Introduction The efficacy, safety, and postoperative outcomes of synchronous surgery for concomitant erectile dysfunction (ED) and stress urinary incontinence (SUI) remain unclear. Objectives We performed a systematic review and meta-analysis to evaluate the available synchronous surgical approaches for concomitant ED and SUI and to assess the reoperation rates compared to asynchronous surgery and surgery only for ED or SUI. Methods We searched PubMed, Cochrane Library, and Embase databases until June 2022 for relevant studies. Based on data availability, we performed a meta-analysis of odds ratios (ORs) comparing reoperation rates after synchronous surgery in patients with concomitant ED and SUI versus asynchronous surgery, as well as surgery solely for ED or SUI (PROSPERO: CRD42022326941). Results We included 18 studies in the systematic review (16,517 patients) and 5 in the meta-analysis. Comparing synchronous implantation of penile prosthesis and artificial urinary sphincter (AUS) versus asynchronous surgery, no statistically significant differences were observed in the reoperation rates [OR:0.98, 95% confidence interval (CI): 0.52–1.84, I2:0%). Comparing synchronous implantation of both penile prosthesis and AUS versus implantation of only a penile prosthesis or an AUS, combined surgery was associated with higher reoperation rates (OR:2.02, 95%CI: 1.29–3.16, I2:36% and OR:1.7, 95%CI: 1.25–2.32, I2:0%, respectively). Synchronous surgery led to high satisfaction rates and significant improvement in ED and SUI. Evidence for the combination of penile prosthesis with a male sling or the ProACT device is low, but data suggests it may be safe and effective. The synchronous placement of a Mini-Jupette sling and penile prosthesis represents a promising treatment modality for the correction of ED and mild SUI and/or climacturia. Conclusions Synchronous penile prosthesis and AUS implantation appears safe and effective in patients with severe ED and SUI. Further high-quality studies are mandatory to strengthen the current scarce evidence for synchronous surgery in patients with ED and SUI.

Purpose: Our aim was to determine if the AUA-recommended prophylaxis (vancomycin D gentamicin alone) for primary inflatable penile prosthesis surgery is associated with a higher infection risk than nonstandard regimens. Materials and Methods: We performed a multicenter, retrospective study of patients undergoing primary inflatable penile prosthesis surgery. Patients were divided into those receiving vancomycin D gentamicin alone and those receiving any other regimen. A Cox proportional-hazards model was constructed adjusted for major predictors. A subgroup analysis to identify the appropriate dosage of gentamicin was also performed.

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Background Corporal fibrosis is known to result from prolonged priapism; however, the impact of the timing of penile prosthesis placement after priapism on complication rates is poorly understood. Aim We sought to evaluate the impact of timing of inflatable penile prosthesis (IPP) placement on complications in men with a history of ischemic priapism. Methods We performed a multicenter, retrospective cohort study of patients with a history of priapism undergoing IPP placement by 10 experienced implantation surgeons. We defined early placement as ≤6 months from priapism to IPP. We identified a 1:1 propensity-matched group of men without a history of priapism and compared complication rates between men who had early placement, late placement, and no history of priapism. Outcomes Our primary outcome was postoperative noninfectious complications, and secondary outcomes included intraoperative complications and postoperative infection. Results A total of 124 men were included in the study with a mean age of 50.3 ± 12.7 years. A total of 62 had a history of priapism and 62 were matched control subjects. The median duration of priapism was 37 (range, 3-168) hours and the median time from ischemic priapism to IPP placement was 15 months (range, 3 days to 23 years). Fifteen (24%) men underwent early (≤6 months) IPP placement at a median time of 2 months (range, 3 days to 6 months) following the ischemic priapism event. The remaining 47 (76%) underwent placement >6 months following priapism at a median time of 31.5 months (range, 7 months to 23 years). The complication rate in the delayed placement group was 40.5% compared with 0% in the early placement group and control group. Cylinder-related complications such as migration or leak accounted for 8 (57%) of 14 of the postoperative noninfectious complications. Full-sized cylinders were used in all patients who had a cylinder related complication. Clinical Implications Priapism patients should be referred to prosthetic experts early to decrease complication rates in those needing an IPP. Strengths and Limitations This is a multicenter study from experienced prosthetic urologists but is limited by the retrospective nature and small number of patients in the early placement group. Conclusion IPP complication rates are high in men with a history of ischemic priapism, especially when implantation is delayed beyond 6 months.

Purpose of Review There is a paucity of peer-reviewed evidence to guide medical management of stuttering priapism. The purpose of this review is to summarize the current understanding regarding the pathophysiology of priapism and management options for stuttering priapism. Recent Findings Conducting large-scale, randomized, placebo-controlled trials that elucidate the optimal treatment of stuttering priapism is challenging. Therefore, recent treatment guidelines are based upon small case series, retrospective studies, and expert opinions. Nonetheless, multiple compounds from various drug classes have shown promise in treating stuttering priapism, and a few pharmacotherapies such as Crizanlizumab are currently under active investigation. Summary Stuttering priapism is an under-investigated disorder with a complex pathophysiology. Currently, there is no wildly adopted universal therapeutic strategy. Further research is warranted to identify the appropriate treatment of stuttering priapism and to determine the long-term side effects of current pharmacotherapies.

Objective: To investigate the potential association of the gut microbiome with Peyronie's disease, as there has been no research to date that has studied these topics together. The goal of our study is to better characterize any potential relationships and to discuss possible mechanisms in which they would be related.Methods: Stool samples were collected from 12 participants with Peyronie's disease and 12 age-matched controls. Metatranscriptome sequencing was used to analyze the samples.Results: No signi cant differences were found in the gut microbiome characteristics, including Kyoto Encyclopedia of Genes and Genomes richness (p=0.541), Kyoto Encyclopedia of Genes and Genomes diversity (p=0.134), species richness (p=0.933), and species diversity (p=0.597), between the Peyronie's disease and control group.Conclusions: The results of this study do not support a signi cant change in the gut microbiome of men with Peyronie's disease compared to age-matched controls. Further research is needed to fully understand the impact of the gut microbiome on Peyronie's disease.

Objective: To investigate the potential association of the gut microbiome with Peyronie’s disease, as there has been no research to date that has studied these topics together. The goal of our study is to better characterize any potential relationships and to discuss possible mechanisms in which they would be related. Methods: Stool samples were collected from 12 participants with Peyronie’s disease and 12 age-matched controls. Metatranscriptome sequencing was used to analyze the samples. Results: No significant differences were found in the gut microbiome characteristics, including Kyoto Encyclopedia of Genes and Genomes richness (p=0.541), Kyoto Encyclopedia of Genes and Genomes diversity (p=0.134), species richness (p=0.933), and species diversity (p=0.597), between the Peyronie’s disease and control group. Conclusions: The results of this study do not support a significant change in the gut microbiome of men with Peyronie’s disease compared to age-matched controls. Further research is needed to fully understand the impact of the gut microbiome on Peyronie’s disease. Trial Registration Number: IRB 2017-3746

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