Cavernous tissue sparing penile prosthesis implantation; a pilot Study
1: Cairo University, Egypt, Egypt
Objectives: Sparing cavernous tissue during penile prosthesis implantation to preserve residual erectile function.
Material and Methods: Ten patients had penile prosthesis implantation (PPI). Five patients were injected intraoperatively with 40µg alprostadil, a prostaglandin E1 agonist intracorporeal injection (ICI), and five patients had conventional surgery without prior intraoperative ICI. In the group receiving ICI, the procedure began as soon as maximal tumescence was obtained and mechanical corporeal dilation was seized one number short of the planned penile implant girth, allowing it to be tucked within the pharmacologically relaxed yet mechanically under-dilated corporal tissue. Cases were followed up one month postoperatively with penile duplex examination.
Results: In the post-ICI PPI group, penile duplex revealed the presence of a residual layer of vascularized cavernous tissue of 4.6 mm (±0.33) in thickness, surrounding the implant cylinders, in contrast to a thinner non-vascularized layer of 1.3 mm (±0.29) in patients who had undergone conventional surgery (P<0.002). Patients in the cavernous tissue sparing group, subjectively reported feeling a natural tumescence occurring during arousal even with the implant in place; and physical examination revealed a more naturally looking penis, unlike the thin, “pencil-like” look, often seen after conventional PPI.
Conclusion: Cavernous tissue sparing PPI, is a new technique that may allow patients to experience the occurrence of natural penile tumescence during arousal, even with the implant in place, while having a more aesthetically pleasing penis. The technique also facilitates corporeal dilation, even in cases demonstrating some degree of corporeal fibrosis, by inducing pharmacological cavernous smooth muscle relaxation prior to mechanical dilatation, making the implant procedure safer and less traumatic.
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