Department of Urology, School of Medicine Tor Vergata University of Rome, Rome, Italy.
J Sex Med. 2012 Jul;9(7):1937-44. doi: 10.1111/j.1743-6109.2012.02748.x. Epub 2012 Jun 6.
Implantation of a penile prosthesis in severely scarred corporal bodies represents a great challenge as fibrosis can compromise dilatation and subsequent closure of the corpora cavernosa and limit size, type, and function of the device.
The aim of this study is to report our experience of simultaneous corporeal reconstruction and penile prosthesis implantation in patients with severe penile contracture consequence of diffuse fibrosis.
Between March 2006 and February 2010, 18 patients with severe penile contracture and coporeal fibrosis underwent simultaneous corporeal reconstruction and placement of a penile prosthesis.
Surgical outcome and complications have been recorded during postoperative follow-up. Patients' satisfaction has been assessed 6 months postoperatively with the administration of the modified erectile dysfunction index of treatment satisfaction questionnaire.
Although the dilatation of the corpora was extremely difficult due to the severe fibrosis, a penile prosthesis has been implanted in all patients. A malleable penile prosthesis has been inserted in four patients and a three-piece inflatable device in the remainder. After an average follow-up of 26 months (range 6-36), revision surgery was required in four patients (elective exchange to three-piece inflatable device in three patients and upsizing of the implant in one patient). Although all patients were able to achieve penetrative sexual intercourse, four patients were partially dissatisfied because of significant penile shortening.
In expert hands, simultaneous penile prosthesis implantation and corporal reconstruction of severely scarred corpora yield satisfactory results. Patients must be warned that complication rate in presence of severe fibrosis is significantly higher than in virgin cases and that downsized cylinders might be required due to the contracture of the tunica albuginea.
在严重瘢痕化的海绵体中植入阴茎假体是一项巨大的挑战，因为纤维化可能会影响海绵体的扩张和随后的闭合，并限制假体的大小、类型和功能。
本研究旨在报告我们在弥漫性纤维化导致严重阴茎挛缩的患者中同时进行海绵体重建和阴茎假体植入的经验。
2006 年 3 月至 2010 年 2 月，18 例严重阴茎挛缩伴海绵体纤维化的患者接受了同时进行的海绵体重建和阴茎假体植入术。
记录术后随访期间的手术结果和并发症。术后 6 个月，采用改良勃起功能障碍治疗满意度问卷的治疗满意度指数评估患者满意度。
尽管由于严重纤维化，海绵体扩张极其困难，但所有患者均成功植入了阴茎假体。4 例患者植入了可弯曲阴茎假体，其余患者植入了三件式可充气装置。平均随访 26 个月（6-36 个月）后，4 例患者需要再次手术（3 例患者更换为三件式可充气装置，1 例患者增大假体）。尽管所有患者均能进行有穿透力的性交，但 4 例患者部分不满意，因为阴茎明显缩短。
在专家手中，同时进行阴茎假体植入和严重瘢痕化海绵体的重建可以获得满意的结果。必须警告患者，在严重纤维化的情况下，并发症的发生率明显高于初次手术的情况，并且可能需要缩小圆柱体，因为白膜的挛缩。
