The present invention is a penile prosthesis with an inflatable cylinder that provides significant lengthwise expansion of a male penis. The cylinder has a proximal end which is generally a rigid, solid, tapering cylindrical base member and a distal end comprising an inflatable member. The cylinder wall comprises, in its mid-portion between the distal and proximal ends, an inflatable bellows which attaches at one end to the base member and the other end to the inflatable member.
Disposed over the bellows is a sheath that similarly attaches to the base member and inflatable member. When the bellows is in its retracted position, the sheath is likewise relaxed and not stretched. When the bellows is expanded during inflation thereof, the sheath will stretch.
Inflatable penile prosthesis as tissue expander: what is the evidence?
The inflatable cylinder is connected to a pump, which transfers fluid between a reservoir and the cylinder. When fluid is pumped into the cylinder, the bellows and inflatable member are inflated and the sheath is expanded, allowing the distal end to move distally into an elongated position. When the cylinder is inflated the sheath is under tension. When deflated, the sheath will pull the distal end back into a compact position.
The spring rate of the sheath is relatively high, so that the cylinder readily contracts the penis into a natural flaccid position. Therefore it is an object of this invention to provide a penile prosthesis which has an inflatable cylinder that provides significant penile expansion. It is also an object of this invention to provide a penile prosthesis which has an inflatable cylinder that provides significant penile expansion and readily contracts the penis into a natural flaccid position.
The objects and advantages of the present invention will become more readily apparent to those skilled in the art after reviewing the following detailed description and accompanying drawings, wherein:. Referring to the drawings more particularly by reference numbers, FIG. The implant 10 has a pair of inflatable cylinders 12 attached to a pump 14, which transfers fluid 16 between a reservoir 18 and the cylinders The pump 14 is connected to the cylinders 12 by a pair of first tubes 20 that extend into ports 22 formed in the cylinders The reservoir 18 is attached to the pump 14 by a second tube The tubes 20 and 24 are preferably constructed from either nylon or a silicone rubber, which provide flexibility and protection from contamination.
In the preferred embodiment, the reservoir 18 is constructed from a polyurethane that is flexible enough to be implanted into the pelvic cavity of a patient and compatible with a human body without substantial risk of rejection in a typical patient. The elastic nature of the reservoir 18 also allows the bag 18 to contract and expand when fluid is transferred to and from the cylinders The pump 14 is preferably constructed from a silicone elastomer, which can be easily squeezed by the user and has enough resiliency to return to the original state when released.
The pump 14 has a valve not shown which allows one directional fluid flow into the cylinders 12, when the pump housing 26 is squeezed in and out by the user. The valve prevents fluid from flowing out of the cylinders 12 when the cylinders 12 are in an extended position. Manual manipulation of the pump 14 can open up the valve, so that fluid can flow from the cylinders 12 back to the reservoir The cylinder 12 has a bellows 28 attached to an inflatable member The inflatable member 30 and bellows 28 have an inner cavity 32 that can be filled with fluid.
The bellows 28 is surround on its exterior by an elastic sheath 34 which extends from a base member 36, and is attached to the inflatable member 30 connecting the inflatable member 30 to the base The base member 36 is constructed from a silicone elastomer and is rigid enough to anchor the cylinder 12 into the root end of the corpus cavernosum. The base member 36 also has a bore 39 that provides fluid communication between the inner cavity 32 and the port The port 22 and bore 39 allow fluid to flow between the inner cavity 32 and the pump Operation of the pump 14 causes the fluid pressure within the cylinder 12 to increase, so that the bellows 28 expands and the inflatable member 30 moves in the axial direction, as shown in FIG.
The inflatable member 30 is preferably constructed from a distensible material such as polyurethane between 0. The distensible material allows the inflatable member 30 to expand and grow in both the axial and radial directions, thereby increasing the length and girth of the penis pendulum. In the preferred embodiment the bellows 28 is constructed from a silicone elastomer that allows the bellows 28 to expand when the fluid reaches a predetermined pressure.
The sheath 34 is preferably constructed from a silicone elastomer that is approximately 0. The sheath 34 has a resilient memory and a high spring rate, so that when the fluid pressure within the cylinder 12 is reduced, the sheath 34 pulls the inflatable member 30 toward the base 36 until the cylinder 12 is in the retracted position shown in FIG. The cylinder 12 initially comprises two pieces, wherein the bellows 28 is attached to the inflatable member 30 and the sheath 34 extends from the base member As shown in FIGS.
As shown more clearly in FIGS. The protrusions 42 also seal the inner cavity 32 from the area between the bellows 28 and the sheath A vacuum is then created in the inner cavity 32 to contract the bellows 28 into a compressed position as shown in FIG. An uncured adhesive 44, preferably a fumed silica, is placed on an annular groove 46 formed at the interface of the bellows 28 and the inflatable member The sheath 34 is then unrolled and pulled over the bellows The cylinder 12 is left in that state until the adhesive 44 cures and bonds the sheath 34 to the inflatable member The vacuum is then removed so that the bellows 28 returns to the normal position shown in FIG.
Installation of the prosthesis 10 can be performed by any surgical procedure known in the art. The preferred method is to make an incision at the pelvic bone near the scrotum. The corpus cavernosa are then dilated and the cylinders 12 are inserted within the penis. Although two cylinders are shown, it is to be understood that only one cylinder 12 can be used in the present invention.
The pump 14 is placed into the scrotal sac and the reservoir 18 is inserted into the abdomen. The cylinders 12 are placed within the penis such that the bellows 28 are completely within the pelvic cavity when the penis is in the flaccid position. In this manner the bellows 28 are not physically apparent to the touch when the penis is in the normally flaccid position.
To operate the prosthesis 10, the user squeezes the pump 14 inside the scrotal sac to increase the fluid pressure within the cylinder The pumping action causes the inflatable member 30 and bellows 28 to expand, thereby increasing the length and girth of the penis. In the preferred embodiment the operating pressure is approximately 12 psi.
The yield pressure of the sheath 34 is approximately 12 psi, such that the cylinder 12 does not create significant length extension until the yield pressure is obtained within inner cavity This construction prevents lengthening of the penis upon accidental squeezing of the pump When the desired length is achieved, the pumping operation is desisted, wherein the penis remains in an erect position as shown in FIG.
When an erection is no longer desired, the pump 14 is manipulated so that the fluid within the cylinder 12 can flow back into the resevoir 18, to allow the penis to return to the flaccid position shown in FIG. Pumping fluid into the cylinder builds up the fluid pressure within the cylinder 12 to a level higher than the pressure in the reservoir 18, so that when the pump valve is opened the fluid will have a tendency to flow back into the reservoir The elastic spring characteristic of the sheath 34 pulls the inflatable member 30 toward the base Consequently, the spring force of the sheath 34 creates a reverse pressure within the inner cavity 32, to accelerate the flow of the fluid into the reservoir Penile prosthesis has become one of the most accepted treatment options in patients who do not respond to conservative medical therapies oral or intracavernous injections.
When penile fibrosis is present, this surgery becomes a real surgical challenge even for a skillful surgeon. The aim of this study was to review latest techniques to implant a penile prosthesis in patients with corporal fibrosis. We performed a systematic search in the following databases: When penile corporal fibrosis is present, this surgery becomes a real surgical challenge even for a skillful surgeon.
Over the years, multiple surgical approaches have been suggested to facilitate implantation in this difficult situation. Traditional approaches include the resection of scar tissue, performing extensive corporotomies and the eventually use of grafts to cover the corporal gap. Outcomes can be improved combining the use of techniques for scar incision extensive wide excision, multiple incisions minimizing excision, corporal counter incisions, corporal excavation technique or Shaeer's technique and cavernotomes and downsized prosthesis.
Surgical strategies like upsizing prosthesis, suspensory ligament release or scrotoplasty must be kept in mind to utilize in this special scenario. Penile prosthesis in a patient with severe corporal fibrosis remains a surgical challenge. There are several techniques and surgical strategies that an implant surgeon should know and manage to minimize complications and improve outcomes. Management of intraoperative penile implant complications. Dec Curr Sex Health Rep. The three-piece inflatable penile prosthesis has the highest patient satisfaction and lowest mechanical revision rate of any medically implanted device.
Revisions of inflatable penile prostheses are more often required for nonmechanical reasons than for device failure. Intraoperative complications of penile implant placement can be distressing for the prosthetic surgeon, but with recognition of the dilemma, most of these complications can be navigated with excellent postoperative results. More than half of these intraoperative complications occur during dilatation of the corpora cavernosa. Dilation of the corpora cavernosa is a critical step in the placement of any type of penile prosthesis and can be especially difficult in a patient with corporal fibrosis.
This review article summarizes the techniques, outcomes, and new developments in the field of complicated penile prosthetic surgery. Salvage surgery for penile prosthesis infection. Sep Curr Sex Health Rep. Penile implants offer an effective surgical treatment for erectile dysfunction, with very high patient satisfaction rates.
One of the most devastating complications of this procedure is infection, which requires removal of the device and all associated foreign material. With more recent developments in product design and understanding of infection, surgeons now have more options to offer patients. Surgeons may leave the device out and allow the wound to heal before returning in the future to replace the prosthesis, or they may cleanse the wound and replace the device in the same setting.
Immediate salvage surgery has had good results with appropriate patient selection. This paper reviews the related literature and provides expert testimony on the current state of salvage surgery. Penile prosthesis surgery for the fibrotic penis. Penile fibrosis renders implantation of a penile prosthesis a formidable procedure.
Fibrosed corporate cavernosa resist dilation by blunt dilators, mandating the use of force and resulting in a high percentage of complications. This is a report on advances in the field of penile prosthesis surgery for the fibrotic penis through the years to In that time, bovine pericardium was added to the choices of graft materials used to expand the corpora to accommodate the implant alongside the fibrous tissue. Also, the technique for open excavation of fibrous tissue through extended corporotomies was further evaluated in a series of nine cases. Downsized prostheses that were previously implanted in cases of penile fibrosis were replaced by regular-sized ones after having served as tissue expanders.
Finally, minimally invasive, visually guided, sharp excavation of fibrous tissue has evolved through three stages, combining endoscopy and ultrasonography to safely excavate corporeal fibrous tissue. Outcomes and Patient Satisfaction. Jun J Sex Med. Demographic data, cylinder sizes, and patient satisfaction were compared between the NLMT and standard techniques.
Of the 14 NLMT patients, There were ethnic differences between the samples: However, longer cylinders were utilized more often, with Nationwide data reveal At 6 months postimplantation, patient satisfaction with NLMT was no different than standard techniques. There were no distal erosions, complications, infections, or pain concerns reported through 24 months among the NLMT patients. The NLMT resulted in a larger number of subjects implanted with larger cylinders.
Satisfaction with performance and complication rates for NLMT patients was comparable to those implanted using standard techniques. Jan J Sex Med. The field of erectile dysfunction ED is evolving and there is a need for state-of-the-art information in the area of treatment. To develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery. To provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period.
Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. The inflatable penile prosthesis IPP is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis.
Organic ED responds well to vacuum erection device VED therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma.
Currently, surgery to limit venous leakage is not recommended. It is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient's medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery. Practice patterns of urologists performing penile prosthesis surgery vary based on surgeon volume: Results of a practice pattern survey.
Inflatable penile prostheses IPPs are widely accepted as a means of surgical treatment of erectile dysfunction. It has been suggested that surgeon volume influences patient outcomes after IPP implantation. We used a written questionnaire to ask urologists who perform IPP surgery about their practice patterns. Our analysis correlated specific practices to self-reported IPP volume.
A written questionnaire was distributed to urologists. Responses were collated and analyzed. Our main outcome measures were surgeon volume, approach to initial IPP placement penoscrotal vs infrapubic , strategy for reservoir management during IPP revision surgery, strategy for reservoir replacement when deemed necessary, approach to suspected IPP infections, and utilization of revision washout protocols. This study does not require institutional review board approval from our institution, given that patient information is not used at all, this is a practitioner survey only.
HVIs were significantly more likely to incorporate both penoscrotal and suprapubic approaches into their armamentarium, more likely to manipulate previously placed IPP reservoirs during revision surgery, and more likely to operate immediately when confronted with a suspected IPP infection. They were also more likely than LVIs to use the Mulcahy revision washout protocol. The importance of these differences for patient outcomes remains undefined.
Phalloplasty and penile implant surgery. Nov Curr Urol Rep. Impotence is often accompanied by loss of phallic length. To enhance penile prosthesis surgery, it is possible to perform simple adjuvant procedures that will increase perceived or true length.
This article presents an overview of these techniques, which may be categorized as involving removal or fixation of tissue above or below the shaft of the penis; division of the suspensory ligament; and augmentation of the corpora cavernosa through stretch or grafting.
We believe that the use of these techniques will become increasingly commonplace as patient satisfaction is reported. Complications that arise after placement of a penile prosthesis may result in the need for revision surgery. Few contemporary penile prosthesis series have focused solely on describing the efficacy and patient satisfaction associated with penile prosthesis revision surgery. To determine the overall success of penile prosthesis revision surgery in providing the patient with a functional implant. Device efficacy and patient satisfaction with penile prosthesis revision surgery will be assessed using psychometrically validated instruments.
The erectile function EF and satisfaction domains of the International Index of Erectile Function IIEF were used to quantify the overall efficacy and patient satisfaction with revision surgery. Data were derived from a prospective database of consecutive patients undergoing penile prosthesis revision surgery performed by a single surgeon B. Eleven patients filled out the IIEF prior to surgery and 26 completed it following surgery. Thirty-nine consecutive patients underwent 55 revision procedures related to a prior penile prosthesis.
Significant improvements in the overall IIEF, EF domain, and satisfaction domain were seen in those patients studied prior to and following revision surgery. Patients with fibrotic corporal bodies scored significantly lower on the EF and satisfaction domains than did any other group. Penile prosthesis revision surgery is highly successful in providing men with a functional implant.
The prostheses function well and patients are satisfied with their devices. Further study of those men with corporal fibrosis is warranted in order to determine the factors needed to improve their overall satisfaction with revision surgery. Penile Prosthesis Surgery: Although more invasive than some of the other currently available therapies, penile prosthesis surgery has the advantages of high patient satisfaction rates and avoidance of systemic adverse events in the vast majority of cases.
This article provides a review of the more widely used implants and some of the more frequently encountered complications of penile prosthesis surgery. A retrospective review peer reviewed publications relevant to the field of penile prosthesis surgery. Review of historical milestones and newer penile prostheses, as well as a review of prosthesis surgery complications. Improved designs and materials have resulted in decreased incidence of mechanical failures or infectious complications while simultaneously simplifying the operation of these devices.
Penile prosthesis surgery remains an excellent alternative for restoring erectile function to those in whom medical therapies such as phosphodiesterase inhibitors are contraindicated or who have failed more conservative measures. Low flow priapism. Treatment by sapheno-cavernous shunt. May Arch Esp Urol. We report the clinical case of a year-old male presenting with a 36 hour history of low flow priapism, its diagnosis and treatment. We performed a bibliography review on the etiology, physiopathology, diagnosis and treatment options. The patient underwent unsuccessful punction-aspiration of intracavernous blood with phenylephrine injection and cavernous irrigation with saline solution.
A covernous-spongiosum shunt was performed subsequently, firstly using the Winter technique and followed by the AlGorab technique with a final positive response. The performance of a sapheno-cavernous shunt is an effective treatment for the low flow priapism resistant to usual medical-surgical treatment. Long-term revision-free survival, greater than 10 years has never been reported for inflatable penile prostheses. We conducted a historical prospective study to estimate 10 and 15 years survival of first time virgin implantations in 2, patients with four different models.
Evaluation of and year mechanical and overall revision-free survival of inflatable penile prostheses. Kaplan-Meier product limit method, and comparison using the log rank test, were used to estimate the and year revision-free survival. Data were obtained from medical records and patient interviews, entered into a computerized database, and analyzed by a third party. Information included implant type, date, revision history with date, and reason.
Fourteen different inflatables were examined. Because of failure times being confounded as a result of prior implants, only virgin implants were examined. For the entire series, estimated year revision-free survival for all reasons was Freedom from mechanical breakage at 10 years was Recent mechanically enhanced models did even better. In , Mentor Alpha added pump reinforcement to forestall mechanical breakage. This improved year survival from This is the first report on long-term reliability of inflatable penile prostheses.
Newer enhanced models are currently available, and our tracking predicts even better long-term survival for these devices. Despite previous reports showing consistently elevated patient satisfaction with penile implantation, it is our impression that patients who have had a prosthesis placed often complain of penile shortening postoperatively.
We sought to evaluate if the release of the penoscrotal web would optimize patient perception and satisfaction regarding penile length after such procedure. Utilizing a questionnaire, we evaluated patient satisfaction, focusing on phallic size. Ninety patients mean age 62 underwent penile prosthesis placement during a month period. Forty-three were carried out with takedown of penoscrotal web during a month period group 1.
Of group 1, 39 patients had an inflatable implant placed inflatable penile prosthesis and 4 had a semirigid implant. The patients were directly inquired with a seven-item questionnaire 3 months after the procedure. These results were then compared to a group of 37 patients that had penile implants placed without release of the penoscrotal web group 2. All the patients involved in the study had a high insertion of the scrotum ventrally penoscrotal web.
The remaining two patients reported a decreased penile length. The operative time for group 1 patients was approximately 12 minutes mean Release of penoscrotal web is a simple, safe, and reproducible procedure that can enhance patient perception of penile length and further improve satisfaction.
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Ventral phalloplasty. To present a simple technique during penile prosthesis implantation that promotes the perception of increased phallic length. The penoscrotal web is defined. A "check mark" incision is made with excision of scrotal tissue. Excellent exposure is provided for implantation of the cylinders, pump and reservoir.
Wound closure is performed longitudinally. This technique is a modified extension of surgeries described in the pediatric literature for webbed penis. Loss of penile length following penile implantation surgery is worrisome for patients suffering from erectile dysfunction ED. This technique helps with patient satisfaction, cosmetic results, and improves perception of penile length. Ventral phalloplasty is a safe, technically simple procedure that may be performed in concert with penile prosthesis implantation or as a stand alone procedure under certain circumstances.
Surgical TIPs to prevent urethral stricture during insertion of an inflatable penile prosthesis. Mar Int J Urol. The aim of this study was to find the mechanism that causes urethral stricture with a view to preventing its occurrence after implantation of a three-piece inflatable penile prosthesis. When implanting a three-piece inflatable penile prosthesis, we draw two longitudinal lines parallel to the long axis of the proximal cylinder and the tubing leading from each cylinder into the cavernosal space, to prevent degree rotation of the cylinder.
From September to February , a total 86 three-piece penile prosthesis implantations were carried out in 70 patients. Urethral stricture occurred in 5. Fifteen three-piece penile prosthesis reinsertions were carried out in A successful outcome was achieved in the patients who received penile implantation with the three-piece penile prosthesis that were marked with longitudinal lines. The rotation of the cylinder may cause compression on the urethra from the tubing leading from the cylinder or pump crossing over the urethra and resulting in urethral stricture.
The drawing of longitudinal lines at the proximal cylinder and tubing leading from the cylinder could prevent the urethral stricture induced by tubes that are twisted by rotation of the cylinder. Aug J Sex Med. Fifty-two-year-old male with history of multiple insults to his erectile tissue, including insertion and removal of penile implant, presents with significant partial erectile function, substantial enough for anal penetration during sexual intercourse.
Erectile function rigid enough for anal penetration, let alone any erectile function after removal of an inflatable penile prosthesis IPP , is rare. This article, to our knowledge, is the first case of a patient who has undergone multiple insults to his erectile tissue, including an episode of ischemic priapism followed by implantation and removal of an IPP, who presents with erectile function sufficient enough for coitus.
Main outcome measures: Outcome measured via standardized patient questionnaires and penile Doppler following injection of Trimix. An objective measure of the patient's erectile function was performed via penile Doppler. Penile Doppler after mcg injection of Trimix revealed numerous perforating vessels from the corpora spongiosum providing blood flow to the corpora cavernosa.
To our knowledge, and after thorough review of the literature, we could not find any reports of erectile function significant enough to take part in sexual intercourse and penetration after removal of a three-piece IPP. The implant usually disrupts the normal anatomy which allows for cavernosal arterial vasodilation and increased blood flow into the corpora.
Following dilation of the corpora the cylinders are inserted and inflated, and the smooth muscle that makes up the corpora cavernosum is compressed against the wall of the tunica albuginea. Theoretically, the remaining smooth muscle tissue may retain some of its physiologic function, adding some additional girth to the penis with an already activated IPP during sexual intercourse. Distal Penile Shaft Reconstruction and Reinforcement: The "Double-Windsocks" Technique.
Jul J Sex Med. The management of penile prosthesis protrusion and the implantation of a prosthesis in fibrotic penile corporal bodies represents a challenging task even for experienced surgeons. To demonstrate the long-term efficacy and safety of a new technique for distal shaft reconstruction and reinforcement in cases of penile prosthesis protrusion or cases of penile prosthesis implantation in corporal fibrosis.
Between August and August , 69 patients underwent surgery for penile prosthesis protrusion 45 patients or severe distal corporal fibrosis 24 patients. The mean age at the time of surgery was 56 years range All patients underwent distal shaft reconstruction using our technique, involving the creation of two neocorpora "double windsocks". Furthermore, clinical data concerning the early postoperative outcome were analyzed retrospectively. Mean follow-up time was Furthermore, answers to the self-confidence domain question EDITS item 7 revealed that 63 patients No patient exhibited device extrusion, postoperative infection, or skin dehiscence, and glans sensation as well as orgasmic ability were also preserved in all cases.
Neuropraxia was reported in five cases 3.
Upsizing of inflatable penile implant cylinders in patients with corporal fibrosis
The recovery of orgasmic ability was delayed in 17 All patients were able to perform sexual intercourse postoperatively. The "double-windsocks" technique is an effective option for difficult cases of distal penile shaft reconstruction and reinforcement. Distal penile shaft reconstruction and reinforcement: The "double-windsocks" technique. Indications et techniques. Semi-rigid and inflatable penile implants have emerged more than 30 years ago, almost simultaneously. Refractory organic erectile dysfunction remains infrequent but penile implant is sometimes the only solution.
Each step of the total procedure indication, patient and couple preparation, operative technique, implant selection, and sexual re-initiation must be precise and efficient for optimal functional outcome. Apr Curr Urol Rep. Peyronie's disease PD is a wound healing disorder of the tunica albuginea of the penis. PD is generally categorized into two phases: Surgical reconstruction is only recommended during the latter established phase.
There are a variety of options when erections are functional. However, when erectile dysfunction is present, the gold standard treatment is the placement of an inflatable penile prosthesis with or without additional straightening procedures. General recommendations include that after implanting and inflating the cylinders, if a clinically significant curvature is present, manual modeling is performed. Causes of corporal fibrosis include complications from an infected implant such as explantation, priapism, penile trauma, and prolonged use of an intracavernosal injection agent.
Implant placement in the setting of corporal fibrosis can be technically challenging. Available strategies include incision or excision of the scar, corporotomies with or without grafting, the use of cavernotomes, or other specialized dilators, implant downsizing, and transcorporeal resection. The use of penile prostheses in the management of priapism. Priapism is a relatively uncommon condition that can result in erectile dysfunction ED and corporal fibrosis. Cases of prolonged priapism are particularly prone to ED, which arises when priapism is treatment refractory or had a delayed presentation.
Due to the emergent nature of priapism, it behooves urologists to be familiar with all potential treatment modalities to minimize adverse outcomes. In this review paper, we aim to summarize the literature regarding the use of penile prosthesis PP implantation in the setting of ischemic priapism IP.
In some patients who present later or have prolonged initial treatment, early insertion of PP may be indicated. The management of the acute ischemic priapism: A state of the art review. Objective To review the current literature on early penile prosthesis implantation in patients with refractory ischemic priapism IP. Synthesis of evidence Cavernosal tissue damage in IP is time related. Immediate penile prosthesis implantation in patients with refractory IP settles the priapic episode, maintains the long term rigidity necessary to engage in penetrative sexual intercourse and prevents the otherwise inevitable penile shortening.
Although complication rates after penile prosthesis implantation in acute priapism are higher than in virgin cases, they are still lower than after implantation in patients with severe corporal fibrosis due to chronic priapism. Regardless of the complication rates, penile prosthesis implantation in refractory IP should be preferred as it allows the preservation of penile length, which is one of the main factors influencing postoperative patient's satisfaction following surgery.
Inflatable penile prosthesis as tissue expander: May Many patients who undergo inflatable penile prosthesis IPP replacement are often upsized to larger cylinders, suggesting the IPP may serve as a tissue expander and increase internal penile length. The objective of this study is to evaluate whether cylinder length increases with subsequent IPP insertion.
Materials and methods: We selected the 2-year mark for subgroup analysis to allow time for tissue expansion to occur and to exclude patients who underwent early explantation e. As demonstrated, the IPP may provide tissue expansion over time. Further evaluation is needed to determine if increased cylinder length correlates to increased functional length and patient satisfaction.
A practical overview of considerations for penile prosthesis placement. Penile prostheses have remained the gold-standard therapy for medically refractory erectile dysfunction ED since their popularization.
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Advances in device design and surgical techniques have yielded improved rates of infection, satisfaction, and mechanical survival of devices. Operative techniques in penile prosthesis surgery include the use of adjunctive procedures such as ventral phalloplasty and release of the suspensory ligament , management of penile fibrosis, and manoeuvres to correct Peyronie's-disease-related curvature.
Long-term data regarding mechanical, overall, and infection-free survival demonstrate excellent results, and, given the consistently high satisfaction rates and limited alternatives for medically refractory ED, penile prostheses are likely to remain a relevant and important treatment strategy for the foreseeable future. Oct A common complaint after inflatable penile prosthesis surgery is reduced penile length. We previously reported how using the Coloplast Titan inflatable penile prosthesis with aggressive new length measurement technique NLMT coupled with postoperative IPP rehabilitation of the implant for 1-year helped to improve patient satisfaction and erectile penile measurements.
This is a 2 years follow-up of a prospective, three-center, study of 40 patients who underwent Titan prosthesis placement, with new length measurement technique for erectile dysfunction. Patient instructions were to inflate daily for 6 months and then inflate maximally for h daily for months. Fifteen penile measurements were taken before and immediately after surgery and at follow-up visits. Measurement changes were improved at 24 months as compared to immediately postoperative and at 12 months. All but one subject This study suggests using the Coloplast Titan with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol can optimize patient satisfaction and erectile penile measurements at 2 years postimplant.
Implantation of an inflatable penile prosthesis IPP is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis. The AMS LGX IPP is in common use but reports on its mechanical reliability, medium-term postsurgical patient satisfaction, and mean penile length preservation are lacking. We investigate the mean penile length, mechanical reliability, and patient satisfaction at 6 and 12 months after implantation of the AMS LGX.
This prospective study consecutively enrolled men undergoing first-time IPP implant surgery from February to April AMS LGX is a powerful tool for preserving penile length in men undergoing penile prosthesis implantation. Prospective Evaluation of Postoperative Penile Rehabilitation: The most prevalent long-term complaint after successful inflatable penile prosthesis IPP surgery is reduction of penile length. The purpose of this study was to evaluate penile measurements in patients whose implantation experience included the aggressive new length measurement technique NLMT coupled with postoperative IPP rehabilitation daily inflation of the implant for 1 year.
Moreover, we aimed to document objective data concerning dimensional changes of the phallus over time. Postoperative IPP rehabilitation has been discussed and presented at meetings, but no multi-institutional prospective data have been published. The patient was instructed to inflate daily for 6 months and then inflate maximally for hours daily for months. Penile length measurements after implantation compared with 12 months postimplantation.
Penile measurement changes were statistically significantly improved at 12 months as compared with immediately postoperative and at 6 months. A total of All but two subjects This study suggests using the Coloplast Titan IPP with aggressive cylinder sizing, and a postoperative penile rehabilitation inflation protocol may help optimize patient satisfaction and erectile penile measurements. Prospective evaluation of postoperative penile rehabilitation: Mar IntroductionHistorically, early surgical treatment for erectile dysfunction involved the placement of rigid devices outside of the corpora cavernosa.
However, this practice resulted in high rates of erosion and infection. Today, most urologists in the United States place an inflatable penile prosthesis IPP with an infection-retardant coating inside the corpora cavernosa. In addition to changes in the type of implant used, surgical techniques have evolved greatly in recent years, resulting in reduced operating times, lower infection rates, and improved outcomes. AimThis review of surgical techniques and approaches provides step-by-step guidance from pre- to postoperative patient care within the scope of uncomplicated IPP cases.
Methods The published literature is reviewed for important contributions to penile prosthesis surgical techniques. Main Outcome MeasurePenoscrotal IPP surgical techniques that have improved outcomes and advanced the field of prosthetic urology for the treatment of medically refractive erectile dysfunction are presented.
ResultsA review of outcome analyses demonstrates that both the design and techniques of penile prostheses placement have advanced in terms of less postoperative pain, swelling, hematomas, and mechanical failures, with improved patient satisfaction and device survival rates. Conclusions Penoscrotal implantation of an IPP has improved both in terms of surgeon ease in placement and patient satisfaction. Surgical techniques in penoscrotal implantation of an inflatable penile prosthesis: A guide to increasing patient satisfaction and surgeon ease.
Inflatable penile prosthesis implant length with baseline characteristic correlations: Dec We prospectively correlated co-morbid conditions and demographic data with implanted penile prosthesis size to enable clinicians to better predict implanted penis size following penile implantation. We present many new data points for the first time in the literature and postulate that radical prostatectomy RP is negatively correlated with penile corporal length.
Patient demographics, medical history, baseline characteristics and surgical details were compiled prospectively. Pearson correlation coefficient was generated for the correlation between demographic, etiology of ED, duration of ED, co-morbid conditions, pre-operative penile length flaccid and stretched and length of implanted penile prosthesis. Multivariate analysis was performed to define predictors of implanted prosthesis length. From June to June , 1, men underwent primary implantation of penile prosthesis at a total of 11 study sites.