RESUMEN
PURPOSE: The most devastating complication after the insertion of a penile prosthesis is the development of infection. The standard approach involves removing the entire device, treating intensively with antibiotics and attempting to reinsert a prosthesis at a later date, often with a suboptimal result. Based on the encouraging results of others, during the last 24 months we have used in 2 separate private urological practices a salvage procedure for treatment of infected inflatable penile prostheses. MATERIALS AND METHODS: The protocol used in 7 men with an infected inflatable penile prosthesis included removal of all device components, a 7-step vigorous intraoperative irrigation with 4 different solutions, including vancomycin, immediate reimplantation of a new inflatable penile prosthesis and postoperative outpatient antibiotics with oral ciprofloxacin or intravenous vancomycin or cefazolin. RESULTS: Of the 7 men 6 have experienced excellent results with no infection, minimal morbidity and preservation of penile length. The only failure occurred in a poorly controlled diabetic who required multiple revisions and may have had latent infection for months before it became apparent. CONCLUSIONS: We believe that an immediate salvage procedure for an infected inflatable penile prosthesis is an effective treatment for this difficult complication.
Asunto(s)
Prótesis de Pene/efectos adversos , Infecciones Relacionadas con Prótesis/terapia , Terapia Recuperativa , Adulto , Anciano , Antibacterianos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/cirugía , ReoperaciónRESUMEN
A new approach to the use of topical medications to induce penile erections is suggested. Many impotent patients treat erectile dysfunction with injected vasoactive drugs like papaverine, phentolamine and PGE-1. However, many patients fear using needles and the possible side effects from injections are well known (pain, ecchymosis, priapism, fibrosis of corpora cavernosa). In six patients with erectile impotence who sought an alternative to pharmacologic injection therapy, a 1 cm square window was created in Buck's fascia and tunica albuginea and covered with a piece of the deep dorsal vein of the penis. The penile skin overlying the window was marked with India ink and vasoactive medication was applied to this area. The goal of this procedure was to enable the topical erection-inducing medication to pass through the skin of the penis, through the window and into the corpus. All of the patients experienced a satisfactory erectile response after application of nitroglycerin cream as documented by penile Doppler ultrasound evaluation. Two of the six patients currently use only the nitroglycerin cream to induce erections satisfactory for sexual intercourse. Three patients alternate the use of the cream and injections. One patient prefers injection. This procedure may offer a desirable alternative to injection therapy for selected patients with impotence.
Asunto(s)
Impotencia Vasculogénica/tratamiento farmacológico , Nitroglicerina/administración & dosificación , Administración Tópica , Alprostadil/administración & dosificación , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Humanos , Impotencia Vasculogénica/diagnóstico por imagen , Masculino , Papaverina/administración & dosificación , Pene/irrigación sanguínea , Ultrasonografía Doppler/efectos de los fármacos , Venas/trasplanteRESUMEN
The aim of this clinical investigation was to obtain preliminary treatment outcome data concerning the Mentor Alpha-1, the first 3-piece inflatable penile prosthesis with pre-connected tubing between the pump and the penile cylinders. The study was designed to be the first multi-institutional treatment outcome report for any clinically available penile prosthesis with data analysis to be independent of the participating surgeons. A total of 12 board-certified urologists of mixed surgical training backgrounds and practices implanted the Alpha-1 device in 112 consecutive patients. With a mean of 27 +/- 5 months of followup the surgical complication rate included a 4% mechanical malfunction, 2% infection rate and 9% reoperation rate. Patient experience with the implanted device was computed from information on 96 of the 112 patients who returned a questionnaire. Of the patients 82% stated that the device fulfilled expectations as a treatment for impotence and 83% had improved sexual intercourse by 8 weeks after implantation. Patient satisfaction was computed on a scale of 12 equally weighted interrelated variables. Of the patients 77% recorded 9 or more cumulative satisfaction points. Patient and physician questionnaire data were analyzed for their relation to the cumulative prosthesis satisfaction score. A significant difference in cumulative scores was found for physician reported long-term postoperative problems (mean satisfaction score 8.1 for patients with problems versus 10.2 for patients without problems, p = 0.018). The Alpha-1, with its feature of pre-connected tubing, is a reliable 3-piece inflatable penile prosthesis associated with a high level of patient satisfaction.
Asunto(s)
Disfunción Eréctil/cirugía , Prótesis de Pene , Recolección de Datos , Disfunción Eréctil/epidemiología , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Prótesis de Pene/psicología , Prótesis de Pene/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Diseño de Prótesis , Factores de Tiempo , Resultado del TratamientoRESUMEN
In a cooperative, private practice, multi-institutional impotence study, dynamic infusion cavernosometry and cavernosography (DICC) was performed on 743 patients to make an accurate diagnosis and/or identify candidates for penile revascularization. Maximum equilibrium intracorporeal pressure achieved following papaverine and phentolamine injection (Phase I) averaged 29.42 +/- 0.76 mm Hg, approximately one third of normal erection pressure. Corporeal pressure fall from 150 mm Hg over thirty seconds (cavernosometry) averaged 82.38 +/- 1.33 mm Hg (Phase II). The gradient between systolic and cavernosal artery pressure averaged 42.84 +/- 1.12 mm Hg on the right and 43.33 +/- 1.13 mm Hg on the left (Phase III). Cavernosography at 90 mm Hg erection pressure was performed in Phase IV. Of the 124 patients from one center who were reviewed in greater detail, pure cavernosal artery insufficiency (CAI) was found in 25 (20.2%), corporeal veno-occlusive dysfunction (CVOD) in 26 (21.0%), and 73 patients (58.9%) demonstrated combined CAI and CVOD. Diabetics (n = 69) achieved lower equilibrium intracorporeal pressures than nondiabetics, had similar CVOD, and worse CAI. Smokers (n = 365) and patients with Peyronie's disease (n = 32) had erectile dysfunction similar to those without these conditions. Patients impotent after trauma (n = 124) were younger, achieved higher intracorporeal pressures, and showed better corporeal veno-occlusive function than those without trauma. Complications of DICC were minimal and infrequent. After DICC, 169 patients underwent internal pudendal arteriography, 105 had arterial bypass surgery with or without penile venous ligation procedures, and 45 had venous surgery alone. Dynamic infusion cavernosometry and cavernosography is a useful erectile function study to evaluate impotence and can be performed easily in a private practice setting.