Levine L A, Dimitriou R J
Rush-Presbyterian-St. Luke's Medical Center, Department of Urology, Chicago, IL 60612, USA.
Int J Impot Res. 2000 Jun;12(3):147-51. doi: 10.1038/sj.ijir.3900515.
We developed an algorithm for surgical management and placement of penile prostheses in patients with erectile failure (ED) and Peyronie's disease (PD). We identified 46 men ages 40 to 77 y with PD who could not attain an adequate erection with sexual stimulation and pharmacotherapy. All men were candidates for penile straightening and inflatable prosthesis placement using the following algorithm. Manual molding was attempted initially, followed by tunica incision for insufficient straightening. For tunical defects greater than 2 cm, polytetrafluoroethylene (PTFE) patch grafting was performed to prevent prosthesis cylinder herniation and recurrent deformity from cicatrix contraction. Mean preoperative penile curvature was 53 degrees (0-90). Prosthesis implantation with manual molding, implant with plaque incision, and implant with plaque incision and PTFE grafting were successfully accomplished in 25 (54%), 12 (26%), and nine (20)% respectively. Mean follow-up was 39 months (range 1-74). Full erectile capacity with a straight phallus was achieved in all patients. Complications included temporary (< 8 months) decreased penile sensation in four (9%), mild (< 2 cm) penile shortening in three (7%), delayed ejaculation in one (2%), and infection requiring explanation in one diabetic male (2%). All of the implanted prostheses provided satisfactory rigidity with no mechanical failures or recurrent curvature. We conclude that inflatable penile prosthesis implantation is a safe and effective therapy with a high satisfaction rate in men with ED and PD. The developed algorithm helps define prosthesis placement and straightening techniques to obtain optimal results with minimal complications.
我们开发了一种算法，用于对勃起功能障碍（ED）和佩罗尼氏病（PD）患者进行阴茎假体的手术管理和植入。我们确定了46名年龄在40至77岁之间患有PD的男性，他们在性刺激和药物治疗下无法获得足够的勃起。所有男性均符合使用以下算法进行阴茎矫直和可膨胀假体植入的条件。最初尝试手动塑形，随后对于矫直不足的情况进行白膜切开。对于大于2 cm的白膜缺损，进行聚四氟乙烯（PTFE）补片移植，以防止假体圆柱疝出和瘢痕收缩导致的复发性畸形。术前阴茎平均弯曲度为53度（0 - 90度）。分别有25例（54%）、12例（26%）和9例（20%）成功完成了手动塑形假体植入、白膜切开假体植入以及白膜切开和PTFE移植假体植入。平均随访时间为39个月（范围1 - 74个月）。所有患者均实现了阴茎挺直的完全勃起功能。并发症包括4例（9%）出现暂时（< 8个月）阴茎感觉减退、3例（7%）出现轻度（< 2 cm）阴茎缩短、1例（2%）出现射精延迟，以及1例糖尿病男性患者（2%）出现需要处理的感染。所有植入的假体均提供了令人满意的硬度，没有机械故障或复发性弯曲。我们得出结论，可膨胀阴茎假体植入是一种安全有效的治疗方法，对于患有ED和PD的男性具有较高的满意度。所开发的算法有助于确定假体植入和矫直技术，以获得最佳效果并减少并发症。
