Carson C C, Noh C H
University of North Carolina, Division of Urology, Chapel Hill 27599-7235, USA.
Int J Impot Res. 2002 Apr;14(2):81-4. doi: 10.1038/sj.ijir.3900829.
Subcutaneous extrusion of penile prosthesis cylinders beneath the glans penis is an unusual but difficult complication of penile prosthesis. Without surgical repair, extrusion, infection, and corporeal fibrosis may ensue. Twenty-eight patients with distal corporeal extrusion were reviewed to identify the optimum treatment outcome for these penile prosthesis complications. Records of 28 men with subcutaneous distal penile prosthesis cylinder extrusion were reviewed. Mean age was 56.2 y. Etiology of erectile dysfunction was diabetes mellitus in 11, vasculogenic in 10, Peyronie's disease in five, radical pelvic surgery in five. Duration of penile prosthesis was 8-72 months (mean 42.6). No patient had penile prosthesis infection or device exposure through the skin. Distal corporoplasty was treated on 18/28 men using cylinder repositioning and direct tunica albuginea repair. Ten men underwent repair using a Gortex windsock. 8/18 corporoplasty and 6/10 windsock patients required glans fixation for treatment of hypermobile glans following cylinder relocation. In two patients with windsock repair, extrusion recurrence occurred 6 and 18 months following surgery and 1/6 had post operative infection requiring prosthesis removal. Mean surgical time for corporoplasty was 52.8 minutes while windsock reconstruction was 89.6 minutes. Distal subcutaneous penile prosthesis cylinder extrusion produces coital pain and predisposes to cylinder exposure and infection. Early repair with or without additional prosthetic materials will return penile prostheses to a normal functioning state. Distal corporoplasty with cylinder repositioning appears to be a simple, low morbidity solution to this difficult dilemma. Outcomes with distal corporoplasty result in better function, less pain, and fewer recurrences than Gortex windsock repair.
阴茎假体圆柱体在阴茎头下方皮下挤出是阴茎假体一种罕见但棘手的并发症。若不进行手术修复，可能会继而发生挤出、感染和海绵体纤维化。对28例远端海绵体挤出患者进行了回顾，以确定这些阴茎假体并发症的最佳治疗结果。回顾了28例阴茎假体圆柱体远端皮下挤出男性患者的记录。平均年龄为56.2岁。勃起功能障碍的病因包括11例糖尿病、10例血管源性、5例佩罗尼氏病、5例根治性盆腔手术。阴茎假体使用时间为8 - 72个月（平均42.6个月）。没有患者发生阴茎假体感染或假体经皮肤外露。18/28例男性采用圆柱体重新定位和白膜直接修复进行远端海绵体成形术。10例男性使用戈尔特斯风袋进行修复。18例海绵体成形术患者中的8例和10例风袋修复患者中的6例在圆柱体重新定位后需要进行龟头固定以治疗活动度过大的龟头。在2例风袋修复患者中，术后6个月和18个月发生挤出复发，6例中有1例术后感染需要取出假体。海绵体成形术的平均手术时间为52.8分钟，而风袋重建为89.6分钟。阴茎假体圆柱体远端皮下挤出会导致性交疼痛，并易发生圆柱体暴露和感染。早期修复无论是否使用额外的假体材料都能使阴茎假体恢复正常功能状态。采用圆柱体重新定位的远端海绵体成形术似乎是解决这一难题的一种简单、低发病率的方法。与戈尔特斯风袋修复相比，远端海绵体成形术的治疗效果功能更好、疼痛更少且复发更少。
