scholarly journals Chronic pain associated with penile prostheses may persist despite revision or explantation

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Jeffrey D. Campbell ◽  
Ernest Pang Chan ◽  
Andrew Di Pierdominico ◽  
Serkan Karakus ◽  
Bruce Trock ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Surgical Intervention ◽  
Penile Prosthesis ◽  
Pain Syndrome ◽  
High Volume ◽  
Persistent Pain ◽  
Self Report ◽  
Inflatable Penile Prosthesis ◽  
Penile Prostheses ◽  
Primary Indication

Introduction: Inflatable penile prosthesis (IPP) implantation is the gold-standard treatment for medically refractory erectile dysfunction. New chronic pain after IPP implantation is rarely discussed and the optimal treatment is unclear. We evaluated whether IPP reoperation for a primary indication of chronic pain improves patients’ symptoms. Our secondary aim was to explore factors associated with resolution or persistence of pain after IPP reoperation. Methods: We conducted a retrospective analysis of 315 patients who had an IPP revision or explantation at two high-volume prosthetic centers between May 2007 and May 2017. We excluded patients who had device malfunction, pain for <2 months, pain associated with infection or erosion, and patients without long-term followup data. Persistent pain was diagnosed based on patient self-report. Results: A total of 31 patients met our criteria for having undergone a surgical revision (n=18) or explantation (n=13) for pain relief. Eighteen (58%) patients had persistent pain despite surgical intervention. Only patients who had pain secondary to a device malposition improved after reoperation (n=13). A prior diagnosis of a chronic pain syndrome was associated with persistent pain despite intervention. Pain improvement was not associated with age, comorbid conditions, duration of implant, or the number of surgical revisions performed. Conclusions: Surgical intervention for chronic penile prosthesis pain is unlikely to relieve symptoms, particularly for patients with chronic pain disorders. Patients should be counselled that IPP reoperative procedures as a treatment for pain should be avoided unless the device is identified to be malpositioned, and consideration of alternative therapeutic options may be more beneficial.

scholarly journals MP32-14 NEW FINDINGS REGARDING THE TIMELINE OF MICROORGANISMS, INFECTION SEVERITY AND SURGICAL INTERVENTION IN INFLATABLE PENILE PROSTHESIS INFECTIONS

2018 ◽  
Vol 199 (4S) ◽  
Author(s):  
Martin Gross ◽  
Jason Greenfield ◽  
Laurence Levine ◽  
Joseph Alukal ◽  
William Conners ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Penile Prosthesis ◽  
Inflatable Penile Prosthesis ◽  
New Findings

047 Inflatable Penile Prosthesis Using Rear-Tip Extenders: Device Outcomes with 5-Year Follow-Up Data from a Single High-Volume Implanter

2019 ◽  
Vol 16 (4) ◽  
pp. S25
Author(s):  
W.J.G. Hellstrom ◽  
A. Gabrielson ◽  
N. Scherzer ◽  
L. Alzweri ◽  
J. Greenberg ◽  
...  
Keyword(s):  
Penile Prosthesis ◽  
High Volume ◽  
Inflatable Penile Prosthesis

scholarly journals An update on the best approaches to prevent complications in penile prosthesis recipients

2019 ◽  
Vol 11 ◽  
pp. 175628721881807 ◽  
Author(s):  
Sarah C. Krzastek ◽  
Ryan Smith
Keyword(s):  
Erectile Dysfunction ◽  
Patient Selection ◽  
Penile Prosthesis ◽  
Inflatable Penile Prosthesis ◽  
Device Implantation ◽  
Penile Prostheses ◽  
Operative Complications ◽  
Partner Satisfaction

Placement of inflatable penile prosthesis is a procedure frequently performed for medication-refractory erectile dysfunction. Device implantation is not without risks, and as the frequency of device implantation increases, so do associated complications. The aim of this work is to review the most frequent operative complications associated with implantation of inflatable penile prostheses, and to review the best approaches to prevent these most common complications. Complications can broadly be categorized as infectious, noninfectious tissue-related, device-related, or related to patient and partner satisfaction. With understanding of these complications and ways to avoid them, as well as with appropriate patient selection and counseling, the inflatable penile prosthesis is an excellent option for the treatment of erectile dysfunction.

Literature Review

1999 ◽  
Vol 4 (4) ◽  
pp. 7-11
Keyword(s):  
Chronic Pain ◽  
Pain Syndrome ◽  
Persistent Pain ◽  
Maladaptive Behavior ◽  
Final Report ◽  
Chronic Pain Syndrome ◽  
Psychosocial Consequences ◽  
Chronic Pain Patients ◽  
Essential Questions ◽  
Pain Patients

Abstract Pain is the most common presenting complaint at an impairment evaluation. In the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), the term chronic pain is synonymous with chronic pain syndrome. The AMA Guides differentiates between pain of longstanding duration, termed persistent pain, and chronic pain syndrome, which is characterized as “the devastating and recalcitrant type [of pain] with major psychosocial consequences.” Persistent pain may exist in the absence of chronic pain syndrome, but chronic pain syndrome always presumes the presence of persistent pain, according to the AMA Guides. The assessment of chronic pain syndrome involves a multidimensional approach, and a physical examination alone may be misleading. Chronic pain syndrome is a biopsychosocial phenomenon of maladaptive behavior, and the AMA Guides describes diagnostic criteria for chronic pain syndrome. In addition, this article includes a checklist of characteristics shared by chronic pain patients, along with a list of essential questions that evaluators can ask in assessing pain and a list of pain, behavioral, and psychological inventories commonly used in independent medical evaluations. Physicians should choose a battery that is consistent with the needs of the assessment, and the final report should explain the findings and significance of the inventories used.

scholarly journals Complications of Inflatable Penile Prostheses Implantation Classified according to the Modified Clavien System

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Ioannis Vakalopoulos ◽  
Spyridon Kampantais ◽  
Konstantinos Gkagkalidis ◽  
Stavros Ioannidis ◽  
Georgios Dimitriadis ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Adverse Events ◽  
Classification System ◽  
Treatment Options ◽  
Penile Prosthesis ◽  
Late Complications ◽  
Inflatable Penile Prosthesis ◽  
System A ◽  
Penile Prostheses

Introduction. In patients with erectile dysfunction (ED), inflatable penile prosthesis (IPP) surgery is regarded as the gold standard treatment in medically refractory cases or where its conservative treatment options are contraindicated. Despite improvements in surgical technique and implanted materials, IPP surgery retains a substantial complication rate. The aim of the study was to record and grade the postoperative complications of IPP implantation according to a modified Clavien system. Methods. A total of 60 three-piece IPP implantations were performed between 2007 and 2013 by a single surgeon. The primary outcome was to stratify the early (first 30 days) complications into five categories using the modified Clavien-Dindo classification system. A secondary aim was to record the long-term adverse events and to identify possible factors related to complication occurrence. Results. Overall, there were 21 (35%) postoperative complications in 17 of 60 men (28.3%), with 15 adverse events occurring early after surgery. In terms of late complications, there were six (10%) major complications managed by either revision surgery or removal of the prosthesis. Conclusion. This study utilizes a validated morbidity scale thus overcoming problems of previous studies reporting IPP surgery complications. The modified Clavien classification system easily aids in assessing and comparing accurately patients’ postoperative complications, thus improving management and prevention.

scholarly journals Contemporary Patient Satisfaction Rates for Three-Piece Inflatable Penile Prostheses

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Raymond M. Bernal ◽  
Gerard D. Henry
Keyword(s):  
Patient Satisfaction ◽  
Erectile Dysfunction ◽  
Penile Prosthesis ◽  
Surgical Approaches ◽  
Patient Dissatisfaction ◽  
Inflatable Penile Prosthesis ◽  
Penile Prostheses ◽  
The Many ◽  
Data Collation ◽  
Satisfaction Rates

Among the many treatments for erectile dysfunction, implantation of a penile prosthesis has been associated with high patient satisfaction rates. Specifically, the placement of a three-piece inflatable penile prosthesis (IPP) confers the highest rates of satisfaction. We reviewed the literature over the past 20 years regarding satisfaction rates for penile prostheses, with a focus on patients who had undergone an initial IPP implantation for erectile dysfunction. In all, 194 articles were reviewed, and of these, nine met inclusion criteria for analysis and data collation. We determined contemporary satisfaction rates to reflect patients’ experiences with newer products and surgical approaches. Of importance, we noted that varied metrics were used to determine patient satisfaction, and overall satisfaction could not be precisely determined. Nevertheless, we found that patients in general were quite satisfied with their three-piece IPPs and restoration of sexual function. We also identified reasons for patient dissatisfaction and reviewed the literature to find ways by which satisfaction could be improved. Given the various means by which patient satisfaction was determined, future efforts should include standardized and validated questionnaires.

scholarly journals Dual Implantation of Artificial Urinary Sphincter and Inflatable Penile Prostheses for Concurrent Male Urinary Incontinence and Erectile Dysfunction

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Tariq F. Al-Shaiji
Keyword(s):  
Urinary Incontinence ◽  
Erectile Dysfunction ◽  
Surgical Techniques ◽  
Cost Savings ◽  
Penile Prosthesis ◽  
Artificial Urinary Sphincter ◽  
Inflatable Penile Prosthesis ◽  
Penile Prostheses ◽  
Urinary Sphincter ◽  
Negative Effect

Erectile dysfunction and urinary incontinence secondary to sphincter dysfunction are common conditions affecting many men worldwide with a negative effect on quality of life. They are encountered in a number of etiologies most commonly following radical prostatectomy in which they coexist in the same patient. Implantations of an artificial urinary sphincter and inflatable penile prosthesis have proven to be effective in the treatment of both conditions should conservative and minimally invasive measures fail. The recent literature has shown that dual implantation of these devices is feasible and safe with a durable clinical outcome. Once indicated, this can be done in a synchronous or nonsynchronous manner; however, the emerging of the single transverse scrotal incision as well as advancement in the prostheses has made synchronous dual implantation more favourable and appealing option. It provides time and cost savings with an evidence of high patient satisfaction. Synchronous dual implantation should be offered initially when indicated. This paper discusses the surgical techniques of artificial urinary sphincter and inflatable penile prosthesis dual implantation in the management of concurrent moderate-to-severe urinary incontinence and medically refractive erectile dysfunction, in addition to highlighting the existing literature pertaining to this approach.

212 The Relationship Between Infection Severity, Microorganisms, and Surgical Intervention in Inflatable Penile Prosthesis Infections

2018 ◽  
Vol 15 (2) ◽  
pp. S70
Author(s):  
M.S. Gross ◽  
J.M. Greenfield ◽  
L.A. Levine ◽  
J. Alukal ◽  
W.P. Conners ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Penile Prosthesis ◽  
Inflatable Penile Prosthesis ◽  
The Relationship

scholarly journals P118 Orthopaedic surgical interventions in a cohort of patients with hypermobility related disorders, compared with chronic pain syndrome patients in a tertiary referral centre

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Sarah Wright ◽  
Puja Mehta ◽  
Anisur Rahman ◽  
Hanadi Kazkaz
Keyword(s):  
Chronic Pain ◽  
Surgical Procedures ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Referral Centre ◽  
Beighton Score ◽  
Tertiary Referral Centre ◽  
Surgical Interventions ◽  
Pain Syndromes ◽  
Chronic Pain Syndromes

Abstract Background Mechanisms of pain associated with hypermobility are poorly understood and include nociceptive pain due to structural joint changes, neuropathic pain due to disrupted proprioception, muscle weakness and central sensitisation. The influence of anxiety and low mood is also unknown. There is limited published evidence regarding orthopaedic interventions in hypermobile patients particularly following the updated 2017 Ehlers-Danlos syndrome (EDS) classification criteria. We aimed to evaluate the characteristics of a hypermobility patient cohort who had received surgical interventions and compare these with a patient population with chronic pain syndromes. Methods A retrospective analysis of medical records was conducted of patients attending a tertiary referral centre (University College London Hospital) between January 2018 and December 2018. A hypermobility-related disorders cohort was compared with a cohort of patients with chronic pain syndrome, including fibromyalgia (but without any evidence of hypermobility). Results There were 350 patients (300 females, 50 males) in the hypermobility cohort with a mean age of 36 years (range 18-71 years) at time of clinic review. 63% had hypermobility spectrum disorder or hypermobility syndrome and 37% had EDS (hypermobile, classic, vascular and other rare types). 24% of hypermobile patients had undergone orthopaedic interventions. The Beighton score did not correlate with surgical procedures. 134 patients (121 females, 13 males) with chronic pain syndromes were identified, with a mean age of 51 years (range 26-85 years). 16% of chronic pain patients had received orthopaedic surgery. 76% of hypermobile patients who had orthopaedic interventions were under 50 years old, compared to 23% in the chronic pain cohort. The total number of surgical procedures in the hypermobility cohort was 227 (0.6485 interventions per patient) compared with 25 in the chronic pain cohort (0.1865 interventions per patient); relative risk 3.477 (95% CI 2.42-4.99; P &lt; 0.0001, chi-squared test). 33% of hypermobile patients had surgery on two or more joint groups (including 8 patients who had surgery in four or more joint groups), whereas 95% of chronic patients had surgery on only one joint group. In the hypermobile group the knee (23%) and hips (24%) were the most common site of operative intervention; however in the chronic pain cohort the most common sites were the knee (32%), spine (20%) and shoulders (20%), with only 4% requiring hip surgery. Conclusion Patients with hypermobility have a greater number of surgical procedures at multiple joint sites and at a younger age than patients with chronic pain syndromes, suggesting that mechanical pathology (rather than pain alone) and anticipated surgical success may contribute to the need for surgical intervention. The Beighton score does not appear to be a reliable predictor of surgical intervention. Earlier diagnosis and a holistic, non-operative approach, including physiotherapy and pain management, may reduce the need for surgical procedures. Disclosures S. Wright None. P. Mehta None. A. Rahman None. H. Kazkaz None.

scholarly journals Inflatable Penile Prosthesis Insertion in Men with Severe Intracorporal Fibrosis

2016 ◽  
Vol 10 (2) ◽  
pp. 92-96 ◽  
Author(s):  
Bruce B. Garber ◽  
Caitlin Lim
Keyword(s):  
Surgical Technique ◽  
Surgical Approach ◽  
Surgical Techniques ◽  
Penile Prosthesis ◽  
High Volume ◽  
Successful Outcome ◽  
Prosthetic Infection ◽  
Inflatable Penile Prosthesis ◽  
The Subject ◽  
Failed Attempt

Objectives: To retrospectively review a series of men who underwent attempted inflatable penile prosthesis (IPP) insertion into severely scarred corpora, and to analyze the surgical techniques and instruments that contributed to a successful outcome. Patients and Methods: All IPP procedures done by a high-volume prosthetic surgeon during a 5-year period were retrospectively reviewed. Fourteen patients with severe intracorporal fibrosis underwent 15 attempted IPP insertion procedures, and are the subject of this review. Results: A standardized surgical approach was employed for all patients. Thirteen of the 15 procedures were successful (i.e., an IPP was inserted, with satisfactory cylinder position). One procedure failed due to corporal obliteration. One patient underwent an initial failed attempt, but was successfully implanted 10 months later. Two of the 14 patients (14%) developed peri-prosthetic infection and were explanted. Conclusion: IPP insertion into scarred corpora is difficult and occasionally impossible. We have developed a standardized surgical approach for these cases, using limited corporal excavation, followed by the use of sequential Uramix and then Carrion-Rossello cavernotomes, that we feel has improved our chance of a successful implant. However, due to the rarity of these cases, it is not possible to make definitive statements concerning the optimal surgical technique.

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