Liberman S N, Gomella L G, Hirsch I H
Department of Urology, Jefferson Medical College, Philadelphia, PA 19107, USA.
Int J Impot Res. 1998 Sep;10(3):175-9. doi: 10.1038/sj.ijir.3900337.
The Ultrex and Ultrex Plus penile prosthesis incorporate sequential design modifications that afford important functional advantages that reduce the potential for mechanical failure. This retrospective study reviews our experience with these models emphasizing innovations in surgical technique and postoperative results. Implantation of Ultrex (31%) and Ultrex Plus (69%) penile prosthesis was performed in 90 impotent men with organic erectile dysfunction following comprehensive multi-disciplinary evaluation. During a follow-up interval of 7-50 months, postoperative outcome was assessed. Of this group, 10% underwent simultaneous explant of another malfunctioning inflatable device or conversion from a semi-rigid prosthesis due to patient preference. Of the remainder, 20% selected implant surgery as their primary therapy while 73% were initially treated with various nonsurgical options prior to implantation. In all patients we employed a single peno-scrotal incision and applied the concept of controlled radial dilatation of all compartments. In our last 32 consecutive patients including eight with previous radical pelvic surgery, we utilized the preperitoneal distention balloon (PDB) facilitating safe and non-traumatic creation of the prevesical space for reservoir insertion. Post operative complications occurred in 8% of patients including pump infection and corporal deformity requiring reimplantation with AMS 700 CX cylinders, or self-contained unitarian prosthesis as a salvage procedure. Satisfactory, functional and anatomic outcome was reported in 95% of patients. Interim advances incorporated into the Ultrex and Ultrex Plus prosthesis have markedly reduced mechanical failure during our follow-up interval of up to 50 months. Importantly, controlled, non-traumatic radial dilatation of the prevesical space by the PDB may encourage broader use of the multicomponent inflatable models, particularly in a setting of pelvic fibrosis due to previous pelvic surgery or radiation.
Ultrex和Ultrex Plus阴茎假体采用了一系列设计改进，具有重要的功能优势，可降低机械故障的可能性。这项回顾性研究回顾了我们使用这些模型的经验，重点关注手术技术的创新和术后结果。在对90例患有器质性勃起功能障碍的阳痿男性进行全面的多学科评估后，植入了Ultrex（31%）和Ultrex Plus（69%）阴茎假体。在7至50个月的随访期间，对术后结果进行了评估。在该组中，10%的患者因患者偏好同时取出了另一个故障的可膨胀装置或从半刚性假体转换而来。其余患者中，20%选择植入手术作为主要治疗方法，73%在植入前最初接受了各种非手术治疗。在所有患者中，我们采用了单一的阴茎阴囊切口，并应用了所有腔室控制性径向扩张的概念。在我们最近连续的32例患者中，包括8例先前接受过根治性盆腔手术的患者，我们使用了腹膜前扩张球囊（PDB），便于安全、无创地创建膀胱前间隙以插入储液器。8%的患者发生了术后并发症，包括泵感染和阴茎体畸形，需要用AMS 700 CX圆柱体或独立的一体式假体重新植入作为挽救措施。95%的患者报告了满意的功能和解剖学结果。在我们长达50个月的随访期间，Ultrex和Ultrex Plus假体所采用的中期改进措施显著降低了机械故障。重要的是，PDB对膀胱前间隙进行控制性、无创性径向扩张可能会促使多组件可膨胀模型得到更广泛的应用，特别是在先前盆腔手术或放疗导致盆腔纤维化的情况下。
