Department of Urology, Einstein Healthcare Network, Philadelphia, PA; Department of Urology, Fox Chase Cancer Center, Philadelphia, PA.
Section of Urology, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Urology. 2020 Dec;146:133-139. doi: 10.1016/j.urology.2020.08.055. Epub 2020 Sep 19.
To assess outcomes of a variant of traditional modeling ("optimal modeling," OM) in patients with residual curvature following prosthesis implantation.
We performed a retrospective review of all patients who underwent penile implant insertion. Patients with >30° of residual curvature after cylinder placement and inflation underwent OM and were compared 1:1 to a demographically-matched cohort who received implantation without ancillary straightening. Optimal modeling was performed by forcibly bending the erect penis in the direction opposite the point of maximal curvature while maintaining glanular pressure to prevent urethral injury. This was performed for 90-second intervals for as many cycles as necessary to achieve <15° curvature.
Eighty patients were included in the final analysis; 40 (50.0%) underwent optimal modeling while 40 (50.0%) did not need additional straightening following surgery. The mean premodeling curvature was 47.8° (range 30°-90°) while post-modeling curvature improved to a mean of 10.6° (range 0°-30°, P < .001); 87.5% of patients had <15° of residual curvature. Patients in the OM cohort experienced longer operative times (82.7 vs 75.8 min, P = .15). No patient in either group experienced an intraoperative or postoperative complication at a mean follow-up of 29.9 months.
Although many prosthetic urologists forego manual modeling in cases of moderate-severe penile curvature, our contemporary series shows it to be both safe and effective. OM may preclude the need for more time-consuming and complex surgical procedures.
评估在假体植入后仍存在残余弯曲的患者中，传统建模方法的变体（“优化建模”，OM）的结果。
我们对所有接受阴茎植入术的患者进行了回顾性研究。在放置和充气后残余曲率>30°的患者中，我们对接受 OM 的患者进行了 1:1 比例的比较，并与接受无辅助拉直的植入术的患者进行了匹配。OM 通过在最大曲率点的相反方向强制弯曲勃起的阴茎，同时保持龟头压力以防止尿道损伤来进行。这以 90 秒为间隔进行，直至曲率<15°。
最终分析纳入 80 例患者；其中 40 例（50.0%）接受了优化建模，而 40 例（50.0%）在手术后不需要额外的拉直。术前平均曲率为 47.8°（范围 30°-90°），而术后曲率改善至平均 10.6°（范围 0°-30°，P<0.001）；87.5%的患者残余曲率<15°。OM 组患者的手术时间更长（82.7 分钟比 75.8 分钟，P=0.15）。在平均 29.9 个月的随访中，两组患者均无术中或术后并发症。
尽管许多泌尿科假体医生在中度至重度阴茎弯曲的情况下避免手动建模，但我们的当代系列研究表明它既安全又有效。OM 可能避免了更耗时和复杂的手术程序。
