Organization of the operating room and specific instruments for the implant of penile prosthesis

After more than 1600 penile implant surgeries, we can affirm the need for a procedure protocol of the steps prior to this type of surgery, and the importance of carefully control the preparation for the surgical act. The instruments that must be available for surgery include elements that have been specifically designed for this type of intervention, such as the Cavernotomo dilators (Rossello®) or the Furlow. These are essential for penile implant surgeries in the usual practice, especially in complex cases or when complications arise. We should avoid complications as much as we can, or at least we should be able to minimize, address and resolve them with effective organization and adequate instruments. Undoubtedly, the surgeon's skills and experience are one of the key components for success, but the great importance of an adequately performed and rigorously applied protocol by all team members should not be underestimated. The objective of this article is to explain the basis of the details of this procedure in a clear and realistic way.

Angiomiolipoma renal gigante detectado por leve traumatismo lumbar y tratado por nefrectomía: presentación de un caso

A case of giant angiomyolipoma of the kidney discovered during the study of a light lumbar trauma is presented. Disseminated tuberous sclerosis lesions are demonstrated at the brain, cerebellum, liver and contralateral kidney. External cutaneous stigmas of this illness are shown at the face. The size of the viscera and the loss of function of the left kidney conditioned the nephrectomy. The piece weighed upon extracting 6300 g, without malignant signs. To the microscopic exam atrophic sclerosis for compression was demonstrated. The postoperative course was satisfactory. Actually his arterial tension is controlled by medical treatment.

[A new vacuum mechanism for the etiologic treatment of erectile dysfunction]

OBJECTIVES

To demonstrate the usefulness of the new, computerized and programmable electronic vacuum erection devices in the etiological treatment and prevention of erectile dysfunction.

METHODS

In erectile dysfunction due to incipient fibrosis of the penile vascular system, the programmable vacuum erection devices that achieve passive erection with low negative pressures, act as dilators of the corpus cavernosum arterial vascular system.

RESULTS

20 patients with grades I and II erectile dysfunction were treated with the new Vacuum Plus Tratamiento (VPT) with highly satisfactory results.

CONCLUSIONS

The results achieved with the new vacuum erection devices like the VPT show their efficacy in the etiological treatment, as well as prevention, of erectile dysfunction arising from fibrosis of the penile vascular system.

[Digital inflection rigidometry in the study of erectile dysfunction. A new technique]

OBJECTIVES

A device for reliable measurement of penile axial rigidity has been sought for some time. Three years of research have led to the development of the Digital Inflexion Rigidometer. The new technique and the results obtained are described herein.

METHOD

The Digital Inflexion Rigidometer was utilized in 150 patients that had consulted for erectile dysfunction of different etiologies.

RESULTS

In 60% of the cases, the Rigiscan recorded a circumferential rigidity of 60-70%; However, the Digital Inflexion Rigidometer showed penile axial rigidity to be insufficient for coitus. Fourteen cases with psychogenic erectile dysfunction had an axial rigidity greater than 600 gms, a difference of more than 300 gms in comparison with the recorded clinical postinjection rigidity. Home Digital Inflexion Rigidometry of 14 cases suspected of having venous leakage showed a difference of 300 to 500 gms between the first and second measurement (performed after taking 3 or 4 steps).

CONCLUSION

In our view, the Digital Inflexion Rigidometer is a useful diagnostic tool in erectile dysfunction which permits precise and painless measurement of the penile axial rigidity, relative intracavernosal pressure and penile temperature.

[Penile prosthesis. Indications, classification, technic, complications, and safety]

OBJECTIVES

To review the indications of penile prosthesis in the treatment of erectile dysfunction and describe a new classification based on the design and material of the prosthesis.

METHODS

Penile prosthesis are classified. The advantages and disadvantages of the different prosthesis types are given. The surgical technique is described, as well as the pre-, intra- and postoperative complications observed in 300 procedures involving penile prosthesis performed over a 10-year period.

RESULTS

6 of the 300 prosthesis required removal (4 of these 6 prosthesis were reimplanted); 17 prosthesis were changed due to implant failure.

CONCLUSIONS

Penile prostheses are the best solution currently available for erectile dysfunction not amenable to any other type of treatment and carry minimal complications if the technique is performed correctly.

[The rigidometer]

Fifty patients with erectile dysfunction were evaluated with the Rigidometro (CUASBA) penile rigidity monitor and the data were compared with those obtained with the erectometer device for nocturnal monitoring with the Ambulatory Rigidity Tumescence Monitor (ART 1000, Surgitex) penile rigidity monitoring following intracavernal injection of vasoactive agents. Similar results were observed. In our view, the Rigidometro (CUASBA) provides reliable information comparable with those provided by other monitoring devices. It gives very precise data on the quality of erection achieved. It is inexpensive and easy to-use. All the foregoing make it a useful tool in the diagnosis and evaluation of erectile dysfunction.

[Cavernotomy]

Corpus cavernosal dilatation in patients undergoing implantation of a penile prosthesis may occasionally be impossible to achieve with the Edgart dilator owing to sclerosis. For this reason, we have developed the cavernotome, a specially designed dilator that allows for easy dilatation of the corpus cavernosum. Its salient edges and grooves permit cutting through the sclerotic areas without difficulty. It is indispensable for placement of an anatomic penile prosthesis in these cases.