A case of penile cavernitis following a penile prosthesis implantation]

A 25-year old man, who had an inferiority of having a small penis and normal potency, underwent intracavernous implantation of hand-made silicone rods by a cosmetic surgeon in order to enlarge his penis. He had pyrexia and swelling of the penis 2 days after the implantation, and penile cavernitis developed. The penile symptoms improved by drainage and strict chemotherapy, and then the silicone rods were removed from his penis. Histopathological findings of the corpus cavernosum showed marked inflammatory and granulomatous changes. The patient lost his potency due to poor blood flow into the cavernous.     

Severe penile curvature after implantation of an inflatable penile prosthesis

We describe 6 cases of penile curvature following implantation of inflatable penile prostheses. Exploration revealed severe scarring of the corpora cavernosa, which produced the curvature in 4 patients. In all 4 cases this area was incised and the defect was filled with a polytetrafluoroethylene vascular graft. The penis was straightened and the prosthesis functioned normally. The remaining 2 patients were treated with inflation for 8 weeks with resolution of the curvature. To our knowledge, these cases represent the first reported complications produced by abnormal scar tissue outside of the inflammatory pseudocapsule after implantation of an inflatable penile prosthesis.     

Current status of penile prosthesis implantation

Today most men with erectile dysfunction (ED) can be effectively treated with less invasive means than penile prosthesis implantation. Nevertheless, there remain men who do not respond to simple treatments such as systemic medication and who either do not respond to or reject intermediate treatment such as penile injection therapy. For these men, penile prosthesis implantation remains a reasonable option. This review discusses types of penile prostheses, how to choose among prosthesis types, key features of implant techniques, infection management, penile reconstruction related to prosthesis implantation, and patient and partner satisfaction.     

Contemporary aspects of penile prosthesis implantation

PURPOSE: Erectile dysfunction today has a number of effective treatment options. This review was undertaken to examine the contemporary role of penile prosthesis implantation in the treatment of this disorder. MATERIALS AND METHODS: A MEDLINE search was performed on the topic of penile prostheses and implants. Current literature was reviewed with regard to types of penile implants, issues related to prosthesis implantation, results, and patient/partner satisfaction. RESULTS: Mechanical failure rates for early penile prostheses, especially the inflatable type, were unacceptably high. Advances in both prosthesis design and implantation techniques have resulted in increased device survival with 5-year actuarial survival rates free of mechanical failure ranging from 86.2 to 93.6%. Recent reviews of implant recipients show 83 and 85% satisfaction and for partners 70 and 76% satisfaction. CONCLUSIONS: When systemic therapy for erectile dysfunction fails, men have a variety of other options to choose from. Penile prosthesis implantation is an option that is feasible for nearly every man with this disorder. Current device survival rates and patient and partner satisfaction rates are high.     

Management of the complications of penile prosthesis implantation

Penile prostheses are considered to be the definitive solution for the treatment of organic erectile dysfunction in those in whom medical therapy, such as phosphodiesterase inhibitors, is contraindicated or in those who have failed more conservative measures. The advent of new surgical tools and new infection-resistant materials has significantly reduced the risk of intra- and postoperative complications. Nevertheless, complications do still occur and need to be recognized and managed. This review highlights the more frequently encountered complications of penile prosthetic implants and makes some suggestions on how to prevent or correct them.     

Combined implantation of artificial sphincter and penile prosthesis

Concurrent sphincteric incontinence and organic impotence are not uncommon; they can be caused by many congenital and acquired conditions. In the past simultaneous implantation of the artificial sphincter and penile prosthesis was met with skepticism. Of 65 patients who had concurrent implantation of the artificial sphincter and various categories of penile prosthesis 60 were followed for a mean of 35.74 months (range 8 to 55 months). Continence was graded as good or satisfactory in 95 per cent of the patients and poor in 5 per cent. The penile implants were functional in 98 per cent of the patients. Of the 60 patients 33 required 59 corrections, for an average of 0.98 correction per patient. These results indicate that staged or concurrent implantation of dual prostheses is feasible technically, functionally and cosmetically, and without increased risk for surgical or mechanical problems.     

Risk profiling in patients undergoing penile prosthesis implantation

Penile prosthesis implantation is the gold standard of surgical therapy for patients with medication-refractory erectile dysfunction.However,this umbrella definition includes significant heterogeneity and associated risk profiles that should be candidly discussed and addressed perioperatively.Factors associated with operative success and patient satisfaction are often surgery specific;however,risk profiling via patient selection,preoperative optimization,proper device selection,and intraoperative consideration are highly correlated.Some examples of common risk profiles include comorbidity(ies)such as cardiovascular disease,diabetes mellitus,prior abdominal surgery,Peyronie's disease,and psychological risk factors.Similarly,integration of surgeon-and patient-amenable characteristics is key to decreasing risk of infection,complication,and need for revision.Finally,patient risk profiling provides a unique context for proper device selection and evidence-based intraoperative considerations.     

Management of residual penile curvature after penile prosthesis placement

Residual penile curvature is a common situation following the implantation of a penile prosthesis in patients with Peyronie’s disease.Currently,there is a variety of options for the correction of residual curvature,including penile modeling,plication techniques,as well as tunical incision/excision with or without grafting.A literature search of PubMed and Medline databases was conducted from 1964 until 2020,using search terms for all articles in the English language.In this article,we provide a review of the techniques and the outcomes,according to the published literature.     

The management of residual curvature after penile prosthesis implantation in men with Peyronie's disease

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

? To report our experience in the management of residual curvature after implantation of a penile prosthesis in men with Peyronie’s disease (PD).

PATIENTS AND METHODS

? From January 1985 to June 2009, 62 (29%) of the 209 patients with PD that have undergone the insertion of a penile prosthesis have required an additional straightening procedure to correct the residual curvature after the insertion of the cylinders of the implant. ? The types of additional manoeuvres, their success in correcting the residual curvature and eventual complications have been reported.

RESULTS

? Among the additional straightening procedures, modelling was more successful in achieving straightening when performed on an inflatable device (84%) than on a malleable implant (54%). ? If the curvature persisted after modelling or if the curvature was ventral, straightening was achieved with tunical plications or incision with or without grafting.

CONCLUSION

? Although it is common for the simple implantation of cylinders alone to straighten the penis, some patients will present a residual curvature that must be successfully corrected with additional straightening procedures.     

Dorsal vein rupture after practice of taqaandan, necrotising cavernositis, penile reconstruction, urethroplasty and penile prosthesis implantation

Penile fracture is an uncommon and emergent urologic condition defined as traumatic rupture of the corpus cavernosum secondary to a blunt trauma of the erect penis. Tunica albuginea is thinned and stretched in the erect state, and a transverse tear in the corpus cavernosums may occur by a buckling force. However, penile dorsal vein tears may mimic penile fracture. Also, corporeal infection and purulent cavernositis are associated with trauma, cavernosography, priapism, intracavernosal injection therapy and penile prosthesis.     

Management of Peyronie disease by implantation of inflatable penile prosthesis

Sixty-seven patients with advanced Peyronie disease were treated by implantation of an inflatable penile prosthesis (IPP). Twenty-eight of the 67 patients had documented total erectile failure. The remaining 39 patients had significant penile curvature causing "mechanical impotence" due to inability to achieve adequate vaginal penetration and chose implantation of an inflatable penile prosthesis (in some cases, combined with a straightening procedure) rather than one of the standard penile straightening procedures. Currently, 63 of the 67 patients have functioning prosthetic devices; in 3 other patients the device was removed because of infection, and 1 patient was dissatisfied and had the device removed. For impotent patients with severe Peyronie disease for whom other medical or surgical treatment is neither desirable nor suitable, we recommend implantation of an inflatable penile prosthesis combined with a possible straightening procedure.     

Fluoroscopy guided implantation of penile prosthesis in cases of severe fibrosis

Penile prosthesis implantation in men with scarred corpora presents a challenge to surgeons due to the fibrosis created and the loss of normal anatomic boundaries. We present a new technique to recreate corporal spaces and preserve circulation in a patient with a neophallus that we believe can be used in other circumstances of atypical anatomy such as extensive fibrotic scarring. The operation was performed in a hybrid operating room that was capable of complete angiography as well as complete sterility for operative procedures. Angiography of the femoral vessels documented the blood supply to the neophallus and decreased the risk of accidental injury to its vascular supply. Under fluoroscopic guidance a 16 cm needle was extended through the pseudo-corpora of the neophallus to provide a channel for a super stiff guide-wire to be advanced. The needle was then removed and an inflatable Amplatz dilator was advanced along the wire. The balloons were inflated with contrast media under fluoroscopic guidance to create two pseudo corporeal spaces. Appropriately sized inflatable penile prosthesis cylinders were then advanced into these spaces. Successful outcome was maintained at 2 year and 5 months follow-up. Corporoplasty provides an alternative to standard approaches in patients with fibrosis and atypical blood vessel anatomy.     

阴茎假体植入术治疗勃起功能障碍548例分析

目的 了解阴茎假体植入术的手术合并症和机械信赖性。分析植入各种假体治疗阴茎勃起功能障碍患者的远期效果。方法 利用随访调查表对５４８例假体植入术后虱进行随访调查。结果 ５４８例患者中，植入单件套可屈性假体２２８例（４１．６％），单件套膨胀性假体４５例（８．２％）。三件套膨胀性假体２７３例（５０．２％）。阴茎假体植入术后合并症发生率为５．１％（２８／５４８），包括非机械性合并症８例（１．５％），机械性合并症２０例（３．６％）。ＡＭＳ Ｍａｌｌｅａｂｌｅ６００可屈性假体和ＡＭＳ７００ＣＸＭ三件套膨胀性假体的机械性合并症发生率分别为１．３％（３／２２８）和５．５％（１５／２７３），ＡＭＳ７００ＣＸＭ三件套膨胀性假体的圆柱体泄漏１０例，占３．７％（１０／２７３）。结论 ＡＭＳ７００ＣＸＭ三件套膨胀性假体的机械性能和隐蔽性     

10 years of experience with penile prosthesis implantation in Taiwanese patients

PURPOSE: We evaluated the long-term results of penile prosthesis implantation during the last 10 years. Special considerations were examined concerning Asian corporeal diameter, device survival and sociocultural factors influencing patient-partner satisfaction. MATERIALS AND METHODS: We followed 331 patients who underwent penile prosthesis implantation from December 1985 to May 1996. Surgical data, postoperative complications and information from a survey on satisfaction are reported. RESULTS: The most prevalent corporeal diameter in our patients was 11.0 to 11.5 cm. Postoperatively wound infection was the most serious surgical complication. The 5-year device survival was similar in the malleable and inflatable types except for a poorer outcome with the self-contained inflatable Hydroflex penile prosthesis. Overall patient satisfaction with surgery was 86.6%. CONCLUSIONS: Penile prosthesis implantation still has its place as definitive therapy in some patients with uncorrectable erectile dysfunction. In Taiwanese society more consideration of prosthesis selection, surgical preparation and patient-partner counseling is the basis for further success in the future.     

Two-stage technique for implantation of inflatable penile prosthesis in pelvic cancer surgery

A two-stage technique for implantation of an inflatable penile prosthesis has been developed for patients undergoing radical pelvic cancer surgery. Over the past five years, this method has been utilized in 147 men undergoing radical cystectomies or prostatectomies. The technique involves implanting the reservoir and pump of the prosthesis at the time of the radical cancer operation when the lateral neurovascular bundles of erection are being sacrificed. The reservoir and pump are permanently connected, and the cylinder tubings from the pump are temporarily connected and placed in the subcutaneous tissue overlying the pubis. During a second procedure, usually six to twelve weeks later, the cylinders are implanted infrapubically and connected to the easily located pump tubing. The advantages are several. (1) The pump and reservoir are easily implanted during the pelvic surgery while importantly not adding significantly to the operative time or morbidity of the primary procedure. (2) The reservoir is easily positioned in the pelvis. (3) The scrotum with its contained pump already will be healed when the entire prosthesis is connected, bypassing the initial scrotal pain and edema. (4) Psychologically the patients feel relieved that their erectile dysfunction is being treated immediately. This two-stage technique appears to maximize the gain of early and easy implantation while minimizing the potential problems of concomitant surgery.     

Inflatable penile prosthesis cylinder failure after internal urethrotomy

Transurethral direct vision internal urethrotomy can be performed safely in the presence of an inflatable penile prosthesis with several caveats. A case of prosthesis cylinder rupture by urethrotome is reviewed.