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Textbook Of Urogenital Prosthetic Surgery


This textbook gives comprehensive coverage to the surgical management of erectile dysfunction with penile prostheses (PP) and the management of stress urinary incontinence using bladder outflow resistance created by the artificial urinary sphincter (AUS). Its intended audience are urologists who are interested in one or both topics.

The text is divided into 3 sections.

The first one deals with the history of the development of PP and the AUS, the surgical anatomy related to male erectile function and male and female urinary incontinence, operating room logistics for PP surgery, and the steps in setting up a dedicated urologic prosthetic practice.

The second part is devoted to restoring erectile function using PP. It includes chapters dealing with the appropriate evaluation of the surgical candidate, techniques of implant placement by various incisions, management of the patient postoperatively including addressing complications, and the use of PP in special circumstances including priapism, Peyronie""s Disease, fibrotic corporal bodies and the neophallus. The section concludes with a chapter on building a prosthetic urology practice, periprocedural counseling, and optimizing patient and partner satisfaction.

The third segment compromises with the AUS including evaluating patient candidates, basic scrotal and perineal placement techniques, intraoperative and postoperative management of the patient and any complications which may develop.

A final chapter deals with the use of the AUS in women.

SECTION I. General Contents
CHAPTER 1. The History of the Penile Prostheses
First descriptions and management of erectile dysfunction
Initial attempts at penile prosthesis for the treatment of ED
1974 to Today
Current considerations and new directions
CHAPTER 2. Historical Aspects of the Artificial Urinary Sphincter
Early Devices
Evolution of the American Medical Systems (AMS) devices
AMS 800
CHAPTER 3. Functional and Surgical Anatomy in Erectile Dysfunction Restoration Surgery
Smooth Muscle Anatomy
Tunical anatomy
Vascular anatomy
Space of Retzius Anatomy
Extraperitoneal anatomy
Other Anatomical Considerations
CHAPTER 4. Functional and Surgical Anatomy in Male and Female Incontinence Surgery
General concepts of stress urinary incontinence
Female anatomy
Male anatomy
CHAPTER 5. Logistics and operating room material for penile prosthesis implant
Patient selection
Surgical logistics
CHAPTER 6. How to set up a prosthetic urology centre
The unconditional advantage of a dedicated team
Pre- and post-operative involvement of dedicated nurses
The next step: growing and teaching
SECTION II. Erectile Restoration (Inflatable Penil Prosthesis Placement-IPP Placement)
CHAPTER 7. Preoperative Assessment (Standard and Troubleshooting)
Penile Prostheses
Informed Consent
Medical Clearance
Patient Personal Preparation
Skin Preparation
MRI, Metal Detectors
CHAPTER 8. Basic Scrotal/Infrapubic Techniques
Penoscrotal vs. Infrapubic Approach
The Penoscrotal (PS) Approach
The Infrapubic (IP) Approach
Salient Features of Each Approach
CHAPTER 9. Intraoperative Management I (Standard and Troubleshooting)
Antibiotic Use
Foley Catheter Placement
Incisions and Retractors
Corporal Dilation and Implant Placement
Cylinder Choice
Cylinder Sizing
Ambicor-Rod Width Sizing
Cylinder Placement
Corporotomy Closure
PTFE Sleeve
CHAPTER 10. Intraoperative Management II (Standard and Troubleshooting)
Reservoir Placement
Iliac Vessel Injury
Bladder Injury
Pump Placement
Routing of Tubing
Tubing Length (Inadequate or Redundant)
The use of Drains
Simultaneous Surgery
Skin Closure-Wound Dressing
Semi-inflation of an IPP
Special Considerations
CHAPTER 11. Postoperative Considerations I (Standard and Troubleshooting)
Penile Positioning
Corporotomy Disruption
Cylinder Aneurysm
Impending Cylinder Erosion (Laterally or into the Urethra)
Cylinder Erosion (Laterally or into the Urethra)
Reservoir Erosion into the Bowel or Bladder
Impending Pump or Tubing Erosion
Disrupted Outer Silicone Layer
Presence of Calcified Matrix (Putty) or Calcified Biofilm
Scar Incased in PTFE Sleeve
Tubing Kink
Connector Failure
Approach to Repair of an Uninfected Implant
CHAPTER 12. Postoperative Considerations II (Standard and Troubleshooting)
Penile Necrosis
CHAPTER 13. IPP & Corporal Fibrosis
Etiology of corporal fibrosis
Surgical strategies in fibrosis
Other strategies for fibrosis
Does length matter? Strategies to maximize it
CHAPTER 14. IPP and Peyronie""s Disease
Specific Features of Prosthetic Surgery in Peyronie""s Disease
Surgical Algorithm
Residual Curvature Correction after Penile Prosthesis Implantation
Lengthening Procedures in Peyronie""s Disease
Complications Related to Penile Prosthesis in the Peyronie""s Population
Postoperative Rehabilitation
Satisfaction Outcomes after Penile Prosthesis in Peyronie""s Population
CHAPTER 15. Re-do Penile Prosthesis Implantation for Mechanical Failure
Causes of Penile Prosthesis Failure
Tips and Tricks in Re-do Penile Implant Surgery for Mechanical Failure
CHAPTER 16. Penile Implants and Priapism
Clinical Features of Priapism
Immediate Penile Prosthesis Placement
Penile Prosthesis with Severe Corporal Fibrosis
CHAPTER 17. IPP in neophallus
Wai Gin Lee, Nim Christopher and David Ralph History
Use of Prosthetic Implants in the Neophallus
Principles of Penile Prosthesis Insertion in the Neophallus
Preoperative Considerations
Operative / Intra-Op
Postoperative Care
Functional Outcomes
Device Survival
Explantation for Infection or Erosion
Revision Surgery
CHAPTER 18. Building an IPP Practice & Peri-Procedural Counseling to Optimize Patient Satisfaction
Building an IPP Practice
Peri-Procedural Counseling to Optimize Patient Satisfaction
Final Thoughts on Optimizing a High-Volume IPP Clinic from Dr. Köhler
Final Thoughts on Optimizing a High-Volume IPP Clinic from Dr. Wilson
SECTION III. Urinary Incontinence: Artificial Urinary Sphincter (AUS) and Sling
CHAPTER 19. Urinary Incontinence (AUS). Preoperative Assessment (Standard and Troubleshooting)
Initial Evaluation
Challenging Situations
Revision Surgery
CHAPTER 20. Basic Perineal & Scrotal Techniques
Surgical Procedure
Comparison of the Different Approaches
CHAPTER 21. AMS 800 Prosthesis - Intraoperative Management
Foley Catheter
Incisions - Retractors
Double versus Single Cuff
Cuff Sites
Measuring for Cuff Sizing
Urethral Dissection
Urethral Injury
Transcorporal (TC) Cuff with or without Penile Implant
Urethral Wrap
Hydraulic Testing
Choice of Reservoir Pressure
Reservoir Placement - Inguinal, Midline, Ectopic
Reservoir Filling - Technique, Volume
Pump Placement
Routing of Tubing
Wound Closure - Dressing
Urethral Catheter Removal
CHAPTER 22. Artificial Urinary Sphincter (AUS) Postoperative Considerations (Standard and Troubleshooting)
Initial Deactivation (6 - 8 Weeks)
Urinary Retention
Wound Separation
Early Device Infection
Subsequent Post-Operative Period
Late Complications
Risk Factors
Device Information Card and Medic Alert
Management of Situations after Recovery is Complet
Other Conditions that Complicate Artificial Sphincter Use and Longevity
Concern about the Pressure-Regulating Balloon Location
CHAPTER 23. Artificial Urinary Sphincters (AMS 800 , Boston Scientific, MA, USA) in Women
History of the Prosthesis and its Use in Women
Indication and Counterindications
The AMS 800 Device in Neurogenic Patients
Surgical Procedure

ESSM - European Society for Sexual Medicine

John Mulcahy
Ignacio Moncada Iribarren
Enrique Lledó García
Juan Ignacio Martínez Salamanca
Panamericana, S.A. Editorial Médica
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