Congresso dell’Associazione americana di Urologia (AUA-2017) è il più grande evento annuale in campo urologico e quest’anno si è svolto tra il 12 e il 16 maggio a Boston.

ABBIAMO RIPORTATO LA NOSTRA ESPERIENZA SULL’ANCORAGGIO AL GLANDE DI APICE PROTESI PENIENA IDRAULICA DOPO PSEUDO-ESTRUSIONE DISTALE

Boston (Massachusetts, USA), maggio 2017 – (www.aua2017.org)

Nella comunicazione vengono descritti i passaggi fondamentali della tecnica di ancoraggio della protesi peniena idraulica con un punto non riassorbibile al glande. Sono stati sottoposti a questa procedura chirurgica 53 pazienti con un tentativo di estrusione dell’apice protesico destro.

La tecnica descritta prevede i seguenti passaggi operatori: incisione longitudinale sub-glandulare ventrale destra di circa 3 cm. Incisione sub-glandulare destra a livello dell’apice protesico con bisturi elettrico per non danneggiare la protesi. Retrazione del cilindro protesico verso la porsione prossimale del pene. Con una forbice da uretere si apre la pseudocapsula fino sotto il glande e si ricrea lo spazio apicale. Si ancora al glande l’apice della protesi con un filo in prolene 3/0. Si effettua sul glande un’incisione a stella.

Si nasconde la sutura non riassorbibile suturando il glande con un punto in Vicryl 3/0. Assenza di complicanze nel decorso post-operatorio. I controlli a 6 e 12 mesi di distanza hanno evidenziato un corretto posizionamento e soddisfacente funzionamento dall’impianto protesico. Tale procedura è stata sviluppata per non effettuare degloving dell’asta e ricostruzione dell’apice cavernoso con manovre chirurgiche rischiose per la sensibilità e vascolarizzazione dell’asta e soprattutto per salvare l’impianto protesico ed evitare una estrusione con conseguente possibile infezione dello stesso.

Procedure e descrizione (in lingua inglese):

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Gabriele Antonini (Sapienza University of Rome)

“Distal Corporal Anchoring Stitch” a technique to address distal corporal crossovers and impending lateral extrusions of a penile prosthesis,

BACKGROUND
Unidentified distal crossovers, delayed distal crossovers and impending lateral extrusion are complications of penile prosthesis implant insertion but not as common as prosthesis infection or mechanical failure.
In almost al cases surgical repair is requie and can be carried out with or withous prosthesis explant.
These complications may cause pain and place the patient at high risk for erosion. Distal fiation of an IPP is a useful surgical adjunct to treating these patients.

AIM
We aim to evaluate results of a surgical technique that addresses fixation of penile prosthesis in patients with these complications. Herein we describe a distal corporal anchoring stitch in order to manage this problem.

METHODS 1

A lateral, longitudinal, and subcoronal incisin of 1 cm is utilized on the side where the crossed over or laterally extruding cylinder should be positioned.

In order to avoid prosthesis damage it is important to use cautery with needle point electrode.

METHODS 2

Dissection is carried through Buck’s fascia, follone by a transverse incision of the tunica albuginea where the distal aspect of the affected cylinder is delivered.
A 4-0 PDS suture is threaded through the distal cylinder ring of the implant after the original suture is removed.

The pseudo capsule incision is made with a cold steel scalpel both on proximal and distal aspect.

METHODS 3

A new intracorporal canne is created using scissors and Hegar dilators. Using a Keith needle and Furlow device, the 4-0 PDS is passed through the distal end of this channel.

METHODS 4

Once the suture is through the glans and the cylinder is in the correct position, a small cruciate incision is made on the glans, at the location of the anchor stitch. The suture s tied with the knot buried in the glans tissue.

This creates a fibrotic process that fixes the prosthesis to the glans.

METHODS 5

The cruciate incision is then closed with Dermabond.

The corporoplasty is closed in standard fashion and routine postoperative care is followed.

RESULTS 1

A total of 53 patients with a mean age of 61.3 years have undergone treatment of their distal penile implant crossover with a distal corporoplasty utilizing the “Distal Corporal Anchoring Stitch” technique (39 lateral extrusions, 9 unidentified crossovers and 5 delayed crossovers).

NO patients ha experienced any infections, wound healing defect, glandular hypoesthesia, anestesia, altered sensation or pain in the glans related to the suture and only two patients (3.8%) reported recurrence of a lateral herniation. None of the prostheses have requie replacement due to extrusion, mechanical failure or infection.

RESULTS 2

Mean IIEF-5 was 18.8 ± 3.4 and mean EDITS score was 79.1 ± 19.8. Stratifying cases by EDIT’s score (0-20: very unsatisfied, 21-40: moderately unsatisfied, 41-60: moderately satisfied, 61-80: very satisfied and 81-100: completely satisfied) we had 2 patients moderately unsatisfied, 8 moderately satisfied, 33 very satisfied and 10 completely satisfied.

CONCLUSIONS

The “Distal Corporal Anchoring Stitch” is a safe and effecive technique in securing distal fixation of the inflatable penile implant. Patients and partner satisfaction is high and intra and postoperative complications  are rare.

We believe that this is a feasible technique for experienced surgeons that can be applied in almost all cases of prosthesis lateral extrusions or crossovers.