The Evolution and Utility of the Small-Carrion Prosthesis, Its Impact, and Progression to the Modern-Day Malleable Penile Prosthesis.

INTRODUCTION: Erectile dysfunction has plagued humanity for millennia. For years, treatment had been in the hands of mental health professionals. It was not until the 1970s that urologists created a modality that was marketable, reproducible, and consistently successful at treating impotence, the Small-Carrion Penile Prosthesis. AIM: We present the evolution of the malleable/semi-rigid penile prosthesis, concentrating our efforts reviewing and critiquing the pivotal article published by Drs. Michael P. Small, Hernan M. Carrion, and Julian A. Gordon. We then discuss its continued advancement, current-day utilization, and the future of the malleable prosthesis. METHODS: From the early 1900s, surgeons have been toying with the idea of creating a penile implant. These initial attempts utilized rib cartilage, and eventually synthetic materials, including acrylic, silicone, and polyethylene. RESULTS: In 1975, Drs. Carrion and Small presented their initial experience of 31 patients utilizing their silicone implant. In their manuscript titled, "The Small-Carrion Penile Prosthesis: New Implant for the Management of Impotence," they discuss their technique, perioperative management of complications, and results. CONCLUSIONS: The malleable penile prosthesis continued to evolve throughout the years to the current day Genesis and Spectra. Although the current market is dominated by the inflatable penile prosthesis, there are specific situations where the malleable is ideally utilized. The pivotal article by Drs. Carrion and Small helped pave the way for the "New Era" of penile prosthetics and still remains one of the most impactful contributions to the management of erectile dysfunction.

[Salvage surgery of hydraulic penile prosthesis by modified Mulcahy protocol. Case report and literature review]. / Cirugía de rescate de extrusión de prótesis hidráulica de pene mediante protocolo de Mulcahy modificado. Revisión de la literatura a propósito de un caso.

The extrusion of a penile prosthesis is an indicator of infection and implies its removal, causing fibrosis and shortening of the penis. We present a 62-year-old man, to whom we implanted a hydraulic prosthesis, and three weeks later we underwent salvage surgery by extrusion of the activation pump. After removing the prosthesis, we wash the cavities with four dilutions. The 1st to 50% of hydrogen peroxide; the 2nd to 50% of povidone iodine; the 3rd with 1 g of cefazolin and 40 mg of tobramycin, the 4th with 80 mg of gentamicin and 500 mg of vancomycin. In the act we implanted a malleable prosthesis bathed in antibiotic solutions. The postoperative period was satisfactory. A year later, the patient presents an adequate penile length and aesthetic appearance, maintaining satisfactory sexual relations. Surgical rescue by washing with antiseptic solutions and a malleable prosthesis implant, minimizes the risk of reinfection, preserving sexual function.

Cirugía de rescate de extrusión de prótesis hidráulica de pene mediante protocolo de Mulcahy modificado. Revisión de la literatura a propósito de un caso / Salvage surgery of hydraulic penile prosthesis by modified Mulcahy protocol. Case report and literature review

La extrusión de una prótesis peneana es indicador de infección e implica su retirada, provocando fibrosis y acortamiento del pene.Presentamos el caso de un varón de 62 años, al que implantamos una prótesis hidráulica, y tres semanas después sometimos a cirugía de rescate por extrusión de la bomba de activación. Tras extraer la prótesis, lavamos las cavidades con cuatro diluciones. La primera al 50% de agua oxigenada; la segunda al 50% de povidona yodada; la tercera con 1 g de cefazolina y 40 mg de tobramicina, la cuarta con 80 mg de gentamicina y 500 mg de vancomicina. En el acto implantamos una prótesis maleable bañada en las soluciones antibióticas.El posoperatorio fue satisfactorio. Un año después, presenta una adecuada longitud peneana y aspecto estético, manteniendo relaciones sexuales satisfactorias.El rescate quirúrgico mediante el lavado con soluciones antisépticas e implante de prótesis maleable, minimiza el riesgo de reinfección, preservando la función sexual. (AU)

The extrusion of a penile prosthesis is an indicator of infection and implies its removal, causing fibrosis and shortening of the penis.We present a 62-year-old man, to whom we implanted a hydraulic prosthesis, and three weeks later we underwent salvage surgery by extrusion of the activation pump. After removing the prosthesis, we wash the cavities with four dilutions. The 1st to 50% of hydrogen peroxide; the 2nd to 50% of povidone iodine; the 3rd with 1 g of cefazolin and 40 mg of tobramycin, the 4th with 80 mg of gentamicin and 500 mg of vancomycin. In the act we implanted a malleable prosthesis bathed in antibiotic solutions.The postoperative period was satisfactory. A year later, the patient presents an adequate penile length and aesthetic appearance, maintaining satisfactory sexual relations.Surgical rescue by washing with antiseptic solutions and a malleable prosthesis implant, minimizes the risk of reinfection, preserving sexual function. (AU)