Penile prostheses have remained the gold-standard therapy for medically refractory erectile dysfunction (ED) since their popularization. Advances in device design and surgical techniques have yielded improved rates of infection, satisfaction, and mechanical survival of devices. Operative techniques in penile prosthesis surgery include the use of adjunctive procedures (such as ventral phalloplasty and release of the suspensory ligament), management of penile fibrosis, and manoeuvres to correct Peyronie's-disease-related curvature. Complications include urethral and corporal perforation, crossover, infection, impending erosion, and/or supersonic transporter deformity. Long-term data regarding mechanical, overall, and infection-free survival demonstrate excellent results, and, given the consistently high satisfaction rates and limited alternatives for medically refractory ED, penile prostheses are likely to remain a relevant and important treatment strategy for the foreseeable future.
INTRODUCTION AND OBJECTIVES: Laser vaporization and enucleation have been introduced to reduce morbidity and postoperative hospital stay as compared to standard treatment like TUR-P. Comparative studies including large numbers of patients treated in daily routine are yet missing.METHODS: Patients treated with either TURP or laser procedures between 2011 and 2014 for BPO in four urological departments were included into this prospective observation. Multivariate evaluation was carried out to identify factors influencing postoperative stay. Subgroups for prostate volume were analysed.RESULTS: 2648 consecutive men were included into this prospective multicentre observation. Multivariate analyses proved the influence of the surgical procedure on the duration of the postoperative stay, with significantly shorter hospital stay for laser treatments as compared to resection (GL. -2.03 days, enucleation: -1.2 days; p<0.001). Increasing age prolonged the postoperative stay (+0.3 days/ decade; p<0.001). In patients with on-going anticoagulation or bridging the postoperative stay increased by +0.6 days on average (p<0.001). Analysing the subgroups for prostate volume, it showed, that vaporisation as well as enucleation was superior to resection independently of prostate volume (p<0.001). The advantage of enucleation over resection increased with prostate volume (<40cc: -0.9 days; 40-79cc: -1.13 days; > 80cc: -2.12 days; p>0.001). In small prostates (<40cc) on-going anticoagulation did not influence postoperative duration of hospital stay (p¼0.254), while increasing prostate volume led to increased postoperative length of stay, if anticoagulation was not discontinued (40-79cc: +0.6 days; >80cc: +1,2 days; p¼0.002) CONCLUSIONS: Laser treatment of the prostate is linked with significantly shorter postoperative stay as compared to resection. With increasing prostate size the advantage of enucleation over resection becomes more dominant. Surgery under on-going anticoagulation prolonged the postoperative hospital stay, if the prostate volume was larger than 40cc.
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