Wilson Steven K, Delk John R, Mulcahy John J, Cleves Mario, Salem Emad A
Department of Urology, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Wishard Memorial Hospital, Indianapolis, IN, USA.
J Sex Med. 2006 Jul;3(4):736-742. doi: 10.1111/j.1743-6109.2006.00263.x.
Placement of an inflatable penile prosthesis in a patient with scarred corporal bodies secondary to priapism or removal of a previously infected implant is a formidable surgical challenge; use of downsized implants has improved chances of successful reimplantation. Nevertheless, patients are frequently dissatisfied with the resulting short penises.
This study investigates the use of downsized inflatable penile prosthesis cylinders as tissue expanders in patients with corporal fibrosis.
Corporal length and width were calibrated before implantation of downsized prostheses and after 1 year of their use as tissue expanders.
Thirty-seven patients had insertion of Mentor Narrow Base (18), AMS CXM (9), or AMS CXR (10) into scarred corporal bodies. Etiology was previously infected and removed implant (29) or priapism (8). In each of these cases it was not possible to dilate to 12 mm in order to place standard-sized cylinders. Patients were encouraged to inflate their implant for up to 3 hours daily. After several months intracorporal stretching occurred. The patients were reoperated; corporal length and width were recalibrated.
Upon reoperation, it was possible to pass dilators of 12 mm width proximally allowing the substitution of standard-sized AMS 700 CX (23), Mentor Alpha 1 (10), or Mentor Titan (2). Additionally, corporal length measurements in the previously infected patients increased an average of 2.2 cm allowing placement of longer cylinders. Although priapism patients did not show this phenomenon of corporal lengthening, the implant space widened enough to permit replacement with standard-size cylinders improving girth, rigidity, and appearance.
Wider and sometimes longer cylinders can be substituted in patients with corporal fibrosis that required implantation with downsized cylinders because of fibrotic corpora. Prolonged inflation over an 8- to 12-month period results in expansion of the cylinder cavity, permitting standard-sized cylinders in all patients.
对于因阴茎异常勃起导致阴茎海绵体瘢痕形成或先前植入物感染而需取出的患者，植入可膨胀阴茎假体是一项艰巨的外科挑战；使用尺寸较小的假体可提高再次植入成功的几率。然而，患者常常对术后阴茎短小的结果不满意。
本研究探讨在患有海绵体纤维化的患者中，使用尺寸较小的可膨胀阴茎假体圆柱体作为组织扩张器的效果。
在植入尺寸较小的假体前以及将其用作组织扩张器1年后，测量阴茎海绵体的长度和宽度。
37例患者将Mentor窄基型（18例）、美国医学系统公司（AMS）CXM型（9例）或AMS CXR型（10例）假体植入瘢痕化的阴茎海绵体。病因包括先前植入物感染并取出（29例）或阴茎异常勃起（8例）。在这些病例中，均无法扩张至12毫米以植入标准尺寸的圆柱体。鼓励患者每天最多充气3小时。数月后发生了海绵体内扩张。患者接受再次手术；重新测量阴茎海绵体的长度和宽度。
再次手术时，能够在近端通过12毫米宽的扩张器，从而可替换为标准尺寸的AMS 700 CX型（23例）、Mentor Alpha 1型（10例）或Mentor Titan型（2例）假体。此外，先前感染患者的阴茎海绵体长度平均增加了2.2厘米，从而能够植入更长的圆柱体。虽然阴茎异常勃起患者未出现阴茎海绵体延长现象，但植入空间拓宽到足以允许更换为标准尺寸的圆柱体，改善了阴茎周长、硬度和外观。
对于因海绵体纤维化而需植入尺寸较小圆柱体的患者，可替换为更宽且有时更长的圆柱体。在8至12个月的时间内持续充气可使圆柱体腔扩张，从而所有患者都可使用标准尺寸的圆柱体。
