Krishnappa Pramod, Matippa Prasanna, Fraile-Poblador Agustín, Lledo-Garcia Enrique, Moncada Ignacio
Department of Urology and Robotic Surgery, NU Hospitals, Bangalore, India.
Orchidz Health, Bangalore, India.
Int J Impot Res. 2025 Jul 2. doi: 10.1038/s41443-025-01123-5.
Penile Prosthesis (PP) is offered to patients with erectile dysfunction (ED) who prefer a definitive management, but subjective or objective penile length shortening after PP surgery is a concern. This review article aims to describe various preoperative, intraoperative and postoperative procedures and factors that may preserve or increase penile length during PP surgery. Preoperative strategies by the surgeon include vacuum erection devices (1 month), penile traction devices (2-4 months), and optimal surgical timing in priapism (early vs. delayed), and patient decisions include choosing a high-volume centre (>25 PP/year) and implant type (malleable vs. inflatable). The intraoperative manoeuvres included the subcoronal no-touch technique, cavernosal tissue-sparing dilatation, ventral phalloplasty, suspensory ligament release, suprapubic lipectomy, the sliding technique, the multiple-slit technique, and tunical expansion procedures. Simultaneous radical prostatectomy and PP surgery is gaining momentum to preserve the penile length in patients who have preexisting ED. Postoperative protocols included immediate postoperative inflation (60-80% inflated for 6 weeks), pump inflation protocol and the use of a vacuum device (without the ring, for 12 weeks). Using the above factors, the gain in penile length may range between 0.2 and 6.0 cm. The outcomes of these procedures are not universally reproducible at all centres.
阴茎假体（PP）适用于那些倾向于确定性治疗的勃起功能障碍（ED）患者，但PP手术后阴茎长度出现主观或客观缩短是一个令人担忧的问题。这篇综述文章旨在描述各种术前、术中和术后的程序以及在PP手术期间可能保持或增加阴茎长度的因素。外科医生的术前策略包括使用真空勃起装置（1个月）、阴茎牵引装置（2 - 4个月）以及阴茎异常勃起时的最佳手术时机（早期与延迟），而患者的决策包括选择高手术量的中心（每年>25例PP手术）和植入类型（可弯曲型与可膨胀型）。术中操作包括冠状沟下免接触技术、海绵体组织保留扩张、阴茎腹侧成形术、悬韧带松解、耻骨上脂肪切除术、滑动技术、多切口技术以及白膜扩张程序。对于已有ED的患者，同期进行根治性前列腺切除术和PP手术在保留阴茎长度方面正逐渐受到关注。术后方案包括术后立即充盈（以60 - 80%的充盈度维持6周）、泵充盈方案以及使用真空装置（不使用环，持续12周）。利用上述因素，阴茎长度的增加幅度可能在0.2至6.0厘米之间。这些手术的结果并非在所有中心都能普遍重现。
