priapism, Peyronie's disease and phalloplasty

60 Pages·2014·45.16 MB·English

The 3 “p” of penile prosthesis 
surgery: priapism, Peyronie’s 
disease and phalloplasty
Giulio Garaffa
Consultant Urological Surgeon and Honorary Senior Lecturer in 
Urology
St Peter’s Andrology and the Institute of Urology
UCLH
Penile prostheses in priapism
• Acute episode
• Chronic  stage
Penile Prosthesis in Priapism
Early insertion Maintains penile length
Easy insertion
Treats the condition
Late Penile shortening
Difficult implantation
Management of acute Ischaemic 
priapism
• Penile duplex scan
– Aspiration
– Phenylephrine infusion (repeated)
– Cavernosal smooth muscle biopsy (GA)
Viable Necrotic
| |
Extensive washout Penile Prosthesis
in theatre
Penile prosthesis implant in acute priapism
• N = 50
• 13 had previous shunts
• Malleable 43, Inflatable 7
• 96% satisfaction
• 42 resumed sexual intercourse
• Biopsy – all necrotic
Ralph et al; Eur Urol. 2009 ;56(6):1033‐8
Time to implant insertion
10
8
S
T
N
E 6
I
T
A
P

F
O

R
4
E
B
M
U
N
2
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
TIME TO IMPLANT INSERTION (DAYS)

Complications and revision surgery
Type of procedure Number of patients
Salvage for infection 3
Elective exchange to inflatable 6
Revision for erosion 2
Cylinders too short 2
Autoinflation 1
Ralph et al; Eur Urol. 2009 ;56(6):1033‐8
End stage corporal fibrosis
Transverse Scrotal Incision
Rossello/ Moreville Dilators
Downsized prosthesis
Chordee/Shortening
Higher Infection Rate
Urethral/Corporal Injuries