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Testosterone Replacement, Low T, HCG, & Beyond
When Testosterone Is Not Enough
Recent technological development of penile prosthesis
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<blockquote data-quote="madman" data-source="post: 276315" data-attributes="member: 13851"><p><strong>Background and Objective</strong></p><p></p><p><em>In contemporary Urology, the gold standard for treatment of erectile dysfunction refractory to medical therapy has been implantation with a penile prosthesis. The past 40 years have witnessed evolutions in technology and surgical techniques, which have led to increased patient satisfaction rates and decreased complication and infection rates.<strong> This review is an update to a prior review article that evaluates these advancements in the context of patient satisfaction and different rates of complications following surgeries. In addition, the review compares malleable and inflatable prostheses with regard to infection rate, mechanical failure rate, and erosion rate.</strong></em></p><p></p><p></p><p><strong>Methods</strong></p><p></p><p><em>A literature search was conducted using Medline and Google Scholar to examine papers from 1973 to the present day. Keywords, such as, “penile prosthesis surgery”, “malleable penile prosthesis”, “inflatable penile prosthesis”, “two-piece Inflatable Penile Prosthesis (IPP)”, and “three-piece IPP” were utilized during the search. A total of 76 papers were included, and all were in English.Key</em></p><p> </p><p></p><p><strong>Content and Findings</strong></p><p></p><p><em>Studies on the latest models of each of the three prostheses (malleable, two-piece IPP, three-piece IPP) revealed patient satisfaction ratings at or above 75%. <strong>Both types of IPPs were associated with greater satisfaction and lower erosion rates while malleable prostheses were associated with lower mechanical failure rates. Although no significant differences in infection rates were noted between the prosthesis types, a history of diabetes, obesity, and smoking were predictive of infection events.</strong></em></p><p></p><p></p><p><strong>Conclusions</strong></p><p></p><p><em><strong>The three-piece IPP, if indicated for a suitable patient, is generally accepted as the best type of prosthesis given its biological mimicry to an erect human penis.</strong></em></p><p></p><p></p><p></p><p><strong>Introduction</strong></p><p></p><p><em>In 1936, a Russian surgeon named Nikolaj Bogaraz designed the first autologous penile implant using a patient’s rib cartilage (1). A few decades later, the first inflatable penile prosthesis (IPP) and the Small-carrion malleable prosthesis were introduced in 1973 (2). <strong>In contemporary times, penile prostheses are the mainstay treatment for male urologic conditions, namely erectile dysfunction (ED) that is refractory to pharmacologic therapy</strong>. <strong>Penile prostheses are often classified as malleable (also known as semi-rigid), two-piece inflatable, or three-piece inflatable; each necessitating a distinct surgical technique. Of the three classes, the <u>three-piece IPP is considered the most technologically advanced implant in the realm of penile prostheses and is used in the majority of penile implant surgeries</u> (3). Prior reviewsof penile prostheses has stratified findings based on the type of prosthesis (i.e., two-piece) but not by the model type (i.e., Coloplast Titan). The present review is an update to our previously published article and emphasizes the postoperative outcomes of penile prosthesis procedures by implant type and model (4). </strong>We present this article in accordance with the Narrative Review reporting checklist (available at <a href="https://tau.amegroups.com/article/view/10.21037/tau-22-741/rc" target="_blank">Recent technological development of penile prosthesis: a literature review - Patel- Translational Andrology and Urology</a>).</em></p><p></p><p></p><p></p><p></p><p><strong>Malleable prostheses</strong></p><p><em>Historical perspective</em></p><p><em>Technological development of malleable prostheses</em></p><p><em>New Tactra, Rigi10, and touchless memory shape prostheses</em></p><p><em>Surgical considerations and post-operative results for malleable implants</em></p><p></p><p></p><p></p><p></p><p><strong>Inflatable prostheses</strong></p><p><strong></strong></p><p><strong>Two-piece IPP</strong></p><p><em>Historical perspective</em></p><p><em>Technological development of two-piece prostheses</em></p><p><em>Surgical Considerations and post-operative results for Two-piece Implants</em></p><p></p><p></p><p></p><p></p><p><strong>Three-piece inflatable prostheses</strong></p><p><em>Historical perspective</em></p><p></p><p></p><p><strong>Technological development of 3-piece prostheses</strong></p><p><em>Cylinder development</em></p><p><em>Antibacterial coatings</em></p><p><em>Pump development</em></p><p><em>Reservoir development</em></p><p><em>Latest 3-piece IPP developments</em></p><p></p><p></p><p><strong>Surgical considerations and post-operative results for3-piece implants</strong></p><p><em>Cylinders</em></p><p><em>Infection control</em></p><p><em>Reservoirs</em></p><p></p><p></p><p></p><p></p><p><strong>*Predictive factors and comparison of IPP and malleable prostheses in infection rates, erosion rates, and mechanical dysfunction</strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong></strong></p><p><strong>Conclusions</strong></p><p></p><p><em><strong>Since the early 1980s, advancements in technology and surgical techniques have transformed penile prosthetic implants. <u>The unique features of various models of the three types of implants from this review paper are summarized in Table 6 with associated images</u> (114-122). <u>The use of advanced polymeric prosthetic materials, antibiotic coatings, and increased length and width options have led to improvements in functionality, strength, and device longevity</u>. <u>Concurrently, these advances have also decreased both infections and overall complication rates </u>(123). Studies on the latest models of the three penile prosthetic device types reveal patient satisfaction ratings consistently at or above 75% (42,43,45,110-112). <u>Two- and three-piece IPPs were associated with greater satisfaction, lower erosion rates, and higher failure mechanical rates compared to malleable prostheses</u>. No notable differences in infection rate were found between IPPs and malleable prostheses, though diabetes, obesity, and a history of smoking were associated with higher infection rates. <u>Given that a patient is a suitable candidate for a 3-piece IPP, many experts consider this device type to be the highest standard for biological mimicry of an erect human penis</u>.</strong></em></p></blockquote><p></p>
[QUOTE="madman, post: 276315, member: 13851"] [B]Background and Objective[/B] [I]In contemporary Urology, the gold standard for treatment of erectile dysfunction refractory to medical therapy has been implantation with a penile prosthesis. The past 40 years have witnessed evolutions in technology and surgical techniques, which have led to increased patient satisfaction rates and decreased complication and infection rates.[B] This review is an update to a prior review article that evaluates these advancements in the context of patient satisfaction and different rates of complications following surgeries. In addition, the review compares malleable and inflatable prostheses with regard to infection rate, mechanical failure rate, and erosion rate.[/B][/I] [B]Methods[/B] [I]A literature search was conducted using Medline and Google Scholar to examine papers from 1973 to the present day. Keywords, such as, “penile prosthesis surgery”, “malleable penile prosthesis”, “inflatable penile prosthesis”, “two-piece Inflatable Penile Prosthesis (IPP)”, and “three-piece IPP” were utilized during the search. A total of 76 papers were included, and all were in English.Key[/I] [B]Content and Findings[/B] [I]Studies on the latest models of each of the three prostheses (malleable, two-piece IPP, three-piece IPP) revealed patient satisfaction ratings at or above 75%. [B]Both types of IPPs were associated with greater satisfaction and lower erosion rates while malleable prostheses were associated with lower mechanical failure rates. Although no significant differences in infection rates were noted between the prosthesis types, a history of diabetes, obesity, and smoking were predictive of infection events.[/B][/I] [B]Conclusions[/B] [I][B]The three-piece IPP, if indicated for a suitable patient, is generally accepted as the best type of prosthesis given its biological mimicry to an erect human penis.[/B][/I] [B]Introduction[/B] [I]In 1936, a Russian surgeon named Nikolaj Bogaraz designed the first autologous penile implant using a patient’s rib cartilage (1). A few decades later, the first inflatable penile prosthesis (IPP) and the Small-carrion malleable prosthesis were introduced in 1973 (2). [B]In contemporary times, penile prostheses are the mainstay treatment for male urologic conditions, namely erectile dysfunction (ED) that is refractory to pharmacologic therapy[/B]. [B]Penile prostheses are often classified as malleable (also known as semi-rigid), two-piece inflatable, or three-piece inflatable; each necessitating a distinct surgical technique. Of the three classes, the [U]three-piece IPP is considered the most technologically advanced implant in the realm of penile prostheses and is used in the majority of penile implant surgeries[/U] (3). Prior reviewsof penile prostheses has stratified findings based on the type of prosthesis (i.e., two-piece) but not by the model type (i.e., Coloplast Titan). The present review is an update to our previously published article and emphasizes the postoperative outcomes of penile prosthesis procedures by implant type and model (4). [/B]We present this article in accordance with the Narrative Review reporting checklist (available at [URL='https://tau.amegroups.com/article/view/10.21037/tau-22-741/rc']Recent technological development of penile prosthesis: a literature review - Patel- Translational Andrology and Urology[/URL]).[/I] [B]Malleable prostheses[/B] [I]Historical perspective Technological development of malleable prostheses New Tactra, Rigi10, and touchless memory shape prostheses Surgical considerations and post-operative results for malleable implants[/I] [B]Inflatable prostheses Two-piece IPP[/B] [I]Historical perspective Technological development of two-piece prostheses Surgical Considerations and post-operative results for Two-piece Implants[/I] [B]Three-piece inflatable prostheses[/B] [I]Historical perspective[/I] [B]Technological development of 3-piece prostheses[/B] [I]Cylinder development Antibacterial coatings Pump development Reservoir development Latest 3-piece IPP developments[/I] [B]Surgical considerations and post-operative results for3-piece implants[/B] [I]Cylinders Infection control Reservoirs[/I] [B]*Predictive factors and comparison of IPP and malleable prostheses in infection rates, erosion rates, and mechanical dysfunction Conclusions[/B] [I][B]Since the early 1980s, advancements in technology and surgical techniques have transformed penile prosthetic implants. [U]The unique features of various models of the three types of implants from this review paper are summarized in Table 6 with associated images[/U] (114-122). [U]The use of advanced polymeric prosthetic materials, antibiotic coatings, and increased length and width options have led to improvements in functionality, strength, and device longevity[/U]. [U]Concurrently, these advances have also decreased both infections and overall complication rates [/U](123). Studies on the latest models of the three penile prosthetic device types reveal patient satisfaction ratings consistently at or above 75% (42,43,45,110-112). [U]Two- and three-piece IPPs were associated with greater satisfaction, lower erosion rates, and higher failure mechanical rates compared to malleable prostheses[/U]. No notable differences in infection rate were found between IPPs and malleable prostheses, though diabetes, obesity, and a history of smoking were associated with higher infection rates. [U]Given that a patient is a suitable candidate for a 3-piece IPP, many experts consider this device type to be the highest standard for biological mimicry of an erect human penis[/U].[/B][/I] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
When Testosterone Is Not Enough
Recent technological development of penile prosthesis
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