Sinopsis

This textbook gives comprehensive coverage to the surgical management of erectile dysfunction with penile prostheses (PP) and the management of stress urinary incontinence using bladder outflow resistance created by the artificial urinary sphincter (AUS). Its intended audience are urologists who are interested in one or both topics.

The text is divided into 3 sections.

The first one deals with the history of the development of PP and the AUS, the surgical anatomy related to male erectile function and male and female urinary incontinence, operating room logistics for PP surgery, and the steps in setting up a dedicated urologic prosthetic practice.

The second part is devoted to restoring erectile function using PP. It includes chapters dealing with the appropriate evaluation of the surgical candidate, techniques of implant placement by various incisions, management of the patient postoperatively including addressing complications, and the use of PP in special circumstances including priapism, Peyronie’s Disease, fibrotic corporal bodies and the neophallus. The section concludes with a chapter on building a prosthetic urology practice, periprocedural counseling, and optimizing patient and partner satisfaction.

The third segment compromises with the AUS including evaluating patient candidates, basic scrotal and perineal placement techniques, intraoperative and postoperative management of the patient and any complications which may develop.

A final chapter deals with the use of the AUS in women.

Índice

SECTION I General Contents

CHAPTER 1 The History of the Penile Prostheses

First descriptions and management of erectile dysfunction
Initial attempts at penile prosthesis for the treatment of ED
1974 to Today
Current considerations and new directions

CHAPTER 2 Historical Aspects of the Artificial Urinary Sphincter

Early Devices
Evolution of the American Medical Systems (AMS) devices
AMS 800

CHAPTER 3 Functional and Surgical Anatomy in Erectile Dysfunction Restoration Surgery

Smooth Muscle Anatomy
Tunical anatomy
Neuroanatomy
Vascular anatomy
Space of retzius anatomy
Extraperitoneal anatomy
Glans
Other anatomical considerations

CHAPTER 4 Functional and Surgical Anatomy in Male and Female Incontinence Surgery

General concepts of stress urinary incontinence
Female anatomy
Male anatomy

CHAPTER 5 General Aspects for a Correct Penile Prosthesis Implant Strategy

Introduction
Patient selection
Surgical logistics

CHAPTER 6 How to Set Up a Prosthetic Urology Centre

Introduction
The unconditional advantage of a dedicated team
Pre‑ and post‑operative involvement of dedicated nurses
The next step: growing and teaching
Conclusions

SECTION II Erectile Restoration (Inflatable Penil Prosthesis Placement-IPP Placement)

CHAPTER 7 Preoperative Assessment

Penile prostheses
Informed consent
Medical clearance
Patient personal preparation
Skin preparation
Antibiotics
MRI, metal detectors

CHAPTER 8 Basic Scrotal and Infrapubic Techniques

Anaesthesia
Penoscrotal vs. infrapubic approach
The penoscrotal (PS) approach
The infrapubic (IP) approach
Salient features of each approach

CHAPTER 9 Intraoperative Management I

Antibiotic use
Foley catheter placement
Incisions and retractors
Corporal dilation and implant placement
Cylinder choice
Cylinder sizing
Ambicor‑rod width sizing
Cylinder placement
Corporotomy closure
PTFE sleeve

CHAPTER 10 Intraoperative Management II

Reservoir placement
Iliac Vessel injury
Bladder injury
Pump placement
Routing of tubing
Tubing length (inadequate or redundant)
Use of drains
Simultaneous surgery
Skin closure‑wound dressing
Semi‑inflation of an IPP
Special considerations

CHAPTER 11 Postoperative Considerations I

Antibiotics
Penile Positioning
Postoperative visits and wound care
Cycling the device
Corporotomy disruption
Cylinder aneurysm
Impendingcylinder erosion (laterally or into the urethra)
Cylinder erosion (laterally or into the urethra)
Reservoir erosion into the bowel or bladder
Impending pump or tubing erosion
Disrupted outer silicone layer
Presence of calcified matrix (putty) or calcified biofilm
Scar incased in PTFE sleeve
Tubing kink
Connector failure
Approach to repair of an uninfected implant

CHAPTER 12 Postoperative Considerations II

Penile necrosis
Infection
Bleeding
Pain

CHAPTER 13 IPP & Corporal Fibrosis

Introduction
Etiology of corporal fibrosis
Surgical strategies in fibrosis
Other strategies for fibrosis
Does length matter? Strategies to maximize it

CHAPTER 14 IPP and Peyronie's Disease 169

Introduction
Specific features of prosthetic Surgery in Peyronie's disease
Surgical algorithm
Residual curvature correction after penile prosthesis implantation
Lengthening procedures in Peyronie’s Disease
Complications related to penile prosthesis in the Peyronie’s population
Postoperative rehabilitation
Satisfaction outcomes after penile prosthesis in Peyronie’s population

CHAPTER 15 Redo Penile Prosthesis Implantation for Mechanical Failure

Epidemiology
Causes of penile prosthesis failure
Imaging
Tips and tricks in redo penile implant surgery for mechanical failure

CHAPTER 16 Penile Implants and Priapism

Clinical features of priapism
Treatment
Immediate penile prosthesis placement
Penile prosthesis with severe corporal fibrosis

CHAPTER 17 IPP in neophallus

History
Use of prosthetic implants in the neophallus
Principles of penile prosthesis insertion in the neophallus
Preoperative considerations
Operative / intra‑op
Postoperative care
Functional outcomes
Complications
Device survival
Explantation for infection or erosion
Revision surgery

CHAPTER 18 Building an IPP Practice & Peri‑Procedural Counseling to Optimize Patient Satisfaction

Building an IPP practice
Peri‑procedural counseling to optimize patient satisfaction
Final thoughts on optimizing a high‑volume IPP clinic from Dr. Köhler
Final thoughts on optimizing a high‑volume IPP clinic from Dr. Wilson

SECTION III Urinary Incontinence: Artificial Urinary Sphincter (AUS) and Sling

CHAPTER 19 Urinary Incontinence (AUS). Preoperative Assessment (Standard and Troubleshooting)

Initial evaluation
Challenging stuations
Revision surgery

CHAPTER 20 Basic Perineal & Scrotal Techniques

Anatomy
Basics
Surgical procedure
Comparison of the different approaches

CHAPTER 21 AMS 800 Prosthesis ‑ Intraoperative Management

Antibiotics
Foley catheter
Incisions – retractors
Double versus single cuff
Cuff sites
Measuring for cuff sizing
Urethral dissection
Urethral injury
Transcorporal (TC) cuff with or without penile implant
Urethral wrap
Hydraulic testing
Choice of reservoir pressure
Reservoir placement – Inguinal, midline, ectopic
Reservoir filling – technique, volume
Pump placement
Routing of tubing
Wound closure – Dressing
Urethral catheter removal

CHAPTER 22 Artificial Urinary Sphincter (AUS) Postoperative Considerations

Initial deactivation (6 – 8 weeks)
Antibiotics
Urinary retention
Wound separation
Early device infection
Subsequent post‑operative period
Late complications
Risk factors
Device information card and medic alert
Management of situations after recovery is complete
Other conditions that complicate artificial sphincter use and longevity
Concern about the pressure‑regulating balloon location

CHAPTER 23 Artificial Urinary Sphincters (AMS 800®, Boston Scientific, MA, USA) in Women

History of the prosthesis and its use in women
Indication and counterindications
The AMS 800® device in neurogenic patients
Surgical procedure
Results