Implantation of penile prosthesis in a patient with severe corporeal fibrosis induced by cavernosal injection therapy

Park, J K; Kim, H J; Kang, Min Ho; Jeong, Young Beom

doi:10.1038/sj.ijir.3900930

Cited by 18 publications

(12 citation statements)

References 4 publications

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“…Corporal fibrosis and the resultant loss of penile length have stimulated considerable interest in prosthetic urology research. Park and colleagues reported electric resection and electrovaporization of fibrotic tissue for implantation of penile prosthesis in a patient with severe corporeal fibrosis [10]. Mulcahy reported long-term experience with salvage of infected penile implant by the salvage protocol.…”

Section: Discussionmentioning

confidence: 99%

Upsizing of Inflatable Penile Implant Cylinders in Patients with Corporal Fibrosis

Wilson

Delk

Mulcahy

et al. 2006

The Journal of Sexual Medicine

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Introduction Placement of an inflatable penile prosthesis in a patient with scarred corporal bodies secondary to priapism or removal of a previously infected implant is a formidable surgical challenge; use of downsized implants has improved chances of successful reimplantation. Nevertheless, patients are frequently dissatisfied with the resulting short penises. Aim This study investigates the use of downsized inflatable penile prosthesis cylinders as tissue expanders in patients with corporal fibrosis. Main Outcomes Measures Corporal length and width were calibrated before implantation of downsized prostheses and after 1 year of their use as tissue expanders. Methods Thirty-seven patients had insertion of Mentor Narrow Base (18), AMS CXM (9), or AMS CXR (10) into scarred corporal bodies. Etiology was previously infected and removed implant (29) or priapism (8). In each of these cases it was not possible to dilate to 12 mm in order to place standard-sized cylinders. Patients were encouraged to inflate their implant for up to 3 hours daily. After several months intracorporal stretching occurred. The patients were reoperated; corporal length and width were recalibrated. Results Upon reoperation, it was possible to pass dilators of 12 mm width proximally allowing the substitution of standard-sized AMS 700 CX (23), Mentor Alpha 1 (10), or Mentor Titan (2). Additionally, corporal length measurements in the previously infected patients increased an average of 2.2 cm allowing placement of longer cylinders. Although priapism patients did not show this phenomenon of corporal lengthening, the implant space widened enough to permit replacement with standard-size cylinders improving girth, rigidity, and appearance. Conclusions Wider and sometimes longer cylinders can be substituted in patients with corporal fibrosis that required implantation with downsized cylinders because of fibrotic corpora. Prolonged inflation over an 8- to 12-month period results in expansion of the cylinder cavity, permitting standard-sized cylinders in all patients.

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Section: Discussionmentioning

confidence: 99%

Upsizing of Inflatable Penile Implant Cylinders in Patients with Corporal Fibrosis

Wilson

Delk

Mulcahy

et al. 2006

The Journal of Sexual Medicine

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“…Bilateral longitudinal corporotomies were made at the penoscrotal junction of the tunica albuginea and extended to the glans penis. The extensive corporeal fibrotic tissue was dissected from the tunica albuginea with scissors and the remaining fibrotic tissue was resected and evaporated with the resectoscope and the resection loop commonly used for transurethral resection [6].…”

Section: Discussionmentioning

confidence: 99%

“…Alternatives have been proposed, all of which involve one or more of the aforementioned reasons for unfavorable outcome [3][4][5][6][7][8][9][10][11].…”

Section: Implantation Of a Penile Prosthesis Into Fibrosed Corpora Camentioning

confidence: 99%

Corporoscopic Excavation of the Fibrosed Corpora Cavernosa for Penile Prosethesis Implantation: Optical Corporotomy and Trans-Corporeal Resection, Shaeer’s Technique

Shaeer

Shaeer²

2007

The Journal of Sexual Medicine

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Introduction Implantation of a penile prosthesis in cases of neglected or resistant ischemic priapism, or delayed re-implantation following prosthesis infection and extraction, is usually a difficult and risky procedure due to fibrosis of the corpora cavernosa. Among the common complications are perforation of the urethra, tunica albuginea, and infection. The complications are usually due to the use of blind force against resistance. Aim We propose the techniques of Trans-Corporeal Resection and Optical Corporotomy as adjuvant measures for excavating the fibrosed corpora cavernosa under vision, without the use of force against resistance. Methods Six patients with diffuse fibrosis of the corpora cavernosa were operated on. The instruments and technique are the same as for optical urethrotomy and transurethral resection. Optical Corporotomy was started with, where the corpora are incised from within. After establishment of a satisfactory passage, Trans-Corporeal Resection followed to scrape the fibrous tissue. Implantation of penile prosthesis was completed as usual. The procedure was performed through 1.5 cm incision in the tunica albuginea. Main Outcome Measures Length, girth, and straightness in the erect position, as well as the incidence of complications. Results Operative time was an average of 90 minutes. No difficulty was encountered during the procedure. No complications were noted through 1 year of follow-up. Conclusion Optical Corporotomy and Trans-Corporeal Resection allow for force-free, visually monitored excavation of the fibrosed corpora cavernosa, aiming at safer penile prosthesis implantation.

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“…Park et al [22] described the use of electrical resection and evaporization utilizing the surgical unit for transurethral resection for excavation of the fibrous tissue in the corpora. This surgery was also performed through an extended corporotomy, which may potentially predispose to prosthesis infection and add to the operation time and effort.…”

mentioning

confidence: 99%

“…[9,12,21,22] Therefore, we think that the ideal surgical technique that can be used in patients with severe corporeal fibrosis to excavate the fibrosed corpora cavernosa for penile prosthesis implantation should be safe, easy, fast, and effective. To the best of our knowledge, the recent study represents the first reported use of a microdebrider in patients with severe corporeal fibrosis to excavate the corpora for penile prosthesis implantation.…”

mentioning

confidence: 99%

Use of a microdebrider for corporeal excavation and penile prosthesis implantation in men with severely fibrosed corpora cavernosa: a new minimal invasive surgical technique

Bozkurt

Yonguç

Aydoğdu

et al. 2015

Turkish Journal of Urology

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Objective: To propose a new minimal invasive surgical technique using a microdebrider (shaver) to excavate the fibrosed corpora cavernosa for penile prosthesis implantation in patients with severe fibrosis. Material and methods:Two patients with severe corporeal fibrosis were implanted with a penile prosthesis using this technique. In the first patient, fibrosis was due to neglected idiopathic ischemic priapism and the second patient had his prosthesis extruded because of erosion in another center. Both patients were counseled about the procedure and the possible complications related to the experimental nature of the technique. A written informed consent was obtained from both patients. Excavation of the corpora was performed using microdebrider in both patients.Results: Both operations were performed successfully without any intraoperative complications, including urethral injury or perforation of the tunica. The mean operation time was 57 min. The postoperative period was uneventful without any infection, migration, erosion, or mechanical failure. The penile length was increased nearly 2 cm in both patients, and the penile girth was increased around 30% in the patient who underwent inflatable penile prosthesis implantation. Conclusion:The microdebrider potentially provides an important advance in patients with severe corporeal fibrosis to excavate the fibrosed corpora cavernosa for penile prosthesis implantation. The main advantages include fast, safe, and effective excavation of fibrous corpora cavernosa adequate for a satisfactory penile prosthesis implantation.

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Implantation of penile prosthesis in a patient with severe corporeal fibrosis induced by cavernosal injection therapy

Cited by 18 publications

References 4 publications

Upsizing of Inflatable Penile Implant Cylinders in Patients with Corporal Fibrosis

Upsizing of Inflatable Penile Implant Cylinders in Patients with Corporal Fibrosis

Corporoscopic Excavation of the Fibrosed Corpora Cavernosa for Penile Prosethesis Implantation: Optical Corporotomy and Trans-Corporeal Resection, Shaeer’s Technique

Use of a microdebrider for corporeal excavation and penile prosthesis implantation in men with severely fibrosed corpora cavernosa: a new minimal invasive surgical technique

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