1,721,042 research outputs found
Comment on: “Surgeon variations in the perioperative evaluation of penile prosthesis patients”
No full textDISTAL CORPOROTOMY LOCALISATION IS A RISK FACTOR FOR DISTAL CYLINDER EXTRUSION AND REROUTING SURGERY IN PENILE PROSTHESIS IMPLANTATION
No full textDISTAL CORPOROTOMY LOCALISATION IS A RISK FACTOR FOR DISTAL CYLINDER EXTRUSION AND REROUTING SURGERY IN PENILE PROSTHESIS IMPLANTATION
No full textQuality of care: the vital role of nurses in the pre and postoperative care
No full textcitation ID: qdaf077.160 Objectives: Approximately 200 penile implant procedures are performed annually at our hospital. These patients are supervised pre and post-operatively by well-trained nurses. In recent years, the care process for these patients has been changed, led by our extensive experience. The main goal is to better meet the patient's needs in order to increase patient satisfaction. Additional aims are to improve quality of care and reduce the doctor's workload. Methods: In our single surgeon institute, we guide the pros-thetic patient through a well-designed patient care pathway established after many years of experience. Especially in the last 5 years the nurse's tasks have been expanded. First and foremost, preoperative counselling by the nurse was introduced , in order to inform the patient about the advantages and disadvantages of the penile implant, the differences in erection compared to a natural erection and the changes in size and shape. These changes were based on our experience with these patients postoperatively. We're making sure their expectations are realistic. Furthermore we guide the patient through the process and plan their follow up, including: wound checks, activation of the penile implant, practice sessions and an end of term evaluation at 12 weeks after surgery. We guarantee a low threshold accessibility, we make an intensive postopera-tive follow up protocol possible and constantly work in close cooperation with the surgeon. Results: After introducing preoperative counselling by the nurse, we've seen an improvement in the patient and partner satisfaction scores and a decrease in the doctor's workload. When the patient has doubts about the surgery or the implant, a nurse can take time for the patient to listen to their concerns, to inform them once more and to facilitate their decision. We aim towards a shared, well-informed decision making approach, in which the patient's and partner's expectations are met. Finally the follow up protocol and the time we invest in the patient results in less complications
Combined inflatable penile prosthesis with mini-jupette: patient selection and step-by-step surgical technique
No full textPassivation is playing a significant role in achieving excellent performance in perovskite solar cells. However, traditional characterization in this context is often limited to the analysis of current-voltage (IV) and sometimes the analysis of superficial chemical properties via UV or X-ray photoelectron spectroscopy (UPS or XPS). This is not sufficient in order to provide a full understanding of the passivation impact and target the best passivation strategies. In this work, a more developed characterization protocol is introduced, aiming at establishing a clearer link between nano-scale electrical properties and macro-scale device characteristics. Traditional IV measurements are combined with admittance spectroscopy (AS) and deep-level transient spectroscopy (DLTS) for the analysis of charge-related performance losses and with Time-of-Flight Secondary Ion Mass Spectrometry (ToF SIMS) to complete the understanding of ionic accumulation at the perovskite interfaces. This protocol is tested on two experimental devices, a reference MAPI-based p-in perovskite cell and the same cell passivated at both perovskite interfaces. First, IV measurements show an increase of both Voc and FF of approximately 10% for the passivated cell, with an absolute efficiency increase of 4%. AS measurements suggest that the higher FF in the passivated sample cannot be attributed to a lower series resistance, but possibly to a lower diffusivity of some ionic species present at the interface. Analysis of the DLTS response yields an activation energy of 0.37 eV. The pre-exponential factor for these ions is lower for the passivated cell, which is also suggested by the higher Voc. Finally, preliminary ToF SIMS results showcase different ionic species that accumulate at the perovskite interfaces. Overall, this novel characterization approach enables a rather comprehensive understanding of the device and points to leads for future work about passivation for perovskite solar cells
A Modified Surgical Technique for Reservoir Placement During Inflatable Penile Prosthesis Implantation
No full textINTRODUCTION: At the moment, there is an ongoing debate regarding the controversial issue of the ideal reservoir placement (RP) surgical technique during implantation of a 3-piece inflatable penile prosthesis, but a definitive winner has not yet emerged. AIM: In this light, we herein describe our modified technique for RP into the space of Retzius through the external oblique muscle fascia and present its results. METHODS: In total, 253 inflatable penile prosthesis procedures (110 AMS 700 and 143 Coloplast Titan) via a single transverse penoscrotal incision were retrospectively reviewed. 2 Kocher-Langenbeck retractors were placed over the right side of the penoscrotal incision and were used to retract the incision superior to the pubic bone. Then, the external oblique muscle fascia was incised medially to the spermatic cord which was retracted laterally. Next, a "W", Vicryl 1, stay suture was placed to the incision, and under direct visualization, external oblique muscle fibers were dissected and fascia transversalis was perforated using a Metzenbaum scissor. A Foerster lung grasping clamp was then used to dissect further into the extraperitoneal space and create the reservoir space. The reservoir was placed into the created space and fascia incision was closed using the prepositioned stay suture. The procedure was then completed in a standard fashion. OUTCOMES: The main outcome measures were intraoperative or postoperative complications of our modified RP technique. RESULTS: All 253 patients were available for short-term follow-up (average 9.1 months, range 3-22 months). No intraoperative or postoperative complications were reported. Reservoir-related prolonged pain (1 month) was reported by 1 patient, resolving completely after treatment with non-steroidal analgesics. CONCLUSION: We are, surely, not proposing that our modified RP technique should supplant all other methods; rather, it should be considered another useful option for RP in the implanter's armamentarium. Mykoniatis I, Osmonov D, van Renterghem K. A Modified Surgical Technique for Reservoir Placement During Inatable Penile Prosthesis Implantation. Sex Med 2020;8:378-382.status: Publishe
Penile prosthesis in the medically complex patient: a narrative review
No full textBackground and Objective: Penile prosthesis surgery is considered a safe and effective treatment for patients with erectile dysfunction. Implantation in the medically complex patient can be a challenge. The benefits of treatment must outweigh the possible risks or complications. A description of possible problems and how to cope with them is given in this narrative review.Methods: Literature search was performed in January 2023 using different search prompts in PubMed. These articles, excluding non-English and non-full text articles, were listed by the two authors and afterwards, the most relevant ones were included.Key Content and Findings: This article is divided into five important topics. We evaluated different comorbidities such as spinal cord injury, diabetes mellitus and cardiovascular disease, in which preoperative work-up and counseling is of significant importance. A detailed description of these comorbidities and how to handle these can be found in each section. In addition to the preoperative aspect in organ transplant patients, problems during surgery can arise, e.g., with the reservoir placement. Similarly, in patients with previous pelvic surgery, an ectopic reservoir placement can prevent possible complications.Conclusions: Preoperative diagnostics are crucial and prosthetic surgery should be done by an experienced high-volume surgeon with a diverse range of surgical techniques at his disposal
Majority of erectile dysfunction patients would have preferred earlier implantation of their penile prosthesis: validation of the recently changed EAU guidelines
No full textUntil 2019, the European Association of Urology guidelines recommended the implantation of a penile prosthesis as a third-line therapy, which has since then changed to "if other treatments fail or depending on the patient's preference". Primary endpoint was to assess whether patients with a penile prosthesis and their partner would have preferred earlier implantation. Secondary endpoints were the reason why patient and partner wanted earlier implantation, how much earlier they wanted it, satisfaction of patient and partner and if patient and partner would have recommended the intervention. We selected patients with a virgin inflatable penile prosthesis operated between April 2013 and December 2019. We included 155 patients and 65 partners. Telephonic interview was conducted in a structured manner. Further data were collected retrospectively. The preference for earlier implantation was reported in 59.4% of patients and 46.2% of partners. Of them, respectively 53.2% and 46.6% would have wanted the prosthesis more than 5 years earlier. Satisfaction was seen in 83.2% of patients and 73.8% of partners. Respectively 82.6% and 78.4% of patients and partners would recommend the procedure. Our results indicate that a more patient-oriented approach with good counseling is desirable and that the "three-level" concept must be abandoned.All contributors to the article are mentioned in the author list. We would like to thank our surgical team for their great work resulting in our high quality of care
Simultaneous implant of inflatable penile prosthesis and artificial urinary sphincter: a single high-volume center experience
No full textErectile dysfunction and stress urinary incontinence are both an important sequel after local therapy for prostate cancer, such as radical prostatectomy and radiotherapy. The implant of an inflatable penile prosthesis or an artificial urinary sphincter is an option if other treatments fail in both cases. There is a lack of literature regarding a simultaneous dual implantation. The aim of this study is to describe per- and postoperative morbidity and functional results. We included 25 patients operated between January 2018 and August 2022. Data were collected retrospectively. Standardized questionnaires for evaluating satisfaction were administered. There was a median operative time of 45 min (IQR 41.25-58). No intra-operative complications were seen. Four patients needed revision surgery, all of them regarding the sphincter prosthesis. One of these patients had additional revision surgery due to leakage of the penile implant reservoir. There were no infectious complications. There was a median follow-up time of 29 months (IQR 9.5-43). There was a satisfaction rate of 88% with patients and 92% with partners. Postoperative pads per day were reduced to zero or one in 96% of patients. We conclude that the dual implantation of an inflatable penile prosthesis and an artificial urinary sphincter was a safe and effective treatment in our series for patients with conservative treatment-refractory stress urinary incontinence and erectile dysfunction.All contributors to the article are mentioned in the author list
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