The Immediate Insertion of a Penile Prosthesis for Acute Ischaemic Priapism
The Immediate Insertion of a Penile Prosthesis for Acute Ischaemic Priapism
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DOI：
10.1016/j.eururo.2008.09.044
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发表时间：
2009-12-01
期刊：
影响因子：
23.4
通讯作者：
Minhas, Sukbinder
中科院分区：
文献类型：
--
作者：
Ralph, David J.;Garaffa, Giulio;Minhas, Sukbinder
背景：缺血性异常勃起（IP）是传统医疗和手术干预难以治愈的，会导致海绵体平滑肌坏死。这些患13名患者的分流手术失败。所有患者都有海绵体平滑肌坏死的证据，因此在紧急情况下立即植入阴茎假体。测量：记录平均年龄、阴茎异常勃起持续时间（以小时为单位）、术中和术后并发症、手术结果和患者满意度。结果和局限性：43 名患者植入可延展阴茎假体，7 名患者植入三件式可膨胀植入物；随后，6 名患者选择性地将可延展性装置更换为充气装置。中位随访 15.7 个月（4-60 个月）后，42 名患者已经恢复成功的性交。 3 名患者（6%）发生假体感染，通过拔出和延迟重新插入进行处理。另外 6 名患者需要进行翻修手术。没有患者抱怨阴茎缩短，总体满意度为96%。结论：立即插入阴茎假体治疗急性难治性缺血性异常勃起是一种简单而成功的手术，可以治疗急性发作以及保留阴茎长度时不可避免的勃起功能障碍。 (C) 2008 年欧洲泌尿外科协会。由 Elsevier B.V 出版。保留所有权利。
Background: Ischaemic priapism (IP), which is refractory to conventional medical and surgical intervention, results in necrosis of the corpus cavernosum smooth muscle. These patients eventually develop a variable degree of corporal smooth muscle fibrosis that presents as erectile dysfunction and penile shortening.Objectives: To evaluate the long-term outcome of patients who have undergone the immediate insertion of a penile prosthesis as a treatment for an acute episode of IP refractory to medical therapy or shunt surgery.Design, setting, and participants: A total of 50 patients presented with prolonged IP that was unresponsive to conventional treatment. Unsuccessful shunt surgery had been performed in 13 patients. All patients had evidence of cavernosal smooth muscle necrosis and, therefore, underwent an immediate insertion of a penile prosthesis in the acute setting.Measurements: Mean age, duration of priapism in hours, intraoperative and postoperative complications, the surgical outcome, and patients' satisfaction were recorded.Results and limitations: A malleable penile prosthesis was inserted in 43 patients and a three-piece inflatable implant in was inserted in 7 patients; a subsequent elective exchange of a malleable to an inflatable device was performed in 6 patients.After a median follow-up of 15.7 mo (4-60 mo), 42 patients had already resumed successful sexual intercourse. Prosthesis infection occurred in three patients (6%), which was managed by explantation and delayed reinsertion.A further six patients needed revision surgery. No patient complained of penile shortening, and the overall satisfaction rate was 96%.Conclusions: The immediate insertion of a penile prosthesis for acute refractory ischaemic priapism is a simple and successful procedure that treats the acute episode as well as the inevitable erectile dysfunction that will occur with preservation of penile length. (C) 2008 European Association of Urology. Published by Elsevier B. V. All rights reserved.