三件式人工陰莖植入物感染後使用單件式人工陰莖的臨床經驗

許耕榕^1,2、張奕凱³、闕士傑³

栩仕診所¹；尹書田醫療財團法人書田泌尿科眼科診所²；臺大醫院泌尿部³

Clinical experience with malleable penile implantation for salvaging inflatable implant infection

Geng-Long Hsu^1,2, Yi-Kai Chang³Jeff SC Chueh³

Microsurgical Potency Reconstruction and Research Center, Hsu’s Andrology,¹

Shu-Tien Urology Ophthalmology Clinic, Taipei, Taiwan²

Department of Urology, National Taiwan University Hospital, Taipei, Taiwan³

Purpose: Antibiotic irrigation for treating prostheses is commonly believed to be a proper administration for those whose penile implant contract with infection. However, there is no standard procedure for the irrigation period. As a result, we encounter patients whose sinusoids were ruined from irrigation attempts for over three months.   We sought to report an experience of salvaging with malleable penile implantation.

Materials and Methods: From 2010 to 2022, six patients requested salvage penile implantation for treating unsuccessful inflatable implantation elsewhere. They report repeated antibiotic rescuing and wound debridement from 50 to 121 days of hospitalization.  The diameter of the glans penis is measured and recorded in mm. Pelvic X-rays were made while the penis was downward and upward. One 44-year-old patient received no further salvaging penile implant because the corporeal sinusoid had too hardly coalesced to allow the contrast medium injection. The remaining five received malleable types of penile implants ambulatory under acupuncture-assisted local anesthesia.  In addition, the novel method of glans enhancement was performed unexceptionally. The approach was longitudinal pubic (n=3) and circumferential (n=2). The pain level was assessed on the acupoint needle location or penis property.  It was recorded on blood loss amount and operation times.  A 32 to 35 ligation was performed at the retrocoronal venous plexus, which is readily identified by glans milking manipulation. A 5cm coroporotomy was made along the 11 or 1 o'clock position of the corpora cavernosa.  To minimize the sinusoidal compression, corporal dilatation was made along the dorsal and medial directions distally and dorsolaterally proximally. Neither a Bovie nor suction apparatus was used because of minimal blood loss from manual compression. The water-tight suture was made to the tunic wound, closed continuously with 6-0 nylon with intermittent enhanced suture per centimeter. The overlying fascia layers and skin was finally closed with 6-zero chromic layer by layer. All patients received postoperative pelvic X-rays evidencing the appropriate housing of the cylinder. Sexual satisfaction was followed up yearly by INTERNET.

Results: The operation time was 2.5 to 4.5 hours, and the blood loss was negligible. The pain level was more substantial at the arm acupoint at 80% (4/5).  It was 11 to 61 months from the first and salvaging prosthesis implantation. The diameter of the glans increased from 26.0±2.3 mm to 35.3±2.2 mm. Four patients report couple satisfaction, whereas the remaining one feels male self-esteemed and female acceptable. All patients reported partial sinusoidal erection and no soft glans syndrome eventually.

Conclusion: A malleable penile prosthesis is viable for salvaging inflatable prosthesis infection.  An anatomy-based corporeal dilation seems a proper way to minimize sinusoidal compression. The glans girth enhancement was feasible.