Method prosthetic penis in total cavernous fibrosis
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 .
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 .
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 .
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.
SUBSTANCE: method involves applying one or two parallel through draining tubes having lateral perforations. Flow lavage of the retroperitoneal space with antiseptic solutions is carried out via the perforations at room temperature and cooled solutions are administered concurrently with vacuum suction. Omental bursa is concurrently drained using the two parallel through draining tubes. Flow lavage of the omental bursa is carried out using these tubes.
EFFECT: enhanced effectiveness of treatment in healing pyo-inflammation foci.
5 cl, 1 dwg
SUBSTANCE: method involves carrying out left-side laparophrenotomy. Esophagus and stomach stump extirpation is carried out. Large intestine is conducted in the posterior mediastinum. Distal end-to-end anastomosis of transplant and the duodenum is created using atraumatic sutures.
EFFECT: enhanced effectiveness of plastic repair in the cases of resected stomach cancer.
SUBSTANCE: method involves carrying out hernia removal in intralaminar way. Posterior longitudinal ligament defect is covered with Tacho-Comb plate after having done disk cavity curettage. Subcutaneous fat fragment on feeding pedicle is brought to dorsal surface of radix and dural sac.
EFFECT: enhanced effectiveness of treatment; reduced risk of traumatic complications.
FIELD: medical engineering.
SUBSTANCE: device has thread knitted into fabric. Fabric for tamponing wound and removing it by pulling the thread is connected to internal film surface with collagen gel. The film overlaps fabric area and has opening equal to two-lumen draining tube canal connected to external film surface and having one canal longer than the other one. Distal end of the shorter canal is connected to opening in the film and distal end of the longer one is brought outside of its boundary. Proximal ends are connectable to vacuum receiver. Fabric thread is brought to the shorter canal from the internal wall and fixed on the external shorter canal wall.
EFFECT: reliability in stopping hemorrhages and retaining patient mobility.
SUBSTANCE: method involves applying sling urethropexy. Pneumoextraperitoneum is created by means of trocar introduced under the pubis. Then, longitudinal perineotomy and paraurethral tissue dissection is carried out to the right and to the left towards the descending branches of pubic bones to pelvic fascia. The urethra is moved to its left. TVT needle is introduced under descending branch of pubic bone to the right of the urethra. The pelvic fascia is perforated in away that needle tip enters retropubic space laterally with respect to the prostate and in front of the urinary bladder. The needle is brought along the posterior pubic bone surface and exits via abdominal wall outside pulling one end of polypropylene ribbon. The like manipulations are accomplished at the left side to form a loop around the urethra tightly adjacent to bulbocavernous muscles. Final ribbon fixation is carried out after having eliminated the pneumoextraperitoneum and having removed the trocar.
EFFECT: simplified operation; avoided intra- and postoperative complications and recidivation.
SUBSTANCE: method involves evaginating duodenum stump with polypotomy loop into organ wall followed by electric surgical excision.
EFFECT: stable hemostasis; provided aseptic conditions in sealing the stump.
3 dwg 1 tbl
SUBSTANCE: method involves carrying out rein performing pancreaticoduodenal resection. Cholecystoenteroanastomosis is built. Anastomosis application takes place between the right hepatic duct and gallbladder neck near its flexure.
EFFECT: prevented biliary hypertension.
FIELD: medicine, surgery.
SUBSTANCE: one should perform incisions of parietal peritoneum by leaving 2 cm against inferior and superior edges of patient's pancreas being of 1.5 cm length to apply them in checkered order for the purpose to prevent vascular lesion.
EFFECT: higher efficiency of decompression.
FIELD: medicine, surgery.
SUBSTANCE: the method is applied for the purpose to correct combined deformations of external nose due to oral-vestibular operative access. The method deals with dissecting mucosal membrane and periosteum in oral vestibule followed by separating soft tissues of the upper lip. Then one should perform internal incision along the edge of alar cartilages to connect two incisions together. Then comes final tissue separation at subsequent correction of the shape, size of external nose structures and its septum. The method enables to achieve wide access to all the structures of external nose and provide optimal cosmetic result.
EFFECT: higher efficiency of correction.
FIELD: medicine, urology.
SUBSTANCE: the present innovation deals with affecting the sclera and applying deformation-correcting sutures at the background of medicinal erection. Along lateral surfaces of cavernous bodies symmetrically from both sides one should make incisions of scleral surface layer. Then comes manual derotation, moreover, at the side of derotation incision's lower edge should be shifted downwards and backwards, its upper edge - upwards and to the front, and at contralateral side the lower edge is shifted downwards and to the front, and the upper edge - upwards and backwards. After manual penile derotation one should apply sutures onto the edges of dissected scleral layer in incision area by shifting needle's puncture out towards the side being opposite to shift direction of the lower edge against incision's perpendicular axis. The quantity of incisions should be calculated by the following formula: Q = N/n, where Q - the desired quantity of incisions, N - the angle of total initial rotation, n - the angle of derotation achieved after applying sutures onto the first pair of incisions. The method enables to decrease the risk for development of either new or residual penile deformation in postoperational period.
EFFECT: higher efficiency of correction.
3 dwg, 1 ex