (5/52, 9.6%) trended towards a higher incidence than primary cases (7/194, 3.1%) (HR=2.61, p=0.072). Conclusions: Complex IPP surgery performed for revision or with ancillary procedures are more likely to result in clinically significant hematomas that require surgical management, suggesting a need for heightened caution in managing these individuals.

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Section: Discussionmentioning

confidence: 99%

Defining the Incidence and Management of Postoperative Scrotal Hematoma after Primary and Complex Three-piece Inflatable Penile Prosthesis Surgery

Simhan

Braun

Swerdloff³

et al. 2022

Preprint

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“…They state in the preoperative setting there is need for: (I) cardiology/medical clearance; (II) urine culture; (III) HbA1c <10; (IV) stop antiplatelet seven days prior to surgery. However, they state that they are also comfortable for doing surgery under aspirin 81 mg ( 31 ).…”

Section: Cvdmentioning

confidence: 99%

“…In patients with a significant cardiovascular history, preoperative work-up together with a cardiologist and anesthesiologist should be performed, e.g., based on the Princeton Consensus Conference ( 22 ). The checklist by Masterson et al is a simple and easy to use preoperative tool, including the medical clearance by a cardiologist and a guide for anticoagulant or antiplatelet medication ( 31 ).…”

Section: Cvdmentioning

confidence: 99%

Penile prosthesis in the medically complex patient: a narrative review

Van Huele,

Van Renterghem

2023

Transl Androl Urol

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Background and Objective Penile prosthesis surgery is considered a safe and effective treatment for patients with erectile dysfunction. Implantation in the medically complex patient can be a challenge. The benefits of treatment must outweigh the possible risks or complications. A description of possible problems and how to cope with them is given in this narrative review. Methods Literature search was performed in January 2023 using different search prompts in PubMed. These articles, excluding non-English and non-full text articles, were listed by the two authors and afterwards, the most relevant ones were included. Key Content and Findings This article is divided into five important topics. We evaluated different comorbidities such as spinal cord injury, diabetes mellitus and cardiovascular disease, in which preoperative work-up and counseling is of significant importance. A detailed description of these comorbidities and how to handle these can be found in each section. In addition to the preoperative aspect in organ transplant patients, problems during surgery can arise, e.g., with the reservoir placement. Similarly, in patients with previous pelvic surgery, an ectopic reservoir placement can prevent possible complications. Conclusions Preoperative diagnostics are crucial and prosthetic surgery should be done by an experienced high-volume surgeon with a diverse range of surgical techniques at his disposal.

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“…The evidence for prophylactic antibiotic coverage for an IPP is less than desired, although it is well-established for other surgeries involving foreign bodies [ 13 ]. On this basis, multiple review articles support the use of oral antibiotics (either sulfamethoxazole/trimethoprim or ciprofloxacin) 2 days prior to surgery [ 14 , 15 ]. The steps for preoperative management are included in Table 1 [ 14 ].…”

Section: Preoperative Measuresmentioning

confidence: 99%

Tips and tricks in the management of inflatable penile prosthesis infection: A review

Brimley

Yousif

Kim

2021

Arab Journal of Urology

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Objective:: To review the management of inflatable penile prosthesis (IPP) infection. Methods: The 'gold-standard' treatment for medication-refractory erectile dysfunction is the IPP, wherein the most dreaded complication is infection. To prevent and manage an infected IPP requires a strict protocol during the pre-, intra-, and postoperative course. A variety of techniques and antibiotics are used in conjunction with IPP implantation to prevent contamination. This modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) review of the literature examines the current practices by leading urologists in the management of IPP infection, as well as provides insights for improved patient outcomes. Results: : Patient selection is important to reduce IPP infections, and those with risk factors need to be optimised prior to surgery. Proper antibiotic prophylaxis includes pre-, intra-, and postoperative administration. As most infections derive from normal skin flora, every measure must be taken to sterilise the skin and avoid direct device skin contact. Up to 3% of virgin IPPs develop infections and this number increases to 18% in revision cases. Antibiotic coverage depends on the presenting microbe, which can vary significantly between patients. Conclusions: : A greater success in IPP implantation can be attributed to appropriate prophylaxis, field sterilisation, and surgical technique. For those implants that do become infected, often erectile function can be preserved by immediate antibiotic coverage combined with salvage procedures.

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Medical pre-operative considerations for patients undergoing penile implantation

Cited by 13 publications

References 40 publications

Defining the Incidence and Management of Postoperative Scrotal Hematoma after Primary and Complex Three-piece Inflatable Penile Prosthesis Surgery

Defining the Incidence and Management of Postoperative Scrotal Hematoma after Primary and Complex Three-piece Inflatable Penile Prosthesis Surgery

Penile prosthesis in the medically complex patient: a narrative review

Tips and tricks in the management of inflatable penile prosthesis infection: A review

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