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The VJPU welcomes the new Editorial Board-members!

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Word from The Editor-In-Chief

It is with great pride that I welcome you to participate in the Journal of Prosthetic Urology (VJPU). The journal was created by the ISSM to serve as a forum for sexual medicine to allow its members to exchange notable ideas via the visual medium. Our members are scattered across the globe and prosthetic urology is a tiny subspecialty of sexual medicine. A specific goal was to facilitate the transmission of surgical technique knowledge regarding the implantation of surgical devices related to sexual medicine.

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Penuma(R) Concealed Technique Featuring A New Scrotal Incision

Authors: Steven K Wilson, James J. Elist, Kambiz Tajkarimi, Laurence Levine, Robert Valenzuela, Shawn Blick

Key Words: Penuma Implant, Girth, Enhancement, Cosmetic Urology, Penile Implant, Cosmetic Improvement of Penis

The purpose of this video is to demonstrate the “concealed” technique with the insertion of the Penuma® implant through a scrotal incision. Multiple prosthetic urologists have conducted the Penuma® insertion procedure, employing the “concealed” technique. The technique is demonstrated and narrated in the video. Patients were followed post-operatively for at least three months following the procedure to help identify the benefits of the “concealed” technique versus the traditional infrapubic approach. The new scrotal approach appears to be a simpler, quicker, and more aesthetically favorable alternative to the traditional suprapubic approach. The “concealed” technique is especially ideal in cosmetic surgery where peno-centric patients are focused on penile appearance. Physicians employing the use of the scrotal incision seem to agree that there is a lessened chance of seroma formation, simpler post-operative care, and favorable immediate results. Further evaluation must be conducted to identify additional benefits, but the initial benefits appear to be very promising.

Acknowledgement: We acknowledge International Medical Devices for sponsoring the production of this video.

Disclosures:

Steven K Wilson:  Consultant for AMT, Coloplast, International Medical Devices, Uramix

James J Elist: Medical Director of International Medical Devices

Laurence Levine: Consultant for International Medical Devices

Robert Valenzuela: Consultant for International Medical Devices

References:

  • Elist J, The Penuma® Silicone Implant: A new implantable device improving penile appearance and adding additional girth and length of penis outside the body. VJPU 2018; 2: 119

Penoscrotal Decompression of Refractory Ischemic Priapism: Surgical Technique

Authors: Nicholas Ottaiano, Ganesh Sanekommu, Christopher Koller, Wayne Hellstrom, Allen Morey, Omer A. Raheem

Key Words: Priapism, Penoscrotal Decompression, Refractory Ischemic Priapism

The video covers the etiology and multiple causes of each subtype of priapism with a special emphasis on a newer surgical technique, penoscrotal decompression. Outcomes after distal shunting have low rates of success in cases of refractory ischemic priapism lasting more than 48 hours. Current American Urological Association (AUA) guidelines recommend proximal shunting following a failed distal shunt; however, proximal shunting is no longer common practice due to the technically challenging nature of the procedure. Corporal decompression via a penoscrotal incision has recently emerged as a viable alternative to proximal shunting with favorable outcomes. In the video, we describe the technique in a step-by-step fashion as well as the preoperative workup and outcome.

Acknowledgement: None

Disclosures: The authors have nothing to disclose

References:

  • Montague DK, Jarow J, Broderick GA, Dmochowski RR, Heaton JP, Lue TF, et al. American Urological Association guideline on the management of priapism. J Urol. 2003;170(4 Pt 1):1318-24.
  • Salonia A, Eardley I, Giuliano F, Hatzichristou D, Moncada I, Vardi Y, et al. European Association of Urology guidelines on priapism. Eur Urol. 2014;65(2):480-9.
  • Muneer A, Ralph D. Guideline of guidelines: priapism. BJU International. 2017;119(2):204-8.
  • Sikka SC, Hellstrom WJ, Brock G, Morales AM. Standardization of vascular assessment of erectile dysfunction: standard operating procedures for duplex ultrasound. J Sex Med. 2013;10(1):120-9.
  • Fuchs JS, Shakir N, McKibben MJ, Mathur S, Teeple S, Scott JM, et al. Penoscrotal Decompression—Promising New Treatment Paradigm for Refractory Ischemic Priapism. The Journal of Sexual Medicine. 2018;15(5):797-802.
  • Baumgarten AS, VanDyke ME, Yi YA, Keith CG, Fuchs JS, Ortiz NM, et al. Favourable multi-institutional experience with penoscrotal decompression for prolonged ischaemic priapism. BJU International. 2020;126(4):441-6.

Simple Orchiectomy for Genital Dysphoria: A Step-By-Step Surgical Technique

Authors: Jacob Tannenbaum, Bryan Herzog, Omer Raheem. Department of Urology, Tulane University, School of Medicine, New Orleans Louisiana  

Key Words: Simple Orchiectomy, Surgical technique, gender dysphoria

In this video we demonstrate a step-by-step surgical technique for a simple orchiectomy of a neonatal male who identifies as female. An orchiectomy is the complete removal of both testicles and their surgical indications including gender dysphoria, metastatic prostate cancer, and chronic orchalgia. According to World Professional Association for Transgender Health (WPATH), patients who elect to undergo gender affirming surgeries can proceed with bilateral simple orchiectomy as standards of care. It is critical that the simple orchiectomy is performed meticulously to avoid any potential surgical complications as demonstrated in this video.  

Acknowledgement: None

Disclosures: None

References: None

Surgical Technique for Concurrent Penile Plication and Excision with Grafting for Severe Peyronie’s Disease

Authors: Jacob Tannenbaum, Bryan Herzog, Omer Raheem. Department of Urology, Tulane University, School of Medicine, New Orleans Louisiana  

Key Words: Penile plication; surgical technique; Grafting; Peyronie’s disease

This video covers the surgical technique used for grafting and the removal of the plication caused from a severe case of Peyronie’s disease (PD). Individuals with severe PD may elect to undergo surgical treatment to improve their sexual satisfaction during sexual intercourse. Indications for surgical treatment with grafting of PD include a penile deviation > 60 degrees, short penis, hourglass deformity, and satisfactory preoperative erectile function. In this video, we demonstrate the usage of preoperative imaging using penile duplex ultrasound and CEEVRA MRI penis 3D imaging to identify and model the plication. Furthermore, this video is a step-by-step guide to the health professional on the meticulous technique that can be used for a successful removal of a plication, grafting, as well as correction of penile curvature from PD.

Acknowledgement: None

Disclosures: None

References: None

Extracapsular Tunneling for the Management of Impending Cylinder Erosion

Author: Jonathan Clavell-Hernández, MD

Key Words: Inflatable penile prosthesis, Extracapsular Tunneling, Impending Erosion, Cylinder Extrusion

Impending erosion, or extrusion, of the distal cylinders is a complication which may cause cosmetic deformity or pain and may lead to patient dissatisfaction, device infection and erosion with subsequent inflatable penile prosthesis (IPP) removal. There are multiple approaches that have been described to manage this rare complication, many of which include a counter-incision(Mulcahy). Shaeer previously described the use of ‘extracapsular implantation’ to avoid implant reinfection during salvage cases (Shaeer et al). We believe this technique can be extrapolated to include cases of extrusion. This video shows the use of ‘extracapsular tunneling’ for the management of impending cylinder erosion at the time of IPP revision. Through a penoscrotal approach (although this technique can be performed through an infrapubic approach), the posterior wall of the capsule is superficially incised until the surgeon is able to identify the sinusoidal tissue surrounding the capsule. An extracapsular tunnel is then created and the stay sutures are placed at the edges of both the capsule and the corporotomy’s tunica albuginea. The IPP is then placed through the new extracapsular sinusoidal space which will collapse the intracapsular space when inflated. In summary, the extracapsular tunneling technique provides for an alternative method for management of distal impending erosion at the time of IPP revision without the use of a counter-incision.

Acknowledgement: None

Disclosures: Consultant – Boston Scientific, Coloplast

References:

1. Mulcahy JJ. Distal corporoplasty for lateral extrusion of penile prosthesis cylinders. J Urol 1999;161:193-5.
2. Shaeer O, Shaeer K, AbdelRahman IFS. Salvage and extracapsular implantation for penile prosthesis infection or extrusion. J Sex Med 2019;16:755-59.

Editor-In-Chief

Rafael.Carrion

Rafael Carrion, MD

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Ast. Editor-in-Chief

Justin Parker

Justin Parker, MD

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Ast. Editor-in-Chief

Lucas Wiegand

Lucas Wiegand, MD

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Editorial Board

Rafael Carrion, MD

Faysal A. Yafi, MD, FRCSC

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Editorial Board

Giulio Garaffa, MD

Prof.Dr. Osama Kamal Zaki Shaeer

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Editorial Board

Tobias Kohler, MD, MPH

Javier Otero Romero, MD, PhD, FEBU, FECSM

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Editorial Board

Christian Leiber, MD

Christopher Love, MD

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Editorial Board

Christian Leiber, MD

César Rojas Cruz, MD, FECSM

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Marah C. Hehemann, MD

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