Inflatable Penile Implantation

A support is implanted in the corpus cavernosum that loses erectile function, so that the penis reaches a hardness sufficient to insert sexual intercourse. This support is called a prosthesis. Penile prosthesis implantation began in the 1930s and generally went through four stages. 1. Application of costal cartilage and ribs Bogaras in 1936 and Frumkin in 1944 using costal cartilage. In 1948, Bergman used ribs as a prosthesis, but was abandoned because the implant was easily absorbed and the long-term effect was unsatisfactory. 2. Hard prosthesis In 1950 Scardino first applied acrylic as a prosthesis. In 1966, Beheri used a polyethylene rod as a prosthesis and was successful. 3. Semi-hard prosthesis In 1967, Pearman used a semi-circular silica gel as a prosthesis, implanted between the Buck's fascia on the dorsal side of the penis and the white membrane. The effect was not satisfactory. In 1975, Small-Carrion studied a prosthesis with silicone rubber as the outer shell and silicon sponge as the core. In 1980, Jonas designed a silver-silicone rubber prosthesis with a spiraled silver screw embedded in the silicon rod. It has the advantages of simple structure, low price, small operation, bending and not easy to break. In 1983, the American medical system designed a flexible semi-rigid prosthesis with an extender at the back end that can be extended or shortened according to the size of the penis, eliminating the need for intraoperative cutting. 4. Inflatable Prosthesis In 1973, Scott and Bradley designed an inflatable silicone rubber prosthesis that was reinforced with polyester. Its main advantage is that the penis is erect when inflated and naturally relaxed when not inflated. The prosthesis comprises a liquid storage bag (a storage of 30% sodium sulphate about 60 ml), a suction pump, and a hollow cylindrical body, which are respectively placed in the lower abdominal extraperitoneal space, the scrotum and the corpus cavernosum. There is a pipeline and a pump connection between the liquid storage bag and the two cylinders. The pump can be manually controlled to inflate or suck back the liquid in the liquid storage bag, and the penis can be erect or soft at will. In recent years, two new inflatable prostheses have emerged, namely hydroflex penile prosthesis and self-contained mechanical prosthesis. The advantage of the hydraulic bendable prosthesis is that it relies on the liquid conversion in the device to make the penis erect, and integrates the liquid storage bag, the suction pump and the cylinder. The hollow cylinder has a double-layer structure, and the "storage bag" of the tail and the outer layer is connected with the driving pump and the valve at the front end, and the pump at the front end of the penis is squeezed several times, the liquid is expanded from the tail into the inner layer, and the liquid of the squeeze valve is returned to the liquid. Tail. The disadvantage is that the hardness is not ideal. The self-contained prosthesis has an Ominiophase penile prosthesis and a Duraphase penile prosthesis. The prosthetic device has no valve and liquid conversion. Treating diseases: erectile dysfunction Indication Expandable penile prosthesis implantation is suitable for irreversible organic ED, especially neurological ED is the preferred indication for prosthesis implantation. Others such as vascular, traumatic, drug-induced, psychological ED treatment failure. Preoperative preparation 1. Choosing the appropriate prosthesis can inflate the prosthesis with erectile erection, require more rigorous surgery, more mechanical failures, and higher prices. Adhesive prosthesis should be used in the following situations: 1 need to have a catheterization; 2 nerve bladder; 3 need to repeat cystoscopy and TUR; 4 penile sensation. 2. Understand whether the bilateral corpus cavernosum is equal, whether there is penile induration, inflammation and congenital malformation. If necessary, cavernous angiography is used to confirm. 3. Apply broad-spectrum antibiotics such as cephalosporin 1d before surgery, and use it for 3 days after surgery to prevent Gram-positive bacterial infection. 4. The patient was scrubbed with strong iodine for 10 min before and after the operation. 5. Scrape the field hair in the operating room, then disinfect the genitals with strong iodine for 10 min, and inject 3 ml of bacitracin-neomycin solution from the outer urethra, and clamp the penis with the penis. For a perineal incision, use a tape to separate the surgical field from the anus. A warning sign is placed on the door to limit the movement of personnel in the operating room. 6. Select a good inflatable prosthesis, immerse in erythromycin solution (500mg erythromycin dissolved in 500ml isotonic saline) for disinfection. Intraoperative use of antibiotic solution to wash the incision from time to time. Surgical procedure Position and incision Supine position. A longitudinal incision was made from 1 cm above the pubic symphysis to the base of the penis, or a 5 cm transverse incision was made in the middle of the pubic symphysis. Cut the skin and subcutaneous tissue, cut the anterior sheath of the rectus abdominis, separate the rectus abdominis muscle, free the anterior space of the bladder, and use the index finger to expand into a dimple on the left or right side of the rectus abdominis to place the reservoir. 2. Implanted reservoir The reservoir is placed in the anterior bladder space. Poke a small hole in the anterior rectus sheath of the right incision, and take the reservoir output tube from the Hex's triangle on the side of the hole or the pump to be filled, and inject 65ml of contrast medium into the syringe with a blunt needle. The sac is for X-ray examination. Carefully check that the crypt is adequate to hold the reservoir and clamp the output tube with a silicone tube clamp. The anterior sheath and subcutaneous tissue of the rectus abdominis were sutured. 3. Establish a cavernous tunnel The lower edge of the incision was retracted, and the corpus cavernosum was revealed in the midline of the incision. A 2-needle pull line was sutured at 2 cm near the pubis on the right side of the corpus cavernosum, and a 2 cm long straight incision was made between the lines. Do not damage the vascular nerve bundle in the midline. The sponge was first sneaked under the tunica with scissors, and then the distal end was made with a cervical dilator with a diameter of 8 to 13 mm. And the proximal end. Gradually expand and build a tunnel. 4. Measuring tunnel The tunnel length is measured with a Furlow introducer. The first step: measuring the distance from the proximal end of the tunica incision to the distal end of the corpus cavernosum, and adding 4 cm to the base is the length of the cylinder to be implanted. It is necessary to increase this 4cm because the back end of the prosthesis to the outlet of the output tube is 4cm. Step 2: Measure the distance from the proximal end of the incision to the attachment point of the sponge. For example, >4cm, a prosthetic end extender should be selected. Since the distance from the end of the cylinder to the outlet of the outlet tube is 4 cm, the distance measured in the second step is subtracted by 4 cm, which is the length of the desired extension body. When the measurement result has a mantissa of half a centimeter, it should be subtracted, and the total length of the prosthesis should be reduced by one number. 5. Implantation of the cylinder A pull line is made at the distal end of the cylinder, and the pull line is hung on the puncture needle at the tip of the introducer, and the needle should be fully retracted before being inserted into the guide. Inject a contrast agent into the cylinder and expel the air until the cylinder is rounded and do not over-expand. Insert the introducer into the distal end of the cavernous body, and then pass the needle through the penis head 1 to 2 cm from the outside of the urethral opening and 1 cm from the proximal side. Pull out the guide, clamp and pull the suture, and the cylinder enters the distal end of the tunnel. The end of the cylinder is implanted into the penis foot. The white membrane was sutured and the contralateral cylinder was implanted in the same manner. 6. Implanted suction pump Place the nozzle of the reservoir outlet tube below the level of the contrast agent, and continuously squeeze the suction pump to discharge the air inside the pump. A scrotal lacuna is separated by fingers on the outside of the testes and spermatic cords, under the scrotal meat layer, which should be large enough to allow the pump to be located at the bottom of the scrotum and separated from the testes. The suction button should be placed on the outside. After the installation is completed, the suction pump input tube and the output tube are clamped under the scrotum skin with a tail-clamp to prevent the suction pump from being pulled out when connected. 7. Connecting the pipe The tube of the reservoir is connected to the input tube of the suction pump, and the two output tubes of the suction pump are respectively connected with the tubes of the two cylinders. If a plastic quick connector is used, first put a clamp ring on the pipe end, insert the joint into one pipe end, rinse the pipe, then insert the other end, and finally use the assembly tool to fasten the clamp ring and the joint. If the pipe is too long, it can be cut short, but it should not be too short. It is too short to lift the suction pump to the outer ring of the inguinal region, which makes operation difficult. 8. Test the prosthesis After the tube is connected, the suction pump can be tested several times. It is believed that the prosthesis can expand evenly, accurately under the head of the penis, and can be collapsed as required, and the pull line of the penis head can be cut and extracted. 9. Suture incision Check the suture of the white incision. Make sure that the cylinder is not broken when filled with water and the liquid is released. The incision was sutured in two layers around the catheter, and the drainage strip was placed under the skin and the bottom of the scrotum, and removed at 24 to 48 hours. A thin balloon catheter was placed in the urethra and left overnight.