We retrospectively evaluated the clinical outcome of penile prosthesis implantation （PPI） in Chinese patients with severe erectile dysfunction （SED）. From July 2000 to December 2011, 224 patients （mean age： 35.9...We retrospectively evaluated the clinical outcome of penile prosthesis implantation （PPI） in Chinese patients with severe erectile dysfunction （SED）. From July 2000 to December 2011, 224 patients （mean age： 35.9±11.8 years, range： 20-75 years） with SED underwent PPI by experienced surgeon according to standard PPI procedure at our centre. A malleable prosthesis （AMS 650） was implanted in 45 cases （20.1%）, and a three-piece inflatable prosthesis （AMS 700 CXM or AMS 700 CXR） was implanted in 179 cases （79.9%）. Surgical outcomes, including postoperative complications, clinical efficacy and couple satisfaction, were evaluated over than 6 months postoperatively using medical record abstraction, IIEF-5, quality of life （QoL） scores, and the patient/partner sexual satisfaction score proposed by Bhojwani etaL Of the 224 patients eligible for the study, 201 subjects （89.7%） completed follow-up. All of patients could perform sexual intercourse post PPI with the mean postoperative IIEF-5 and QoL scores were 20.02±2.32 and 5.28±0.76, respectively, which were significantly improved compared with the preoperative scores （6.29±1.5 and 2.13±0.84, P〈0.01）. Of the 201 men, mechanical malfunction occurred in four cases （2.0%） and three cases were re-implanted new device, and two cases （1.0%） developed a mild curvature of the penis. Scrotal erosion with infection occurred in one case with diabetes mellitus （0.5%） and required complete removal of the implanted AMS 700 CXM. Satisfactory sexual intercourse at least twice per month was reported by 178 men （88.6%）, and overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners. Patient satisfaction in the three-piece inflatable prosthesis group was higher than in the malleable prosthesis group （P〈0.05）. Satisfaction, however, between the types of prostheses, did not differ in the partner survey. PPI is a safe and effective treatment option for Chinese patients with SED and experienced surgeon perform PPI according to standard PPI procedure could reduce the postoperative complications of PPI and could improve patient satisfaction ratio and QoL.展开更多
Aim： To report a short-time result of three-piece inflatable penile prosthesis （IPP） implantation on treating patients with organic erectile dysfunction （ED）. Methods： Three-piece IPPs were implanted in 42 Chine...Aim： To report a short-time result of three-piece inflatable penile prosthesis （IPP） implantation on treating patients with organic erectile dysfunction （ED）. Methods： Three-piece IPPs were implanted in 42 Chinese patients with ED refractory to systemic treatment between May 2002 and May 2004. The etiologies of ED were neurogenic （28 with paraplegia and seven with traumatic nervi-erigentes injury）, congenital venous leakage （5 cases）, fibrosis of corpus cavernosum （lcase） and Klinefelter＇s syndrome （1 case）. The follow-up period ranged from 24 to 57 months. Results： Implantation procedures were successfully performed upon all 42 patients. The length of implanted prosthesis was from 13 cm to 18 cm, and the diameter was 1 cm. The implanted prosthesis was made by the Medical Instrumentation Company of Muping （Muping, Shandong, China）. Localized infection occurred in only one patient and mechanical complications occurred in five patients. Coitus could be performed in 41 cases （97.6%）. Three patients with congenital venous leakage made their spouses pregnant after implantation. Conclusion： Implantation of three-piece IPP is an effective and safe modality for treating patients with ED. It can be well accepted by Chinese patients because of its efficacy.展开更多
Background: Modification of surgical techniques to minimize wound infections in penile implant surgery using malleable prosthesis which is easy to use, of very low risk of mechanical failure and is financially suitabl...Background: Modification of surgical techniques to minimize wound infections in penile implant surgery using malleable prosthesis which is easy to use, of very low risk of mechanical failure and is financially suitable to improve outcome and ensures less complications. The aim of the study is to compare infrapubic approach and Penoscrotal approach in penile semi-rigid prosthesis implantation surgery. Patients and methods: Fifty patients were randomly divided into two groups and each group underwent one approach. Results: No statically significant differences were found between both groups in terms of operative time. Corporeal cross over was the most common intraoperative complications, 3 cases in IP approach and 6 cases in PS but not statistically significant. Peyronie’s disease patients underwent penile implant through infrapubic approach in 3 cases and PS in 4 cases with one recorded complication of keloid formations with IP. Urethral false passage reported only in one case with PS approach without affecting the procedure. Only minor complications including superficial wound infection which was significantly more with PS, 6/25 (24%) and IP 1/25 (4%), p value = 0.041. Penile and scrotal edema was common with IP approach (92%) in comparison with PS approach (60%). The urethral catheter can be abandoned with IP to avoid the risk of catheterizations. No significant relation between diabetes and infections and no erosions were encountered. Conclusion: Through this research work, infrapubic approach is better than Penoscrotal approach even if it is not commonly used by surgeon.展开更多
Objective:To evaluate surgical outcomes after implantation of the Zephyr ZSI 475 inflatable penile prosthesis(IPP)and patients’quality of life.Methods:From December 2014 to September 2018,15 patients underwent prosth...Objective:To evaluate surgical outcomes after implantation of the Zephyr ZSI 475 inflatable penile prosthesis(IPP)and patients’quality of life.Methods:From December 2014 to September 2018,15 patients underwent prosthesis implantation with ZSI 475.A retrospective review of clinical data was performed.Patients’quality of life after implantation was investigated with Quality of Life and Sexuality with Penile Prosthesis(QoLSPP)questionnaire.Results:The median age of patients was 57 years and the average follow-up time was 22 months.Twelve patients received a standard implantation due to severe erectile dysfunction(ED);three patients also presented penile curvature and additional corporoplasty with grafting was necessary.Three procedures had to be interrupted due to defects of the insertion tools.In one case a manufacturing defect resulted in a pump leak.In one case,a severe postoperative complication occurred,which requested explanation of the device.During the follow-up,four patients experienced mechanical failure of the prosthesis.Results of QoLSPP questionnaire at 12 months were skewed toward the positive end of the scale in all domains.Conclusion:In our initial experience,ZSI 475 suffered a high rate of mechanical failures;on the other hand,the company showed great commitment in order to improve the quality and reliability of the device.The lower cost of ZSI 475 may add to the chances of the product to become a cost-effective alternative to treat those patient who need a IPP.展开更多
Erectile dysfunction （ED） and stress urinary incontinence （SUI） from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical ...Erectile dysfunction （ED） and stress urinary incontinence （SUI） from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.展开更多
Penile prosthesis surgery is a definitive treatment for erectile dysfunction(ED).The two categories of penile prosthesis are endorsed by professional guidelines,inflatable penile prosthesis(IPP)and malleable penile pr...Penile prosthesis surgery is a definitive treatment for erectile dysfunction(ED).The two categories of penile prosthesis are endorsed by professional guidelines,inflatable penile prosthesis(IPP)and malleable penile prosthesis(MPP).Each modality of penile prosthesis offers distinct advantages and incorporates specific design features,allowing for personalized device selection that aligns with individual needs and preferences.While the overall complication rate of penile implant surgery remains low,surgeons should maintain a high index of suspicion for complications in the perioperative time period.Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain.Finally,the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.展开更多
A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement techniq...A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique （NLMT） coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfact on and erectile peni e measurements Th s is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, With new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer （30.8%） or the same （46.2%） as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject （96.5%） was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.展开更多
Penile prosthesis implant(PPI)remains an effective and safe treatment option for men with erectile dysfunction(ED).However,PPI surgery can be associated with a higher risk of complications in certain populations.This ...Penile prosthesis implant(PPI)remains an effective and safe treatment option for men with erectile dysfunction(ED).However,PPI surgery can be associated with a higher risk of complications in certain populations.This article provides a critical review of relevant publications pertaining to PPI in men with diabetes,significant corporal fibrosis,spinal cord injury,concurrent continence surgery,and complex salvage cases.The discussion of each category of special populations includes a brief review of the surgical challenges and a practical action-based set of recommendations.While specific patient populations posed considerable challenges in PPI surgery,strict pre-and postoperative management coupled with safe surgical practice is a prerequisite to achieving excellent clinical outcomes and high patient satisfaction rate.展开更多
Most widespread three-component penile prosthesis models are 700CXTM and Titan~. Our purpose is to assess patient and partner satisfaction after the first implant. This is a multicenter, retrospective, nonrandomized s...Most widespread three-component penile prosthesis models are 700CXTM and Titan~. Our purpose is to assess patient and partner satisfaction after the first implant. This is a multicenter, retrospective, nonrandomized study in which all patients who met the inclusion criteria between 2009 and 2013 were included. In total, 248 patients agreed to participate. To evaluate patient satisfaction, a validated but modified 11-question questionnaire was completed （EDITS）; and a nonvalidated two-item questionnaire was given to the partner. Statistical analysis used an ordinal logistic regression model. Two hundred and forty-eight patients （194 with 700CXTM vs 54 with Titan） and 207 couples completed the questionnaire （165 with 700CXTM vs 42 with Titan）. Overall satisfaction was high. Both showed great reliability for sexual intercourse and high compliance with prior expectations. Most patients were able to manage the penile prosthesis correctly within 6 months. Postoperative penile shortening led to some dissatisfaction in 42% and 46% of cases （700CX/Titan）. Significant differences were found in three questions of patients＇ questionnaire. There were more patients satisfied with the 700CXTM （P= 0.0001）. No patient with Titan implant took longer than 6 months to optimal management. Only 4% of patients with 700CXTM implant were dissatisfied with the deflation, in contrast to 24% with the Titan （P = 0.0031）. Of the two partners＇ questions, one showed a statistically significant difference （P = 0.0026）. It seems that group 700CX＂ would recommend to re-implant the prosthesis with a greater tendency. The overall satisfaction was very high for both prostheses. The final aspect of the erected and flaccid penis was satisfactory, but both groups showed significant discontent with its final size. Partners＇ overall satisfaction was high.展开更多
Since their popularization,genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction.They ...Since their popularization,genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction.They have also represented an area of significant innovation,which has contributed to excellent long-term outcomes.Given this history,the objective of the current review was to provide a 5-10-year outlook on anticipated trends and developments in the field of genitourinary prosthetics.To accomplish this objective,a PubMed and patent search was performed of topics relating to penile and testicular prostheses and urinary sphincters.In regard to penile prostheses,findings demonstrated several new concepts including temperature-sensitive alloys,automated pumps,devices designed specifically for neophalluses,and improved malleable designs.With artificial urinary sphincters,new concepts include the ability to add or remove fluid from an existing system,two-piece systems,and new mechanisms to occlude the urethra.For testicular prosthetics,future implementations may not only better replicate the feel of a biological testicle but also add endocrinological functions.Beyond device innovation,the future of prosthetics is also one of expanding geographic boundaries,which necessitates variable cost modeling and regulatory considerations.Surgical trends are also changing,with a greater emphasis on nonnarcotic,postoperative pain control,outpatient surgeries,and adjunctive techniques to lengthen the penis and address concomitant stress incontinence,among others.Concomitant with device and surgical changes,future considerations also include a greater need for education and training,particularly given the rapid expansion of sexual medicine into developing nations.展开更多
基金This work was supported by the National Natural Science Foundation of China （Nos. 81270693 and 81272531）.
文摘We retrospectively evaluated the clinical outcome of penile prosthesis implantation （PPI） in Chinese patients with severe erectile dysfunction （SED）. From July 2000 to December 2011, 224 patients （mean age： 35.9±11.8 years, range： 20-75 years） with SED underwent PPI by experienced surgeon according to standard PPI procedure at our centre. A malleable prosthesis （AMS 650） was implanted in 45 cases （20.1%）, and a three-piece inflatable prosthesis （AMS 700 CXM or AMS 700 CXR） was implanted in 179 cases （79.9%）. Surgical outcomes, including postoperative complications, clinical efficacy and couple satisfaction, were evaluated over than 6 months postoperatively using medical record abstraction, IIEF-5, quality of life （QoL） scores, and the patient/partner sexual satisfaction score proposed by Bhojwani etaL Of the 224 patients eligible for the study, 201 subjects （89.7%） completed follow-up. All of patients could perform sexual intercourse post PPI with the mean postoperative IIEF-5 and QoL scores were 20.02±2.32 and 5.28±0.76, respectively, which were significantly improved compared with the preoperative scores （6.29±1.5 and 2.13±0.84, P〈0.01）. Of the 201 men, mechanical malfunction occurred in four cases （2.0%） and three cases were re-implanted new device, and two cases （1.0%） developed a mild curvature of the penis. Scrotal erosion with infection occurred in one case with diabetes mellitus （0.5%） and required complete removal of the implanted AMS 700 CXM. Satisfactory sexual intercourse at least twice per month was reported by 178 men （88.6%）, and overall satisfaction with the PPI surgery was reported by 89.0% of men and 82.5% of partners. Patient satisfaction in the three-piece inflatable prosthesis group was higher than in the malleable prosthesis group （P〈0.05）. Satisfaction, however, between the types of prostheses, did not differ in the partner survey. PPI is a safe and effective treatment option for Chinese patients with SED and experienced surgeon perform PPI according to standard PPI procedure could reduce the postoperative complications of PPI and could improve patient satisfaction ratio and QoL.
文摘Aim： To report a short-time result of three-piece inflatable penile prosthesis （IPP） implantation on treating patients with organic erectile dysfunction （ED）. Methods： Three-piece IPPs were implanted in 42 Chinese patients with ED refractory to systemic treatment between May 2002 and May 2004. The etiologies of ED were neurogenic （28 with paraplegia and seven with traumatic nervi-erigentes injury）, congenital venous leakage （5 cases）, fibrosis of corpus cavernosum （lcase） and Klinefelter＇s syndrome （1 case）. The follow-up period ranged from 24 to 57 months. Results： Implantation procedures were successfully performed upon all 42 patients. The length of implanted prosthesis was from 13 cm to 18 cm, and the diameter was 1 cm. The implanted prosthesis was made by the Medical Instrumentation Company of Muping （Muping, Shandong, China）. Localized infection occurred in only one patient and mechanical complications occurred in five patients. Coitus could be performed in 41 cases （97.6%）. Three patients with congenital venous leakage made their spouses pregnant after implantation. Conclusion： Implantation of three-piece IPP is an effective and safe modality for treating patients with ED. It can be well accepted by Chinese patients because of its efficacy.
文摘Background: Modification of surgical techniques to minimize wound infections in penile implant surgery using malleable prosthesis which is easy to use, of very low risk of mechanical failure and is financially suitable to improve outcome and ensures less complications. The aim of the study is to compare infrapubic approach and Penoscrotal approach in penile semi-rigid prosthesis implantation surgery. Patients and methods: Fifty patients were randomly divided into two groups and each group underwent one approach. Results: No statically significant differences were found between both groups in terms of operative time. Corporeal cross over was the most common intraoperative complications, 3 cases in IP approach and 6 cases in PS but not statistically significant. Peyronie’s disease patients underwent penile implant through infrapubic approach in 3 cases and PS in 4 cases with one recorded complication of keloid formations with IP. Urethral false passage reported only in one case with PS approach without affecting the procedure. Only minor complications including superficial wound infection which was significantly more with PS, 6/25 (24%) and IP 1/25 (4%), p value = 0.041. Penile and scrotal edema was common with IP approach (92%) in comparison with PS approach (60%). The urethral catheter can be abandoned with IP to avoid the risk of catheterizations. No significant relation between diabetes and infections and no erosions were encountered. Conclusion: Through this research work, infrapubic approach is better than Penoscrotal approach even if it is not commonly used by surgeon.
文摘Objective:To evaluate surgical outcomes after implantation of the Zephyr ZSI 475 inflatable penile prosthesis(IPP)and patients’quality of life.Methods:From December 2014 to September 2018,15 patients underwent prosthesis implantation with ZSI 475.A retrospective review of clinical data was performed.Patients’quality of life after implantation was investigated with Quality of Life and Sexuality with Penile Prosthesis(QoLSPP)questionnaire.Results:The median age of patients was 57 years and the average follow-up time was 22 months.Twelve patients received a standard implantation due to severe erectile dysfunction(ED);three patients also presented penile curvature and additional corporoplasty with grafting was necessary.Three procedures had to be interrupted due to defects of the insertion tools.In one case a manufacturing defect resulted in a pump leak.In one case,a severe postoperative complication occurred,which requested explanation of the device.During the follow-up,four patients experienced mechanical failure of the prosthesis.Results of QoLSPP questionnaire at 12 months were skewed toward the positive end of the scale in all domains.Conclusion:In our initial experience,ZSI 475 suffered a high rate of mechanical failures;on the other hand,the company showed great commitment in order to improve the quality and reliability of the device.The lower cost of ZSI 475 may add to the chances of the product to become a cost-effective alternative to treat those patient who need a IPP.
文摘Erectile dysfunction （ED） and stress urinary incontinence （SUI） from urethral sphincteric deficiency is not an uncommon problem. The commonest etiology is intervention for localized prostate cancer and/or radical cystoprostatectomy for muscle invasive bladder cancer. Despite advances in surgical technology with robotic assisted laparoscopic prostatectomy and nerve sparing techniques, the rates of ED and SUI remain relatively unchanged. They both impact greatly on quality of life domains and have been associated with poor performance outcomes. Both the artificial urinary sphincter and penile prosthesis are gold standard treatments with proven efficacy, satisfaction and durability for end-stage SUI and ED respectively. Simultaneous prosthesis implantation for concurrent conditions has been well described, mostly in small retrospective series. The uptake of combination surgery has been slow due in part to technical demands of the surgery and to an extent, a heightened anxiety over potential complications. This paper aims to discuss the technical aspect of concurrent surgery for both disease entity and the current published outcomes of the various surgical techniques with this approach.
文摘Penile prosthesis surgery is a definitive treatment for erectile dysfunction(ED).The two categories of penile prosthesis are endorsed by professional guidelines,inflatable penile prosthesis(IPP)and malleable penile prosthesis(MPP).Each modality of penile prosthesis offers distinct advantages and incorporates specific design features,allowing for personalized device selection that aligns with individual needs and preferences.While the overall complication rate of penile implant surgery remains low,surgeons should maintain a high index of suspicion for complications in the perioperative time period.Multimodal analgesic regimens including nerve blocks and narcotic-free pathways should be administered to manage perioperative pain.Finally,the high patient satisfaction after penile prosthesis surgery underscores the success of this ED treatment option.
文摘A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique （NLMT） coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfact on and erectile peni e measurements Th s is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, With new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for 1-2 h daily for 6-24 months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. 67.8% of subjects were satisfied with their length at 2 years, and 77% had perceived penile length that was longer （30.8%） or the same （46.2%） as prior to the surgery. 64.3% and 17.9% of subjects had increased and unchanged satisfaction, respectively, with penile length as compared to prior to penile implant surgery. All but one subject （96.5%） was satisfied with the overall function of his implant. This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.
文摘Penile prosthesis implant(PPI)remains an effective and safe treatment option for men with erectile dysfunction(ED).However,PPI surgery can be associated with a higher risk of complications in certain populations.This article provides a critical review of relevant publications pertaining to PPI in men with diabetes,significant corporal fibrosis,spinal cord injury,concurrent continence surgery,and complex salvage cases.The discussion of each category of special populations includes a brief review of the surgical challenges and a practical action-based set of recommendations.While specific patient populations posed considerable challenges in PPI surgery,strict pre-and postoperative management coupled with safe surgical practice is a prerequisite to achieving excellent clinical outcomes and high patient satisfaction rate.
文摘Most widespread three-component penile prosthesis models are 700CXTM and Titan~. Our purpose is to assess patient and partner satisfaction after the first implant. This is a multicenter, retrospective, nonrandomized study in which all patients who met the inclusion criteria between 2009 and 2013 were included. In total, 248 patients agreed to participate. To evaluate patient satisfaction, a validated but modified 11-question questionnaire was completed （EDITS）; and a nonvalidated two-item questionnaire was given to the partner. Statistical analysis used an ordinal logistic regression model. Two hundred and forty-eight patients （194 with 700CXTM vs 54 with Titan） and 207 couples completed the questionnaire （165 with 700CXTM vs 42 with Titan）. Overall satisfaction was high. Both showed great reliability for sexual intercourse and high compliance with prior expectations. Most patients were able to manage the penile prosthesis correctly within 6 months. Postoperative penile shortening led to some dissatisfaction in 42% and 46% of cases （700CX/Titan）. Significant differences were found in three questions of patients＇ questionnaire. There were more patients satisfied with the 700CXTM （P= 0.0001）. No patient with Titan implant took longer than 6 months to optimal management. Only 4% of patients with 700CXTM implant were dissatisfied with the deflation, in contrast to 24% with the Titan （P = 0.0031）. Of the two partners＇ questions, one showed a statistically significant difference （P = 0.0026）. It seems that group 700CX＂ would recommend to re-implant the prosthesis with a greater tendency. The overall satisfaction was very high for both prostheses. The final aspect of the erected and flaccid penis was satisfactory, but both groups showed significant discontent with its final size. Partners＇ overall satisfaction was high.
文摘Since their popularization,genitourinary prosthetics have remained a gold-standard therapy for the treatment of erectile dysfunction and stress urinary incontinence and in cases of testicular loss or dysfunction.They have also represented an area of significant innovation,which has contributed to excellent long-term outcomes.Given this history,the objective of the current review was to provide a 5-10-year outlook on anticipated trends and developments in the field of genitourinary prosthetics.To accomplish this objective,a PubMed and patent search was performed of topics relating to penile and testicular prostheses and urinary sphincters.In regard to penile prostheses,findings demonstrated several new concepts including temperature-sensitive alloys,automated pumps,devices designed specifically for neophalluses,and improved malleable designs.With artificial urinary sphincters,new concepts include the ability to add or remove fluid from an existing system,two-piece systems,and new mechanisms to occlude the urethra.For testicular prosthetics,future implementations may not only better replicate the feel of a biological testicle but also add endocrinological functions.Beyond device innovation,the future of prosthetics is also one of expanding geographic boundaries,which necessitates variable cost modeling and regulatory considerations.Surgical trends are also changing,with a greater emphasis on nonnarcotic,postoperative pain control,outpatient surgeries,and adjunctive techniques to lengthen the penis and address concomitant stress incontinence,among others.Concomitant with device and surgical changes,future considerations also include a greater need for education and training,particularly given the rapid expansion of sexual medicine into developing nations.
