Deformidades peneanas: enfermedad de la Peyronie / Deformities of the penis: Peyronie´s disease

La enfermedad de la Peyronie es un endurecimiento de los cuerpos cavernosos del pene, que provoca incurvación y una serie de complicaciones en el paciente que van desde un intenso dolor a trastornos de la función sexual. Pese a ser una patología conocida desde la antigüedad, descrita por primera vez en 1704, la etiopatogenia sigue siendo desconocida. Como consecuencia del desconocimiento de la etiopatogenia sigue siendo desconocida. Como consecuencia del desconocimiento de la etiopatogenia de la enfermedad, los tratamientos van cambiando constantemente aunque no se ha demostrado hasta ahora la efectividad de un tratamiento específico (AU)

Ultrex cylinders: problems with uncontrolled lengthening (the S-shaped deformity).

PURPOSE: We investigated whether the AMS Ultrex cylinder, developed to provide cylinder lengthening while controlling girth expansion, acted as a tissue expander and, thus, promoted penile lengthening. MATERIALS AND METHODS: Between December 1990 and January 1992, 59 AMS Ultrex prostheses were implanted. Cylinder length corresponded to intracorporeal measurements. The results of lengthening and occurrence of an S-shaped deformity were statistically analyzed. RESULTS: No penile lengthening occurred. In 19 patients (32%) cylinder replacement was required for the S-shaped deformity. CONCLUSIONS: Ultrex cylinders should be downsized and prolonged inflation should be avoided. They should not be implanted in cases of Peyronie's disease, or to replace malleable or self-contained inflatable implants.

Penile prosthesis implantation in total phalloplasty.

A series is presented of 8 patients who had undergone either total phalloplasty or free flap penile reconstruction. Our experience with prosthetic implantation is reviewed as is a brief history of phallic construction, including previously reported efforts at achieving rigidity with prosthetic implantation, autologous material implantation and so forth. We present in detail our current technique of implantation in these 8 patients, who underwent 10 attempts at implantation. In 4 patients infection necessitated removal of the prosthesis (2 have since undergone successful reimplantation). Of the 8 patients in whom implantation was attempted 6 (60%) currently have prostheses in place.

Inflatable cavernosal body device: feasibility and acute safety study in the canine model.

OBJECTIVES: To determine the feasibility, safety, and acute mechanical reliability of a two-piece, implantable, inflatable cavernosal body compression device in the canine model. METHODS: Six large male dogs underwent implantation of an inflatable cavernosal compression device consisting of an inflatable cuff and a pump reservoir. The device was implanted around the corpora cavernosa excluding the corpus spongiosum near the crura. RESULTS: All devices were cycled three times a week for 2 months and radiographic evaluation found them to be mechanically reliable. Infusion cavernosometry with inflation of the device demonstrated greater than a 100% increase of intracorporeal pressure from baseline levels. Histologic assessment showed no adverse tissue effects on the penile tissue underlying the cuff or remote from the cuff in the penis and there was no development of distant thromboembolism. CONCLUSIONS: The results from this study will form the basis of long-term canine studies to investigate physiologic changes on the canine erection and chronic safety and reliability of the device.

Clinical experience with Mentor Alpha I inflatable penile prosthesis. Report on 333 cases.

Penile prostheses are a well-established form of therapy for erectile dysfunction. We report our experience with 333 cases using the Mentor Alpha I inflatable penile prosthesis. With a follow-up period of 15.4 months, there were 25 (7.5%) complications with 15 (4.5%) major complications that required reoperation. We also review the advantages and the procedures for implanting the penile prosthesis on an outpatient basis or a one-day hospital stay.

Intraluminal device pressures in 3-piece inflatable penile prostheses: the "pathophysiology" of mechanical malfunction.

The role of intraluminal device pressure in the development of mechanical failures in 3-piece inflatable penile prostheses was investigated in a 2-part study. An in vitro study was performed in which mean intraluminal device pressures were recorded in Mentor IPP, Mentor Alpha-1, AMS 700 CX and AMS Ultrex devices. At maximum inflated volumes mean intraluminal device pressures exceeded 600 and 1,000 mm. Hg at rest, and 850 and 1,300 mm. Hg following external loading in Mentor and AMS products, respectively. The AMS 700 CX was associated with the highest mean intraluminal device pressure, with values approaching 1,400 mm. Hg following external loading. A 4-year clinical review at our institution was performed comparing the mechanical malfunctions in 51, 3-piece implants with connectors between the pump and cylinders (AMS 700 CX) to the mechanical malfunctions of 50, 3-piece implants with pre-connected tubing between the pump and cylinders (Mentor Alpha-1). Fluid leaks were identified in 16% of the former and 4% of the latter devices. It is proposed that the high intraluminal device pressures are an important factor in the pathophysiology of the mechanical malfunctions in 3-piece inflatable penile prostheses and that connectors are considered components at risk for pressure-associated fluid leaks. The ideal penile prosthesis should maintain the superior rigidity and cosmetic features of the 3-piece inflatable penile prosthesis. However, the device should be pre-connected and designed to mimic more closely the anatomy of the human penis to achieve functional erections at lower intraluminal device pressure values.

Malleable penile prosthesis removal leaving behind the rear tip extenders: a clinical presentation.

Perineal pain and a foreign body in a scout abdominal X-ray are reported as presenting symptoms of a patient who later gave an anamnesis of a penile prosthesis implantation which had become infected and was removed. The foreign bodies turned out to be two rear tip extenders of the prosthesis left behind causing the perineal pain.

Osseous fixation of a penile prosthesis after transsexual phalloplasty: a case report.

We report on a patient who had undergone female-to-male transsexual surgery and subsequent phalloplasty by means of a free latissimus dorsi muscle graft with pudendal nerve coaptation elsewhere 10 years ago. The surgical strategy for implantation and osseous fixation of a penile prosthesis is described. We discuss whether the primary implantation of a penile prosthesis during 1-stage surgical phalloplasty is more advantageous in comparison with the currently favored secondary implantation. Phalloplasty should be represented by a 1-stage surgical procedure encompassing the creation of a neourethra, restoration of tactile and possibly erogenous sensibility, and implantation of a penile prosthesis. The result should have aesthetic value and be pleasing to the patient.