Continuing Medical Education A Case of Mechanical Failure with Proximal Perforation at the Time of Revision Surgeryj sm_1475 2629..2632

Background. Implantation of inflatable penile prosthesis (IPP) is a well-established treatment for medically refractory erectile dysfunction with proven long-term reliability. However, if an IPP fails, the subsequent surgery to fix the IPP can be more difficult with higher risks of complications than the primary implantation. Aims. To review and evaluate a case of a difficult IPP replacement surgery for ways to improve surgical techniques and outcomes. Materials & Methods. Perform a case report of a difficult IPP replacement surgery in which the patient had proximal perforation of the tunica albuginea with a review of the pertinent literature. Results. The rear tip sling is a successful way to repair proximal perforation of the tunica albuginea. Recent publications show new surgical techniques to lower infection rates in IPP revision surgery. Discussion. The rear tip sling appears to have better outcomes than a synthetic windsock for repairs of proximal perforation of the tunica albuginea. Recent publications have shown that the revision washout decreases penile prosthesis infection rates in revision surgeries

Microorganism Profiles of Penile Prosthesis Removed for Infection, Erosion, and Mechanical Malfunction Based on Next-Generation Sequencing.

BACKGROUND: Next-generation sequencing (NGS) is an emerging technology that may allow for more sensitive and sophisticated microbial testing of the microbiota of penile prostheses (PP). AIM: To describe the microorganism profiles of PP explanted for infection, erosion, and mechanical malfunction using NGS. METHODS: All patients who underwent PP removal by two physicians at two institutions were identified. Differences in alpha diversity (ie, number of species detected, species diversity across samples) and microbiome compositional profiles (Bray-Curtis community dissimilarities) across samples were assessed using ANOVA and PERMANOVA, respectively. OUTCOMES: Number of species detected, species diversity across samples, and microbiome compositional profiles. RESULTS: A total of 83 patients who underwent device removal for infection (n = 8, 10%), erosion (n = 5, 6%), and mechanical malfunction (n = 70, 84%) were included. When considering all devices, 56% (n = 48) of NGS and 29% (n = 24) of standard cultures resulted positive for presence of microorganisms. Culture only detected the most abundant NGS species in 62.5% (n = 5) of infected devices. Species richness and microbiome compositional profiles varied by surgical indication, but not by age, race, diabetes status, or implant duration. Most frequent organisms by surgical indication were Pseudomonas aeruginosa (infection), Staphylococcus epidermidis (erosion), and Escherichia coli (mechanical malfunction). The highest relative abundance organisms were P aeruginosa (infection), Corynebacterium jeikeium (erosion), and E coli (mechanical malfunction). CLINICAL IMPLICATIONS: Identifying microbiome profiles of PP removed for infection, erosion, and mechanical malfunction may guide the selection of peri-operative antibiotics and PP antibiotic coatings or hydrophilic dip solutions for each individual scenario. STRENGTHS AND LIMITATIONS: While this is the first study to utilize next-generation sequencing to evaluate penile prosthesis biofilm, the clinical significance of these findings has yet to be determined. A prospective, randomized trial aimed at evaluating the clinical significance of NGS in patients with PP infection is currently underway. CONCLUSION: NGS testing identified distinct microbiome profiles of PP removed for infection, erosion, and mechanical malfunction. Chung PH, Leong JY, Phillips CD, Henry GD. Microorganism Profiles of Penile Prosthesis Removed for Infection, Erosion, and Mechanical Malfunction Based on Next-Generation Sequencing. J Sex Med 2022;19:356-363

A Survey of Patients with Inflatable Penile Prostheses: Assessment of Timing and Frequency of Intercourse and Analysis of Implant Durability

Introduction.  This study was conducted to determine how long after inflatable penile prosthesis (IPP) surgery patients attempt sexual intercourse and the frequency of subsequent relations. We also examined survival‐related factors for the AMS 700 CX, Mentor Alpha 1, and Mentor Alpha Narrow Base. Aims.  The aim was to survey men who received IPPs and collect information about their return to sexual function and frequency of use, and to assess the resilience of their devices. Methods.  Phase I involved retrospective chart review of 1,298 virgin IPP surgeries performed by one surgical team from January 1992 to December 1998. Phase II included 330 subjects selected by stratified, systematic, random sampling from phase I patients. Data were collected by computer‐assisted telephone interview, using a 27‐question survey. All patients had been instructed to wait 4 weeks before using the implant and were taught how to inflate/deflate their prostheses at the 4‐week postsurgical visits. Main Outcome Measures.  The survey examines the length of time after surgery for men to resume sexual function. In the same study, information was garnered about mechanical durability of the device. Results.  Among phase I subjects, the 5‐year survival rate was 83% (N = 1,069) for IPP revision for any reason. Of the 330 phase II subjects, 248 (75%) were successfully contacted; 199 (80%) responded to the full survey and 49 (20%) responded to selected parts of the survey. Sexual intercourse was resumed postoperatively at 1–4 weeks for 41% (78/190), at 5–6 weeks for 31% (59/190), at 7–8 weeks for 16% (30/190), and at >8 weeks for 12% (23/190) of the patients. More than 60% of patients reported using their IPP at least once weekly. Conclusion.  The three‐piece IPP has excellent 5‐year survival rates. Most patients return to sexual activity relatively quickly, with high frequency of usage of their prostheses. Henry GD, Brinkman MJ, Mead SF, Delk JR II, Cleves MA, Jennermann C, Wilson SK, and Kramer AC. A survey of patients with inflatable penile prostheses: Assessment of timing and frequency of intercourse and analysis of implant durability. J Sex Med 2012;9:1715–1721.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/92055/1/j.1743-6109.2012.02729.x.pd

Subarachnoid versus General Anesthesia in Penile Prosthetic Implantation: Outcomes Analyses

The leading patient complaint during the perioperative period for penile prosthesis implantation is postoperative pain, while emesis and urticaria also affect the procedure’s perceived success. In analyzing surgical outcomes, assessment of the anesthetic for postoperative pain and side effects should be included. This paper retrospectively reviews 90 consecutive, primary inflatable penile prosthetic operations performed by a single surgeon at one private medical center. Fifty-seven patients were included in final analysis. Patients who had more than one procedure that day or who used chronic pain medication were excluded. The type and amount of each drug used for each respective side effect (within the first 24 hours after procedure) were compared to determine relative benefit. Twenty patients received general anesthesia (denoted herein as “GA”) and 37 received spinal (or also known as subarachnoid) anesthesia (denoted herein as “SA”). Patients receiving GA had significantly greater (P<0.0001) occurrence and amount of intravenous pain treatment than those receiving SA. Patients with SA required less intravenous pain medication and less treatment for nausea/emesis

Observations of Binary Stars with the Differential Speckle Survey Instrument. IX. Observations of Known and Suspected Binaries, and a Partial Survey of Be Stars

We report 370 measures of 170 components of binary and multiple star systems, obtained from speckle imaging observations made with the Differential Speckle Survey Instrument at Lowell Observatory's Discovery Channel Telescope in 2015 through 2017. Of the systems studied, 147 are binary stars, 10 are seen as triple systems, and 1 quadruple system is measured. Seventy-six high-quality non-detections and fifteen newly resolved components are presented in our observations. The uncertainty in relative astrometry appears to be similar to our previous work at Lowell, namely linear measurement uncertainties of approximately 2 mas, and the relative photometry appears to be uncertain at the 0.1 to 0.15 magnitude level. Using these measures and those in the literature, we calculate six new visual orbits, including one for the Be star 66 Oph, and two combined spectroscopic-visual orbits. The latter two orbits, which are for HD 22451 (YSC 127) and HD 185501 (YSC 135), yield individual masses of the components at the level of 2 percent or better, and independent distance measures that in one case agrees with the value found in the Gaia DR2, and in the other disagrees at the 2-$\sigma$ level. We find that HD 22451 consists of an F6V+F7V pair with orbital period of $2401.1 \pm 3.2$ days and masses of $1.342 \pm 0.029$ and $1.236 \pm 0.026$ $M_{\odot}$. For HD 185501, both stars are G5 dwarfs that orbit one another with a period of $433.94 \pm 0.15$ days, and the masses are $0.898 \pm 0.012$ and $0.876 \pm 0.012$ $M_{\odot}$. We discuss the details of both the new discoveries and the orbit objects

A scoping review of penile implant biofilms-what do we know and what remains unknown?

Background: Penile prosthesis (PP) is a gold standard for treatment of erectile dysfunction given its reliability and efficacy. Infection remains the most feared complication of prosthetic surgery, which usually results in device removal, and places a significant economic burden on the healthcare system. While biofilms have shown to support the persistence of microorganisms, the degree by which this matrix is truly pathogenic remains unknown given its high prevalence even in asymptomatic patients. We aim to review and summarize the current literature pertaining to biofilm formation in the setting of PP surgeries in clinically infected and non-infected cases. Methods: Searches were performed in the MEDLINE online database through PubMed using a combination of keywords “penile prosthetic” OR “penile prosthesis” OR “penile implant” AND “biofilm” OR “revision” OR “removal” OR “infection” OR “explant”. Eleven articles met inclusion criteria. There were only three studies that explicitly listed the number of biofilms identified in their cohort, but we also included eight articles that mentioned swabbing and culturing of any bacterial biofilm during revision procedures for both clinically infected and non-infected implants. Results: Infected PP yielded a 11–100% rate of biofilm presence, while non-infected PP yielded a 3–70% rate of biofilm presence. Time to reoperation from initial PP placement were also largely variable, ranging from 2 weeks to over 2 years. Coagulase-negative staphylococcus (i.e., Staphylococcus epidermidis) were the most commonly reported organisms among non-infected implants, however, newer studies have identified a change towards more virulent organisms. Conclusions: Since the advent of PP surgery, diabetes control, revision washout protocols and antibiotic-impregnated devices have led to an overall decrease in biofilm formation and infectious complications. There is an overall paradigm shift in microbial profiles with more virulent organisms, such as Escherichia coli, Pseudomonas aeruginosa, Enterococcus species, and even fungal species beginning to replace the more common coagulase-negative staphylococcal species, especially in clinically infected implants. Additional studies are necessary to define the significance of bacterial presence in biofilms using impactful technologies such as next-generation sequencing. Currently, preliminary and experimental biofilm-control strategies are also underway to further address this clinical issue

First bromine doped cryogenic implosion at the National Ignition Facility

We report on the first experiment dedicated to the study of nuclear reactions on dopants in a cryogenic capsule at the National Ignition Facility (NIF). This was accomplished using bromine doping in the inner layers of the CH ablator of a capsule identical to that used in the NIF shot N140520. The capsule was doped with 3$\times$10$^{16}$ bromine atoms. The doped capsule shot, N170730, resulted in a DT yield that was 2.6 times lower than the undoped equivalent. The Radiochemical Analysis of Gaseous Samples (RAGS) system was used to collect and detect $^{79}$Kr atoms resulting from energetic deuteron and proton ion reactions on $^{79}$Br. RAGS was also used to detect $^{13}$N produced dominantly by knock-on deuteron reactions on the $^{12}$C in the ablator. High-energy reaction-in-flight neutrons were detected via the $^{209}$Bi(n,4n)$^{206}$Bi reaction, using bismuth activation foils located 50 cm outside of the target capsule. The robustness of the RAGS signals suggest that the use of nuclear reactions on dopants as diagnostics is quite feasible

Whole Earth Telescope Observations of the Helium Interacting Binary PG 1346+082 (CR Bootis)

We present our analysis of 240 hr of white-light, high-speed photometry of the dwarf nova-like helium variable PG 1346+082 (CR Boo). We identify two frequencies in the low-state power spectrum, at 679.670 ± 0.004 μHz and 669.887 ± 0.008 μHz. The 679.670 μHz variation is coherent over at least a 2 week time span, the first demonstration of a phase-coherent photometric variation in any dwarf nova-like interacting binary white dwarf system. The high-state power spectrum contains a complex fundamental with a frequency similar, but not identical, to the low-state spectrum, and a series of harmonics not detected in low state. We also uncover an unexpected dependence of the high-frequency power\u27s amplitude and frequency structure on overall system magnitude. We discuss these findings in light of the general AM CVn system model, particularly the implications of the high-order harmonics on future studies of disk structure, mass transfer, and disk viscosity