Re: Intra-Abdominal Reservoir Placement During Penile Prosthesis Surgery in Post-Robotically Assisted Laparoscopic Radical Prostatectomy Patients: A Case Report and Practical Considerations

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Re: Intra-Abdominal Reservoir Placement During Penile Prosthesis Surgery in Post-Robotically Assisted Laparoscopic Radical Prostatectomy Patients: A Case Report and Practical Considerations
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  penile implant utilization rate was 0.8% for the entire group, 0.3% for the RT group, and 2.3% for theRP group. Predictors of penile implant utilization were initial treatment modality, younger age, and African American or Hispanic race, being unmarried and residing in the South or West. Conclusions:Penile implant utilization after prostate cancer treatment is relatively uncommon in men over 65.Men who are younger, African American or Hispanic, and those who have an RP are more likely thantheir peers to receive a penile implant after prostate cancer treatment. Editorial Comment: This study of more than 68,000 patients with prostate cancer (includ-ing more than 50,000 who underwent radical prostatectomy) revealed an astoundingly lowrate of penile implant use (0.8% overall). Predictors of penile implant use were initialtreatment modality (surgery 2.3%, radiation 0.3%), younger age, black or Hispanic race,being unmarried and residing in the South or West. Although a variety of factors maycontribute to this remarkably low rate of penile implant use, physicians who treat forerectile dysfunction in patients with prostate cancer should ensure that all treatmentoptionsincludingsurgicalinterventionhavebeenpresentedadequatelytothepatientandthe sexual partner. Allen F. Morey, M.D. Re: Intra-Abdominal Reservoir Placement During Penile Prosthesis Surgery inPost-Robotically Assisted Laparoscopic Radical Prostatectomy Patients: A CaseReport and Practical Considerations H. Sadeghi-Nejad, R. Munarriz and N. Shah Division of Urology, UMDNJ New Jersey Medical School, Newark, New Jersey J Sex Med 2011;   8:   1547–1550. Introduction: Robotically assisted laparoscopic radical prostatectomy (RALP) provides decreasedsurgical morbidity and faster recovery for patients, but has not significantly changed the incidence of erectile dysfunction and many post RALP patients may require penile prosthesis surgery. Aim: Tomake physicians aware of the anatomical changes after RALP in comparison to traditional retropubicradical prostatectomy and to make suggestions for safer reservoir placement. Main Outcome Mea-sures: Reservoir location after RALP. Methods: A 68 year-old patient with severe vasculogenic EDrefractory to pharmacologic management following RALP underwent a 3-piece penile prosthesisinsertion surgery and laparoscopic right lower abdominal hernia repair. Laparoscopy revealed anintraperitonealreservoirthatwasoverlyingthesigmoidcolonwithmultiplediverticula.Thereservoirwas laparoscopically repositioned in the dependent pelvis away from the diverticula and the pelvic vessels. Results: The patient’s postoperative course was uneventful without any postoperative com-plications (2 year follow up). Conclusions: The altered anatomy of the space of Retzius following RALPwill likely result in significantly more cases of inadvertent intraperitoneal reservoir placement.Surgeons performing inflatable penile prosthesis surgery should be aware of these anatomicalchanges and prepared to consider ectopic reservoir placement when necessary. Editorial Comment: RALP has become increasingly popular, and now the implications forprosthetic urologists are beginning to take shape. Obliteration of the retroperitonealspace of Retzius after transperitoneal robotic prostatectomy may complicate reservoirplacement and increase the likelihood of intraperitoneal reservoir placement, as reportedin this case.I continue to be troubled by the litany of reservoir related complications that one seemsto encounter regularly at a tertiary referral center, where most patients have undergonemultiple prior pelvic surgeries. Not only are they often difficult to place initially, I haveseen perireservoir hernias and intravesical reservoir erosion occur long after inflatablepenile prosthesis placement in RALP cases.New flat reservoirs are now available that enable ectopic subfascial abdominal wallplacement.Thesereservoirsgenerallyarenotpalpableeveninthinpatients,andthusthey TRAUMA, AND GENITAL AND URETHRAL RECONSTRUCTION 2300  appear to be a safer and more sensible solution in patients following radical pelvicsurgery. We have recently converted entirely to ectopic reservoir placement due to itssimplicity, safety and good performance characteristics. Allen F. Morey, M.D. Diagnostic Urology, Urinary Diversion and Perioperative Care Re: Effective Surgical Safety Checklist Implementation D. M. Conley, S. J. Singer, L. Edmondson, W. R. Berry and A. A. Gawande Harvard School of Public Health, Boston, Massachusetts J Am Coll Surg 2011;   212:   873–879. Background: Research suggests that surgical safety checklists can reduce mortality and other post-operative complications. The real world impact of surgical safety checklists on patient outcomes,however, depends on the effectiveness of hospitals’ implementation processes. Study Design: Westudied implementation processes in 5 Washington State hospitals by conducting semistructuredinterviews with implementation leaders and surgeons from September to December 2009. Interviewswere transcribed, analyzed, and compared with findings from previous implementation research toidentify factors that distinguish effective implementation. Results: Qualitative analysis suggestedthat effectiveness hinges on the ability of implementation leaders to persuasively explain why andadaptively show how to use the checklist. Coordinated efforts to explain why the checklist is being implemented and extensive education regarding its use resulted in buy-in among surgical staff andthorough checklist use. When implementation leaders did not explain why or show how the checklistshould be used, staff neither understood the rationale behind implementation nor were they ade-quately prepared to use the checklist, leading to frustration, disinterest, and eventual abandonmentdespite a hospital-wide mandate. Conclusions: The impact of surgical safety checklists on patientoutcomes is likely to vary with the effectiveness of each hospital’s implementation process. Furtherresearch is needed to confirm these findings and reveal additional factors supportive of checklistimplementation. Editorial Comment: Surgical checklists are rapidly being adopted by hospitals in an effortto reduce postoperative morbidity and mortality. However, the effectiveness of implemen-tation of these efforts is quite variable. The authors reviewed the implementation of surgical checklists within 5 Washington state hospitals. They conclude that adoption andimplementation of such measures depend on a culture change within the hospital andsurgical staff. Without adequate communication and buy in, these measures may go un-heeded or even be abandoned. The authors suggest that a coordinated multidisciplinaryeffort is needed to educate operating room personnel and promote checklists to gainmeaningful adoption of these measures. Richard K. Babayan, M.D. DIAGNOSTIC UROLOGY, URINARY DIVERSION AND PERIOPERATIVE CARE  2301
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