Fernandez Crespo Raul E, Stroie Florian, Taylor Laura, Pignanelli Michael, Parker Justin, Carrion Rafael
University of South Florida, Morsani College of Medicine, Tampa, FL, USA.
Transl Androl Urol. 2024 Jan 31;13(1):127-138. doi: 10.21037/tau-23-206. Epub 2024 Jan 23.
Implantation of penile prosthesis (PP) into scarred and fibrotic corpora can be a difficult challenge. In this review article, we provide a review of penile fibrosis, discuss current medical and surgical management and summarize preventative strategies.
In this study, we searched PubMed between the years 2000-2023 for publications with search strategy: "penile fibrosis" OR "scarred corpora" OR "fibrosed corpora".
This search returned a total of 137 articles. We examine the evidence for preoperative patient evaluation and penile ultrasound (US), oral phosphodiesterase-5 inhibitors, pentoxifylline, and L-arginine, vacuum device therapy and the use of surgical approaches and tools in the context of complex penile fibrosis cases. Severe penile fibrosis is most associated with priapism and infection. Estimating the degree of fibrosis via preoperative US may help set realistic patient expectations. Phosphodiesterase inhibitors and L-arginine reduce fibrosis in animal models however their impact in humans remains unclear despite theoretical advantage for their use. Vacuum device therapy may preserve penile length following priapism and infected PP cases. The use of Coloplast Narrow-Based or AMS-700 CXR implants are used primarily for severe fibrosis. Various surgical excisional/incisional techniques, the Carrion-Rossello, Mooreville Uramix cavernotomes and reverse cutting scissors are all options, and their use varies from case to case. Finally, prevention of penile fibrosis in patients with history of penile implant infection and the safety of early implantation of a penile implant in patients with refractory priapism is encouraged.
The management of penile fibrosis remains a challenge but there are multiple options to assist clinicians. Complex cases should be managed and studied at high volume centers.
将阴茎假体（PP）植入瘢痕化和纤维化的海绵体可能是一项艰巨挑战。在这篇综述文章中，我们对阴茎纤维化进行综述，讨论当前的药物和手术治疗方法，并总结预防策略。
在本研究中，我们于2000年至2023年间在PubMed上搜索了相关出版物，搜索策略为：“阴茎纤维化”或“瘢痕化海绵体”或“纤维化海绵体”。
此次搜索共返回137篇文章。我们研究了术前患者评估和阴茎超声（US）、口服磷酸二酯酶-5抑制剂、己酮可可碱和L-精氨酸、真空装置治疗以及在复杂阴茎纤维化病例中手术方法和工具使用的证据。严重阴茎纤维化与阴茎异常勃起和感染最为相关。通过术前超声估计纤维化程度可能有助于设定患者的现实期望。磷酸二酯酶抑制剂和L-精氨酸在动物模型中可减少纤维化，然而尽管其使用具有理论优势，但其对人类的影响仍不明确。真空装置治疗可在阴茎异常勃起和感染性PP病例后保留阴茎长度。科洛普拉斯窄基或AMS-700 CXR植入物主要用于严重纤维化。各种手术切除/切开技术，如卡里翁-罗塞洛、穆尔维尔尿道混合海绵体切开刀和反向切割剪刀都是选择，其使用因病例而异。最后，鼓励预防有阴茎植入感染史患者的阴茎纤维化以及为难治性阴茎异常勃起患者早期植入阴茎假体的安全性。
阴茎纤维化的管理仍然是一项挑战，但有多种选择可协助临床医生。复杂病例应在大型中心进行管理和研究。
