25/01/2014 · Female Sex Organs: Vagina ..
Rhee reported the first small series of combined InVance™ sling (American Medical Systems) and penile prosthesis for concurrent treatment of ED and SUI using a two-incision technique (perineal and trans-scrotal). He reported 100% efficacy in continence rates with good restoration of erections with no adverse events in a mean follow-up duration of 15 months. Subsequently Gorbatiy et al. described the first series of combination surgery using InVance™ or Advance™ male sling (American Medical Systems) and IPP via a single perineal incision. They reported cost benefits and clinical outcomes in eight patients (three InVance and five Advance male sling) with mean follow-up of 13.6 months. All men had excellent post-operative Sexual Health Inventory for Men scores with significant decrease in pad use to mean of 1 pad. In addition, patients with dual implants were able to save US$9000 on average. One patient developed urinary retention requiring catheterization. No complications with erosion or infection were reported. Cornu et al. reported on their initial experience combination transobturator male sling and penile implant after radical prostatectomy in four patients (two synchronous and two sequential implants) with 100% continence and high satisfaction in sexual function. Christine et al. reported on their intermediate outcomes in their combination series with a two-incision technique and reported continence cure rate of 86% and a sexual function satisfaction of 89% at a mean of 22 months follow-up. The same author also further reported on an infection rate of 1.2% in their series of 78 men at mean of 16 months follow-up. The above studies demonstrate good safety and efficacy of dual synchronous implantation with short to intermediate term follow-up.
The cosmetic surgery for male sex organ is common now.
The pressure regulation balloon is placed retropubically through the designated external inguinal ring after puncturing transversalis fascia. The subdartos pocket is formed and AUS pump is inserted in dependent position on the ipsilateral hemiscrotum. All tubings are connected using the quick-connect system. At this point, the AUS is cycled and locked in the deactivated mode. The penile prosthesis is subsequently implanted as per routine and the reservoir is inserted in the contralateral retropubic space. The tubings are connected to the pump using quick connectors, which are placed in the left hemiscrotum and partially inflated following corporotomy closure. It is important to have tubings for each device compartmentalized separately to avoid cross over. In the event of previous inguinal mesh hernia repairs, a separate lower midline incision may be required to place both balloon reservoirs. A tight circumferential wrap with Kerlix gauze is used for additional hemostasis and prevention of hematoma formation.
Depending on institution referral patterns and available expertise, most patients are assessed independently for ED and SUI following failure of conservative management. The evaluation process consists of: (i) clinical history to elicit etiology (surgery, radiotherapy, multimodal therapy), duration of impairment, previous treatment regimes, previous abdominal or genitourinary surgery and comorbidities; (ii) genito-urinary examination for documentation of penile length, evidence of penile plaques, scrotal contents and evidence of inguinal hernia. Health of genital skin will be assessed and any evidence of skin-related infections warrants active treatment prior to prosthetic surgery; (iii) quantification of organ dysfunction severity with pad use and validated questionnaires such as the International Continence Society short form (men) and Sexual Health Inventory for Men score; and (iv) genito-urinary investigations including but not limited to a 3-day voiding diary, 24-h pad test, urodynamic study and flexible cystoscopy. Urodynamic testing is used to assess bladder stability, bladder compliance and sphincteric integrity/incompetence. ED work-up, if indicated, includes hormonal profile with testosterone and penile doppler study.