Cohen Andrew J, Bhanvadia Raj R, Pariser Joseph J, Hatcher David M, Gottlieb Lawrence J, Bales Gregory T
Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
Section of Urology, Department of Surgery, University of Chicago, Chicago, IL.
Urology. 2017 Jul;105:2-5. doi: 10.1016/j.urology.2017.01.016. Epub 2017 Feb 2.
To describe outcomes of bone anchoring of penile implant in a neophallus with an accompanying video focusing on operative technique and salient tips for surgeons performing these procedures. Penile prosthesis insertion allows individuals with a neophallus to achieve erectile function. Lack of corporal bodies to accommodate cylinders makes anchoring of any prosthesis challenging. Anchoring the device to the pubic bone is one strategy to achieve proximal stabilization.
A single-institution, retrospective chart review of 10 neophallus patients undergoing penile prosthesis placement from 2006 to 2015 was done. The pubic symphysis is exposed and corticotomy created for placement of the rear tip extender of the implant using a Stryker TPS bone drill. Anchoring sutures through the corticotomy defect, rear tip, and proximal cylinder seat the implant. The remainder of the implantation procedure mirrors that used in native tissue.
The overall perioperative complication rate was 20%, with a mean follow-up of 49 months. Seventy percent of the patients required reoperation, with a mean of 1.4 prosthesis revision surgeries per patient. Primary causes of revision included infection, poor fixation of the rear tip, and prosthesis failure. Despite high revision rates, 80% of the patients have fully functioning prosthesis as of last follow-up. Limitations include retrospective study design and the small patient cohort.
Penile prosthesis placement in the neophallus is feasible and effective. A bone-anchored rear tip is an option to provide proximal stabilization. Continued efforts to minimize the need for revisions are ongoing and necessary.
通过一段视频描述阴茎假体在人造阴茎中的骨锚定效果，该视频重点介绍手术技术以及为实施这些手术的外科医生提供的重要技巧。阴茎假体植入可使拥有人造阴茎的个体实现勃起功能。缺乏容纳圆柱体的阴茎海绵体使得任何假体的锚定都具有挑战性。将假体固定于耻骨是实现近端稳定的一种策略。
对2006年至2015年期间10例接受阴茎假体植入的人造阴茎患者进行单机构回顾性病历审查。暴露耻骨联合，使用史赛克TPS骨钻进行皮质切开术，以放置假体的后端延长器。通过皮质切开术缺损、后端和近端圆柱体穿过锚定缝线来固定假体。植入手术的其余部分与在天然组织中使用的方法相同。
围手术期总体并发症发生率为20%，平均随访49个月。70%的患者需要再次手术，每位患者平均进行1.4次假体翻修手术。翻修的主要原因包括感染、后端固定不佳和假体故障。尽管翻修率较高，但截至最后一次随访，80%的患者假体功能完全正常。局限性包括回顾性研究设计和患者队列较小。
阴茎假体在人造阴茎中的植入是可行且有效的。骨锚定后端是提供近端稳定的一种选择。持续努力尽量减少翻修需求是持续且必要的。
