Mooreville M, Adrian S, Delk J R, Wilson S K
Mercy Medical Center, Thomas Jefferson University Hospital and Drexel University, Philadelphia, Pennsylvania, USA.
J Urol. 1999 Dec;162(6):2054-7. doi: 10.1016/S0022-5347(05)68099-8.
Implantation of penile prosthetic cylinders into scarred corpora remains a challenge in the field of prosthetic urology. We describe a new penile cavernotome, which allows for easier dilation of fibrotic corpora cavernosa and facilitates inflatable penile prosthesis cylinder insertion.
A set of 5 cavernotomes between 6 and 13 mm. in diameter are used to drill a space in fibrotic corpora with controlled 1 mm. cuts. The cavernotomes are advanced in an oscillating fashion and also allow shaving of severely stenotic areas for easier cavity development. They were used in 16 patients with fibrotic corpora secondary to different etiologies. A high transverse scrotal incision was used in all cases. Of the 16 patients 14 received downsized cylinders.
Implantation of both cylinders of an inflatable 3-piece device was successful in all cases. Proximal crural perforation occurred intraoperatively in 5 patients and was corrected by attaching the rear tip extender to the tunica with nonabsorbable suture. Postoperatively, distal tunical perforation of the corpora in 4 patients was repaired with natural tissue. Operative time was reduced compared to our previous experience with implantation in cases of corporeal fibrosis using extensive corporotomies or the Carrion-Rossello cavernotomes. In no case was the procedure terminated for urethral laceration or inadequate dilation for cylinder insertion. No grafting materials were necessary to close the corporotomy.
The new cavernotomes along with the high transverse scrotal incision and downsized prostheses resulted in successful implantation in all of our cases. Dilation of fibrotic corpora was easier and quicker with the new cavernotomes because extensive corporeal resection was not necessary. Complications were acceptable for these difficult cases and prosthesis survival is 100% to date.
在假体泌尿外科领域，将阴茎假体圆柱体植入瘢痕化的海绵体仍是一项挑战。我们描述了一种新型阴茎海绵体切开刀，它能更轻松地扩张纤维化的海绵体，并便于可膨胀阴茎假体圆柱体的插入。
使用一组直径在6至13毫米之间的5把海绵体切开刀，以1毫米的可控切口在纤维化海绵体中钻出空间。海绵体切开刀以振荡方式推进，还能对严重狭窄区域进行刮削，以更轻松地形成腔隙。它们被用于16例因不同病因导致海绵体纤维化的患者。所有病例均采用高位阴囊横切口。16例患者中有14例植入了尺寸缩小的圆柱体。
所有病例中，三件式可膨胀装置的两个圆柱体均成功植入。术中5例患者出现近端海绵体脚穿孔，通过用不可吸收缝线将后尖端延长器固定于白膜得以纠正。术后，4例患者海绵体远端白膜穿孔用天然组织修复。与我们之前使用广泛的海绵体切开术或卡里翁 - 罗塞洛海绵体切开刀处理海绵体纤维化植入病例的经验相比，手术时间缩短。无一例因尿道撕裂或圆柱体插入扩张不足而终止手术。无需移植材料来闭合海绵体切开处。
新型海绵体切开刀结合高位阴囊横切口和尺寸缩小的假体，使我们所有病例的植入均获成功。使用新型海绵体切开刀扩张纤维化海绵体更轻松、快捷，因为无需进行广泛的海绵体切除。对于这些困难病例，并发症是可接受的，迄今为止假体存活率为100%。
