array:23 [ "pii" => "S2173578620300664" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2020.01.008" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "1255" "copyright" => "AEU" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 0 "subdocumento" => "rev" "cita" => "Actas Urol Esp. 2020;44:377-81" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0210480620300711" "issn" => "02104806" "doi" => "10.1016/j.acuro.2020.01.010" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "1255" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Actas Urol Esp. 2020;44:377-81" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Artículo de revisión</span>" "titulo" => "Implante de prótesis peneana: indicaciones y abordaje penoescrotal" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "377" "paginaFinal" => "381" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Penile prosthesis surgery: Indications and penoscrotal approach" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figura 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 94757 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los dilatadores deben deformar la pared lateral. Foto personal.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Vendeira" "autores" => array:1 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Vendeira" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173578620300664" "doi" => "10.1016/j.acuroe.2020.01.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578620300664?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480620300711?idApp=UINPBA00004N" "url" => "/02104806/0000004400000005/v1_202007012143/S0210480620300711/v1_202007012143/es/main.assets" ] ] "itemAnterior" => array:19 [ "pii" => "S2173578620300652" "issn" => "21735786" "doi" => "10.1016/j.acuroe.2020.04.001" "estado" => "S300" "fechaPublicacion" => "2020-06-01" "aid" => "1266" "copyright" => "AEU" "documento" => "article" "crossmark" => 1 "subdocumento" => "rev" "cita" => "Actas Urol Esp. 2020;44:367-76" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Three-piece inflatable penile prosthesis: Ectopic reservoir placement" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "367" "paginaFinal" => "376" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Prótesis de pene inflable de 3 componentes: emplazamiento ectópico del reservorio" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1568 "Ancho" => 805 "Tamanyo" => 72632 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Reservoirs adapted for ectopic placement: (A) Conceal® (Boston Scientific). (B) Cloverleaf® (Coloplast).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Martínez-Holguín, E. Lledó-García, J. González, C. Hernández-Fernández" "autores" => array:4 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Martínez-Holguín" ] 1 => array:2 [ "nombre" => "E." "apellidos" => "Lledó-García" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "González" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Hernández-Fernández" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480620300966" "doi" => "10.1016/j.acuro.2020.04.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480620300966?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578620300652?idApp=UINPBA00004N" "url" => "/21735786/0000004400000005/v1_202007141053/S2173578620300652/v1_202007141053/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Penile prosthesis surgery: indications and penoscrotal approach" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "377" "paginaFinal" => "381" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "P. Vendeira" "autores" => array:1 [ 0 => array:3 [ "nombre" => "P." "apellidos" => "Vendeira" "email" => array:1 [ 0 => "pvendeira@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidade de Urologia/Andrologia, Saúde Atlântica, Clínica do Dragão, Oporto, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Implante de prótesis peneana: indicaciones y abordaje penoescrotal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 94757 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dilators should always deform the lateral wall. <span class="elsevierStyleItalic">Personal photo</span>.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">“Physicians must be aware that there is no single treatment that fits all patients or all situations” (EAU Guidelines on Erectile Dysfunction, Premature Ejaculation, Penile Curvature and Priapism) (EAU, 2019)</p></span></p><p id="par0010" class="elsevierStylePara elsevierViewall">In the last century, one of the sentinel events in erectile dysfunction (ED) treatment was the development of the inflatable penile prosthesis (IPP) in 1973.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In 1998, with the advent of ED oral treatment with phosphodiesterase type 5 inhibitors (PDE5I), first line care for men with ED was established.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> However, despite the high efficacy of PDE5I, IPP remains a relevant and desired option. The fact is that surgical implantation of a penile prosthesis may be considered in patients with erectile dysfunction (ED) who do not respond to pharmacotherapy or who prefer a permanent solution to their problem. Men who wish to continue sexual activity, that have contra-indications for the use of oral or local treatments with vasoactive agents, that do not have an absolute contra-indication for engaging in sexual activity, that can undergo a surgical procedure, that have a great dissatisfaction with their problem and with their actual treatment, then they should be considered for this kind of definitive treatment. According to the 2019 EAU Guidelines, regardless of the indication, prosthesis implantation has one of the highest satisfaction rates (92–100% in patients and 91–95% in partners) among the treatment options for ED based on appropriate consultation.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The two currently available classes of penile implants include inflatable (2- and 3-piece) and semi-rigid devices. Most patients prefer the 3-piece inflatable devices due to the more “natural” erections obtained. The definitive choice should be based on the personal choice, manual dexterity, degree of obesity, surgical history, cost of the device, etc. The informed consent must include some paramount issues namely the subjective penile shortening, the fact that the device only provides rigidity and has no direct impact on other sexual aspects, and the lack of response to other treatment options if there is a need to remove the device: this is a last resort option. Also, consent must include information on the future possibility of reoperation(s) due to infection, mechanical failures or penile deformity. Injury to adjacent structures (urethra, bowel, vessels and bladder) should also be discussed. Absolute contra-indications for prosthetic penile surgery are: active infection especially in the urinary tract or genital skin, patients that reject the possibility of device revision if needed, and the existence of unresolved urinary disturbances such as elevated residual urine secondary to a neurogenic bladder or bladder outlet obstruction. Data on available devices and surgical approaches are always delivered at this point for a proper shared decision-making.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The initial commonly experienced problems and complications like fluid leaks, tubing kinks, and cylinder aneurysms were substantially reduced overtime to the actual minimal levels, due to the new technology applied over the years, making these devices attractive and a very good choice for ED treatment.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> What we see today is an increasing number of men looking for this type of treatment, showing us that prosthetic devices, namely the inflatable ones, have achieved over time an excellent acceptance and confidence from physicians and patients. Modifications and scientific advances improving reliability, longevity and the penile implant surgery outcomes are of paramount importance. However, we must not forget that the underlying basic indications for surgery remain quite stable in these last 40 years of experience.</p><p id="par0025" class="elsevierStylePara elsevierViewall">One of the main surgical approaches for penile prosthesis implantation is the penoscrotal handling. This approach is the most common accounting for >80% of IPP placed worldwide.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> It does not leave a scar and provides an excellent exposure, namely proximal crural exposure if necessary (even in obese patients), avoids dorsal nerve injury and permits direct visualization of pump placement, preventing its migration. However, with this approach, the reservoir is placed blindly into the retropubic space, which can be a problem in patients with a history of major pelvic surgery (mainly radical cystectomy). However, a separate incision in the abdomen can be used to insert the reservoir under direct vision. Ectopic reservoir placement is always an option to consider in these difficult patients. This approach might lead to an increased scrotal swelling when compared to the infrapubic incision, and this is the reason why a compressive dressing must be used in order to minimize hematoma formation.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In patients with favorable oncologic prognosis after radical prostatectomy for prostate cancer, combination surgery for treatment of ED, with the implant of a penile prosthesis, and stress urinary incontinence (male sling or artificial urinary sphincter) is effective and durable and has an established, definitive role to address this problem.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The penoscrotal approach is the best option when this dual strategy is being planned.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Concerning preoperative considerations, antibiotic infusion is performed one hour before the beginning of the procedure, and shaving must be done immediately before surgery including the penis, scrotum and the suprapubic area. Prep is done with Skinprep®, a mixture of chlorhexidine gluconate and isopropyl alcohol. Trendelenburg position can be quite helpful especially in obese patients by putting the penis and scrotum in a horizontal plane, creating more tension in the abdominal musculature.</p><p id="par0040" class="elsevierStylePara elsevierViewall">An empty bladder is crucial to prevent the possibility of injury during the blind placement of the reservoir into the retropubic space. After bladder catheterization, the Scott retractor is placed with the beaded strapped adjusted to push the corpora cavernosa forward. The penoscrotal basic incision should be made longitudinally (a norm in virgin cases) about 1 cm up the penoscrotal junction and 3 cm below (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In revision cases, it is probably better to perform a transversal incision also with 4 cm that should be made 2 cm below the penoscrotal junction. This incision will allow for a better exposition of the lateral aspects of the corpora cavernosa when more extensive dissecting procedures are needed.</p><p id="par0050" class="elsevierStylePara elsevierViewall">After entering the dartos, hooks are placed for a better exposure (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a><span class="elsevierStyleItalic">A–B</span>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">After the separation of the scrotal septum from the urethral attachment, the proximal corpora cavernosa are fully exposed. This access is quite important in case of difficult dilation of the crura and in the placement of the cylinder bases. This maneuver is also quite useful because it facilitates the pump placement in the scrotum, and allows a better access to the proximal urethra in case that a simultaneous placement of an artificial urinary sphincter is being planned.</p><p id="par0060" class="elsevierStylePara elsevierViewall">1,5 cm corporotomies should be as proximal as possible in order to ensure that the tubing exits in the scrotum and not in the penile skin. If this happens, patients will complain of the esthetic result. It is also possible that the tubing length is not enough for a correct pump placement if the corporotomy exit is too distal (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Dilation should always deform the lateral wall of the penis in order to prevent urethral injury and cylinder crossover. We start with scissors and then we can use the Brooks dilators (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">In order to check for urethral injury, forced injection with saline is applied distally in the corporotomies to ensure that no fluids are discharged in the meatus.</p><p id="par0075" class="elsevierStylePara elsevierViewall">After dilation, a security test can be used to check both proximal and distal corporal length by inserting both dilators that should be parallel and of equal depth penetration (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Then the Furlow insertion tool is used for proper measurement of both proximal and distal corpora (<a class="elsevierStyleCrossRef" href="#fig0030">Fig. 6</a>).</p><elsevierMultimedia ident="fig0030"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">At this point, and after confirmation of the definitive measures, the device is prepared in a supporting table with the adequate cylinders. It is advisable that this procedure is done by the surgeon that should be skilled in prepping the device. Sometimes, for logistical or operational reasons, trained operative staff may prep the device under the device representative’s guidance. Trying to get all the bubbles out of the components is a waste of time, since small bubbles are absorbed into solution after the implant.</p><p id="par0090" class="elsevierStylePara elsevierViewall">For the cylinder insertion we must be sure that the exit tubbing is placed anteriorly facing the surgeons. With the help of the Keith needle, the Furlow tool leads the guide strings for each cylinder through each distal corpus cavernosum and glans. Stay sutures are used for closing the corporotomies by tying the two top strands and the two bottom strands simultaneously, thus preventing the use of needles at this point, in order to protect the device from inadvertent injuries.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Placement of the pump is easy by developing a scrotal pouch, in order to get the tubing invisible. This pouch can help to ensure a correct position of the pump (inferior and dependent, between the testicles).</p><p id="par0100" class="elsevierStylePara elsevierViewall">Standard placement of the reservoir is in the retropubic space by retracting the anterior wall of the inguinal canal. After location of the pubic tubercle, the transversalis fascia is bluntly dissected with the index finger and the reservoir goes into the created space lateral to the bladder wall. Consider ectopic reservoir placement on patients with a pelvis compromised by previous surgery. Best location is in the space anterior to the transversalis fascia but beneath the rectus muscle. This method is becoming quite popular because it seems more likely to avoid serious complications like vessel or viscus injuries. It is important that the reservoir is placed as high and medial as possible in the abdominal wall. If the location is not correct according to the technique, we will be creating a visible and palpable bulge in the abdominal wall, namely in thin patients that will become quite unsatisfied.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Connections are done at this point and the device is then inflated to seat the cylinders and the final check. Improved hemostasis can be achieved by keeping the cylinders inflated to 70% for at least 24 h.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Scrotoplasty at the time of closure in men with an exaggerated penoscrotal web should be performed whenever possible, because this simple, fast and easy procedure usually will improve the patient perception of the penile length.</p><p id="par0115" class="elsevierStylePara elsevierViewall">A “mummy wrap” is created around the penis and scrotum.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> for compressive purposes. Together, these maneuvers minimize hematoma formation. Bladder catheter is removed after 24 h. The compressive dressing should not be disturbed until its removal 48 h after surgery. To drain or not to drain – this is a controversial issue. Some surgeons do think that drainage is a door for infection. If you want to prevent scrotal hematoma, then you must do a meticulous surgical technique, perform a good hemostasis and always finish the procedure with a compressive dressing. Drainage should be used in specific cases when bleeding is expected, namely in difficult revision procedures. However, other surgeons do use closed suction drainage as a rule. As scrotum is a dependent area, there is always a strong possibility that blood from the corpora cavernosa will collect within the scrotum creating the hematoma, which leads to a higher risk of infection, patient discomfort and delay in the beginning of the device cycling. Drain is removed after 24 h if no abnormal drainage is noticed. Oral antibiotics are usually used in the following days, but there is no clear evidence that this procedure can make a difference in the device infection rate that is currently less than 1%.</p><p id="par0120" class="elsevierStylePara elsevierViewall">Device cycling would normally start at 3–4 weeks and should be used at 4 to 6 weeks for sex. It is advisable that the patient inflates the device maximally daily for 10 min (even without sex), in order to increase the possibility of improving penile length.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">As a conclusion, it must be stressed that the first implant has the best chance of an optimal result. Reconstructive surgeons should use the operative approach that they are most comfortable with. In fact, they all have advantages and disadvantages. The lack of experience from the surgeon should not enter the complication equation. It is “YOUR” technique that will lead to better results and happier patients. The more time the wound is open, the larger the risk of infection. Operate quickly but safe, double glove the surgeon and copiously irrigate the wound with antiseptic solution.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Most frequent complaints and dissatisfaction with IPP are related to technical issues or poor surgical outcomes such as the final length of the penis. There is an urgent need to improve the patient awareness in IPP in the preoperative arena, including the high expectation management, and an effort to select the proper patients for definitive treatment.</p><p id="par0135" class="elsevierStylePara elsevierViewall">While the ideal prosthesis is probably yet to be developed, scientific and technological advances in prosthesis design have made penile implants more natural, durable and reliable.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Take home messages</span><p id="par0140" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0145" class="elsevierStylePara elsevierViewall">Penile prosthesis – a valid treatment for ED</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0150" class="elsevierStylePara elsevierViewall">Must be considered third line therapy</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0155" class="elsevierStylePara elsevierViewall">Patient’s satisfaction is higher than with other treatments</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0160" class="elsevierStylePara elsevierViewall">Penoscrotal approach is the most common technique accounting for >80% of IPP placed worldwide</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0165" class="elsevierStylePara elsevierViewall">Rigorous patient selection, preoperative, operative (surgical technique) and post-operative key measures are the main factors for a successful implant.</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The author declares having no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres1362057" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1252194" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1362058" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1252195" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Take home messages" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-25" "fechaAceptado" => "2020-01-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1252194" "palabras" => array:6 [ 0 => "Erectile dysfunction" 1 => "Inflatable penile prosthesis" 2 => "Penoscrotal approach" 3 => "Pump" 4 => "Cylinders" 5 => "Reservoir" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1252195" "palabras" => array:6 [ 0 => "Disfunción eréctil" 1 => "Prótesis de pene inflable" 2 => "Abordaje penoescrotal" 3 => "Bomba" 4 => "Cilindros" 5 => "Reservorio" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Inflatable penile prosthesis was developed in 1973 as a definitive treatment for erectile dysfunction. Since then these prosthetic devices underwent huge modifications, and scientific and technologic advances were accomplished, improving reliability, longevity and the surgical outcomes. Surgical implantation of a penile prosthesis may be considered in patients with erectile dysfunction who do not respond to pharmacotherapy or who prefer a permanent solution to their problem. According to the 2019 EAU Guidelines, regardless of the indication, prosthesis implantation has one of the highest satisfaction rates (92–100% in patients and 91–95% in partners) among the treatment options for erectile dysfunction based on appropriate consultation. The penoscrotal handling is the most common approach accounting for >80% of inflatable penile prosthesis placed worldwide. Most frequent complaints and dissatisfaction with inflatable penile prosthesis are related to technical issues or poor surgical outcomes such as the final length of the penis. There is an urgent need to improve the patient awareness in inflatable penile prosthesis in the preoperative arena, including the high expectation management, and an effort to select the proper patients for definitive treatment.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La prótesis de pene inflable se desarrolló en 1973 como tratamiento definitivo para la disfunción eréctil. Desde entonces, estos dispositivos protésicos han sufrido grandes modificaciones, produciendo avances científicos y tecnológicos, mejorando la fiabilidad, la longevidad y los resultados quirúrgicos. La implantación quirúrgica de una prótesis de pene puede considerarse en pacientes con disfunción eréctil que no responden a la farmacoterapia o que prefieren una solución permanente a su problema. De acuerdo con las Directrices de la EAU (2019), independientemente de la indicación, y con base en una evaluación adecuada, la implantación de prótesis tiene una de las tasas de satisfacción más altas (92-100% en pacientes y 91-95% en parejas) entre las opciones de tratamiento para la disfunción eréctil. El acceso penoescrotal es el más común, utilizado en > 80% de los implantes de prótesis de pene inflable en todo el mundo. Las quejas y casos de insatisfacción tras la cirugía de prótesis de pene inflable más frecuentes se deben a problemas técnicos o resultados quirúrgicos deficientes, como la longitud final del pene. Es necesario incrementar la información que recibe el paciente en el ámbito preoperatorio de la cirugía de prótesis de pene inflable, incluyendo el manejo de altas expectativas, y debemos ser cuidadosos a la hora de elegir a los pacientes adecuados para el tratamiento definitivo.</p></span>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Vendeira P. Implante de prótesis peneana: indicaciones y abordaje penoescrotal. Actas Urol Esp. 2020;44:377–381.</p>" ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1200 "Ancho" => 900 "Tamanyo" => 168131 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Penoscrotal longitudinal incision. <span class="elsevierStyleItalic">Personal photo</span>.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 640 "Ancho" => 1000 "Tamanyo" => 144385 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A–B) Hook placement with exposure of the left corpora. <span class="elsevierStyleItalic">Personal photo</span>.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 539 "Ancho" => 900 "Tamanyo" => 86247 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Left 1,5 cm corporotomy with 2-0 vicryl stay sutures. <span class="elsevierStyleItalic">Personal photo</span>.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 675 "Ancho" => 900 "Tamanyo" => 94757 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Dilators should always deform the lateral wall. <span class="elsevierStyleItalic">Personal photo</span>.</p>" ] ] 4 => array:8 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1200 "Ancho" => 900 "Tamanyo" => 135023 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Proximal safety check with parallel dilators. <span class="elsevierStyleItalic">Personal photo</span>.</p>" ] ] 5 => array:8 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 674 "Ancho" => 900 "Tamanyo" => 94603 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0030" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Distal measurement with the Furlow insertion tool. <span class="elsevierStyleItalic">Personal photo</span>.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of erectile impotence. 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Penile prosthesis surgery: indications and penoscrotal approach
Implante de prótesis peneana: indicaciones y abordaje penoescrotal
P. Vendeira
Unidade de Urologia/Andrologia, Saúde Atlântica, Clínica do Dragão, Oporto, Portugal