Despite surgical advancements, erectile dysfunction (ED) is a common consequence of radical prostatectomy (RP). This study aimed to evaluate the impact of early penile rehabilitation within a dedicated penile rehabilitation program on assisted and unassisted erectile function (EF) recovery. All patients who underwent RP and at least 1 year follow-up at penile rehabilitation program in the Department of Urology, OORR Policlinico Riuniti (Foggia, Italy) were included. Treatment involved phosphodiesterase type 5 inhibitors (PDE5Is; tadalafil 20 mg, 1 tablet every other day), intracavernous injections (Caverject 5 µg, 1 vial per week), and daily use of vacuum erection devices (VEDs). Primary end point was EF recovery defined as International Index of Erectile Function-5 (IIEF-5) ≥21 with or without rehabilitation aids. IIEF-5 and prescribed treatments were prospectively collected at 3 months, 6 months, 9 months, 12 months, and 24 months. Among 570 eligible patients, 397 (69.6%) underwent rehabilitation. Patients who undergoing andro-rehabilitation were younger (65 months vs 70 months; P < 0.0001), had lower prostate-specific antigen (PSA) levels (5.9 ng ml -1 vs 6.2 ng ml -1 ; P = 0.04), and lower grade tumors ( P = 0.001) compared to the patients who did not undergo sexual rehabilitation after radical prostatectomy. Two-year EF recovery rates in patients undergoing andro-rehabilitation ranged from 75% (preoperative IIEF-5 >16) to 45% (preoperative IIEF-5 <16) with rehabilitation aids. Combination treatments (PDE5I+VEDs with or without intracavernous injections) showed the highest rates of EF recovery (up to 80% at 2 years). EF recovery without rehabilitation aids was significantly higher for patients with IIEF-5 >21 (IIEF-5 >21 [36%] vs IIEF-5 of 17-21 [18%]; P = 0.01). Subanalysis indicated a moderate benefit of rehabilitation in patients with preoperative IIEF-5 <16 who underwent bilateral nerve-sparing RP. Participation in intensive penile rehabilitation programs improves EF recovery in patients undergoing RP. Preserving the neurovascular bundles may be beneficial for patients with preoperative ED.
Humans ; Male ; Prostatectomy/rehabilitation* ; Middle Aged ; Erectile Dysfunction/drug therapy* ; Aged ; Recovery of Function ; Robotic Surgical Procedures/adverse effects* ; Phosphodiesterase 5 Inhibitors/therapeutic use* ; Penile Erection ; Tadalafil/therapeutic use* ; Prostatic Neoplasms/surgery* ; Treatment Outcome

Inflatable penile prostheses are an important tool in the treatment of medically refractory erectile dysfunction. One of the major complications associated with these prostheses is infections, which ultimately require device explanation and placement of a new device. Over the past several decades, significant work has been done to reduce infection rates and optimize treatment strategies to reduce patient morbidity. This article reviews the current state of knowledge surrounding penile prosthesis infections, with attention to the evidence for methods to prevent infection and best practices for device reimplantation.
Anti-Bacterial Agents/therapeutic use* ; Anti-Infective Agents, Local/therapeutic use* ; Antibiotic Prophylaxis/methods* ; Bandages ; Carrier State/drug therapy* ; Chlorhexidine/therapeutic use* ; Coated Materials, Biocompatible ; Device Removal ; Diabetes Mellitus/epidemiology* ; Erectile Dysfunction/surgery* ; Gram-Negative Bacterial Infections/therapy* ; Hair Removal/methods* ; Humans ; Immunocompromised Host/immunology* ; Male ; Penile Implantation/methods* ; Penile Prosthesis ; Preoperative Care/methods* ; Prosthesis-Related Infections/therapy* ; Reoperation ; Risk Factors ; Spinal Cord Injuries/epidemiology* ; Staphylococcal Infections/therapy* ; Staphylococcus aureus ; Staphylococcus epidermidis ; Surgical Drapes ; Surgical Instruments ; Surgical Wound Infection/therapy*

Penile prosthesis implant (PPI) remains an effective and safe treatment option for men with erectile dysfunction (ED). However, PPI surgery can be associated with a higher risk of complications in certain populations. This article provides a critical review of relevant publications pertaining to PPI in men with diabetes, significant corporal fibrosis, spinal cord injury, concurrent continence surgery, and complex salvage cases. The discussion of each category of special populations includes a brief review of the surgical challenges and a practical action-based set of recommendations. While specific patient populations posed considerable challenges in PPI surgery, strict pre- and postoperative management coupled with safe surgical practice is a prerequisite to achieving excellent clinical outcomes and high patient satisfaction rate.
Diabetes Complications ; Diabetes Mellitus ; Erectile Dysfunction/surgery* ; Humans ; Male ; Penile Implantation ; Penile Induration/surgery* ; Penile Prosthesis ; Priapism/surgery* ; Prosthesis-Related Infections/prevention & control* ; Salvage Therapy ; Spinal Cord Injuries/complications* ; Suburethral Slings ; Surgical Wound Infection/prevention & control* ; Urinary Incontinence/surgery* ; Urinary Sphincter, Artificial

This study aimed to evaluate whether adding a vacuum erection device (VED) to regular use of Tadalafil could achieve better penile rehabilitation following posterior urethroplasty for pelvic fracture-related urethral injury (PFUI). Altogether, 78 PFUI patients with erectile dysfunction (ED) after primary posterior urethroplasty were enrolled and divided into two treatment groups: VED combined with Tadalafil (Group 1, n = 36) and Tadalafil only (Group 2, n = 42). Changes in penile length, testosterone level, International Index of Erectile Function-5 (IIEF-5) questionnaire, Quality of Erection Questionnaire (QEQ), and nocturnal penile tumescence (NPT) testing were used to assess erectile function before and after 6 months of ED treatment. Results showed that the addition of VED to regular use of Tadalafil preserved more penile length statistically (0.4 ± 0.9 vs -0.8 ± 0.7 cm, P < 0.01). IIEF-5 score and QEQ score in Group 1 were higher than Group 2 (both P < 0.05). After treatment, 21/36 (58.3%) Group 1 patients and 19/42 (45.2%) Group 2 patients could complete vaginal penetration. Group 1 patients also had markedly improved testosterone levels (P = 0.01). Unexpectedly, there was no significant difference in NPT testing between two therapies. For PFUI patients with ED after posterior urethroplasty, the addition of VED to regular use of Tadalafil could significantly improve their conditions - improving erection and increasing penile length - thus increasing patient satisfaction and confidence in penile rehabilitation.
Adult ; Combined Modality Therapy/methods* ; Erectile Dysfunction/rehabilitation* ; Humans ; Male ; Middle Aged ; Penile Erection ; Penis/surgery* ; Phosphodiesterase 5 Inhibitors/therapeutic use* ; Tadalafil/therapeutic use* ; Treatment Outcome ; Urethra/surgery* ; Vacuum ; Young Adult

The treatment of Peyronie's disease has been a challenge to urologists, as most of the current oral medications are considered hardly valid and the rest of the therapies require strict control of indications, some of which remain controversial, while the final surgical option may be associated with complications such as penile shortening or erectile dysfunction. Collagenase clostridium histolyticum has been proved to be effective in dissolving the penile cavernosal plaque and approved by the Food and Drug Administration of the USA as the first drug to be used for the treatment of Peyronie's disease. This article presents an introduction to the characteristics, safety, efficacy, and procedures of this new treatment, which may benefit urologists and the patients with Peyronie's disease.
Erectile Dysfunction ; etiology ; Humans ; Injections, Intralesional ; Male ; Microbial Collagenase ; therapeutic use ; Penile Induration ; drug therapy ; surgery ; Penis ; Postoperative Complications ; etiology ; Treatment Outcome

Prostate cancer has the highest incidence among malignant tumors of the urinary system in China. Radical prostatectomy (RP) is the most effective treatment for localized prostate cancer with a good long-term prognosis. Erectile dysfunction (ED) is a common complication after RP, which seriously affects the patient's quality of life. With the rising incidence and early diagnosis of prostate cancer, the proportion of young cases of RP is increasing, and so is the importance of the treatment of post-RP ED. The restoration of erectile function after RP is closely related to the timing of penile rehabilitation as well as to pre- and intra-operative measures such as surgical strategies and methods. Common options for the treatment of post-RP ED include oral medication of phosphodiesterase type 5 inhibitors, application of vasoactive substances in the urethra or corpus cavernosum, use of vacuum erection devices, and implantation of penile prosthesis. Stem cell therapy, nerve transplantation, low-intensity extracorporeal shockwave therapy, and erythropoietin have shown great potential in penile rehabilitation after RP. At present, the stress is placed on the remission of symptoms in the treatment of ED. Stem cell therapy may reverse the cause of disease or cure ED by reversing its pathophysiological changes. A series of clinical trials of stem cell therapy are underway and have preliminarily confirmed the safety of stem cell therapy and proved that it can improve erectile function in patients with post-RP ED. This review focuses on the progress in the prevention and treatment of ED after RP.
China ; Erectile Dysfunction ; prevention & control ; therapy ; Humans ; Male ; Penile Erection ; Penile Prosthesis ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Postoperative Complications ; prevention & control ; therapy ; Prostatectomy ; adverse effects ; Prostatic Neoplasms ; surgery ; Quality of Life ; Stem Cell Transplantation ; Treatment Outcome ; Vacuum ; Vasodilator Agents ; therapeutic use

Penile implant usage dates to the 16th century yet penile implants to treat erectile dysfunction did not occur until nearly four centuries later. The modern era of penile implants has progressed rapidly over the past 50 years as physicians' knowledge of effective materials for penile prostheses and surgical techniques has improved. Herein, we describe the history of penile prosthetics and the constant quest to improve the technology. Elements of the design from the first inflatable penile prosthesis by Scott and colleagues and the Small-Carrion malleable penile prosthesis are still found in present iterations of these devices. While there have been significant improvements in penile prosthesis design, the promise of an ideal prosthetic device remains elusive. As other erectile dysfunction therapies emerge, penile prostheses will have to continue to demonstrate a competitive advantage. A particular strength of penile prostheses is their efficacy regardless of etiology, thus allowing treatment of even the most refractory cases.
Biomedical Technology ; Erectile Dysfunction/*surgery/*therapy ; Forecasting ; Humans ; Male ; Penile Implantation/*methods ; Penile Prosthesis/*trends ; Penis/*surgery

OBJECTIVETo compare the incidences of complications associated with 3 different endoscopic procedures, namely transurethral resection of prostate (TURP), bipolar plasmakinetic resection of the prostate (PKRP), and holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH) and assess the clinical value of the Clavien-Dindo classification system for standardizing the evaluation of the complications.

METHODSBetween January 2010 and December 2013, a total of 625 patients with BPH scheduled for endoscopic surgery underwent TURP (214 cases), PKRP (207 cases), or HoLEP (204 cases). The complications were recorded in each group and analyzed using the Clavien-Dindo classification system.

RESULTSThere was no significant difference in the baseline data among the 3 groups (P>0.05). TURP was associated with a higher total incidence rate of complications than PKRP and HoLEP, and the incidences of electrolyte disturbance, massive intraoperative hemorrhage, urinary irritation symptom, urinary blockage, transurethral resection syndrome (TRUS), and erectile dysfunction (ED) differed significantly among the 3 groups (P<0.05). According to Clavien-Dindo classification, the incidence of grade II complications was significantly higher in TURP group than in PKRP and HoLEP groups (P<0.05), and that of grades III and IV complications was significantly higher in TURP group than in HoLEP group (P<0.05); no significant difference was found in grade I or V complications among the 3 groups (P>0.05).

CONCLUSIONAccording to the results of Clavien-Dindo classification analysis, PKRP and HoLEP are associated with fewer complications with a better safety profile in the treatment of BPH. The current Clavien-Dindo classification system can contribute to standardized evaluation of surgical complications but still needs further modifications for better performance.

Blood Loss, Surgical ; Endoscopy ; Erectile Dysfunction ; Holmium ; Humans ; Laser Therapy ; adverse effects ; Male ; Postoperative Complications ; classification ; Prostatic Hyperplasia ; surgery ; Transurethral Resection of Prostate ; adverse effects

OBJECTIVETo explore the clinical value of preserving the integrity of the bladder neck in plasmakinetic vaporization of the prostate (PKVP) in protecting the erectile function and improving the quality of life of patients with benign prostatic hyperplasia (BPH) below 60 years of age.

METHODSThirty-two patients with BPH, with a mean age of 55.4 years (range 50-60 years), were enrolled the study to undergo PKVP with Gyrus bipolar systems, in which the transverse fiber muscle area of the bladder neck were carefully preserved. The erectile function and the quality of life of the patients were evaluated with the International Index of Erectile Function (IIEF)-5 and Quality of Life (QoL) before and after the operation. Retrograde ejaculation was also observed after the operation.

RESULTSIn the 6-month follow-up, only 1 (3.13%) patient was found to have erectile dysfunction. Five patients (15.6%) reported retrograde ejaculation 3 months after the surgery, and only 3 patients (9.4%) had retrograde ejaculation at 6 months.

CONCLUSIONSPreserving the bladder neck in PKVP may protect the erectile function with BPH below 60 years of age.

Erectile Dysfunction ; prevention & control ; Humans ; Laser Therapy ; Male ; Middle Aged ; Organ Sparing Treatments ; Penile Erection ; Prostatic Hyperplasia ; surgery ; Quality of Life ; Urinary Bladder ; Volatilization

OBJECTIVETo investigate the efficacy and safety of vacuum erection device (VED) for erectile dysfunction (ED) after radical prostatectomy (RP).

METHODSSix cases of ED after open RP were reviewed. Three of the patients started a daily rehabilitation protocol using VED 10 min/d within 3 months after RP (group A, early intervention), while the other 3 initiated the same protocol after 12 months (group B, late intervention). We compared the IIEF-5 scores as well as stretched penile lengths and mid-shaft circumferences before and after 3 and 6 months of VED rehabilitation. We also assessed the safety of the device and sexual satisfaction of the patients and their partners.

RESULTSThe mean IIEF-5 score of the six cases was remarkably increased at 3 and 6 months of VED rehabilitation (P < 0.05), significantly higher in group A than in B at 3 months (8.7 +/- 0.6 vs 6.7 +/- 0.6, P < 0.05) and 6 months (13.0 +/- 1.0 vs 8.3 +/- 1.5, P < 0.05). After 6 months of VED rehabilitation, there were no significant changes in stretched penile length or mid-shaft circumference in group A, both significantly decreased in group B (P < 0.05), and sexual satisfaction of the patients and their partners were 83.3% and 50%, respectively. No serious adverse events were observed except mild complaint of pe- nile skin darkening in 1 case and numb feeling during the intercourse in 2.

CONCLUSIONEarly use of VED after RP improves erectile function and helps to preserve the length and mid-shaft circumference of the penis.

Erectile Dysfunction ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Penile Erection ; Prostatectomy ; adverse effects ; rehabilitation ; Prostatic Neoplasms ; rehabilitation ; surgery ; Treatment Outcome ; Vacuum