Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA.
Department of Urology, Einstein Healthcare Network/Fox Chase Cancer Center, Philadelphia, PA, USA.
Sex Med Rev. 2018 Apr;6(2):302-309. doi: 10.1016/j.sxmr.2017.06.006. Epub 2017 Jul 26.
Surgical frailty is a previously unrecognized clinical entity that objectifies a multiorgan decrease in physiologic reserve in those undergoing surgery. Although penile implantation has been demonstrated to be an effective means of restoring erectile function in patients whose previous conservative measures have failed, there are limited data regarding the assessment of frailty in patients undergoing penile implantation.
To review the various objective methods used to describe surgical frailty in medical and surgical disciplines, report on methodologies of frailty assessment, and discuss the relevance of surgical frailty in the preoperative evaluation of patients undergoing implantation of an inflatable penile prosthesis.
A literature review was performed through PubMed regarding surgical frailty in the disciplines of medicine, surgery, and urology. Key words and phrases included frailty, elderly, aging, erectile dysfunction, penile implantation, and penile prosthesis.
Critical assessment of frailty in medicine and its application to male prosthetic health.
Frailty has been assessed by different metrics in multiple fields. Validated modalities to determine physiologic reserve include an accumulation of deficits and phenotypic objective assessments that are reviewed in detail. Frail patients experience longer length of stay, postoperative complications, unplanned returns to the operating room, and readmissions and are less likely to be discharged to home. Novel frailty assessments objectified through grip strength measurements from our institution demonstrate that a considerable number of patients, young and old, undergoing penile implantation exhibit surgical frailty.
There is a growing need to incorporate frailty assessment in the preoperative risk stratification of patients undergoing penile implantation. Grip strength evaluation seems to be an obvious standard because it is likely the easiest to measure and is clinically relevant given the user's dependence on manual dexterity to use the device. Screening for frailty does not create a substantial time, financial, or resource burden for the urologist. Brennan MS, Barlotta RM, Simhan J. Frailty Assessments in Surgical Practice: What is Frailty and How Can It Be Used in Prosthetic Health? Sex Med Rev 2018;6:302-309.
手术脆弱是一种以前未被认识到的临床实体，它使那些接受手术的人的多器官生理储备减少客观化。尽管阴茎植入术已被证明是一种有效的方法，可以恢复那些以前保守治疗失败的患者的勃起功能，但关于评估接受阴茎植入术的患者脆弱程度的数据有限。
回顾医学和外科各学科中用于描述手术脆弱的各种客观方法，报告脆弱评估方法，并讨论手术脆弱在接受可膨胀阴茎假体植入患者术前评估中的相关性。
通过 PubMed 对医学、外科和泌尿科各学科的手术脆弱进行文献复习。关键词和短语包括脆弱、老年人、衰老、勃起功能障碍、阴茎植入和阴茎假体。
对医学中的脆弱进行批判性评估及其在男性假体健康中的应用。
脆弱已在多个领域通过不同的指标进行评估。确定生理储备的有效模式包括缺陷的积累和表型客观评估，这些评估在详细审查。脆弱的患者住院时间更长，术后并发症更多，计划外返回手术室，再入院，出院回家的可能性更小。通过我们机构进行的握力测量来客观评估的新脆弱评估表明，相当数量的年轻和年老的接受阴茎植入术的患者表现出手术脆弱。
在接受阴茎植入术的患者的术前风险分层中，越来越需要纳入脆弱评估。握力评估似乎是一种明显的标准，因为它很可能是最容易测量的，并且鉴于患者依赖于手动灵巧性来使用设备，因此在临床上具有相关性。对脆弱进行筛查不会给泌尿科医生带来实质性的时间、经济或资源负担。Brennan MS, Barlotta RM, Simhan J. 手术实践中的脆弱评估：什么是脆弱，它如何用于假体健康？性医学评论 2018;6:302-309.
