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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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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.

Placement of a Malleable Penile Prosthesis in the subcoronal approach

Author: Scott Brimley, Bryan Herzog, Ayad Yousif, Wayne Hellstrom, Omer Raheem

Key Words: Penile implant, malleable, subcoronal

This video shows a clear demonstration of a malleable penile implant through the subcoronal approach. MPPs are placed for patients who have poor manual dexterity, prefer a simpler penile implant option, or have a history of a previously infected device. This is a rare procedure that can be difficult to perform due to the challenge of placing the distal portion. The malleable implants are placed in the corpora after dilation and measurement with special devices.

Acknowledgement: None

Disclosures: The authors have nothing to disclose

References:

1. Levine LA, Becher EF, Bella AJ, Brant WO, Kohler TS, Martinez-Salamanca JI, Trost L, Morey AF. Penile Prosthesis Surgery: Current Recommendations From the International Consultation on Sexual Medicine. J Sex Med. 2016 Apr;13(4):489-518. doi: 10.1016/j.jsxm.2016.01.017. Epub 2016 Mar 25. Erratum in: J Sex Med. 2016 Jul;13(7):1145. PMID: 27045255.

Scrotal Tunnel and Ventral Phalloplasty-- a practical alternative to the split thickness skin graft for penile skin coverage

Author: Bhavik B. Shah MD 

Key Words: Penile reconstruction, penile skin coverage, liquid silicone explant. 

This video provides a novel technique one may utilize when addressing the challenges of removing a "self-made" liquid silicone girth enhancement implant.  The video shows the consequential result of self-addressing concerns about penile size.  This trend of inserting penile objects appears to be most prevalent among men in areas of Indonesia, the Philippines, Thailand, and Malaysia. More importantly this video provides an alternative to the split thickness skin graft that may be extremely advantageous in any setting requiring penile skin coverage where there is sufficient scrotal skin available. The obvious negative to the use of scrotal flaps apply, including the use of hair bearing skin on the penile shaft.  Step by step instructions are given to make this procedure easily reproducible. 

Acknowledgement: None

Disclosures: The authors have nothing to disclose

References:

References: 1. Sasidaran, Ramesh, et al. “Low-Grade Liquid Silicone Injections as a Penile Enhancement Procedure: Is Bigger Better?” Urology Annals, Medknow Publications & Media Pvt Ltd, Sept. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3519113/.

Everything you want to know about IPP via subcoronal incision

Authors: Sung Hun Park, Cesar Mora-Estaves, Steven K Wilson

Key words: penile implant, subcoronal incision, disposable retractor

This video covers tips and tricks with step by step surgical method of subcoronal incision for inflatable penile prosthesis placement. Subcoronal incision has several advantages including excellent exposure for fixing Peyronie’s, best match for local anesthesia and easier pump & reservoir placement. Several surgical steps are highlighted: complete dissection of Dartos fascia, applying twin Deaver maneuver to expose proximal corpora, deploying disposable Wilson retractor with Cowboy blanket roll to facilitate the exposure and minimize distal corporal crossover or urethral perforation. In summary, we believe the subcoronal incision has the advantage of the infrapubic incision in reservoir placement and the advantage of the penoscrotal incision in pump placement.

Acknowledgements: Educational grant from Coloplast

Disclosures:SK Wilson consultant for AMT, Coloplast, International Medical Devices, Lecturer for Boston Scientific.  Stockholder for NeoTract, Sung Hun Park – consultant for Coloplast and Boston Scientific, Cesar Mora-Estaves – None

References

  1. Weinburg AC, Pagano MJ, Deibert CM, Valenzuela RJ. Sub-Coronal Inflatable penile prosthesis placement with modified no touch technique: a step by step approach with outcomes. J Sex Med 2016:13:270
  2. Park SSH, Wilson SK, Morey AF. Inflatable penile prosthesis implantation is possible under local anesthesia with conscious sedation: technique and results. J Sex Med 2015:12:136

Pudendal and Dorsal Penile Nerve Blocks during Inflatable Penile Prosthesis Implantation

Authors: Farouk M. El-Khatib1, Aron Liaw1, Charles A. Loeb1, Jeanie T. Nguyen1, Jay Simhan2, Faysal A. Yafi1

1- Department of Urology, University of California Irvine, Orange, CA, USA
2- Department of Urology, Einstein Healthcare Network, Philadelphia, PA, USA

Keywords: pudendal nerve, dorsal penile nerve, nerve blocks, penile prosthesis

Pudendal nerve blocks (PNB) have historically been used as regional anesthesia during obstetric procedures, but not as much for urological procedures [1]. While dorsal penile nerve blocks (DPNB) can be used for a variety of urethral surgeries and repair of penile lacerations [2]. In a large, multicenter patient cohort undergoing Inflatable Penile Prosthesis (IPP) implantation whose pain was managed using a multimodal analgesia (MMA) protocol, results showed that patients adhering to this protocol had significantly lower postoperative pain measures, significantly lower usage of narcotics (both inpatient and outpatient), without any discernable side effects [3]. Both PNB and DPNB were part of the MMA protocol. This video demonstrates our easily reproducible technique of performing these procedures pre-operatively in the setting of our MMA protocol. In conclusion, dorsal penile and pudendal nerve blocks are simple and safe procedures that may offer better pain control to patients undergoing penile prosthesis implantation.

Acknowledgements: None

Disclosures: Antares Pharma: Advisory board, speaker. Coloplast: Advisory board, consultant. Endo Pharmaceuticals: Advisory board, speaker. Viome: Research grant primary investigator

References

  • Oelhafen K, Shayota BJ, Muhleman M, Klaassen Z, Tubbs RS, Loukas M. Benjamin Alcock (1801-?) and his canal. Clin Anat. 2013 Sep;26(6):662-6.
  • Rose G, Costa V, Drake A, Siadecki S. Ultrasound-guided dorsal penile nerve block performed in a case of zipper entrapment injury. J Clin Ultrasound.45:589–591. https://doi.org/10.1002/jcu.22459
  • Lucas J, Gross M, Yafi F, et al. A Multi-institutional Assessment of Multimodal Analgesia in Penile Implant Recipients Demonstrates Dramatic Reduction in Pain Scores and Narcotic Usage. J Sex Med. 2020;17(3):518‐ doi:10.1016/j.jsxm.2019.11.267

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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