Background: Penile prosthesis surgery (PPS) is a commonly used treatment for erectile dysfunction (ED), either as first-line therapy or in cases refractory to other treatment options. In patients with a urologic malignancy such as prostate cancer, surgical interventions like radical prostatectomy (RP) as well as nonsurgical treatments such as radiation therapy can all induce ED. PPS as a treatment for ED has high satisfaction rates in the general population. Our aim was to compare sexual satisfaction in patients with prosthesis implantation for ED following RP versus ED following radiation therapy for prostate cancer.Methods: A retrospective chart review from our institutional database was conducted to identify patients who underwent PPS at our institution from 2011 to 2021. Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire data at least 6 months from implant operative date available was required for inclusion. Eligible patients were placed in one of two groups depending on etiology of ED-following RP or prostate cancer radiation therapy. To prevent crossover confounding; patients with history of pelvic radiation were excluded from the RP group and patients with history of RP were excluded from the radiation group. Data was obtained from 51 patients in the RP group and 32 patients in the radiation therapy group.Mean EDITS scores and additional survey questions were compared between the radiation and RP groups.Results: There was a significant difference in mean survey responses for 8 of the 11 questions in the EDITS questionnaire between the RP group and the radiation group. Additional survey questions administered also found RP patients reported significantly higher rate of satisfaction with size of penis postoperatively versus the radiation group.Conclusions: These preliminary findings, while requiring large-scale follow-up, suggest that there is greater sexual satisfaction and penile prosthesis device satisfaction in patients undergoing IPP placement following RP versus radiation therapy for prostate cancer. Use of validated questionnaires should continue to be utilized in quantifying device and sexual satisfaction following PPS.
Based on this national case log sample resident operative experience has rebounded one year after COVID-19. However, 27.3% of programs still report significantly reduced case volumes per resident after COVID-19 and this may warrant further examination to ensure focal deficiencies in training don't arise.
Introduction: Limited data exist on in atable penile prosthesis (IPP) complication rates following dual implantation with an arti cial urinary sphincter (AUS) or bulbourethral male sling via a single perineal incision. Herein, we assess IPP complication rates after dual implantation via a single perineal incision versus more traditional penoscrotal approach.Methods: Patients with dual implantations of an IPP and AUS or sling between the 2011-2021 were identi ed. Postoperative IPP complications were assessed using the Clavien-Dindo (CD) classi cation at <30 days, 30 days-6 months, and >6 months. Treatment satisfaction was assessed using the validated EDITS questionnaire. IPP complication rates and mean EDITS scores were compared between the perineal and penoscrotal groups.Results: A total of 38 patients underwent dual implantation; 24 perineal vs 14 penoscrotal. There was no statistical difference in rate of complications between the two groups. The penoscrotal group had only two CD Grade I complications reported in the 30-day period and one Grade III complication in the >30 day to 6-month postoperative period. The perineal group had only two Grade III reported complications in the >6 month time frame. One patient in the perineal group and two in the penoscrotal group reported device malfunction at any point during follow-up, with no statistical difference in the rate of device malfunction.Conclusion: Patients undergoing dual IPP and AUS/sling placement via a perineal vs penoscrotal incision had similar IPP complication rates. A single perineal incision is a viable surgical approach for the dual implantation of an IPP and AUS or bulbourethral male sling.
BACKGROUND: One of the best predictors of positive outcomes in bladder cancer (BC) is pT0 following radical cystectomy (RC). Discordance between clinical and pathologic staging affects decision-making in patients with clinical absence of disease (cT0). OBJECTIVES: We sought to determine whether a restaging transurethral resection of bladder tumor (re-TURBT) improves clinical staging accuracy relative to pathologic stage RC in patients treated with neoadjuvant chemotherapy (NAC) versus those who did not receive NAC. METHODS: We queried our prospectively maintained IRB approved institutional database to identify 129 patients who underwent RC from 2013 to 2019 with a re-TURBT prior to RC. 53 patients were treated with NAC between their initial and re-TURBT and 76 patients were not treated with NAC. RESULTS: The overall upstaging rate from re-TURBT to RC was 34.9% . There was no significant difference in the upstaging rate between the NAC and no-NAC groups - 31.0% vs. 37.0%, respectively. In patients who were cT0 on re-TURBT, the NAC group did not show a significantly greater rate of pathologic clinical CR (pT0) than the no NAC group - 38.5% vs. 37.5%, respectively. Re-TURBT with staging < rT2 as a predictor for absence of MIBC on pathologic staging (<ypT2) did not show a significant difference between the NAC and no NAC group, with a negative predictive value (NPV) of 69.0% and 66.7%, respectively. CONCLUSIONS: Re-TURBT after NAC does not show statistically significant improvement in staging accuracy relative to pathologic stage at RC compared to re-TURBT in patients not treated with NAC.
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