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1.
J Sex Med ; 17(10): 2093-2103, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32636162

RESUMEN

BACKGROUND: Peyronie's disease, diabetes, trauma, pelvic surgeries, and aging are conditions that promote penile fibrosis and trigger erectile dysfunction associated with penile reduction. These pathologies require an objective preoperative diagnosis and intraoperative management of penile shrinkage. AIM: The goal is to develop a non-grafting procedure to promote lengthening using geometric patterns of multiple staggered small cuts on the tunica albuginea with an optimal ratio between tissue expansion and resistance to confine the cylinders inside the corpora cavernosa. METHODS: Between February 2016 and February 2019, 416 patients suffering penile shortening with or without Peyronie's disease received implants using the tunica expansion procedures (TEP). Incisions were distributed in respective areas of the tunica to allow maximum expansion while maintaining strength to confine prosthetic cylinders within the corpora cavernosa to prevent bulges and denting. OUTCOMES: In accordance with these principles, surgical objectives and patient satisfaction were achieved in length and girth restoration regardless of the type of implant used to obtain adequate axial rigidity. RESULTS: The sample of 416 patients included 287 cases of Peyronie's disease having a mean axial deviation of 51° (0-90°) whose curvature was corrected in surgery, with pressure from the cylinders maintaining straightness for malleable and inflatable devices. Tunica constriction in 40.86% of cases was corrected with vertical relaxing incisions. Ventral glanspexy was performed intraoperatively in 92.8% of patients to prevent hypermobility. A penile gain of 3.3 cm (2-6) was measured intraoperatively. CLINICAL IMPLICATIONS: Diagnosis of penile shortening was performed by a stretch length test and pharmacologically induced erection together with the patient's subjective opinion of penile loss. Lengthening procedure depends on the limit of the dissected neurovascular bundle. The patient and surgeon select the type of implant in accordance with his individual anatomic characteristics. STRENGTHS AND LIMITATIONS: The TEP strategy is a non-grafting procedure based on tissue restitution by expansion instead of substitution, which provides surgeons a solution for penile enlargement to the limit of the dissected neurovascular bundle. CONCLUSIONS: The TEP strategy has been demonstrated to be safe and effective to resolve problems of penile size reduction independently of penile curvature. It eliminates grafting and improves penile lengthening techniques using small, staggered cuts on the tunica albuginea, while maintaining tunica structural resistance to contain cylinders inside the corpora, preventing bulges and denting, facilitating tissue regeneration, and improving axial rigidity. Paulo H. Egydio, An Innovative Strategy for Non-Grafting Penile Enlargement: A Novel Paradigm for Tunica Expansion Procedures. J Sex Med 2020;17:2093-2103.


Asunto(s)
Disfunción Eréctil , Enfermedades del Pene , Implantación de Pene , Induración Peniana , Prótesis de Pene , Disfunción Eréctil/cirugía , Humanos , Masculino , Induración Peniana/cirugía , Pene/cirugía
2.
J Sex Med ; 15(2): 261-269, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29275049

RESUMEN

BACKGROUND: Patients with severe erectile dysfunction (ED) and penile size issues, especially seen in Peyronie's disease (PD), are candidates for more invasive penile prosthesis insertion techniques that aim for penile length and girth reconstruction. AIM: To present the feasibility and safety of penile length and girth restoration based on the so-called multiple-slit technique (MUST) for patients with severe ED and significant penile shortening with or without PD. METHODS: From July 2013 through January 2016, 138 patients underwent the MUST. The International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction were completed. OUTCOMES: Outcome analysis was focused on penile length restoration, penile curvature correction, intra- and postoperative complications, and patient satisfaction. RESULTS: 138 patients underwent the procedure (103 malleable and 35 inflatable devices). Etiologies of penile shortening and narrowing were PD, severe ED, post-radical prostatectomy, and androgen-deprivation therapy with or without brachytherapy or external radiotherapy for prostate cancer, and post-penile fracture in 60.1%, 24.6%, 10.1%, 3.6%, and 2.2%, respectively. In PD cases, the mean deviation of the penile axis was 55° (range = 0-90°). Mean subjective penile length loss reported was 3.2 cm (range = 1-5 cm), and shaft constriction was present in 44.9%. Median follow-up was 15.2 months (range = 6-36 months). Mean penile length gain was 3.1 cm (range = 2-5 cm). No penile prosthesis infection caused device explantation. One glans necrosis was encountered. The average IIEF score increased from 22 points at baseline to 66 points at 6-month follow-up. CLINICAL IMPLICATIONS: The MUST helps address penile size issues in cases of severe ED with concomitant conditions that impair penile length or girth. STRENGTHS AND LIMITATIONS: The strength of the study is its applicability to provide surgeons with a solution for cases in which patients have severe ED and penile size impairment owing to underlying conditions such as PD. The study is limited by the relatively short follow-up. CONCLUSIONS: The MUST is an effective, safe, and viable treatment option for a selected patient cohort. Because of the potential complications, proper counseling should take place and only experienced surgeons should perform this type of surgery. Egydio PH, Kuehhas FE. The Multiple-Slit Technique (MUST) for Penile Length and Girth Restoration. J Sex Med 2018;15:261-269.


Asunto(s)
Implantación de Pene/métodos , Prótesis de Pene , Pene/cirugía , Adulto , Anciano , Antagonistas de Andrógenos/administración & dosificación , Disfunción Eréctil/etiología , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Erección Peniana , Induración Peniana/fisiopatología , Induración Peniana/cirugía , Complicaciones Posoperatorias/epidemiología , Prostatectomía/efectos adversos , Neoplasias de la Próstata/cirugía , Cirujanos
3.
BJU Int ; 116(6): 965-72, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25644141

RESUMEN

OBJECTIVE: To present the feasibility and safety of penile length and girth restoration based on a modified 'sliding' technique for patients with severe erectile dysfunction (ED) and significant penile shortening, with or without Peyronie's disease (PD). PATIENTS AND METHODS: Between January 2013 and January 2014, 143 patients underwent our modified 'sliding' technique for penile length and girth restoration and concomitant penile prosthesis implantation. It is based on three key elements: (i) the sliding manoeuvre for penile length restoration; (ii) potential complementary longitudinal ventral and/or dorsal tunical incisions for girth restoration; and (iii) closure of the newly created rectangular bow-shaped tunical defects with Buck's fascia only. RESULTS: In all, 143 patients underwent the procedure. The causes of penile shortening and narrowing were: PD in 53.8%; severe ED with unsuccessful intracavernosal injection therapy in 21%; post-radical prostatectomy 14.7%; androgen-deprivation therapy, with or without brachytherapy or external radiotherapy, for prostate cancer in 7%; post-penile fracture in 2.1%; post-redo-hypospadias repair in 0.7%; and post-priapism in 0.7%. In patients with ED and PD, the mean (range) deviation of the penile axis was 45 (0-100)°. The mean (range) subjective penile shortening reported by patients was 3.4 (1-7) cm and shaft constriction was present in 53.8%. Malleable penile prostheses were used in 133 patients and inflatable penile prostheses were inserted in 10 patients. The median (range) follow-up was 9.7 (6-18) months. The mean (range) penile length gain was 3.1 (2-7) cm. No penile prosthesis infection caused device explantation. The average International Index of Erectile Function (IIEF) score increased from 24 points at baseline to 60 points at the 6-month follow-up. CONCLUSION: Penile length and girth restoration based on our modified sliding technique is a safe and effective procedure. The elimination of grafting saves operative time and, consequently, decreases the infection risk and costs associated with surgery.


Asunto(s)
Implantación de Pene/métodos , Pene/cirugía , Adulto , Anciano , Disfunción Eréctil/cirugía , Humanos , Masculino , Persona de Mediana Edad , Induración Peniana/cirugía
4.
BJU Int ; 115(5): 822-8, 2015 May.
Artículo en Inglés | MEDLINE | ID: mdl-25327685

RESUMEN

OBJECTIVE: To compare patient-reported outcomes (PROs) of surgical correction of Peyronie's disease (PD) with the Nesbit procedure, plaque incision and grafting, and the insertion of a malleable penile implant after surgical correction of penile curvature. PATIENTS AND METHODS: We performed a retrospective review of men who underwent surgical correction of PD between January 2010 and December 2012 at six international centres. Treatment-related PROs and satisfaction were evaluated with a non-validated questionnaire. RESULTS: The response rate to the questionnaire was 70.9%, resulting in a study cohort of 206 patients. The Nesbit procedure, plaque incision with grafting, or implantation of a malleable penile prosthesis was performed in 50, 48, and 108 patients, respectively. Overall, 79.1% reported a subjective loss of penile length due to PD preoperatively (range 2.1-3.2 cm). Those patients treated with a malleable penile implant reported the greatest subjective penile length loss, due to PD. A subjective loss of penile length of >2.5 cm resulted in reduced preoperative sex ability. Postoperatively, 78.0%, 29.2% and 24.1% patients in the Nesbit, grafting, and implant groups reported a postoperative, subjective loss of penile length (range 0.4-1.2 cm), with 86.3%, 78.6%, and 82.1% of the patients in each group, respectively, being bothered by the loss of length. CONCLUSIONS: Penile length loss due to PD affects most patients. Further penile length loss due to the surgical correction leads to bother among the affected patients, irrespective of the magnitude of the loss. The Nesbit procedure was associated with the highest losses in penile length. In patients with PD and severe erectile dysfunction, a concomitant lengthening procedure may be offered to patients to help overcome the psychological burden caused by the loss of penile length.


Asunto(s)
Satisfacción del Paciente , Implantación de Pene , Induración Peniana/cirugía , Autoinforme , Adolescente , Adulto , Anciano , Humanos , Internacionalidad , Masculino , Persona de Mediana Edad , Psicometría , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Adulto Joven
5.
BJU Int ; 111(4 Pt B): E213-9, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23107452

RESUMEN

OBJECTIVE: To report patient outcomes and satisfaction with our technique for penile length and girth restoration in severe Peyronie's disease (PD). PATIENTS AND METHODS: Between November 2006 and November 2011, 105 men with severe PD and erectile dysfunction (ED) underwent surgical correction using our new approach. The technique consists of penile prosthesis implantation with concomitant penile lengthening and girth restoration through circular and longitudinal incisions in the tunica albuginea according to geometric principles. RESULTS: The overall patient satisfaction rate was 89.4%. The mean (sd; range) functional penile length gain was 3.6 (0.7; 2-5) cm. Patient satisfaction with penile length gain was 95.2%. Three patients (2.9%) developed retraction with residual curvature of up to 30°, but no re-operation was necessary. In one (1%) patient, the prosthesis had to be removed because of wound infection. At a mean (sd; range) follow-up of 18.2 (5.9; 6-46) months, 104 patients (99%) were able to have sexual intercourse. CONCLUSIONS: Our surgical approach for penile length and girth restoration leads to high patient satisfaction rates and excellent functional outcomes. Our surgical approach is a safe and valid therapeutic method for the treatment of severe PD associated with ED.


Asunto(s)
Satisfacción del Paciente , Implantación de Pene/métodos , Induración Peniana/cirugía , Pene/patología , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Induración Peniana/patología , Induración Peniana/fisiopatología , Pene/cirugía , Estudios Retrospectivos , Resultado del Tratamiento
6.
J Sex Med ; 10(10): 2571-8, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23890082

RESUMEN

INTRODUCTION: The management of penile prosthesis protrusion and the implantation of a prosthesis in fibrotic penile corporal bodies represents a challenging task even for experienced surgeons. AIM: To demonstrate the long-term efficacy and safety of a new technique for distal shaft reconstruction and reinforcement in cases of penile prosthesis protrusion or cases of penile prosthesis implantation in corporal fibrosis. METHODS: Between August 2007 and August 2012, 69 patients underwent surgery for penile prosthesis protrusion (45 patients) or severe distal corporal fibrosis (24 patients). The mean age at the time of surgery was 56 years (range 38-69). All patients underwent distal shaft reconstruction using our technique, involving the creation of two neocorpora ("double windsocks"). MAIN OUTCOME MEASURES: Functional outcome and patient satisfaction were evaluated with item numbers 1 and 7 of the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire. Furthermore, clinical data concerning the early postoperative outcome were analyzed retrospectively. RESULTS: Mean follow-up time was 22.5 months (range 6-48). Based on answers to EDITS questionnaire item 1, 42 patients (60.9%) were very satisfied and 19 patients (27.5%) were somewhat satisfied with the outcome of the procedure. Furthermore, answers to the self-confidence domain question (EDITS item 7) revealed that 63 patients (91.3%) felt that the treatment had a positive effect with respect to their ability to engage in sexual activity. No patient exhibited device extrusion, postoperative infection, or skin dehiscence, and glans sensation as well as orgasmic ability were also preserved in all cases. Neuropraxia was reported in five cases (3.4%) immediately after the operation. The recovery of orgasmic ability was delayed in 17 (24.6%) patients. All patients were able to perform sexual intercourse postoperatively. CONCLUSION: The "double-windsocks" technique is an effective option for difficult cases of distal penile shaft reconstruction and reinforcement.


Asunto(s)
Implantación de Pene/instrumentación , Prótesis de Pene , Pene/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Coito , Fibrosis , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Implantación de Pene/efectos adversos , Pene/patología , Pene/fisiopatología , Falla de Prótesis , Procedimientos de Cirugía Plástica/efectos adversos , Recuperación de la Función , Reoperación , Estudios Retrospectivos , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento
7.
Int J Impot Res ; 35(4): 1-8, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33273716

RESUMEN

Since penile prostheses only provide axial rigidity, correction of penile deformity and enlargement of the visible penis during implant surgery may be desired. Evolving techniques of tunica expansion have made it possible to avoid grafting and preservation of the cylindrical appearance without bulges and indentations. After two decades of devising individualized solutions for patients and continuous enhancements of existing surgical solutions, Dr. Paulo Egydio has arrived at his Tunica Expansion Procedure (TEP). This strategy is his newest iteration of a lengthening techniques without grafting accompanied by penile prosthesis implantation. The TEP Strategy permits surgeons to use their own intuitive reasoning to determine the best pattern of multiple, small, staggered incisions to promote length and girth enlargement.


Asunto(s)
Enfermedades del Pene , Implantación de Pene , Induración Peniana , Prótesis de Pene , Masculino , Humanos , Induración Peniana/cirugía , Enfermedades del Pene/cirugía , Pene/cirugía , Implantación de Pene/métodos , Estética
8.
Asian J Androl ; 10(1): 158-66, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-18087656

RESUMEN

AIM: To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie's disease. METHODS: Recent advances in approaches to Peyronie's disease are discussed based on the literature and personal experiences. Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction (ED), and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the dissected neurovascular bundle. The mean age was 55.4 years (32-69 years) and the mean angle of curvature 74.2+/-22.4 degree (0-100 degree). Pericardial grafting was used to cover the defect. The mean follow-up time was 11.2 +/- 5.9 months (3-22 months). RESULTS: Mean functional penile length gain was 3.40+/-0.73 cm (2-5 cm). Penile prosthesis maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. CONCLUSION: Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis (length and rigidity). Length and girth restoration is very important for self-esteem and patient satisfaction.


Asunto(s)
Satisfacción del Paciente , Induración Peniana/cirugía , Pene/cirugía , Adulto , Anciano , Coito , Humanos , Masculino , Persona de Mediana Edad , Implantación de Pene/métodos , Induración Peniana/patología , Induración Peniana/fisiopatología , Pene/patología , Procedimientos de Cirugía Plástica/métodos
9.
Transl Androl Urol ; 5(3): 351-62, 2016 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-27298782

RESUMEN

Loss of penile length is a common complaint of men with Peyronie's disease (PD), both before and after corrective intervention, which has a significant negative effect on patient quality of life. We sought to identify and describe the methods by which penile length can be preserved or increased. We conducted an extensive, systematic literature review, based on a search of the PUBMED database for articles published between 1990 and 2015. Articles with the key words "Peyronie's disease", "penile length" and/or "penile lengthening" were reviewed if they contained subjective or objective penile length outcomes. Only English-language articles that were related to PD and penile size were included. We found no evidence in the literature that medical therapy alone increases penile length. Classic inflatable penile prosthesis (IPP) placement, plication procedures, and the Nesbit procedure appear likely to maintain or decrease penile length. Plaque incision (PI) and grafting appears likely to maintain or increase penile length, but is complicated by risk of post-operative erectile dysfunction (ED). There are several surgical procedures performed concomitantly with IPP placement that may be suitable treatment options for men with comorbid ED, and consistently increase penile length with otherwise good outcomes concerning sexual function. These include the subcoronal penile prosthesis (scIPP), Egydio circumferential technique, the sliding technique, the modified sliding technique (MoST), and the multiple slice technique (MuST). In addition, adjuvant therapies such as penile traction therapy (PTT), post-operative inflation protocols, suspensory ligament relaxation, lipectomy, and adjuvant medical therapy for glans engorgement appear to increase subjective and/or objective penile length for men at high risk of decreased penile length after PD surgery. Considering the psychological burden of length loss in men with PD, providers with adequate volume and expertise should attempt, if possible, to maintain or increase penile length for men undergoing surgical intervention. There are several evidence-based, safe, and effective ways to increase penile length for these men and multiple emerging adjuvant therapies that may help ensure adequate length.

10.
Arab J Urol ; 11(3): 294-8, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26558095

RESUMEN

INTRODUCTION: Corporal fibrosis usually occurs after explantation of an infected penile prosthesis, severe penile trauma, refractory low-flow priapism, Peyronie's disease, or the chronic intracavernous injection of vasoactive drugs. METHODS: We analysed current treatmentss for penile fibrosis. We searched PubMed using the keywords 'penile corporal fibrosis', 'treatment' and 'penile fibrosis', resulting in 63 matches, of which 19 articles met the inclusion criteria. RESULTS AND CONCLUSIONS: This review covers conservative medical therapy for corporal fibrosis and surgical therapeutic methods. The roles of phosphodiesterase- 5 inhibitors and pentoxifylline are analysed. Surgical therapy includes implantation of a penile prosthesis and corporal reconstruction, and these are reviewed. Corporal fibrosis is a major problem for patients, and is associated with severe erectile dysfunction. Conservative treatment options can be applicable in the early phase, but simultaneous corporal reconstruction procedures with concomitant implantation of a penile prosthesis should be attempted in severe cases of corporal fibrosis.

11.
Urology ; 83(1): 124-5; discussion 125, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-24238566
12.
Adv Urol ; : 205739, 2008.
Artículo en Inglés | MEDLINE | ID: mdl-19081785

RESUMEN

Peyronie's disease has been associated with penile shortening and some degree of erectile dysfunction. Surgical reconstruction should be based on giving a functional penis, that is, rectifying the penis with rigidity enough to make the sexual intercourse. The procedure should be discussed preoperatively in terms of length and girth reconstruction in order to improve patient satisfaction. The tunical reconstruction for maximum penile length and girth restoration should be based on the maximum length of the dissected neurovascular bundle possible and the application of geometrical principles to define the precise site and size of tunical incision and grafting procedure. As penile rectification and rigidity are required to achieve complete functional restoration of the penis and 20 to 54% of patients experience associated erectile dysfunction, penile straightening alone may not be enough to provide complete functional restoration. Therefore, phosphodiesterase inhibitors, self-injection, or penile prosthesis may need to be added in some cases.

13.
Urology ; 59(4): 570-4, 2002 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-11927316

RESUMEN

OBJECTIVES: To study the surgical treatment of Peyronie's disease using a single incision in the tunica albuginea and fibrotic plaque and repair of the defect by bovine pericardium graft. METHODS: Between April 1999 and May 2001, 33 patients who had had symptoms of Peyronie's disease for more than 12 months and whose disease had been stable for more than 6 months underwent surgery. The reason for surgery was deformity of the penis that made sexual intercourse, even with erection, difficult or impossible. Two paraurethral incisions were made in Buck's fascia to separate the neurovascular bundle from the tunica albuginea. An incomplete circumferential incision, forked at the extremities, was made in the tunica albuginea and in the plaque at the point of maximal curvature, followed by a septal incision for the lengthening of the short side of the penis. A bovine pericardium graft was used to repair the defect in the tunica. All procedures were performed by a single surgeon (P.H.E.). The average follow-up time was 19.4 months (range 5 to 30). RESULTS: No rejection or retraction of the graft was observed. All patients maintained their state of preoperative erection, with the penis corrected in 87.9% of cases and with discrete curvature (less than 15 degrees ) in 12.1%. All recovered their ability to penetrate with no difficulty. In addition, an intraoperative average increase of 2.21 cm (range 1 to 4) occurred in the size of the penis. CONCLUSIONS: This procedure is effective for all types of penile deformity, regardless of the plaque characteristics.


Asunto(s)
Materiales Biocompatibles/uso terapéutico , Induración Peniana/cirugía , Pene/cirugía , Pericardio/trasplante , Adulto , Anciano , Animales , Bovinos , Humanos , Masculino , Persona de Mediana Edad
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