RESUMEN
BACKGROUND: Patients with severe erectile dysfunction (ED) and penile size issues, especially seen in Peyronie's disease (PD), are candidates for more invasive penile prosthesis insertion techniques that aim for penile length and girth reconstruction. AIM: To present the feasibility and safety of penile length and girth restoration based on the so-called multiple-slit technique (MUST) for patients with severe ED and significant penile shortening with or without PD. METHODS: From July 2013 through January 2016, 138 patients underwent the MUST. The International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction were completed. OUTCOMES: Outcome analysis was focused on penile length restoration, penile curvature correction, intra- and postoperative complications, and patient satisfaction. RESULTS: 138 patients underwent the procedure (103 malleable and 35 inflatable devices). Etiologies of penile shortening and narrowing were PD, severe ED, post-radical prostatectomy, and androgen-deprivation therapy with or without brachytherapy or external radiotherapy for prostate cancer, and post-penile fracture in 60.1%, 24.6%, 10.1%, 3.6%, and 2.2%, respectively. In PD cases, the mean deviation of the penile axis was 55° (range = 0-90°). Mean subjective penile length loss reported was 3.2 cm (range = 1-5 cm), and shaft constriction was present in 44.9%. Median follow-up was 15.2 months (range = 6-36 months). Mean penile length gain was 3.1 cm (range = 2-5 cm). No penile prosthesis infection caused device explantation. One glans necrosis was encountered. The average IIEF score increased from 22 points at baseline to 66 points at 6-month follow-up. CLINICAL IMPLICATIONS: The MUST helps address penile size issues in cases of severe ED with concomitant conditions that impair penile length or girth. STRENGTHS AND LIMITATIONS: The strength of the study is its applicability to provide surgeons with a solution for cases in which patients have severe ED and penile size impairment owing to underlying conditions such as PD. The study is limited by the relatively short follow-up. CONCLUSIONS: The MUST is an effective, safe, and viable treatment option for a selected patient cohort. Because of the potential complications, proper counseling should take place and only experienced surgeons should perform this type of surgery. Egydio PH, Kuehhas FE. The Multiple-Slit Technique (MUST) for Penile Length and Girth Restoration. J Sex Med 2018;15:261-269.
Asunto(s)
Implantación de Pene/métodos , Prótesis de Pene , Pene/cirugía , Adulto , Anciano , Antagonistas de Andrógenos/administración & dosificación , Disfunción Eréctil/etiología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Erección Peniana , Induración Peniana/fisiopatología , Induración Peniana/cirugía , Complicaciones Posoperatorias/epidemiología , Prostatectomía/efectos adversos , Neoplasias de la Próstata/cirugía , CirujanosRESUMEN
OBJECTIVE: To present the feasibility and safety of penile length and girth restoration based on a modified 'sliding' technique for patients with severe erectile dysfunction (ED) and significant penile shortening, with or without Peyronie's disease (PD). PATIENTS AND METHODS: Between January 2013 and January 2014, 143 patients underwent our modified 'sliding' technique for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: (i) the sliding manoeuvre for penile length restoration; (ii) potential complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration; and (iii) closure of the newly created rectangular bow-shaped tunical defects with Buck's fascia only. RESULTS: In all, 143 patients underwent the procedure. The causes of penile shortening and narrowing were: PD in 53.8%; severe ED with unsuccessful intracavernosal injection therapy in 21%; post-radical prostatectomy 14.7%; androgen-deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%; post-penile fracture in 2.1%; post-redo-hypospadias repair in 0.7%; and post-priapism in 0.7%. In patients with ED and PD, the mean (range) deviation of the penile axis was 45 (0-100)°. The mean (range) subjective penile shortening reported by patients was 3.4 (1-7) cm and shaft constriction was present in 53.8%. Malleable penile prostheses were used in 133 patients and inflatable penile prostheses were inserted in 10 patients. The median (range) follow-up was 9.7 (6-18) months. The mean (range) penile length gain was 3.1 (2-7) cm. No penile prosthesis infection caused device explantation. The average International Index of Erectile Function (IIEF) score increased from 24 points at baseline to 60 points at the 6-month follow-up. CONCLUSION: Penile length and girth restoration based on our modified sliding technique is a safe and effective procedure. The elimination of grafting saves operative time and, consequently, decreases the infection risk and costs associated with surgery.
Asunto(s)
Implantación de Pene/métodos , Pene/cirugía , Adulto , Anciano , Disfunción Eréctil/cirugía , Humanos , Masculino , Persona de Mediana Edad , Induración Peniana/cirugíaRESUMEN
INTRODUCTION: 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. AIM: 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. METHODS: Between August 2007 and August 2012, 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 38-69). All patients underwent distal shaft reconstruction using our technique, involving the creation of two neocorpora ("double windsocks"). MAIN OUTCOME MEASURES: Functional outcome and patient satisfaction were evaluated with item numbers 1 and 7 of the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Furthermore, clinical data concerning the early postoperative outcome were analyzed retrospectively. RESULTS: Mean follow-up time was 22.5 months (range 6-48). Based on answers to EDITS questionnaire item 1, 42 patients (60.9%) were very satisfied and 19 patients (27.5%) were somewhat satisfied with the outcome of the procedure. Furthermore, answers to the self-confidence domain question (EDITS item 7) revealed that 63 patients (91.3%) felt that the treatment had a positive effect with respect to their ability to engage in sexual activity. 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 (3.4%) immediately after the operation. The recovery of orgasmic ability was delayed in 17 (24.6%) patients. All patients were able to perform sexual intercourse postoperatively. CONCLUSION: The "double-windsocks" technique is an effective option for difficult cases of distal penile shaft reconstruction and reinforcement.
Asunto(s)
Implantación de Pene/instrumentación , Prótesis de Pene , Pene/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Coito , Fibrosis , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Implantación de Pene/efectos adversos , Pene/patología , Pene/fisiopatología , Falla de Prótesis , Procedimientos de Cirugía Plástica/efectos adversos , Recuperación de la Función , Reoperación , Estudios Retrospectivos , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUCTION: Corporal fibrosis usually occurs after explantation of an infected penile prosthesis, severe penile trauma, refractory low-flow priapism, Peyronie's disease, or the chronic intracavernous injection of vasoactive drugs. METHODS: We analysed current treatmentss for penile fibrosis. We searched PubMed using the keywords 'penile corporal fibrosis', 'treatment' and 'penile fibrosis', resulting in 63 matches, of which 19 articles met the inclusion criteria. RESULTS AND CONCLUSIONS: This review covers conservative medical therapy for corporal fibrosis and surgical therapeutic methods. The roles of phosphodiesterase- 5 inhibitors and pentoxifylline are analysed. Surgical therapy includes implantation of a penile prosthesis and corporal reconstruction, and these are reviewed. Corporal fibrosis is a major problem for patients, and is associated with severe erectile dysfunction. Conservative treatment options can be applicable in the early phase, but simultaneous corporal reconstruction procedures with concomitant implantation of a penile prosthesis should be attempted in severe cases of corporal fibrosis.
RESUMEN
OBJECTIVE: To report patient outcomes and satisfaction with our technique for penile length and girth restoration in severe Peyronie's disease (PD). PATIENTS AND METHODS: Between November 2006 and November 2011, 105 men with severe PD and erectile dysfunction (ED) underwent surgical correction using our new approach. The technique consists of penile prosthesis implantation with concomitant penile lengthening and girth restoration through circular and longitudinal incisions in the tunica albuginea according to geometric principles. RESULTS: The overall patient satisfaction rate was 89.4%. The mean (sd; range) functional penile length gain was 3.6 (0.7; 2-5) cm. Patient satisfaction with penile length gain was 95.2%. Three patients (2.9%) developed retraction with residual curvature of up to 30°, but no re-operation was necessary. In one (1%) patient, the prosthesis had to be removed because of wound infection. At a mean (sd; range) follow-up of 18.2 (5.9; 6-46) months, 104 patients (99%) were able to have sexual intercourse. CONCLUSIONS: Our surgical approach for penile length and girth restoration leads to high patient satisfaction rates and excellent functional outcomes. Our surgical approach is a safe and valid therapeutic method for the treatment of severe PD associated with ED.