Survey: Current Surgical Trends in Prosthetic Urology
Implantation Experience/Trends:
1) How many surgical procedures related to inflatable penile prostheses (IPP's) do you perform per year?
A) 1-5
B) 6-10
C) 11-20
D) 21-50
E) 50+
2) What make/model of IPP do you commonly place? If you place more than one, please estimate the percentage of the time that you use each type.
A) Coloplast Titan (____%)
B) Coloplast Titan with One Touch Release(OTR)pump (____%)
C) Coloplast Titan Narrow Base (____%)
D) AMS CX700 (____%)
E) AMS CXR700 (____%)
F) AMS Ultrex/LGX (____%)
G) AMS Ambicor (____%)
3) What surgical approach do you use for placing IPP's? If you use more than one, please estimate the percentage of the time that you use each approach.
A) Scrotal (____%)
B) Infrapubic (____%)
C) Scrotal with Infrapubic Counter Incision for Reservoir Placement (____%)
Penile Implant Revisions:
4) With regard to surgical approach, when conducting a revision procedure for replacement of a penile prosthesis, do you:
A) Remove/Replace the prosthesis in the same fashion it was placed
B) Remove/Replace the prosthesis in the opposite fashion it was placed
C) Remove/Replace the prosthesis in the approach you are most comfortable
and experienced in
5) Revision surgery for penile prostheses implies removal and replacement or repositioning of specific components. Do you perform revision surgery of IPP's for reasons other than infection?
A) Yes
B) No
6) (If YES to #4) How many revision operations do you perform per year?
A) 1-5
B) 6-10
C) 11-15
D) 16-20
E) 20+
7) Which of the following indications do you perform revisions for? Mark all that apply; please estimate the percentage of each indication.
A) Device-related pain (____%)
B) SST deformity (____%)
C) Autoinflation (____%)
D) Device leak (____%)
E) Pump failure (____%)
F) Reservoir failure (____%)
G) Pump malposition (____%)
H) Cylinder aneurysm or failure (____%)
I) Distal cylinder erosion/pending erosion (____%)
J) Other (please specify:______) (____%)
8) Considering the surgical skill and difficulty necessary to address the causes for revision, please rate the indications in order from 1 to 10 with 1 being the most difficult and 10 being the least difficult:
___A) Device-related pain
___B) SST deformity
___C) Autoinflation
___D) Device leak
___E) Pump failure
___F) Reservoir failure
___G) Pump malposition
___H) Cylinder aneurysm or failure
___I) Distal cylinder erosion/pending erosion
___J) Other
9) When revising an IPP for non-infectious reasons (clinically uninfected IPP), do you perform a washout with antibiotic solution? If yes, please specify the antibiotic(s) that you use.
A) Yes (please specify solution:______)
B) No
10) When revising an IPP for non-infectious reasons, how long post-operatively do you prescribe prophylactic antibiotics? Please specify the agent that you use.
A) 0-48 hours
B) 48 hours-7 days
C) 8-14 days
D) 15-21 days
E) 22-30 days
ANTIBIOTIC USED:______
11) Please respond to the following: When conducting a revision procedure and inserting a new, functioning device I:
A) Always replace all components
B) Sometimes replace all components
C) Never replace all components
12) If you responded “Sometimes replace all components” to question #10 above, what are the mitigating factors that prompt complete removal/replacement:
A) Age of initial device/Duration since initial implant
B) New, innovative product available
C) Unable to ascertain where defect in the prosthesis is located
D) N/A
13) If the mechanical malfunction is identified as a defect related to the pump and/or cylinders, do you replace the reservoir also?
A) Yes, I implant a new reservoir also
B) No, I utilize the previously implanted reservoir for the new cylinder and/or
pump
14) If it becomes necessary to use a new reservoir, how do you proceed?
A) Remove old reservoir, place new one in ipsilateral space of Retzius
B) Remove old reservoir, place new one in contralateral space of Retzius
C) Leave old reservoir in place, place new reservoir in contralateral space
D) Other (please specify)
Prosthetic Infections:
Infection rates for inflatable penile prosthesis have been drastically reduced through peri-operative antibiotics, sterile technique, reduced operative time, and the advent of prosthetics with anti-infection strategies (Coloplast Hydrophilic Coating; AMS Inhibizone). Documented infection rates are between 1-3%. The next set of questions are with regard to post-operative inflatable penile prosthesis infections.
15) When a patient presents with a suspected infection, I do the following
A) Prescribe oral or IV antibiotics (If selected, what regimen?______)
B) Immediately schedule operative session
C) Watch and wait
16) What do you regard as absolute indications for immediate device removal without concurrent replacement? Please mark all that apply.
A)Uncontrolled diabetes
B)Systemic leukocytosis
C)Signs and symptoms of sepsis
D)Device erosion
E)Other (please specify)
17) When operating on a prosthesis you suspect to be infected, do you perform a full salvage procedure that encompasses the following protocol:
Explant of infected prosthetic device (all components)
Copious wound irrigation with protocol of 7 antibacterial solutions:
Antibiotics (Kanamycin-Bacitracin)
Half-strength Hydrogen Peroxide
Half-strength Povidone Iodine
Pressure Irrigation with 1 gm Vancomycin and 80 mg gentamicin
in 5 L irrigating solution
Half-strength Betadine
Half-strength Hydrogen Peroxide
Antibiotics (Kanamycin-Bacitracin)
Change gown, gloves, drapes, and instrumentation
Implantation of new prosthesis
Close wounds with no drains or catheters
Oral antibiotics for 1 month
A) Yes, I complete a full salvage including re-implantation of an IPP
B) No, I complete a “modified salvage” with re-implantation of an IPP
(Please list modifications:______)
C) No, I complete a “modified salvage” with re-implantation of a Malleable
D) No, I do not complete a salvage. I opt for explant with no re-implantation
18) What is your typical post-operative antibiotic regimen after a salvage procedure?
Please specify:______
19) For those patients that you perform an explant with no re-implantation, what percentage return at a later operative session to replace the implant:
A) 0%
B) 1-25%
C) 25-50%
D) 50-75%
E) 75-100%
F) N/A
20) For those patients that receive an implant at a second, later operative session, what percent require extra effort/instrumentation to dilate the corpora adequately? Also, if instrumentation is used to obtain necessary dilation, please specify.
A) 0%
B) 1-25%
C) 25-50%
D) 50-75%
E) 75-100%
F) N/A
INSTRUMENTATION UTILIZED:______
21) In the presence of a fibrotic or scarred corpora, do you place a Narrow-Base prosthesis?
A) Yes, roughly ____% of the time I place a Narrow-Base prosthesis
B) No, I am able to adequately dilate to place a Standard-Base prosthesis