Steven K. Wilson, MD, FACS, FRCS, presented “Changing Paradigms in Prosthetic Urology” during the 24th Annual Innovations in Urologic Practice on September 14, 2019 in Santa Fe, New Mexico.

How to cite: Wilson, Steven K. Changing Paradigms in Prosthetic Urology” September 14, 2019. Accessed Nov 2019. https://grandroundsinurology.com/changing-paradigms-in-prosthetic-urology/

Changing Paradigms in Prosthetic Urology– Summary:

Steven K. Wilson, MD, FACS, FRCS, explores paradigm shifts in the materials and techniques used for inflatable penile prosthesis implants (IPP) and artificial urinary sphincters (AUS). He focuses on how urologists have improved standard of care through the use of new technology and a clearer understanding of the negative effects of these procedures. 

Abstract:

The implantation of inflatable penile prostheses and urinary sphincters has been a part of the urologic armamentarium since Dr. F. Brantley Scott published the first clinical results of his devices in 1973. Scott’s work has proven unusually enduring, but changes have been made to his procedures over the past 46 years. Some were minor improvements, but others represent genuine paradigm shifts. 

One major shift has been in surgical technique. In IPP implantation, the incision location has changed many times since 1973, from perineal to infrapubic to penoscrotal to subcoronal. The subcoronal incision, popularized in 2010 by Drs. Egydio, Valenzuela, and Park,  has significant advantages, and is best for local anesthesia, Peyronie’s correction, lengthening and girth enhancement, and outpatient procedures.

The past decades have also seen a complete reversal from downsizing to upsizing of cylinders of IPP. While it was once traditional to undersize the cylinders, there is a documented trend in the US in favor of longer cylinders. Evidence suggests that deliberately oversized cylinders coincident with daily inflation results in larger penises.   

Other paradigm shifts are in the area of AUS implantation. Many patients are rejecting traditional AUS, an implant which requires frequent revision, in favor of the “mini-jupette” graft for stress incontinence. It has proven to limit climacturia, as well as mild urinary leakage. AUS implantation itself is in the midst of a paradigm shift.

AUS patients are high-maintenance and experience recurrent incontinence. Urethral atrophy has long been viewed as the cause of this and efforts have been made to address this problem. However, current thinking holds that capsule formation and balloon fatigue are the true culprits. A pump that patients could deactivate at night could potentially radically lower the AUS revision rate. Ongoing work and research could continue to improve these old, but still fundamentally useful, procedures.

About the 24th Annual Innovations in Urologic Practice

Innovations in Urologic Practice (Innovations) is an annual, multi-day, CME-accredited conference devoted to innovative diagnostic and treatment strategies for and controversies related to some of the most common urologic problems in the current era. The topics covered include oncological management of the bladder, kidney, and prostate. The conference also emphasizes general urology topics in pelvic reconstruction and trauma, men’s health, and infections in the urology patient. Dr. Wilson presented this lecture during the 24th Innovations in 2019. Please visit this page in order to register for future Innovations meetings.