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Taymour Mostafa - One of the best experts on this subject based on the ideXlab platform.
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spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:Abstract Introduction Spontaneous penile tumescence after penile Prosthesis Implantation has been sporadically reported in the literature. Aim To preserve residual erectile function of patients’ spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation. Methods Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable penile Prosthesis Implantation, and patients undergoing the cavernous tissue–sparing technique. 1 month after surgery, these patients underwent penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced penile tumescence. Main Outcome Measures Postoperative changes were compared with the preoperative ones. Results The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue–sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P Clinical Implications This study provides a step-by-step approach to maintaining post-Implantation penile tumescence and preserving penile girth in a reproducible manner. Strengths & Limitations This is the first study to demonstrate the benefits of implanting a penile Prosthesis while the penis is in a pharmacologically induced tumescent state. It is also the first to make use of ultrasound imaging in assessing postoperative corporal tissue. The main limitations are the short postoperative follow-up period and the non-blinding of measurements. Conclusion It could be concluded that the cavernous tissue–sparing technique is a reproducible technique that has the added value of preserving residual erectile function in the form of retained postoperative penile tumescence and preserved penile girth. Zaazaa A, Mostafa T. Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation. J Sex Med 2019;16:474–478.
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spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:INTRODUCTION: Spontaneous penile tumescence after penile Prosthesis Implantation has been sporadically reported in the literature. AIM: To preserve residual erectile function of patients' spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation. METHODS: Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable penile Prosthesis Implantation, and patients undergoing the cavernous tissue-sparing technique. 1 month after surgery, these patients underwent penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced penile tumescence. MAIN OUTCOME MEASURES: Postoperative changes were compared with the preoperative ones. RESULTS: The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue-sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P < .01). In the cavernous tissue-sparing group, 41 of 46 patients (89.13%) reported having a significantly higher incidence of residual penile tumescence vs 7 of 46 patients (15.2%) in the conventional surgery group (P < .001). The postoperative penile girth was significantly higher in the cavernous tissue-sparing group than in the conventional surgery group (11.16 ± 1.1 cm vs 10.11 ± 1.15 cm, P < .001). CLINICAL IMPLICATIONS: This study provides a step-by-step approach to maintaining post-Implantation penile tumescence and preserving penile girth in a reproducible manner. STRENGTHS & LIMITATIONS: This is the first study to demonstrate the benefits of implanting a penile Prosthesis while the penis is in a pharmacologically induced tumescent state. It is also the first to make use of ultrasound imaging in assessing postoperative corporal tissue. The main limitations are the short postoperative follow-up period and the non-blinding of measurements. CONCLUSION: It could be concluded that the cavernous tissue-sparing technique is a reproducible technique that has the added value of preserving residual erectile function in the form of retained postoperative penile tumescence and preserved penile girth. Zaazaa A, Mostafa T. Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation. J Sex Med 2019;16:474-478.
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Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation.
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:INTRODUCTION: Spontaneous penile tumescence after penile Prosthesis Implantation has been sporadically reported in the literature. AIM: To preserve residual erectile function of patients' spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation. METHODS: Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable penile Prosthesis Implantation, and patients undergoing the cavernous tissue-sparing technique. 1 month after surgery, these patients underwent penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced penile tumescence. MAIN OUTCOME MEASURES: Postoperative changes were compared with the preoperative ones. RESULTS: The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue-sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P
Adham Zaazaa - One of the best experts on this subject based on the ideXlab platform.
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spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:Abstract Introduction Spontaneous penile tumescence after penile Prosthesis Implantation has been sporadically reported in the literature. Aim To preserve residual erectile function of patients’ spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation. Methods Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable penile Prosthesis Implantation, and patients undergoing the cavernous tissue–sparing technique. 1 month after surgery, these patients underwent penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced penile tumescence. Main Outcome Measures Postoperative changes were compared with the preoperative ones. Results The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue–sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P Clinical Implications This study provides a step-by-step approach to maintaining post-Implantation penile tumescence and preserving penile girth in a reproducible manner. Strengths & Limitations This is the first study to demonstrate the benefits of implanting a penile Prosthesis while the penis is in a pharmacologically induced tumescent state. It is also the first to make use of ultrasound imaging in assessing postoperative corporal tissue. The main limitations are the short postoperative follow-up period and the non-blinding of measurements. Conclusion It could be concluded that the cavernous tissue–sparing technique is a reproducible technique that has the added value of preserving residual erectile function in the form of retained postoperative penile tumescence and preserved penile girth. Zaazaa A, Mostafa T. Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation. J Sex Med 2019;16:474–478.
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spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:INTRODUCTION: Spontaneous penile tumescence after penile Prosthesis Implantation has been sporadically reported in the literature. AIM: To preserve residual erectile function of patients' spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation. METHODS: Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable penile Prosthesis Implantation, and patients undergoing the cavernous tissue-sparing technique. 1 month after surgery, these patients underwent penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced penile tumescence. MAIN OUTCOME MEASURES: Postoperative changes were compared with the preoperative ones. RESULTS: The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue-sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P < .01). In the cavernous tissue-sparing group, 41 of 46 patients (89.13%) reported having a significantly higher incidence of residual penile tumescence vs 7 of 46 patients (15.2%) in the conventional surgery group (P < .001). The postoperative penile girth was significantly higher in the cavernous tissue-sparing group than in the conventional surgery group (11.16 ± 1.1 cm vs 10.11 ± 1.15 cm, P < .001). CLINICAL IMPLICATIONS: This study provides a step-by-step approach to maintaining post-Implantation penile tumescence and preserving penile girth in a reproducible manner. STRENGTHS & LIMITATIONS: This is the first study to demonstrate the benefits of implanting a penile Prosthesis while the penis is in a pharmacologically induced tumescent state. It is also the first to make use of ultrasound imaging in assessing postoperative corporal tissue. The main limitations are the short postoperative follow-up period and the non-blinding of measurements. CONCLUSION: It could be concluded that the cavernous tissue-sparing technique is a reproducible technique that has the added value of preserving residual erectile function in the form of retained postoperative penile tumescence and preserved penile girth. Zaazaa A, Mostafa T. Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation. J Sex Med 2019;16:474-478.
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Spontaneous Penile Tumescence by Sparing Cavernous Tissue in the Course of Malleable Penile Prosthesis Implantation.
The Journal of Sexual Medicine, 2019Co-Authors: Adham Zaazaa, Taymour MostafaAbstract:INTRODUCTION: Spontaneous penile tumescence after penile Prosthesis Implantation has been sporadically reported in the literature. AIM: To preserve residual erectile function of patients' spontaneous penile tumescence by sparing cavernous tissue in the course of malleable penile Prosthesis Implantation. METHODS: Overall, 92 patients were randomized into 2 equal arms; patients undergoing conventional malleable penile Prosthesis Implantation, and patients undergoing the cavernous tissue-sparing technique. 1 month after surgery, these patients underwent penile duplex examination to assess the maximal cavernous tissue thickness around the implant cylinders. Additionally, they were asked about the occurrence of any spontaneous or arousal-induced penile tumescence. MAIN OUTCOME MEASURES: Postoperative changes were compared with the preoperative ones. RESULTS: The mean maximal cavernous tissue thickness was shown to be significantly higher in the cavernous tissue-sparing group compared with the conventional surgery group (5.2 ± 0.8 mm vs 2.2 ± 1.04 mm, P
Osama Shaeer - One of the best experts on this subject based on the ideXlab platform.
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Shaeer's Punch Technique: Transcorporeal Peyronie's Plaque Surgery and Penile Prosthesis Implantation.
The journal of sexual medicine, 2020Co-Authors: Osama Shaeer, Islam Fathy Soliman Abdelrahman, Mohamed Mansour, Kamal ShaeerAbstract:Abstract Background Penile Prosthesis Implantation in cases of severe Peyronie’s disease may require plaque excision/incision and grafting, which may require mobilization of the neurovascular bundle or urethra, posing the risks of penile hyposensitivity or urethral injury, and is time-consuming, possibly increasing infection risk. Aim Evaluating transcorporeal debulking of Peyronie’s plaques by “Shaeer’s punch technique.” Methods Penile Prosthesis Implantation and punch technique (PPI-Punch) was performed for 26 patients. After corporotomy and dilatation, Peyronie’s plaques were punched out from within the corpora cavernosa using the punch forceps, and then a penile Prosthesis was implanted. Comparison to a matching retrospective group of 18 patients operated upon by plaque excision-grafting and penile Prosthesis Implantation was performed. Outcomes The study outcomes were straightness of the erect penis, complication, satisfaction with length on a 5-point scale, the International Index of Erectile Function-5, and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Results Average preoperative curvature angle was 58.1 ± 11.7 in the Punch group and 58 ± 14.8 in the excision-grafting group, p=0.99. After surgery, all patients had a straight penis. No tunical perforations, urethral injuries, or extrusions were noted. Average additional operative time for Punch technique ranged from 5 to 10 minutes (7.3 ± 1.7), in contrast to the excision-grafting group where plaque surgery duration was 50.8 minutes ± 11.1, an 85% difference, p Clinical Implications The proposed technique is minimally invasive and prompt, possibly decreasing the known complications of plaque surgery and PPI including sensory loss. Strengths & Limitations One limitation is the inability to accurately measure preoperative erect length in patients with erectile dysfunction with poor response to intracavernous injections. Conclusion Shaeer’s punch technique is a minimally invasive procedure for transcorporeal excavation of Peyronie’s plaques before penile Prosthesis Implantation, omitting the need for mobilization of the neurovascular bundle or spongiosum, and hence, there is low or no risk for nerve or urethral injury and brief plaque surgery time. Shaeer O, Soliman Abdelrahman IF, Mansour M, et al. Shaeer’s Punch Technique: Transcorporeal Peyronie’s Plaque Surgery and Penile Prosthesis Implantation. J Sex Med 2020;17:1395–1399.
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Dorsal phalloplasty accompanying penile Prosthesis Implantation minimizes penile shortening and improves patient satisfaction
International Journal of Impotence Research, 2019Co-Authors: Osama Shaeer, Islam Fathy Soliman Abdelrahman, Kamal Shaeer, Amr RaheemAbstract:Many patients complain of shortened length following penile Prosthesis Implantation. Dorsal phalloplasty (DP) can accompany Prosthesis placement to mitigate this complaint by resulting in more visible penis outside the plane of the patient’s body. DP is done through the same incision. A nonabsorbable suture approximates the under surface of the skin where the penis meets the pubis to the periosteum of the pubic bone. This adjunctive procedure results in more visible proximal penile shaft. We compared penile visible length (pubic skin surface to tip) in patients who had the adjunctive procedure with Prosthesis insertion to patients who had only the penile Prosthesis. Totally, 66 patients had DP and 60 did not. All patients were operated through a penoscrotal incision. The tacking suture of # 5 nonabsorbable braided polyester was passed through the pubic periosteum then into the subcutaneous tissue and dermis of the under surface of the pubic skin. The suture was tied after Prosthesis insertion. Efficacy of DP was evaluated by measured gain in erect visible length in the DP group, maintenance of that length gain until final follow up at 3 years, as well as by the difference in subjective evaluation criteria between both groups. The DP group had a 23% increase in visible length compared to pretacking ( p
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Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique.
The journal of sexual medicine, 2018Co-Authors: Osama Shaeer, Kamal ShaeerAbstract:Abstract Background Penile Prosthesis Implantation into scarred corporeal bodies is one of the most challenging procedures in prosthetic urologic surgery, especially following infection and extrusion of a penile implant. Several instruments and techniques have been used for making dilatation of scarred corporeal bodies easier and safer in expert hands. Nevertheless, in some cases, Implantation is not possible. Aim This work presents extracorporeal transseptal Implantation as a last resort in such cases. Methods In 39 patients with extensive corporeal fibrosis, penile Prosthesis Implantation is attempted. After failure of alternative techniques, extracorporeal Implantation is resorted to in 10 patients. The corpus spongiosum is identified and protected. Diathermy knife is used to cut a longitudinal window into 1 corpus cavernosum, through the septum and into the contralateral corpus cavernosum. A single semirigid implant rod is inserted through the window at the base of the penis, halfway through. The 2 limbs of the rod are bent upward toward the glans, to assume a U shape. The limbs of the U are brought together at midshaft by a gathering suture passed through the corpora cavernosa and septum. The tips of the U are anchored under the glans. Outcomes Achievement of acceptable coital relationship. Results The procedure allowed acceptable coital relationship and concealment in 9/10 cases. In 1 case, infection occurred. ReImplantation with the same method was performed 6 months later, and the implant survived adequately. Perforation, migration, and urethral injury were not encountered. Clinical Implications This technique may help salvage abandoned cases with corporal fibrosis, particularly when the necessary expertise for alternative techniques is unavailable or when such techniques fail. Strengths & Limitations The technique presented is fairly straightforward and safe. However, the number of cases and duration of follow-up are limited. Conclusion Extracorporeal transseptal penile Prosthesis Implantation can salvage cases with severe corporeal fibrosis when all alternatives fail. Shaeer O, Shaeer K. Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique. J Sex Med 2018;15:1350–1356.
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Simultaneous Suprapubic Lipectomy and Penile Prosthesis Implantation.
The journal of sexual medicine, 2018Co-Authors: Osama Shaeer, Kamal Shaeer, Islam Fathi AbdelrahmanAbstract:Abstract Introduction A shorter penis is a frequent complaint following penile Prosthesis Implantation (PPI), and a large redundant suprapubic fat pad can conceal the penis and possibly compromise patient and partner satisfaction with length. Aim To evaluate feasibility and outcome of same-session, same-incision, PPI and suprapubic lipectomy (SPL). Methods In 22 patients, SPL was performed through an abdominal crease incision. Through the same incision, the superficial perineal pouch was opened to gain access to the base of the penis. Penile Prosthesis was implanted (semirigid in 16 patients and girth-expanding 3-piece inflatable in 6). Scarpa’s fascia, subcutaneous fat, and the abdominal crease skin incision were closed. Main Outcome Measure Evaluation was in terms of implant survival, preoperative vs postoperative patient and partner satisfaction with penile length on a 5-point rating scale, subjective opinion over penile length postoperatively, compared with recall of erect length before erectile dysfunction (ED) had set in (longer, same, or shorter), and penile length with the implant rigid, compared in the supine and standing positions postoperatively (pubic skin to tip, using a rigid ruler). Results No infections or extrusions or mechanical failures were encountered. There was a 53.3% increase in patient satisfaction with length comparing preoperative (2.55 ± 0.67) to postoperative (4.77 ± 0.43) ratings, P Clinical Implications Patients with refractory ED and a concealed penis can be counseled as to the option of simultaneous SPL and PPI (SPL-PPI), a modification that may help avoid patient and partner dissatisfaction with length. Strength & Limitations Strengths include objective evaluation of the efficacy of the procedure by comparing supine and standing penile length. Limitations of the current study include inability to evaluate erect length preoperatively owing to refractory ED, and subjectivity of patient and partner opinion. Conclusion Same-incision SPL-PPI appears to be a safe and effective procedure, with high patient and partner satisfaction rates. Shaeer O, Shaeer K, Abdel Rahman IF. Simultaneous suprapubic lipectomy and penile Prosthesis Implantation. J Sex Med 2018;15:1818–1823.
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supersizing the penis following penile Prosthesis Implantation
The Journal of Sexual Medicine, 2010Co-Authors: Osama ShaeerAbstract:Introduction. Following Implantation of a penile Prosthesis, some couples are dissatisfied with penile length, girth, shaft, or glans engorgement. This may be delusional because of the procedure per se or preexisting risk factors such as neglected priapism, Peyronie’s disease, radical prostatectomy, or overhanging suprapubic fat. Aim. In this work, we try to enhance penile size in patients dissatisfied with its dimensions following Implantation of a penile Prosthesis, using various augmentation techniques. Methods. Eighteen patients who have had penile prostheses implanted were enrolled in this study based on dissatisfaction with penile size. The complaint was relieved by counseling and administration of PDE5 inhibitors in seven patients. Two patients had elongation, girth augmentation, and glans injection; six had elongation and girth augmentation; and two had elongation and glans injection. Main Outcome Measures. Penile size, satisfaction, and sexual function. Results. Average preoperative length and girth were 7.87 cm and 11.62 cm, respectively. Mean postoperative length and girth were 11.62 cm and 14.07 cm. The gain in length (47.6%) and girth (21%) were statistically significant (P < 0.005). All patients and partners were satisfied with the results following surgery except one who suffered graft loss. Conclusion. Implantation of a penile Prosthesis may improve penile rigidity, yet may confound couple’s satisfaction with penile size to variable degrees. Sex education may alleviate those concerns. In refractory cases, penile augmentation may enhance phallic size and increase patient/partner satisfaction. Shaeer O. Supersizing the penis following penile Prosthesis Implantation. J Sex Med 2010;7:2608–2616.
Kamal Shaeer - One of the best experts on this subject based on the ideXlab platform.
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Shaeer's Punch Technique: Transcorporeal Peyronie's Plaque Surgery and Penile Prosthesis Implantation.
The journal of sexual medicine, 2020Co-Authors: Osama Shaeer, Islam Fathy Soliman Abdelrahman, Mohamed Mansour, Kamal ShaeerAbstract:Abstract Background Penile Prosthesis Implantation in cases of severe Peyronie’s disease may require plaque excision/incision and grafting, which may require mobilization of the neurovascular bundle or urethra, posing the risks of penile hyposensitivity or urethral injury, and is time-consuming, possibly increasing infection risk. Aim Evaluating transcorporeal debulking of Peyronie’s plaques by “Shaeer’s punch technique.” Methods Penile Prosthesis Implantation and punch technique (PPI-Punch) was performed for 26 patients. After corporotomy and dilatation, Peyronie’s plaques were punched out from within the corpora cavernosa using the punch forceps, and then a penile Prosthesis was implanted. Comparison to a matching retrospective group of 18 patients operated upon by plaque excision-grafting and penile Prosthesis Implantation was performed. Outcomes The study outcomes were straightness of the erect penis, complication, satisfaction with length on a 5-point scale, the International Index of Erectile Function-5, and the Erectile Dysfunction Inventory of Treatment Satisfaction questionnaire. Results Average preoperative curvature angle was 58.1 ± 11.7 in the Punch group and 58 ± 14.8 in the excision-grafting group, p=0.99. After surgery, all patients had a straight penis. No tunical perforations, urethral injuries, or extrusions were noted. Average additional operative time for Punch technique ranged from 5 to 10 minutes (7.3 ± 1.7), in contrast to the excision-grafting group where plaque surgery duration was 50.8 minutes ± 11.1, an 85% difference, p Clinical Implications The proposed technique is minimally invasive and prompt, possibly decreasing the known complications of plaque surgery and PPI including sensory loss. Strengths & Limitations One limitation is the inability to accurately measure preoperative erect length in patients with erectile dysfunction with poor response to intracavernous injections. Conclusion Shaeer’s punch technique is a minimally invasive procedure for transcorporeal excavation of Peyronie’s plaques before penile Prosthesis Implantation, omitting the need for mobilization of the neurovascular bundle or spongiosum, and hence, there is low or no risk for nerve or urethral injury and brief plaque surgery time. Shaeer O, Soliman Abdelrahman IF, Mansour M, et al. Shaeer’s Punch Technique: Transcorporeal Peyronie’s Plaque Surgery and Penile Prosthesis Implantation. J Sex Med 2020;17:1395–1399.
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Dorsal phalloplasty accompanying penile Prosthesis Implantation minimizes penile shortening and improves patient satisfaction
International Journal of Impotence Research, 2019Co-Authors: Osama Shaeer, Islam Fathy Soliman Abdelrahman, Kamal Shaeer, Amr RaheemAbstract:Many patients complain of shortened length following penile Prosthesis Implantation. Dorsal phalloplasty (DP) can accompany Prosthesis placement to mitigate this complaint by resulting in more visible penis outside the plane of the patient’s body. DP is done through the same incision. A nonabsorbable suture approximates the under surface of the skin where the penis meets the pubis to the periosteum of the pubic bone. This adjunctive procedure results in more visible proximal penile shaft. We compared penile visible length (pubic skin surface to tip) in patients who had the adjunctive procedure with Prosthesis insertion to patients who had only the penile Prosthesis. Totally, 66 patients had DP and 60 did not. All patients were operated through a penoscrotal incision. The tacking suture of # 5 nonabsorbable braided polyester was passed through the pubic periosteum then into the subcutaneous tissue and dermis of the under surface of the pubic skin. The suture was tied after Prosthesis insertion. Efficacy of DP was evaluated by measured gain in erect visible length in the DP group, maintenance of that length gain until final follow up at 3 years, as well as by the difference in subjective evaluation criteria between both groups. The DP group had a 23% increase in visible length compared to pretacking ( p
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Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique.
The journal of sexual medicine, 2018Co-Authors: Osama Shaeer, Kamal ShaeerAbstract:Abstract Background Penile Prosthesis Implantation into scarred corporeal bodies is one of the most challenging procedures in prosthetic urologic surgery, especially following infection and extrusion of a penile implant. Several instruments and techniques have been used for making dilatation of scarred corporeal bodies easier and safer in expert hands. Nevertheless, in some cases, Implantation is not possible. Aim This work presents extracorporeal transseptal Implantation as a last resort in such cases. Methods In 39 patients with extensive corporeal fibrosis, penile Prosthesis Implantation is attempted. After failure of alternative techniques, extracorporeal Implantation is resorted to in 10 patients. The corpus spongiosum is identified and protected. Diathermy knife is used to cut a longitudinal window into 1 corpus cavernosum, through the septum and into the contralateral corpus cavernosum. A single semirigid implant rod is inserted through the window at the base of the penis, halfway through. The 2 limbs of the rod are bent upward toward the glans, to assume a U shape. The limbs of the U are brought together at midshaft by a gathering suture passed through the corpora cavernosa and septum. The tips of the U are anchored under the glans. Outcomes Achievement of acceptable coital relationship. Results The procedure allowed acceptable coital relationship and concealment in 9/10 cases. In 1 case, infection occurred. ReImplantation with the same method was performed 6 months later, and the implant survived adequately. Perforation, migration, and urethral injury were not encountered. Clinical Implications This technique may help salvage abandoned cases with corporal fibrosis, particularly when the necessary expertise for alternative techniques is unavailable or when such techniques fail. Strengths & Limitations The technique presented is fairly straightforward and safe. However, the number of cases and duration of follow-up are limited. Conclusion Extracorporeal transseptal penile Prosthesis Implantation can salvage cases with severe corporeal fibrosis when all alternatives fail. Shaeer O, Shaeer K. Extracorporeal Transseptal Penile Prosthesis Implantation for Extreme Cases of Corporeal Fibrosis: Shaeer Implantation Technique. J Sex Med 2018;15:1350–1356.
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Simultaneous Suprapubic Lipectomy and Penile Prosthesis Implantation.
The journal of sexual medicine, 2018Co-Authors: Osama Shaeer, Kamal Shaeer, Islam Fathi AbdelrahmanAbstract:Abstract Introduction A shorter penis is a frequent complaint following penile Prosthesis Implantation (PPI), and a large redundant suprapubic fat pad can conceal the penis and possibly compromise patient and partner satisfaction with length. Aim To evaluate feasibility and outcome of same-session, same-incision, PPI and suprapubic lipectomy (SPL). Methods In 22 patients, SPL was performed through an abdominal crease incision. Through the same incision, the superficial perineal pouch was opened to gain access to the base of the penis. Penile Prosthesis was implanted (semirigid in 16 patients and girth-expanding 3-piece inflatable in 6). Scarpa’s fascia, subcutaneous fat, and the abdominal crease skin incision were closed. Main Outcome Measure Evaluation was in terms of implant survival, preoperative vs postoperative patient and partner satisfaction with penile length on a 5-point rating scale, subjective opinion over penile length postoperatively, compared with recall of erect length before erectile dysfunction (ED) had set in (longer, same, or shorter), and penile length with the implant rigid, compared in the supine and standing positions postoperatively (pubic skin to tip, using a rigid ruler). Results No infections or extrusions or mechanical failures were encountered. There was a 53.3% increase in patient satisfaction with length comparing preoperative (2.55 ± 0.67) to postoperative (4.77 ± 0.43) ratings, P Clinical Implications Patients with refractory ED and a concealed penis can be counseled as to the option of simultaneous SPL and PPI (SPL-PPI), a modification that may help avoid patient and partner dissatisfaction with length. Strength & Limitations Strengths include objective evaluation of the efficacy of the procedure by comparing supine and standing penile length. Limitations of the current study include inability to evaluate erect length preoperatively owing to refractory ED, and subjectivity of patient and partner opinion. Conclusion Same-incision SPL-PPI appears to be a safe and effective procedure, with high patient and partner satisfaction rates. Shaeer O, Shaeer K, Abdel Rahman IF. Simultaneous suprapubic lipectomy and penile Prosthesis Implantation. J Sex Med 2018;15:1818–1823.
Marco Falcone - One of the best experts on this subject based on the ideXlab platform.
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a comparative study between 2 different grafts used as patches after plaque incision and inflatable penile Prosthesis Implantation for end stage peyronie s disease
The Journal of Sexual Medicine, 2018Co-Authors: Marco Falcone, Giulio Garaffa, Carlo Ceruti, M Timpano, O Sedigh, M Preto, M Sibona, Marco Oderda, Paolo Gontero, Luigi RolleAbstract:Abstract Background Although many grafts have been used for plaque incision with grafting (PIG) and penile Prosthesis (PP) Implantation, there is no evidence that favors 1 specific graft over another. Aim To compare fibrin-coated collagen fleece (TachoSil; Baxter International, Deerfield, IL, USA) with porcine small intestinal submucosa (SIS; Cook Biotech, West Lafayette, IN, USA) as grafts. Methods From January 2007 to January 2015, 60 non-randomized consecutive patients affected by end-stage Peyronie disease underwent PIG and PP Implantation (AMS 700CX; Boston Scientific, Marlborough, MA, USA). All patients underwent preoperative penile dynamic duplex ultrasound. All procedures were performed by the same surgeon. Patients were divided in 2 different groups according to the graft used to cover the albuginea defect. SIS was used for grafting in 34 patients (group A) and TachoSil was used in 26 patients (group B). Outcomes Overall hospital stay, operative time, 5-point Likert hematoma scale, visual analog scale, incidence of postoperative complications, and PP mechanical failure were selected as outcome measures. Functional outcomes were assessed through validated questionnaires (International Index of Erectile Function, Erectile Dysfunction Inventory of Treatment Satisfaction, and Sexual Encounter Profile questions 2 and 3) preoperatively and 3, 6, and 12 months postoperatively. Results The patients' median age was 63 years. No statistically significant differences were detected between groups for age and type and degree of curvature (median = 65°). Average follow-up was 35 months. No major intraoperative complications were reported. The average operative time was 145 minutes for group A and 120 minutes for group B. No statistically significant differences between groups were detected for postoperative complications. Only 3 patients developed a major postoperative complication requiring a 2nd surgical intervention: 1 patient in group A for mechanic failure and 1 patient in group A and 1 in group B for inflatable PP infection. Multivariate statistical analysis showed no significant difference for all variables analyzed between the 2 groups, except for operative time, which was significantly shorter for group B. Clinical Implications TachoSil could represent a valuable option for grafting, considering its advantages in operative time and cost compared with SIS. Strengths and Limitations Long-term follow-up represents a strength factor. Main limitations are the non-randomized nature of the study and the small number of patients. Conclusions TachoSil seems to represent an effective solution for grafting after PIG and PP Implantation. However, additional studies are warranted to confirm our results. Falcone M, Preto M, Ceruti C, et al. A Comparative Study Between 2 Different Grafts Used as Patches After Plaque Incision and Inflatable Penile Prosthesis Implantation for End-Stage Peyronie's Disease. J Sex Med 2018;15:848–852.
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prospective analysis of the surgical outcomes and patients satisfaction rate after the ams spectra penile Prosthesis Implantation
Urology, 2013Co-Authors: Marco Falcone, Luigi Rolle, Carlo Ceruti, M Timpano, O Sedigh, M Preto, Andrea Gonella, Bruno FreaAbstract:Objective To evaluate the outcomes, the patients', and their partners' satisfaction concerning the AMS Spectra penile Prosthesis Implantation. Methods Twenty-two unresponsive or dissatisfied patients with phosphodiesterase 5 inhibitor oral therapy or prostaglandin intracavernous injection underwent a Spectra penile Prosthesis Implantation. No major intraoperative or postoperative complications were observed. The preoperative erectile dysfunction (ED) was rated by the International Index of Erectile Function (IIEF) questionnaire. The patients and their partners were submitted to the IIEF and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires through telephonic interviews at the third, sixth, and 12th months after the penile surgery. Results This study demonstrates that 86.4% of the patients and 52.6% of their partners are satisfied by the AMS Spectra penile Prosthesis. The preoperative average IIEF score was equal to 28.5 (range 13-39). The postoperative IIEF rates were 47.7 (43-53), 51.8 (48-58), and 53.9 (50-58) at the third, sixth, and 12th months, respectively. The patient average EDITS score amounted to 39.5 (31-48), 43.4 (36-50), and 45.2 (38-50) at the third, sixth, and 12th months, respectively. The increase between the preoperative and postoperative IIEF parameters resulted to be statistically significant (P Conclusion The AMS Spectra is a reliable device to treat ED as shown by the high grade of the patients' satisfaction. Moreover, the AMS Spectra is highly convenient in terms of cost savings in comparison to an inflatable device. In selected patients, this Prosthesis should be considered as an effective solution to treat severe ED.
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a new innovative lengthening surgical procedure for peyronie s disease by penile Prosthesis Implantation with double dorsal ventral patch graft the sliding technique
The Journal of Sexual Medicine, 2012Co-Authors: Luigi Rolle, Marco Falcone, Carlo Ceruti, M Timpano, O Sedigh, P Destefanis, E Galletto, D FontanaAbstract:Introduction. Peyronie’s disease is the result of the formation of fibrous plaques in the tunica albuginea of the penis; typical presentations of the disease are represented by pain during erection, erectile dysfunction, and penile deformities, such as curvature, narrowing, and penile shortening. The most complex treatment is related to penile shortening. Aim. To find a safe procedure in penile shortening due to Peyronie’s disease providing a satisfactory lengthening, allowing an early stabilization of the penis, and preventing axial tension on the neurovascular bundles during dilation. Methods. We describe a new lengthening surgical procedure based on a ventro-dorsal incision of the tunica albuginea, penile Prosthesis Implantation, and double dorsal-ventral patch grafting with porcine small intestinal submucosa. Three patients, affected by Peyronie’s disease with penile shortening and erectile dysfunction, underwent this procedure with approval of our local ethical committee. We evaluated the penis lengthening, intraoperative and postoperative complications, patient’s preoperative and postoperative sexual life satisfaction (International Index of Erectile Function [IIEF] questionnaire). Results. The average operative time was 2 hours and 50 minutes. No major intraoperative nor postoperative complications occurred. No significant bleedings were recorded. Patients were discharged after 48–72 hours. The average increase in length obtained was 3.2 cm. All patients resumed sexual intercourses with satisfaction; no significant loss of sensitivity or any sign of vascular distress of the glans was recorded. The follow-up is 13 months. The average IIEF score is 60. Conclusions. The lengthening of the penis by a double dorsal-ventral patch graft is an innovative procedure that is based on current techniques of plaque incision and grafting, and that can easily resolve severe shortening of the penis due to Peyronie’s disease. In the cases presented, this procedure resulted easily, effectively, and safely. Nevertheless, the technique proposed in this article shall be validated through prospective studies with larger samples. Rolle L, Ceruti C, Timpano M, Sedigh O, Destefanis P, Galletto E, Falcone M, and Fontana D. A new, innovative, lengthening surgical procedure for Peyronie’s disease by penile Prosthesis Implantation with double dorsalventral patch graft: The “sliding technique.” J Sex Med 2012;9:2389–2395.
