單件式人工陰莖是否能永續使用?

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

Could a single implant in the corpus cavernosum be sustainable?

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: It is widely accepted that the intracorporeal cylinder should be maximally sized and inserted within the corpora cavernosa bilaterally. Given the penile prosthesis aiming to provide rigidity for engaging in intromission sex, would a single corporeal implant be sustainable? We sought to report an experience with a patient-orientated requirement.

Materials and Methods: From 2010 to 2022, 34 patients requested salvage penile implantation for treating previous unsatisfied surgery, including penile vascular surgery (n=16), prosthesis implantation (n=15), and prostatectomy (n=3) elsewhere. Pelvic X-ray film was performed in anterior-posterior view with downward and upward positions of the penile shaft. All received malleable types of penile implants on an ambulatory basis. In addition, the novel method of glans enhancement was performed unexceptionally. They are allocated into bilateral (n=28) and unilateral (n=6) groups by bilateral corporeal or unilateral insertion. The approach was longitudinal pubic (n=15), circumferential (n=11), and semi-circumferential (n=8) under acupuncture-assisted local anesthesia. The pain level was assessed on the acupoint-needle location or penis property. Then, a 5cm coroporotomy was made along the 11 or 1 o'clock position of the corpora cavernosa. Sparing the intracavernosal pillars, corporal dilatation was made along the dorsal and medial directions distally and dorsal-laterally proximally. Next, the water-tight suturing was made to the tunic wound, closed continuously with 6-0 nylon with intermittent enhanced per centimeter. The overlying fascia layers and skin was finally completed with 6-zero chromic layer by layer. Postoperative KUB was made immediately after the operation was done. Parameters were used for assessment, including the international index of erectile function (IIEF-5), conspicuously couple satisfaction index (CSI), and erection hardness scale (EHS) yearly by INTERNET.

Results: The operation time was 5.0±1.8 (2.0-7.0) hours, and the blood loss was 10.0±15.0 (5.0-50.0) mL. There was a significant difference (n=23, P＜0.01, 13.7±2.8 v.s 24.8±0.3) preoperatively and postoperatively. In addition, the diameter of the glans increased from 28.0±2.3 mm to 35.3±2.2 mm. Generally, the CSI reached 97.1 % (33/34); in the unilateral group, surprisingly, it was 100% (6/6), and the expansion of the fellow corpus was admired.

Conclusions: The prosthesis exact housing method appears to decline prosthesis extrusion, and glans enhancement is unexceptionally attainable. Unilateral corporeal implantation seems recommendable, although a larger sample size is required.