Ricardo Munarriz

Boston University | BU · Department of Urology

Introduction and Objective Today's educational landscape continues to evolve due to a technology infrastructure that enables increased accessibility and efficiency for students and educators. In an era when reduced opportunity for traditional teacher- student (“face-to-face”) learning is juxtaposed with the exponential growth of internet-based educ...

Purpose of Review Priapism is a rare condition that has different presentations, etiologies, pathophysiology, and treatment algorithms. It can be associated with significant patient distress and sexual dysfunction. We aim to examine the most up-to-date literature and guidelines in the management of this condition. Recent Findings Priapism is a cha...

Mesh is routinely used to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP). However, its use remains controversial. The FDA (U.S. Food and Drug Administration) ultimately deemed mesh use for SUI and transabdominal POP repair acceptable, while cautioning against transvaginal mesh for POP repair. The objective of this study was...

Penile prosthesis implantation is a safe and effective treatment option in the management of erectile dysfunction, associated with high satisfaction and low complication rates. Infection is a rare complication (0.5–3%), but devastating for the patient and surgeon when it occurs. Adapting from other surgical disciplines, we have utilized vancomycin...

Erectile dysfunction management is intended to restore capacity for penile erection. Although effective, none of the currently available treatments approved by the US Food and Drug Administration reverse erectile dysfunction pathophysiology. Penile arterial bypass surgery is intended to restore erectile function without the need for the chronic use...

Inflatable penile prosthesis (IPP) surgery is an effective, safe and satisfactory treatment option for medication-refractory erectile dysfunction. Postoperative complications include infection, mechanical failure, erosion, and pain. Current literature suggests the need for a better approach to postoperative pain management after IPP surgery. Clinic...

Background: There is a significant need for a non-biohazardous, educational platform to equip and maintain the surgical skills required by urology trainees and low-volume implanters for inflatable penile prosthetic (IPP) placement. Aim: To design and develop an anatomic, hydrogel-based simulation platform for training and evaluate IPP placement...

The purpose of this study is to investigate the relationship between inflatable penile prosthesis (IPP) infection, time of year, climate, temperature and humidity. This is a retrospective IRB-approved analysis of 211 patients at 25 institutions who underwent salvage procedure or device explant between 2001 and 2016. Patient data were compiled after...

The epidemiology of genitourinary foreign bodies (GUFB) has been mainly described through case reports and small series. The aim of this study is to investigate the epidemiologic, medical, and socioeconomic factors associated with GUFB, along with the resultant costs of care in emergency departments (EDs) nationwide. ED visits with the primary diag...

Objective To assess whether a focused, simulation training course can improve trainee surgical knowledge and confidence in the treatment of male stress urinary incontinence. Materials and Methods Urology residents participated in a prosthetic education course as part of the 2018 SUPS and SMSNA annual meeting. The course included didactic lectures...

Intracavernosal injection therapy (ICI) was the first pharmacologic treatment in the management of erectile dysfunction. ICI allows for customization of medication composition and concentrations, making it a highly effective treatment with an acceptable side effect profile. The objective was to investigate the long-term results of ICI using validat...

This is a single-institution retrospective study of closed suction drain outputs in primary three-piece IPP cases performed between 2014 and 2017 by a single surgeon. The aim was to investigate the impact of closed suction drains (CSD) during penile prosthesis placement. One hundred and sixty-nine patients underwent intraoperative placement of a cl...

Penile shunting is the standard of care in management of ischemic priapism refractory (IPR) to non-surgical interventions. Due to high rates of impotence, corporal fibrosis, and loss of penile length, recent literature suggests these patients benefit from immediate penile prosthesis (PP) placement. An IRB-exempt anonymous electronic survey of the 2...

Intracavernosal self-injection (ICI) is an effective treatment for erectile dysfunction. A rare but serious complication is needle breakage. We report an unusual case of a 51-year-old transgender female patient who did not desire gender-affirming surgery, and used ICI to treat her longstanding erectile dysfunction. She presented to the emergency de...

Introduction: The Mulcahy salvage fundamentally altered the management of penile prosthesis infections (PPI). Central to this procedure is a sequence of antiseptic irrigations that aims to remove and eradicate pathogenic microflora from the infected field, thus preparing for immediate reimplantation. The antiseptic solutions and their respective c...

Introduction: The epidemiology of penile fractures in the emergency setting is not well described. Aim: Examine the incidence, evaluation, management, risk factors predicting surgical repair or hospital transfer, and use of financial resources in patients presenting with penile fractures to the emergency departments (ED) nationwide in the Unites...

Introduction Although diabetes mellitus (DM) is often discussed as a risk factor for inflatable penile prosthesis (IPP) infection, the link between DM diagnosis and IPP infection remains controversial. High-quality population-based data linking DM to an increased risk of IPP infection have not been published. Aim To evaluate the association of DM...

Introduction Constraints on surgical resident training (work-hour mandates, shorter training programs, etc.) and availability of expert surgical educators may limit the acquisition of prosthetic surgical skills. As a result, training courses are being conducted to augment the prosthetic surgery learning experience. Aim To evaluate the impact of a...

Background Ectopic placement of penile prosthesis reservoirs has become more common in patients whose space of Retzius has been compromised. Aim To describe techniques and instruments used to place penile prosthesis reservoirs ectopically. Methods We present our method of placing ectopic reservoirs and review the literature for other techniques....

Background: Infra-pubic placement of an inflatable penile prosthesis (IPP) has a well-known configuration deformity from contralateral tubing that crosses the corporal bodies, resulting in tubing visibility and irritation under the penile skin. Aim: To present a novel step to eliminate this tubing crossover deformity. Methods: The V-neck techn...

Introduction: The field of sexual medicine is continuously advancing, with novel outcomes reported on a regular basis. Given the rapid evolution, updated guidelines are essential to inform practicing clinicians on best practices. Aim: To summarize the current literature and provide clinical guidelines on penile traction therapy, vacuum erection...

Introduction: Ischemic priapism is an uncommon urologic emergency characterized by a compartment syndrome-like ischemic insult to the corpora cavernosa of the penis. The goal of treatment in ischemic priapism is rapid detumescence to prevent long-term erectile dysfunction. Non-surgical treatment options include aspiration, irrigation, and intracav...

Introduction: Since the introduction of inflatable penile prostheses (IPPs), risk of infection has decreased. However, concurrent substance abuse has not been investigated in prosthetic urology. Aims: To determine whether substance abuse would stand out as a relevant risk factor for infection in patients undergoing IPP implantation. Methods: T...

The treatment of sexual dysfunction in patients with prior sexual offenses poses ethical and legal dilemmas. Sex offenders are not obligated by law to disclose this history to medical professionals. Over 20% of sex offenders experience sexual dysfunction; however, the number of sex offenders seeking evaluation for sexual dysfunction is unknown. The...

Penile fracture is an uncommon urologic emergency, defined as traumatic rupture of the tunica albuginea of the corpus cavernosum. It occurs mainly in young adults during sexual activity. In the United States, urethral injury is associated with 10-38% of all penile fractures. Diagnosis can be made clinically with the classic triad of an audible crac...

We present a case of corpus cavernosum hematoma mimicking priapism. A 42-year-old man presented to the emergency room with penile pain and partial erection. Examination revealed partial erection and palpable space-occupying lesion of the corpus cavernosum without lymphadenopathy. Malignant workup was negative. Imaging assisted in diagnosis of unila...

Purpose: Since its introduction in 1996, Mulcahy salvage has significantly improved outcomes for removal and replacement of infected IPPs. Long-term follow-up data of Mulcahy salvage shows an infection-free rate of 82%. A multicenter retrospective analysis of the Malleable Implant Salvage Technique (MIST) was conducted to assess infection outcomes...

Introduction: Penile revascularization is a surgical treatment option for erectile dysfunction (ED) in healthy individuals due to a focal arterial occlusion in the absence of generalized vascular disease. Most described failures have been attributed to graft stenosis or disruption of the anastomosis. Aim: We report a novel phenomenon called Peni...

Since the first case of priapism was reported in the scientific literature in 1824, limited attention has been placed on the study of the incidence, etiology, pathophysiology, diagnosis, and timely treatment of priapism. As a result priapism is associated with less than ideal patient outcomes including permanent and irreversible erectile dysfunctio...

Introduction. A single-armed, prospective, multicenter international study evaluated the redesigned Coloplast Titan One Touch Release (OTR) pump inflatable penile prosthesis. The OTR pump has a unique release valve that permits deflation of the implant with one squeeze of opposing touch pads. Aims. To assess the impact of a new penile prosthesis de...

Robotically assisted laparoscopic radical prostatectomy (RALP) provides decreased surgical 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. To make physicians aware of the anatomical changes after RALP in comparison...

Penile microarterial bypass surgery (MABS) may be the only treatment capable of restoring normal erectile function without necessity of chronic use of vasoactive medications or placement of a penile prosthesis. Lack of standardization in patient selection, hemodynamic evaluation, surgical technique, and limited long-term outcome data using validate...

Penile microarterial bypass surgery (MABS) may be the only treatment capable of restoring normal erectile function without the necessity for the chronic use of vasoactive medications or placement of a penile prosthesis. Lack of standardization in patient selection, hemodynamic evaluation, surgical technique, and limited long-term outcome data using...

Penile pain is one of the most distressing, limiting, and difficult to treat manifestations of Peyronie disease. The use of steroid injections for penile deformities associated with Peyronie disease has been ineffective. However, use of steroid injections in managing penile pain has been poorly investigated. The aim of this study was to examine the...

Penile microarterial bypass surgery may be the only treatment capable of restoring normal erectile function without the necessity of chronic use of vasoactive medications or placement of a penile prosthesis. Lack of standardization in patient selection, hemodynamic evaluation, surgical technique and limited long-term outcome data using validated in...

Introduction: The role of androgens in sexual function and in particular in erectile physiology remains controversial. The aim of this chapter is to review the preclinical and clinical data on the impact of androgen deprivation in male sexual functioning since androgen ablation is the main treatment option for men with advanced prostate cancer and...

To report the experience of three highly specialized centres in the vascular evaluation of erectile dysfunction (ED) in teenagers, as there is little information on this topic, and although clinical guidelines support the use of vascular studies in selected cases, our experience is that vascular evaluation aimed at diagnosing organic ED is uncommon...

Is cavernosometry a useful tool in treating men with erectile dysfunction? Five people with expertise and/or interest in the area of cavernosometry were asked to contribute their opinions. To provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine. While one urologist feels dynamic infusion...

Erectile dysfunction (ED) is defined as the consistent inability to obtain or maintain a penile erection satisfactory for sexual intercourse (1). Community epidemiologic studies have revealed that 52% of men aged 40 to 70 years have one of the following forms of impotence: self-reported (17%), moderate (25%), and clinically complete (10%) (2). Alth...

Introduction. Ischemic priapism is associated with cavernosal acidosis, which decreases the efficacy of adrenergic agonists. We determined the effect of acidosis on ligand dissociation from adrenergic receptors and assessed the efficacy of high-dose phenylephrine in treating patients with acute ischemic priapism. Methods. Dissociation rates of [3H]...

Purpose of review: It is generally accepted that androgens are critical for mood, cognition, sex differentiation, development of male sexual characteristics and maintenance of bone density and muscle/fat ratio. Their role in sexual function and in particular in erectile physiology, however, remains controversial. A careful review of preclinical and...

A considerable body of literature is accumulating regarding the therapeutic potential of androgens in women with sexual dysfunction. Most of the studies point to a beneficial role of androgens in improving sexual function in women with limited adverse events. Nevertheless, use of androgens in women remains highly debated and controversial. With the...

Diabetes is associated with declining sexual function in women. However, the effects of diabetes on genital tissue structure, innervation and function remains poorly characterized. In control and streptozotocin-treated female rats, we investigated the effects of diabetes on vaginal blood flow, tissue morphology, and expression of arginase I, endoth...

Introduction: Oral contraceptives (OCs) have been the preferred method of birth control because of their high rate of effectiveness. OC use, however, has been associated with women's sexual health complaints and androgen insufficiency. OC use is associated with a decrease of androgen ovarian synthesis and an increase in the production of sex hormo...

From 1999 to 2004, there had been 21 publications from multiple medical specialties (sexual medicine, urology, neurology, cardiology, biomedical engineering, sports medicine, emergency medicine, and officials from the National Institute for Safety and Occupational Health) investigating the relationship between bicycle riding and erectile dysfunctio...