RESUMEN
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.
Asunto(s)
Enfermedades del Pene/etiología , Pene/patología , Prótesis e Implantes/efectos adversos , Prótesis Vascular , Humanos , Masculino , Persona de Mediana Edad , Erección Peniana , Pene/cirugía , PolitetrafluoroetilenoRESUMEN
The results in 56 children (28 with neurogenic bladder dysfunction) undergoing enterocystoplasty between 1981 and 1985 are presented. Ileal, ileocecal, right colon and sigmoid segments were used in tubular and opened configurations. Our experience leads us to recommend opened ileal segment reconstruction in neurogenic bladder patients and those with weak anal sphincters generally, and open ileocecal or open right colon segments in patients with other etiologies. Continence was achieved in 53 patients, although secondary procedures, particularly at the bladder outlet, were required in 13. When ureteral reimplantation was required we achieved excellent success with normal-sized or mildly dilated ureters regardless of the operative technique used. Initial failures to prevent reflux in the face of marked ureterectasis using the ileocecal valve have been resolved by a modified technique of intussusception and fixation. An over-all favorable experience is reported, which we believe permits us to formulate certain rules that will improve the acceptability and success of bladder reconstruction in general.
Asunto(s)
Intestinos/trasplante , Vejiga Urinaria/cirugía , Adolescente , Adulto , Niño , Preescolar , Estudios de Seguimiento , Humanos , Reoperación , Vejiga Urinaria Neurogénica/cirugía , Derivación Urinaria , Incontinencia Urinaria/cirugíaRESUMEN
A continent ileocecal reservoir was created as an alternative to ileal loop urinary diversion in 7 patients. In 3 patients the bladder neck was closed, the in situ bladder was augmented and a continent stoma was formed by intussusception of the ileocecal valve. In the remaining 4 patients an isolated cecal reservoir with a continent stoma replaced the bladder. Creation of a stoma that was continent and easy to catheterize was achieved by intussusception of the ileocecal valve with stabilization of the intussuscepted nipple using a Marlex collar. In most cases the cecal segment was hyperactive but this was controlled with anticholinergic medication. All 7 patients have a satisfactory capacity and a continent stoma without significant catheterization difficulties.
Asunto(s)
Válvula Ileocecal/cirugía , Enfermedades de la Vejiga Urinaria/cirugía , Derivación Urinaria , Humanos , Cateterismo Urinario , Incontinencia Urinaria/cirugíaRESUMEN
Review of recent implantations of penile prostheses done at Duke University Medical Center reveals 6 patients implanted for impotence secondary to priapism. Of these 6 patients, 5 had sickle cell anemia-induced priapism and 1 had idiopathic priapism. One patient had implantation of an inflatable prosthesis later followed by a semirigid prosthesis, 3 had implantation of a semirigid prosthesis, and 1 had an unsuccessful attempt at implantation of a semirigid prosthesis. The 5 patients with successful implantation have obtained satisfactory postoperative coital function. We believe that penile prostheses are beneficial in patients with impotence secondary to priapism. The degree of fibrosis encountered suggests that a semirigid prosthesis is more favorable, since the inflatable prosthesis may not overcome corporeal rigidity.
Asunto(s)
Disfunción Eréctil/terapia , Pene , Priapismo/complicaciones , Prótesis e Implantes , Adulto , Anemia de Células Falciformes/complicaciones , Disfunción Eréctil/etiología , Humanos , Masculino , Pene/fisiopatología , Priapismo/etiologíaRESUMEN
Of 35 cases of priapism a successful outcome with detumescence of the erection and preservation of potency was achieved in only 6 instances. Patients with sickle cell disease enjoyed a more optimistic outcome, and early presentation appeared to be the key factor. The different therapeutic approaches did not have great impact on the outcome, and we advise an initial conservative approach progressing to glans-cavernosa fistula creation and subsequently to cavernosum-spongiosum shunting for patients failing to respond.
Asunto(s)
Priapismo/terapia , Adolescente , Adulto , Anemia de Células Falciformes/complicaciones , Derivación Arteriovenosa Quirúrgica , Niño , Humanos , Masculino , Persona de Mediana Edad , Pene/cirugía , Priapismo/etiología , Succión , Irrigación Terapéutica , Factores de TiempoRESUMEN
Vasography is a common diagnostic procedure utilized in evaluating the male genital tract for causes of azoospermia, for evaluation of persistent perineal pain and seminal vesiculitis, and recently used in the staging of prostate cancer. In order to evaluate the effects of injectable agents on the healthy vas deferens, 7 groups of 10 rats had the left vas deferens injected by vasopuncture with saline, 4 contrast agents, doxycycline and absolute alcohol. The animals were sacrificed 8 weeks later, and were examined for patency of the vas and inflammatory response. Results revealed that vasopuncture did not produce obstruction. Vasography with water-soluble contrast media does entail a low risk of inflammation in the rat, but produces no obstruction. Intra-vas injection of doxycycline, injected by some for treatment of chronic seminal vesiculitis and perineal pain, is not deleterious in the rat model.