Translating Penile Erectile Hydraulics to Clinical Application in Inflatable Penile Prosthesis Implant

Lee

Liu

et al. 2021

World J Mens Health

Self Cite

Published literature shows low intensity extracorporeal shock wave therapy (LIESWT) and low intensity pulsed ultrasound (LI-PUS) therapy to improve erectile function and penile hemodynamic by inducing neovascularisation and promoting tissue regeneration. Key opinion leaders across the Asia Pacific region attended the recent biennial meeting of the Asia Pacific Society for Sexual Medicine in Australia, and presented the current evidence on LIESWT and LIPUS for erectile dysfunction (ED). The clinical findings were internally discussed, and the quality of evidence was graded based on the Oxford Centre for Evidence-Based Medicine recommendations. Existing literature supports the use of LIESWT and LIPUS in men with ED, with many clinical studies reported encouraging results with improved erectile function, good safety profile and short-term durability. However, controversial exists due to sampling heterogeneity, non-standardised treatment protocol and lack of large multiinstitutional studies. There is a need to better define which subgroup of ED population is best-suited, and specific treatment protocol to optimise shock wave energy delivery. More stringent and larger multi-institutional randomised placebo-controlled trials are warranted before clinical adoption of LIESWT and LIPUS as the new standard of care for men with ED.

Section: Introductionmentioning

confidence: 99%

Clinical Practice Guideline Recommendation on the Use of Low Intensity Extracorporeal Shock Wave Therapy and Low Intensity Pulsed Ultrasound Shock Wave Therapy to Treat Erectile Dysfunction: The Asia-Pacific Society for Sexual Medicine Position Statement

Lee

Liu

et al. 2021

World J Mens Health

Self Cite

“…A malleable penile prosthesis is involves easier to perform surgical procedures, has fewer mechanical issues, and costs less than an inflatable penile prosthesis. However, the inflatable PPI is often regarded as a superior device as its mechanics simulate a more natural penile erection and provide a larger penile size when the device is fully inflated 25 . Contemporary literature regarding long-term follow-up on inflatable PPI shows close to 80% mechanical survival at 10 years for primary implants, up to 10% risk of surgical complications, and more than 85% patient satisfaction rates 26–31 .…”

Section: Methodsmentioning

confidence: 99%

“…The PPI should be offered to men who have medical refractory ED or wish to undergo a definitive surgical treatment 1–3 , 25 . Men with ED should undergo routine blood tests to screen for potential cardiometabolic diseases such as diabetes mellitus (DM) and hypogonadism 1 , 2 , 32 , 33 since the presence of ED itself serves as an important marker for predicting future cardiovascular disease 32 , 33 .…”

Section: Methodsmentioning

confidence: 99%

Clinical recommendations on penile reconstructive and prosthetic surgery: a consensus statement from the Asia-Pacific Society of Sexual Medicine

Jiang

et al. 2023

Sexual Medicine

Introduction Penile reconstructive and prosthetic surgery remains a highly specialized field where potential complications can be devastating, and unrealistic patient expectations can often be difficult to manage. Furthermore, surgical practice can vary depending on locoregional expertise and sociocultural factors. Methods The Asia Pacific Society of Sexual Medicine (APSSM) panel of experts reviewed contemporary evidence regarding penile reconstructive and prosthetic surgery with an emphasis on key issues relevant to the Asia-Pacific (AP) region and developed a consensus statement and set of clinical practice recommendations on behalf of the APSSM. The Medline and EMBASE databases were searched using the following terms: “penile prosthesis implant,” “Peyronie’s disease,” “penile lengthening,” “penile augmentation,” “penile enlargement,” “buried penis,” “penile disorders,” “penile trauma,” “transgender,” and “penile reconstruction” between January 2001 and June 2022. A modified Delphi method was undertaken, and the panel evaluated, agreed, and provided consensus statements on clinically relevant penile reconstructive and prosthetic surgery, namely (1) penile prosthesis implantation, (2) Peyronie’s disease, (3) penile trauma, (4) gender-affirming (phalloplasty) surgery, and (5) penile esthetic (length and/or girth enlargement) surgery. Main outcome measures Outcomes were specific statements and clinical recommendations according to the Oxford Centre for Evidence-Based Medicine, and if clinical evidence is lacking, a consensus agreement is adopted. The panel provided statements on clinical aspects of surgical management in penile reconstructive and prosthetic surgery. Results There is a variation in surgical algorithms in patients based on sociocultural characteristics and the availability of local resources. Performing preoperative counseling and obtaining adequate informed consent are paramount and should be conducted to discuss various treatment options, including the pros and cons of each surgical intervention. Patients should be provided with information regarding potential complications related to surgery, and strict adherence to safe surgical principles, preoperative optimization of medical comorbidities and stringent postoperative care are important to improve patient satisfaction rates. For complex patients, surgical intervention should ideally be referred and performed by expert high-volume surgeons to maximize clinical outcomes. Clinical implications Due to the uneven distribution of surgical access and expertise across the AP region, development of relevant comprehensive surgical protocols and regular training programs is desirable. Strengths and Limitations This consensus statement covers comprehensive penile reconstructive and prosthetic surgery topics and is endorsed by the APSSM. The variations in surgical algorithms and lack of sufficient high-level evidence in these areas could be stated as a limitation. Conclusion This APSSM consensus statement provides clinical recommendations on the surgical management of various penile reconstructive and prosthetic surgeries. The APSSM advocates for surgeons in AP to individualize surgical options based on patient condition(s) and needs, surgeon expertise, and local resources.

“…The malleable penile prosthesis is an ideal option for those who are physically handicapped with poor hand dexterity or limited finger movement, complain of muscle fatigue (as in neurological disorders), or have limited reach or range of mobility (e.g., spinal patients). While malleable penile prosthesis implants have poor concealment, they are cheaper than inflatable penile prosthesis and have a lower mechanical failure rate due to their minimal components [23].…”

Section: Current Standard Erectile Dysfunction Therapymentioning

confidence: 99%

A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction

2019

Medical Sciences

Contemporary treatment algorithms for erectile dysfunction (ED) involve the use of medical therapies such as phosphodiesterase type 5 (PDE5) inhibitors and intracavernosal injection therapy of vasoactive agents, as well as vacuum erection devices and penile prosthesis implants in medically refractory cases. However, the current therapeutic options only address the symptoms of ED and not the underlying pathogenesis that results in ED. Newer and novel ED therapies aspire to reverse ED conditions by preventing cavernosal fibrosis, promoting endothelial revascularization and modulating various neuro-hormonal pathways. Regenerative therapeutic strategies such as low-intensity shock wave, gene and cellular-based therapies, and penile transplants are designed to improve penile hemodynamics and revitalize the cavernosal smooth muscle to mitigate and/or reverse underlying ED. This state-of-art article evaluates current and emerging therapeutic options for ED.