Objectives:Evaluate the demographic data, etiology, operative findings and results of surgical treatment of penile fracture (PF) in men who have sex with men(MSM) with emphasis on sexual complications.Materials and Methods:We studied 216 patients underwent surgical correction of PF at our hospital. Patients self-identified as MSM were followed for at least 6 months. Demographic data, presentation, operative findings, International Index of Erection Function - 5 (IIEF-5) and the Premature Ejaculation Diagnostic Tool.Results:Of 216 PF cases, 4 (1.8%) were MSM. All cases resulted from sexual activity and all patients reported using the “doggy style” position during anal intercourse. Unilateral or bilateral injury of corpus cavernosum was found in 2 patients each. One (25%) patient had complete urethral injury associated with bilateral corpus cavernosum lesion. During the follow-up period, all patients developed some type of sexual complication. One patient reported penile pain during intercourse. Another patient experienced low sexual desire and premature ejaculation. This patient was also dissatisfied with the aesthetic result of the surgical scar and complained about decreased penis size after surgery. The third case developed delayed ejaculation. The fourth patient experienced mild to moderate erectile dysfunction. This same patient presented with penile curvature. Finally, palpable fibrotic nodules in the operative area were observed in all cases.Conclusions:Sexual activity in the “doggy style” position was the commonest cause of PF in MSM. Sexual dysfunction is always present in gay man after surgery for PF. However, additional studies with larger samples should be coinducted.
The Artificial Urinary Sphincter (AUS) is considered the gold standard treatment of non-neurogenic male urinary incontinence in several Guidelines (1-3). Despite the high rates of initial continence, a significant number of patients will need some type of revision, generally due to infection, urethral erosion, return of incontinence or mechanical problems (4). Failure rates and the need for revision are generally associated with patient characteristics and history of previous treatment-for the cancer or for urethral strictures. Several studies compared the long-term results of AUS implantation with age, radiation therapy, urethroplasty, AUS reimplantation, hypogonadism, use of corticosteroids, smoking and other potential risk factors (5-8). Clearly, the preoperative characterization of the patient and his clinical history are fundamental for the establishment of results and complications expectations, which must be properly discussed with the patient to achieve the best satisfaction rates. On the other hand, it is also important to observe the impact of perioperative complications on the late results of the implants. Among these perioperative complications we can mention: surgical infection, urinary infection (UTI), bleeding with the hematoma formation, urinary retention and unrecognized intra-operative urethral lesions. The clinical practice and the current literature demonstrate that these complications are directly related to rates of early explantation (9), but there is a lack of information about the long-term impact. In this study, the authors analyze the impact of perioperative complications in a group of 105 men who underwent an AUS implantation, in high volume centers, with an average follow-up of 38 months, focusing on the rates of explanation, continence and quality of life (10). The authors observed that the perioperative UTI was an independent risk factor for device explantation. When analyzing long-term continence rates, there was no relationship with any type of perioperative complication. The patients' quality of life was affected only by postoperative pain and obviously by the final result of continence. The prevention of perioperative complications is essential to decrease the rates of explantation, as previously demonstrated, including a study by this group (11). This prevention involves the proper preoperative patient evaluation of, identification of risk factors and an appropriate surgical technique. Despite the importance of the UTI, as an independent factor in the rate of late explantation, we still do not have a standardization in the use of antibiotic prophylaxis, as demonstrated in the methodology of this multicenter study, where about 37% of patients used prophylaxis with a single dose against about 63% using antibiotics also in the postoperative period. Despite the methodological limitations, also identified by the authors, this study highlights the importance of UTI as an isolated risk factor for long-term sphincter explantation, demonstrating the need for robust, prospective, multice...
penile prosthesis (PP) devices. The objectives of this study were to evaluate the annual prevalence of ED in a working age population and explore treatment profiles of men with ESH insurance.METHODS: We conducted a cross-sectional claims analysis utilizing Truven Health MarketScan Commercial data from 2009 to 2016. The data includes claims for a nationally representative sample of US workers enrolled in an ESH plan. We identified men aged 18-64 with at least one ED claim and continuous enrollment in a given year. Patient demographics and clinical characteristics were explored. Utilization rates of ED therapies among those with an ED diagnosis were evaluated and categorized as: PP, PDE5I, other ED treatments (eg, vacuum pump, intracavernosal alprostadil), combination treatment, and no insurer-paid treatment. Utilization rates reflect paid claims only.RESULTS: Between 2009 to 2016, the annual prevalence of ED reported among men insured by an ESH plan increased by 82% (Figure 1). Their mean age was 50 years, with a standard deviation of 9 to 10 years. A majority of men with an ED diagnosis had no treatments on their claims (between 73% and 81%). Overall, less than 30% of men with ED received an ED therapy paid by their ESH plans. The proportion of men taking PDE5I has remained relatively stable, fluctuating between 18% and 26%. The rate of men with ED who underwent PP implantation has declined in recent years (0.23% to 0.11%). The rate of men who received other ED treatments or combination treatment has also decreased (0.94% to 0.31% and 0.65% to 0.24%, respectively).CONCLUSIONS: ED reported among men insured by an ESH plan has increased dramatically, yet roughly three-quarters of these men had no claim for ED treatments. The decrease in the rate of men undergoing PP implantation and other ED treatments may reflect access gaps to effective ED treatments. Steps should be taken to ensure men with ED have equitable access to ED therapies.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.