Objective: To investigate how surgeons approach ethically challenging scenarios that arise in penile prosthesis surgery and identify patient-related factors that impact their approach.
Methods: A survey was distributed to the Society for Urologic Prosthetic Surgeons membership consisting of 6 ethically challenging scenarios: an HIV+ patient, a patient with cognitive disability, a registered sex offender, a nonverbal patient, a litigious patient, and an uncontrolled diabetic patient whose insurance will lapse soon. Additional clinical information was provided to assess how the likelihood to offer surgery might change. The primary outcome was the likelihood of offering surgery in each scenario.
Results: The response rate was 15.6% (n = 29). When compared to the baseline patient, respondents had a lower likelihood of offering surgery in all scenarios except the HIV+ patient, with the lowest likelihood of offering surgery to a sex offender (P < .01). Within each scenario, factors associated with an increased odds of offering surgery included knowledge that a patient with Down Syndrome is high functioning (odds ratio [OR] 5.0, confidence interval [CI]: 1.4-17.8), that a prior sex offender is currently married (OR 16.5, CI:3.5-99.8), that a litigious patient sued a surgeon for a retained sponge (OR 6.3, CI:1.7-24.3), and that a nonverbal patient had expressed prior interest in penile prosthesis surgery (OR 4.5, CI: 1.3-16.2).
Conclusion: Ethical principles, including respect for autonomy, nonmaleficence, beneficence, and justice, are appropriately applied by urological prosthetic surgeons when ethical challenges arise. While the likelihood of offering penile prosthesis surgery is decreased with most ethical dilemmas, specific clinical factors often augment decision-making.
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http://dx.doi.org/10.1016/j.urology.2020.10.053 | DOI Listing |
Asian J Androl
December 2024
Department of Maternal Infant and Urologic Sciences, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome 00161, Italy.
Implantation of inflatable penile prosthesis should be considered as a definitive treatment of erectile dysfunction. However, the sole procedure might not allow for optimal dimensional and functional outcomes. The aim of this study was to systematically review the literature and present the findings on the optimal choice of perioperative methods, surgical techniques, and pharmacotherapy to improve penile length, curvature, and erectile function.
View Article and Find Full Text PDFJ Sex Med
December 2024
Department of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, United States.
Background: Inflatable penile prosthesis (IPP) insertion is recommended for the treatment of patients with Peyronie's disease (PD) and significant erectile dysfunction (ED); adjunctive procedures can be used for residual curvature after IPP placement.
Aim: To assess the management of penile curvature correction in PD patients undergoing IPP procedures within a large multinational, multicenter cohort.
Methods: A retrospective analysis was conducted on PD patients treated with IPP by 11 experienced prosthetic surgeons.
Cureus
November 2024
Department of Urology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, TUR.
Penile prosthesis implantation is considered a last-resort treatment for erectile dysfunction, used when pharmacological and other conservative treatments are inadequate or at the patient's request. The well-documented complications of penile prostheses include pain, infection, mechanical failure, improper positioning, and erosion. In this case, we report a patient presenting with penile skin necrosis, despite the absence of typical risk factors such as diabetes mellitus, atherosclerosis, or chronic renal failure, attributed to pressure from a condom catheter that was used 15 years after the inflatable penile prosthesis implantation.
View Article and Find Full Text PDFArch Ital Urol Androl
October 2024
Urology Department, Faculty of Medicine, Fayoum University.
Objectives: To compare the efficacy of intrathecal fentanyl and dorsal penile nerve block for postoperative pain management in patients undergoing inflatable penile prosthesis (IPP).
Patients And Methods: A prospective single-center study included 80 patients amenable to IPP. Patients were divided equally into two groups.
Urology
December 2024
Crane Center for Transgender Surgery, 4407 Bee Caves Rd, Ste 612 Austin TX 78746, USA.
Objectives: To identify specific complications associated with testicle prosthesis at our dedicated transgender surgery center, over a long follow up period exceeding 5 years.
Methods: We conducted a retrospective chart review of all transmasculine patients undergoing testicular implants after metoidioplasty or phalloplasty between January 2016 to November 2019, stopping the series in 2019 to allow at least 3 year follow up.
Results: 23 patients were identified, 16 (70%) of whom had a prior metoidioplasty and 7 (30%) with prior phalloplasty receiving only testicular implants (no penile implant).
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