Method prosthetic penis in total cavernous fibrosis

 

(57) Abstract:

The invention relates to medicine, in particular to surgery, and can be used for prosthetic penis in total cavernous fibrosis. The method includes the skeletization of the penis allowances access and implantation cylinder falloprotezy. First cut out of the vascular prosthesis according to the length of the penis, their ends are tightly sutured. Then the vascular prosthesis is fixed to the protein shell in their distal and proximal parts of the lateral sides of the cavernous phone Adrectal slit strip the vagina of the rectus abdominis muscle, open the aponeurosis and take medial portion of the muscle with the lower epigastric artery as a vascular pedicles, length and width sufficient for its rotation, and cover the penis in the form of the coupling. Plot muscles move under the skin of the penis through the subcutaneous channel and is fixed to the distal part of the penis on vascular prostheses. After 2-3 months implanted semi-rigid penile prosthesis in vascular prostheses. The method can reduce the number of cases periproctal infection and erosion of the skin over the implant.

The invention relates to the field of medicine,EBM cavernous fibrosis refers to the process of diffuse or focal replacement of normal cavernous tissue with fibrous full or partial loss of erectile function. Extreme cavernous fibrosis is called sclerosis or obliteration of the cavernous bodies. the Most common causes of cavernous fibrosis are priapism, intracavernous injections and complications endochironomus prosthetics. To the most severe forms of fibrosis causes priapism lasting more than 3 days, when in the cavernous tissue arise pockets aseptic necrosis, up to the total destruction of the smooth muscle elements. Also prognostically unfavorable bacterial inflammation of the cavernous tissue due prosthetic infection or primary cavernosae when there is purulent fusion of cavernous tissue with consequent formation of a connective tissue scar.

In the recent increase in the occurrence of cavernous fibrosis due to intracavernous injection, given the broad and not always justified application of the method of savinjski vasoactive drugs.

Currently there are no methods of conservative treatment, which could actually reduce the degree of the cavernous fibrosis. The main problems faced in such situations is the difficulty in dilatation of the intra who she is. This sometimes requires the use of prostheses of reduced diameter and length, up to the implantation of only one rod or cylinder. This raises difficulties in the symmetric setting dentures mainly in the apical part, which can lead to deformation of the penis.

Described a number of ways prosthetic penis with cavernous fibrosis.

One of them is the method of peripheral dilatation, which is of particular importance when represirovan when using it you can create intracavernous channel lies lateral to the previous Lodge implants [1].

The described method prosthetic penis with fibrosis of the cavernous bodies, including Bagirova in the usual way, or reconstruction of the cavernous bodies by their longitudinal dissection over 1 cm excision of the fibrous tissue in the proximal part of the corpus cavernosum with the formation of a channel in the proximal part, followed by immersion of the prosthesis and shelter synthetic mesh Gore-Tex [2].

Common disadvantages of these methods is not uncommon perforation of the urethra and frequent prosthetic infection.

The closest proposed method is a way through cavernomas or resection of scar-modified cavernous tissue of their area, depending on the severity of the cavernous fibrosis with subsequent implantation of a cylinder falloprotezov [3].

The disadvantages of the method are a large number of cases periproctal infection or erosion of the skin over the prosthesis due to impaired circulation, leading to the need to remove falloprotezy (reusing them is unacceptable), the inability to restore the original thickness of the penis.

The objective of the invention is a method prosthetic penis in total cavernous fibrosis, allowing to reduce the number of cases periproctal infection and erosion of the skin over the implant.

The problem is solved by the method lies in the fact that allowances access spend the skeletization of the penis, giving vascular prostheses according to the length of the penis, their ends are tightly sutured, and then the vascular prosthesis is fixed to the protein shell in their distal and proximal parts of the lateral sides of the corpora cavernosa, adrectal slit strip the vagina of the rectus abdominis muscle, open the aponeurosis and take medial portion of the muscle with the lower epigastric artery as a vascular pedicles, length and width sufficient to wrap the penis in the form of a clutch, then plot the muscles move under the skin of the penis through sostenibilitat semi-rigid penile prosthesis.

The proposed method prosthetic penis in total cavernous fibrosis using a fragment of the rectus abdominis muscle on the axial flow allows first of all to minimize postoperative complications associated with the development of periproctal infection, erosion of the skin over the prosthesis and its migration that leads to inflammation and graft rejection. This is due to the fact that the fibrous-modified cavernous body remain intact, and in the case of inflammatory etiology cavernous fibrosis (Cabernet) is not activated, hearth dormant infection. Soft tissue layer of a fragment of the rectus abdominis muscle prevents the formation of ulcers and erosion of the skin over the prosthesis. In addition, greater cosmetic effect (keeping the normal thickness).

Clinical case: Patient U. 37 years old, was admitted to the hospital in March 2001 with complaints about the lack of erections. From the anamnesis it is known that in 1999 after seminyaks vasoactive drug the patient has suffered priapism, which was not cropped. Subsequently he developed erectile dysfunction. In the clinic the patient underwent duplex ultrasound examination, that the characters total cavernous fibrosis. Biopsy of the cavernous bodies confirmed the diagnosis.

In the first stage, the patient was made of skeletization of the penis, then vascular prostheses were wykrywanie on the length of the penis and was fixed on the lateral sides of the cavernous bodies. Vascular prosthesis sutured with two sides. Then under the skin of the penis was transplanted fragment of the rectus abdominis muscle on the axial flow. Postoperative period was unremarkable. The patient was released to outpatient treatment.

After 2 months in the second stage the patient in vascular prostheses were implanted semi-rigid penile prosthesis. The postoperative period was uneventful; in the late postoperative period complications (migration of the prosthesis, erosion of the skin, signs of infection) was not recorded.

Thus was achieved satisfactory functional and cosmetic result.

Sources of information

1. Shalev P. A. Implant surgery of the penis. Methodical recommendations. Moscow: Moscow Department of urology, 1998.

2. Hinman F. Operative urology, S. 200.

3. Shalev P. A. Reconstructive and aesthetic surgery of the penis. The abstract of the Lena in total cavernous fibrosis, includes skeletization of the penis allowances access and implantation cylinder falloprotezy, characterized in that you are giving vascular prostheses according to the length of the penis, their ends are tightly sutured, and then the vascular prosthesis is fixed to the protein shell in their distal and proximal parts of the lateral sides of the corpora cavernosa, adrectal slit strip the vagina of the rectus abdominis muscle, open the aponeurosis and take medial portion of the muscle with the lower epigastric artery as a vascular leg length and width sufficient for its rotation, and cover the penis in the form of a clutch, then plot the muscles move under the skin of the penis through the subcutaneous channel and is fixed to the distal part of the penis on vascular prostheses, in 2-3 months implanted semi-rigid penile prosthesis in vascular prostheses.



 

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