Penile Hemodynamic Response to Phosphodiesterase Type V Inhibitors after Cavernosal Sparing Inflatable Penile Prosthesis Implantation: A Prospective Randomized Open-Blinded End-Point (PROBE) Study

Forceful corporal dilatation amidst penile prosthesis implantation may injure cavernosal arteries compromising penile vasculature. In this study, we aimed to compare the conventional and cavernosal sparing techniques regarding cavernosal artery preservation. Overall, 33 patients underwent inflatable penile prosthesis implantation with Coloplast Titan Touch® three-piece inflatable penile implants. 16 patients had conventional implantations with serial vigorous dilatations, while 17 patients were implanted with the cavernosal sparing technique, consisting of a single minimal corporal dilatation after an intraoperative intracavernosal injection (ICI) of Alprostadil. Postoperatively, a penile duplex Doppler ultrasound study was performed. Whenever a cavernosal artery was spared and thus successfully probed, its hemodynamics were studied before and after an oral administration of a phosphodiesterase type 5 inhibitor (PDE5i). A cavernosal artery was successfully probed in 16/17 (94%) of patients in the cavernosal sparing group compared to 5/16 (31%) of patients in the conventional group with a significant statistical difference ( P = 0.001 ). This demonstrated that the cavernosal sparing technique was superior to the conventional approach in preserving the cavernosal artery (odds ratio 35.2, 95% IC 3.5–344.2; P = 0.0022 ). Whenever a cavernosal artery could be probed, its hemodynamic responsiveness was also preserved. This trial is registered with NCT03733860.

Assessment of the Algorithms for Diagnostics and the Possibilities of Treating Patients with a Penile Dysmorphie Disorder

The article discusses issues related to the choice of diagnostic algorithms and planning tactics for treating patients with penile dysmorphophobia. The psychological characteristics of this group of patients, methods of diagnosis, psychotherapy correction and the choice of surgical tactics are sounded. The manifestations of penile dysmorphophobia and dysmorphomania, as disorders of a deeper level, are considered as an integrative problem solved from the standpoint of urology, psychotherapy, and aesthetic surgery. In conjunction with an andrologist, the involvement of a psychotherapist and, if necessary, a psychiatrist is required. At the initial stages of working with a patient, narrowly focused psychotherapy is used. The next level of correction is cognitive behavioral psychotherapy (CBT) with the technique of “exposure and prevention of reactions” or “cognitive restructuring”. The “mindfulness CBT” technique is considered important for teaching the patient the ability to stop subjective perception of personal experiences. To consolidate the result, individual hypnosuggestational therapy and group (family) psychotherapy are used. The indications for surgical enlargement of the penis are divided into medical, functional and aesthetic. Penile dysmorphophobia is an aesthetic indication for surgery. Contradictions in carrying out such interventions include the lack of standardized methods with a high positive prognosis, overestimated patient expectations, and the lack of a result to improve a man’s self-esteem even with a positive result of the operation. The clinic of the Department of Sexopathology and Andrology of the State Institution «Institute of Urology of the National Academy of Medical Sciences of Ukraine» uses a ligamentotomy technique to lengthen the penis and implant a polypropylene mesh under the superficial fascia of the penis to thicken it. For patients with manifestations of penile dysmorphophobia simultaneously with severe forms of erectile dysfunction, a number of operations have been proposed for the simultaneous installation of penile implants and augmentation of the tunica albuginea using a graft: corporoplasty with a circular graft, Sliding Technique, modification of the sliding technique (MoST), Multiple-slid-Technique (MuST) augmentation technique. These techniques are not included in the list of recommendations offered by the urological community; they have high predictable risks of complications requiring urgent explantation of the prosthesis and irreversible loss of penile length.

Red man syndrome caused by intracavernous irrigation with vancomycin at the time of placing penile implants

To the Editor, Erectile dysfunction is a condition that affects more than half of men between 40 and 70 years of age. Penile prosthesis (PP) implant is recognized, at present, as the most effective option to obtain an artificial erection satisfactory for sexual intercourse in those patients in which the pharmacological approach is contraindicated or ineffective. [...]

Penile Implants in the Treatment of Peyronie's Disease with Erectile Dysfunction

Background: Peyronie’s disease and erectile dysfunction is common related pathological condition and single treatment for both conditions is the goal. Objective: To report our practice in the managing of patients with Peyronie’s disease associated with erectile dysfunction. Patients and Methods: This study was carried out during the period of 2014-2018, twenty-one adult patients (39-68) years were treated by malleable penile implant surgery. All patients presented with Peyronie’s disease associated with erectile dysfunction. The sorts of additional maneuvers and their achievement in additional straightening the residual curvature have been stated. Results: We deliberate medical conditions that have an association between erectile dysfunction and Peyronie’s disease and performing straightening procedures, modeling was successful in decrease penile curvature and Patient satisfaction rates 80% for both patients, partners have been reported in this literature. Conclusion: However, when Peyronie’s disease exists with ED, the gold standard treatment is penile prosthesis surgery with additional straightening procedures. Keywords: Penile prostheses, Erectile dysfunction, Peyronie’s disease