What is a Penis Prosthetic?

Penile prosthesis is an implantable artificial organ that can be implanted into the human body and is used to treat patients with penile erectile dysfunction (hereinafter referred to as ED).

Penile prosthesis is suitable for organic impotence such as trauma, pelvic surgery injury and genital nerve, blood vessels, loss of erectile function, and a small number of refractory functional impotence after comprehensive treatment fails.

Chinese name: Penile prosthesis
Foreign name: PenileProsthesis

Management category: Class III medical devices
Category Name: Implantable artificial organ

Development history of penile prosthesis

Surgical treatment of impotence began in the early part of this century, and Wooten (1902) first reported dorsal vein ligation of the penis. The first penile reconstruction was successful in 1936.

Penile prosthesis surgery was developed based on the experience of penile reconstruction, and mainly experienced the following processes:

1. Penile reconstruction of costal cartilage as a prosthesis. The first case of penile reconstruction was inspired by the presence of genital bones in animal penis, and then the success of the use of costal cartilage as a prosthetic implant in a reconstituted skin tube began, and the beginning of penile reconstruction and prosthetic implantation began. Since then, the development of prosthetic materials and the improvement of surgical techniques have continued to improve the prosthetic surgery.

2. Inert material prosthesis. The costal cartilage prosthesis lacks toughness, and has some shortcomings such as absorption, prompting the discovery of acrylic strips, polyethylene rods and other materials.

3. Modern penile prosthesis. The most primitive Small-Carrion prosthesis in the semi-rigid prosthesis was later improved by Finney and Jonas; the most primitive prosthesis in the swellable prosthesis was first introduced by Timm and later developed by Broadly and Scott. Then came many new penile prostheses. They are more clinically effective than previous prostheses. Penile prosthesis implantation has become one of the important methods for treating impotence patients ^[1] .

Penile prosthesis classification

Penile prostheses can be divided into two types: non-expandable and expandable. A three-piece inflatable prosthesis is commonly used in clinical practice. The three-piece inflatable prosthesis consists of a pair of cylinders, a water reservoir, and a pump. Figure 1.

Figure 1 Three-piece penis prosthesis

The choice of the prosthesis should be decided jointly by the doctor and the patient after the patient fully understands the characteristics, use methods and precautions of different prostheses. Generally, except for ED patients who have obvious contraindications, all ED patients who are going to undergo penile prosthesis implantation are recommended to use a three-piece inflatable prosthesis. After the patient implants a three-piece prosthesis, the penis looks close to physical weakness And erection state, at the same time has the characteristics of good concealment. Other prostheses are mainly used in specific patient groups, such as patients with severe peripheral neuropathy and paraplegia, and one-piece implants may be considered. Two-piece prostheses are generally used in patients who have difficulty or contraindications in the placement of water storage sacs, such as patients with occlusion of the posterior pubic space caused by radiotherapy or pelvic surgery, and patients with transplanted kidneys in the pelvis ^[2] .

Indications for penile prosthesis

Penile prosthesis is suitable for patients with organic ED or other ineffective ED patients, such as pelvic fractures, pelvic surgery, spinal cord injury, hypertension, hyperlipidemia, diabetes, and neurological diseases ^[2] .

Penile prosthetic complications

Infection and mechanical failure of the prosthesis are the main complications of penile prosthesis implantation. The incidence of mechanical failure and postoperative infection varies with the type of prosthesis.

1. Postoperative complications include mechanical perforation, rupture, shrinkage of the penis due to scar shrinkage, or reparative surgery due to infection, or even reimplantation after removal of the device.

2. Mechanical failures include spontaneous expansion of the cylinder, fracture of the prosthesis, expansion of the cylinder, tube distortion, leakage and pump failure, and insufficient expansion of the cylinder causes unsatisfactory penile hardness and affects sexual intercourse ^[3] .

Contraindications for penile prosthesis

1. The patient has acute or chronic organic encephalopathy, such as stroke, cerebral hemorrhage, subarachnoid hemorrhage, brain tumor, primary or secondary epilepsy, etc.

2. Serious medical diseases, such as patients with congestive heart failure, renal insufficiency, cirrhosis, abnormal liver function, endocrine system diseases, etc.

3. Patients with mental illness or severe mental depression. Those younger than 40-50 years old who have suspicious mental impotence or whose diagnosis is not clear.

4. People with severe marriage problems.

5. The patient suffers from infectious diseases, during the epidemic, such as tuberculosis active period, various types of hepatitis active period, and various epidemic diseases.

6. Uncontrolled diabetes, hyperthyroidism, and adrenal gland disease cause endocrine disease. Others, such as poor hand and eye coordination, unclear surgical motivation or high postoperative expectations, and severe personality disorders.

7. There are patients with blood diseases.

Penile prosthesis implantation method

Pressure perfusion

One is called hydraulic perfusion. The method is to take out the patient's penile cavernous body and implant it into two round tubes; then a pump is placed in the scrotum, and another large reservoir is placed in the pelvic cavity, which is filled with saline solution. When you need to have sex, squeeze the pump in the scrotum by hand to squeeze the salt solution in the sac into the two round tubes in the penis, so that the penis will erect; it can also be used when ending sex A pump in the scrotum pulls the saline solution out of the circular lumen, so that the penis becomes smaller.

Repair

The second method of implantation is called prosthesis. The surgery first removes the cavernous body of the penis, and then puts two hard and flexible rods into the cavity of the penis sea surface body. (Some doctors will choose the patient's own 12th rib. This is Because the 12 ribs of the human body are made entirely of cartilage, they have a certain degree of flexibility, and no rejection occurs), so that the penis can be in an upright or non-upright state.

Third

The third type of implantation is to use soft connected plastic blocks, wear them together with ropes, and implant them into the cavity of the penis sea surface body, so that the penis can bend and have a certain degree of hardness to help patients complete sexual intercourse.

Human Nursing for Penile Prostheses

Psychological Nursing: Due to penile erectile dysfunction, ED patients directly affect sexual life, suffer great psychological pain, feel depressed, and have low self-esteem. After being admitted to the hospital, the patient was eager to undergo surgery immediately, but did not understand the operation and the effect. She was worried that the penis would still fail to erect after the operation, and there were sequelae. In response to this psychological state of patients, medical staff teach patients about the disease, the performance and use of prostheses, and the conditions that may occur after surgery, so that patients can eliminate inferiority, depression, and fear, and help patients lose the shackles of traditional concepts. Active cooperation with surgery. Introduce the technical level and successful cases of the surgeon to the patient, so that the patient has confidence and courage in the operation. And communicate with their families and get support from their families, because the encouragement, understanding and support of their spouses are important spiritual pillars for patients' smooth recovery. A single room is arranged after the patient is admitted to the hospital to protect the patient's privacy and prepare for postoperative cross infection.

Postoperative care: (1) After the operation, wipe off the disinfectant and blood stains on the patient's skin with warm water, pay attention to keeping warm, and timely feedback the results of the operation to the patient to meet the patient's right to know. Use the 4-person transfer method to smoothly transfer the patient to the flat car and the bed, and the movement should be gentle. (2) Properly fix the urinary catheter and scrotal negative pressure drainage tube to prevent distortion, discounting and compression. Use a stent on the bed to support the cover to prevent the cover from being pressed or rubbed against the penis. At night, it is forbidden to accompany the wife to prevent or reduce the pain and bleeding caused by the penile erection at night; try to avoid visiting to reduce their psychological pressure; do to the patient Good explanation and comfort work. Introduce that most patients in the early stage of prosthesis implantation will have local discomfort, foreign body sensation, and pain in the squeeze pump; encourage patients to overcome difficulties, build confidence, cooperate actively, and eliminate bad emotions. (3) Health education for patients and spouses will be conducted by special persons to guide patients to use the prosthesis correctly after discharge. The prosthesis filling exercise will be performed once a day starting 2 weeks after the operation, each time to maintain the penis erection for 30 minutes. At the beginning, the erection hardness should be smaller, and gradually reach the ideal erection hardness, to prevent scar contracture caused by penile shortening and affect the surgical effect . Attempt to have sexual intercourse 5-6 weeks after surgery. Patients are instructed to pay attention to the intensity and specific operation of sexual intercourse, and do not forcefully pull the control pump located in the scrotum, so as to avoid rupture of the connecting tube and displacement of the water sac. (4) If there is a failure of the prosthesis in daily life, you should promptly seek treatment and follow up regularly at the hospital ^[4] .

Penile Prosthesis Extended Reading

[1] Liu Jihong, Xiao Hengjun. Penile prosthesis implantation [J]. Journal of Clinical Urology, 2004 (12): 705-707.

[2] Qu Xiaowei, Chen Huixing, He Yi, etc. Experience of re-implantation of domestic inflatable single cylindrical penile prosthesis (with a case report) [J]. Chinese Journal of Andrology, 2017, 31 (06) : 57-59.