Penile prosthesis in the management of erectile dysfunction following cancer therapy

Dadhich, Pranav; Hockenberry, Mark; Kirby, E. Will; Lipshultz, Larry I.

doi:10.21037/tau.2017.07.05

Cited by 16 publications

(13 citation statements)

References 36 publications

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“…Stress urinary incontinence and ED are common patient ailments treated in a urologist's o ce, and its concomitant presentation can be seen in speci c patient populations, such as those who undergo robotic-assisted prostatectomy for prostate cancer [10]. Speci cally, in post-prostatectomy patients, for instance, the PIVOT study showed at 2-year follow-up, 17% of patients had SUI or required indwelling catheter.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, comparisons between these various approaches have previously been conducted assessing risk factors for complications like infection or mechanical failure; with one technique not de nitively determined to be superior over the other [5][6][7][8][9]. However, in certain populations, such as men who have undergone robotic-assisted prostatectomy [10], the presence of both refractory stress urinary incontinence and severe ED may require surgical correction with the use of an IPP and a continence device such as an AUS or urethral sling. The synchronous dual implantation of an IPP and arti cial urinary sphincter (AUS) or bulbourethral sling has previously shown to be effective for concomitant treatment of erectile dysfunction (ED) and SUI [11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

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Complication rates in concurrent inflatable penile prosthesis and incontinence surgery: Comparing the penoscrotal versus perineal incision approach

et al. 2022

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Introduction: Limited data exist on in atable penile prosthesis (IPP) complication rates following dual implantation with an arti cial urinary sphincter (AUS) or bulbourethral male sling via a single perineal incision. Herein, we assess IPP complication rates after dual implantation via a single perineal incision versus more traditional penoscrotal approach.Methods: Patients with dual implantations of an IPP and AUS or sling between the 2011-2021 were identi ed. Postoperative IPP complications were assessed using the Clavien-Dindo (CD) classi cation at <30 days, 30 days-6 months, and >6 months. Treatment satisfaction was assessed using the validated EDITS questionnaire. IPP complication rates and mean EDITS scores were compared between the perineal and penoscrotal groups.Results: A total of 38 patients underwent dual implantation; 24 perineal vs 14 penoscrotal. There was no statistical difference in rate of complications between the two groups. The penoscrotal group had only two CD Grade I complications reported in the 30-day period and one Grade III complication in the >30 day to 6-month postoperative period. The perineal group had only two Grade III reported complications in the >6 month time frame. One patient in the perineal group and two in the penoscrotal group reported device malfunction at any point during follow-up, with no statistical difference in the rate of device malfunction.Conclusion: Patients undergoing dual IPP and AUS/sling placement via a perineal vs penoscrotal incision had similar IPP complication rates. A single perineal incision is a viable surgical approach for the dual implantation of an IPP and AUS or bulbourethral male sling.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Complication rates in concurrent inflatable penile prosthesis and incontinence surgery: Comparing the penoscrotal versus perineal incision approach

et al. 2022

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“…Several clinical studies about penile rehabilitation followed, mainly focusing on common erectile aids e.g., oral phosphodiesterase type 5 inhibitors (PDE5-I), ICI therapy, intraurethral alprostadil [Medicated Urethral System for Erection (MUSE®)] therapy, and vacuum erection devices (VED) (11,12). For men who fail these more conservative strategies, inflatable penile prosthesis implantation might be a definitive ED treatment (13) with an excellent cost-effectiveness (14). The basic idea of the aforementioned more conservative strategies of penile rehabilitation is prevention of hypoxia in the penile tissue related to cavernous nerve neuropraxia after RP which leads to fibrosis and atrophy of the corporal smooth muscle cells (15).…”

Section: Original Articlementioning

confidence: 99%

Association between masturbation and functional outcome in the postoperative course after nerve-sparing radical prostatectomy

Meissner¹,

Dumler²,

Kron³

et al. 2020

Transl Androl Urol

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Background: Penile rehabilitation after nerve-sparing radical prostatectomy (nsRP) improves the functional outcome, i.e., erectile function and urinary continence. Masturbation as a concept of penile rehabilitation has been practically not investigated. The aim of this observational and explorative study was to evaluate the association between masturbation and the recovery of the functional outcome in patients after nsRP.Methods: Patients after nsRP (11/2013-3/2016) with preoperative International Erectile Function Score-Erectile Function (IIEF-EF) of ≥22 and/or Erection Hardness Score (EHS) of ≥3 without neo-or adjuvant therapy were included in this analysis. Patients were classified according to their masturbation behavior (yes: m; no: nm). Chi-square tests were used to test for association between masturbation and functional outcome.The main outcome measures were rates of erectile function, morning erections, and urinary continence 6, 12, 24, and 36 months after nsRP.Results: A total of 250 preoperatively potent patients with median age of 63.8 years (1 st , 3 rd quartile: 59.1, 69.6) at nsRP were included. After 24 months, m-patients had a numerically higher rate of moderate to good erectile function compared to nm-patients (47.5% vs. 37.5%; P=0.193) and had morning erections more often than nm-patients (54.6% vs. 34.9%; P=0.011). Urinary continence rate 12 months after nsRP was higher compared to nm-patients (12 months: 83.1% vs. 70.2%; P=0.042).Conclusions: Masturbation might be a promising approach of both erectile function and urinary continence recovery, and patients could be encouraged to masturbate after nsRP. However, due to the study design, causality cannot be concluded. Thus, masturbation as a possible concept of penile rehabilitation warrants further investigation.

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“…Penile rehabilitation programs are also increasingly used, although there is no standard rehabilitation protocol and a lack of evidence of efficacy [10]. Penile implants can provide effective early sexual rehabilitation and improve quality of life without compromising surgical outcomes, although utilisation is low [11].…”

Section: Introductionmentioning

confidence: 99%

Experiences of Support for Sexual Dysfunction in Men with Prostate Cancer: Findings from a U.K.-Wide Mixed Methods Study

Watson

Wilding

Matheson

et al. 2021

The Journal of Sexual Medicine

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Background Men with prostate cancer (PCa) often experience sexual dysfunction following diagnosis and treatment, yet little is known about the support they receive to deal with this. Aim To explore men’s experiences of support for sexual dysfunction following PCa diagnosis. Methods This study included a U.K.-wide survey of men 18–42 months post-diagnosis of PCa, identified through cancer registries. The survey measured sexual function and the extent to which men perceived sexual dysfunction to be a problem (Expanded Prostate Cancer Index Composite-26), access to and experience of medications, devices, and specialist services for sexual dysfunction, and included a free-text question for further comments. Analysis focussed on men who reported poor sexual function, which they considered a moderate or big problem. Descriptive statistics explored the characteristics of men offered intervention and those that found this helpful. Free-text responses were analyzed using thematic analysis. Outcome The main outcome of this study was to assess access to and experience of medications, devices, and specialist services for sexual dysfunction. RESULTS 39.0% of all survey respondents (13,978/35,823) reported poor sexual function, which they considered a moderate or big problem. 51.7% of these men were not offered any intervention to aid sexual functioning. 71.9% of those offered an intervention reported trying it, of whom 48.7% found the intervention helpful. Men treated with surgery or brachytherapy were most likely to be offered an intervention. Medication was the most commonly offered intervention and 39.3% of those who tried medication found this helpful. Although offered less often, approximately half of the men who tried devices or attended specialist services found the intervention helpful. Free-text responses indicated that barriers to accessing support included inadequate information and support from healthcare professionals, embarrassment, negative views about treatment options, concerns about side effects and safety, and inconsistencies between secondary and primary care. Barriers to continuing use included limited effectiveness of treatments, inadequate ongoing support, and funding constraints. Drivers of sexual recovery included patient proactivity and persistence with trying different treatment options and ongoing support from health professionals. Clinical Implications There is an urgent need to ensure that all men are offered, and have equal access to, sexual care support, with referral to specialist services when required. Strengths & Limitations This study presents data from a large, U.K.-wide, population-based study of men with PCa and includes quantitative and qualitative findings. The possibility of non-response bias should, however, be considered. CONCLUSION There are significant shortcomings in the support offered to U.K. men with sexual dysfunction following diagnosis and treatment for PCa which need to be addressed.

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Penile prosthesis in the management of erectile dysfunction following cancer therapy

Cited by 16 publications

References 36 publications

Complication rates in concurrent inflatable penile prosthesis and incontinence surgery: Comparing the penoscrotal versus perineal incision approach

Complication rates in concurrent inflatable penile prosthesis and incontinence surgery: Comparing the penoscrotal versus perineal incision approach

Association between masturbation and functional outcome in the postoperative course after nerve-sparing radical prostatectomy

Experiences of Support for Sexual Dysfunction in Men with Prostate Cancer: Findings from a U.K.-Wide Mixed Methods Study

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