Neuville Paul, Morel-Journel Nicolas, Maucourt-Boulch Delphine, Ruffion Alain, Paparel Philippe, Terrier Jean-Etienne
Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France.
Department of Biostatistics, Hospices Civils de Lyon, Lyon, France.
J Sex Med. 2016 Nov;13(11):1758-1764. doi: 10.1016/j.jsxm.2016.09.013. Epub 2016 Sep 29.
INTRODUCTION: The creation of a neophallus is a complex surgery that must meet functional and esthetic requirements. It is a long and demanding surgical process whose final stage consists of the implantation of a rigid or inflatable material that can be used to reproduce an erection. Data in the literature are scarce, with only the pioneering series present, which includes the use of the first devices and techniques. AIM: To report the outcome of patients with phalloplasty after implantation of erectile implants using standardized surgical techniques and the use of recent prosthesis types with or without a vascular graft. METHODS: This is a retrospective hospital-based analysis of all patients with phalloplasty who underwent implantation of an erectile prosthesis from March 2007 to May 2015. Factors associated with complications were investigated by multivariate logistic regression analysis. MAIN OUTCOME MEASURES: Early-onset (during the first month after surgery) and late-onset complications, including erosion, infections, malpositioning, and dysfunction. RESULTS: Sixty-nine patients were included in the study and 95 procedures were analyzed. After a median follow-up of 4 years (minimum = 169 days, maximum = 6.1 years), the original prosthesis was still in place in 43 patients (62.3%). Patients underwent phalloplasty after female-to-male transsexualism (n = 62, 89.9%), malformation (n = 4, 5.8%), or trauma (n = 3, 4.3%). The proportions for the different types of phalloplasty were 58% for forearm free flap phalloplasty (n = 40), 33.3% for suprapubic phalloplasty (n = 23), and 7% for other (n = 6). The erectile prostheses used were the two-piece AMS Ambicor (n = 71, 74.7%), the Ambicor with a vascular graft (n = 19, 20.0%), and the AMS 700CXR, AMS 700CX, or AMS600-650 (n = 5, 5.2%). There were no early-onset complications in 89 procedures (93.7%) and, when present, they were always related to infection (n = 4, 4.2%). Late-onset complications were erosion (n = 4, 4.2%), infection (n = 4, 4.2%), dysfunction (n = 10, 10.5%), and malpositioning (n = 12, 12.6%). No significant difference was observed for malpositioning (12.7% vs 10.5%, P = .87) and dysfunction (7.0% vs 10.5%, P = .78) between the AMS Ambicor prosthesis and the Ambicor prosthesis with a vascular graft. CONCLUSION: This study provides updated data on complications after the implantation of erectile implants. Multicenter studies, including the evaluation of patient satisfaction, are needed to increase our understanding of factors associated with the outcomes.
引言:阴茎再造术是一项复杂的手术,必须满足功能和美学要求。这是一个漫长且要求苛刻的手术过程,其最后阶段包括植入可用于重现勃起功能的刚性或可膨胀材料。文献中的数据稀少,仅有开创性的系列报道,其中包括首批器械和技术的使用情况。 目的:报告采用标准化手术技术植入勃起装置后阴茎成形术患者的治疗结果,以及使用或未使用血管移植物的新型假体的应用情况。 方法:这是一项基于医院的回顾性分析,纳入了2007年3月至2015年5月期间所有接受阴茎成形术并植入勃起假体的患者。通过多因素逻辑回归分析研究与并发症相关的因素。 主要观察指标:早期(术后第一个月内)和晚期并发症,包括侵蚀、感染、位置异常和功能障碍。 结果:本研究共纳入69例患者,分析了95例手术。中位随访4年(最短169天,最长6.1年)后,43例患者(62.3%)的原假体仍在位。患者接受阴茎成形术的原因包括男变女变性手术(n = 62,89.9%)、畸形(n = 4,5.8%)或创伤(n = 3,4.3%)。不同类型阴茎成形术的比例分别为:前臂游离皮瓣阴茎成形术58%(n = 40)、耻骨上阴茎成形术33.3%(n = 23)、其他类型7%(n = 6)。使用的勃起假体包括两件式AMS Ambicor(n = 71,74.7%)、带血管移植物的Ambicor(n = 19,20.0%)以及AMS 700CXR、AMS 700CX或AMS600 - 650(n = 5,5.2%)。89例手术(93.7%)无早期并发症,若有早期并发症,均与感染有关(n = 4,4.2%)。晚期并发症包括侵蚀(n = 4,4.2%)、感染(n = 4,4.2%)、功能障碍(n = 10,10.5%)和位置异常(n = 12,12.6%)。AMS Ambicor假体与带血管移植物的Ambicor假体在位置异常(12.7%对10.5%,P = 0.87)和功能障碍(7.0%对10.5%,P = 0.78)方面未观察到显著差异。 结论:本研究提供了勃起装置植入术后并发症的最新数据。需要开展多中心研究,包括评估患者满意度,以增进我们对与治疗结果相关因素的理解。
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