PENILE PROSTHESIS - HAPPINESS STICK
Surgical placement of a prosthesis in patients with erectile dysfunction (Impotence); It is a surgical treatment method performed on patients who do not respond to medications and other vascular surgeries or who are thought to fail to achieve results with these methods. Before surgery, penile color Doppler ultrasonography (with papaverine) must be performed to reveal arterial and venous vascular (vascular) blood flow problems and penile lesions that cause penile curvature and hard plaques, known as Peyronie's disease. In addition, hormonal profile and routine blood tests are required. Penile prostheses are a treatment method that should be considered as the last treatment option in patients with erectile dysfunction. These prostheses are materials made of silicone that are surgically placed into the penis. Following the placement of the penile prosthesis, the patient can have sexual contact whenever he wants and maintain intercourse as long as he wants, thus allowing both partners to have a satisfactory relationship. For a while, there may be a feeling of a foreign body in the penis and this new situation may seem strange, but over time, such problems disappear on their own. After the prosthesis is placed, the feeling of penile sensation, ejaculation and satisfaction continues as before. The role of the prosthesis in sexual intercourse is to provide the penis with a hardness and erection angle sufficient to facilitate intercourse.
Indications for Penile Prosthesis Implantation: Penile prosthesis operation not only provides the patient with a healthy sexual life, but also improves the quality of life, improves the psycho-social situation and family health. It is also required for. Penile prosthesis placement surgery can be considered in patients of almost all age groups who have not benefited from oral medications (PDE5 inhibitors, etc.), vasoactive drug injections into the penis, some surgical procedures or auxiliary devices such as vacuum pumps due to erection problems. Direct penile prosthesis placement may be recommended to patients who are determined not to benefit from all these applications. However, if there is Peyronie's disease, which causes long-term and serious erection problems, such patients also have penis prosthesis may be recommended. In addition, penile prosthesis is indicated for patients with spinal cord injury and erectile dysfunction after radical prostatectomy (performed for prostate cancer) or radical cystectomy (for bladder cancer). There is no possibility of returning to one's former natural state after this surgery; it is an irreversible procedure. Therefore, when deciding on a prosthesis, this situation should be explained to the patient in all its dimensions, a consent form should be signed, and if necessary, support or approval should be obtained from psychiatry.
Types of Penile Prosthesis: Basically; There are two types of penile prostheses: one is a one-piece device consisting of silicone-coated metal that remains rigid and can be bent and bent, and the other is a two- or three-piece device made only of silicone that can be inflated and deflated when necessary.
One-piece prostheses (Mallable): This type of penile prostheses are devices made of flexible metal covered with silicone that are placed inside the penis. Thanks to this relatively bendable rod, the patient can have sexual intercourse normally and then During the day, he can twist it and store it in his underwear. However, even though these types of prostheses are flexible, they may cause physical and psychosocial discomfort in patients.
Three-piece prostheses: This type of prosthesis is a silicone device consisting of two inflatable cylinders, a pump unit and a reservoir. By surgery, the cylinders are placed inside the penis, the controllable pump-unit button is placed in the scrotum (next to the testicle), and the reservoir is placed in the abdominal cavity. In this way, no part of the prosthesis remains outside. When the patient wants to have an erection, he/she squeezes the pump hidden in the rim of the testicle and allows the fluid in the reservoir placed in the abdominal cavity to pass into the cylinders, thus providing sufficient erection for sexual intercourse. After the process is completed, the fluid in the cylinders is taken back to the reservoir by pressing the pump button again and the penis is returned to its soft natural state.
Two-piece prostheses: Unlike the three-piece prosthesis, the amount of fluid in the reservoir is low, there is no need for a separate reservoir, the control button also serves as a reservoir. In this type of prosthesis, there is limited space to store fluid. Therefore, some amount of fluid remains in the system and the penis does not relax completely, although not as much as in one-piece, the penis remains slightly hard. The difference between the penis's descended state and full erection decreases.
Complications of the surgery: The operating time for penile prosthesis placement is 1-1.5 hours, depending on the type of prosthesis (one-piece is shorter), in the hospital. The stay is generally 1-2 days. Some complications can be seen at certain rates during surgery and in the postoperative period. Among these:
1-During the penis prosthesis placement surgery, there may be tears and punctures between the two cylindrical structures in the penis. In this case, the repair is made and the procedure is continued.
2-Although rare, bleeding, pain and wound healing problems, edema in the scrotum (bags), bruises in the genital area due to subcutaneous bleeding, which disappear on their own over time.
3- Urinary tract injuries may occur during prosthesis placement and some intra-abdominal injuries and bleeding may occur during intra-abdominal reservoir placement. A urinary catheter is inserted into the urinary tract injuries and kept for a while. If the injury is large, prosthesis placement is postponed to a later date. Again, after regional (from the waist down) anesthesia, a problem such as temporary inability to urinate may be experienced. In such a case, a urinary catheter is placed and monitored for a few days. In addition, a one-piece prosthesis placed in patients who have difficulty urinating or prostate enlargement and who are considering prostate surgery in the future may make the surgery difficult or may not allow closed surgery. Prosthetics should be preferred.
4-The most important complication of these surgeries is infections. Starting 1-2 days before the surgery, the genital area is cleaned and the surgery area is washed with antiseptics. Again, prophylactic comprehensive antibiotics are started a few days before the surgery and continued for 5 days to a week after the surgery. Despite all this, the infection rate in prostheses is around 1-10%, and even if antibiotic-impregnated prostheses are used, the infection rate drops to zero. cannot be downloaded. The risk of infection is higher in diabetic patients and patients with spinal cord injuries. In case of infection, the prosthesis is removed immediately and antibiotics are started again and 3-6 months are waited for a new prosthesis to be placed. Without waiting, the cylindrical structures of the penis can be washed thoroughly with antibiotic liquids and inserted in the same session, but this is not a preferred method.
TESTICULAR PROSTHESES
Testicular prosthesis implantation surgery; It is a surgical procedure performed to aesthetically eliminate the physical deficiency and the psychological trauma caused by testicular deprivation in patients who have lost their testicles or had to have them surgically removed due to any reason (undescended testicle, testicular cancer, testicular torsion, traumas, etc.). This procedure is planned depending on the patient's wishes. Under local or general anesthesia, the prosthesis is properly placed in the missing scrotum; this prosthesis does not have any functional function.
Indications:The testicular prosthesis has no function other than eliminating physical and aesthetic concerns, and is made entirely in line with the patient's wishes. Testicular prosthesis application in children is still debated because the scrotum has not fully developed and the prosthesis to be placed remains smaller than the normal testicle over time, causing psychological distress. The clinical situations in which testicular prosthesis is frequently used are as follows:
1- Most commonly, the testicle has to be removed during surgery due to undescended testicle or in case of congenital absence of the testicle.
2- It may occur during varicocele or inguinal hernia surgery. In case of testicular losses
3-In testicular losses due to testicular torsion
4-Patients whose testicles were removed due to testicular cancer
5-Patients whose testicles were removed due to prostate cancer
Prosthesis Types and Application: As stated above testicular prosthesis placement; It is a surgical procedure performed with the aim of aesthetically relieving the deprivation caused by the loss or congenital absence of the testicle(s).
Testicular prosthesis surgery: Testicular prosthesis placement surgery, general, It is performed under spinal or epidural line local anesthesia, with open surgery, through an incision made in the groin, and the testicular prosthesis is fixed to the prepared slot in the scotum (bag). There may be swelling and tenderness due to edema for a while after the surgery. The patient can return to work within a week. It is necessary to consult a physician in case of excessive swelling, tenderness, possible pain in the surgery area, high fever, chills and shivering.
Complications of testicular prosthesis placement: Early and late complications that may occur in this type of surgery are seen, although rare. Denture allergy or rejection is a rare condition. In fact, over time, the prosthesis may become hardened and thickened as a result of the formation of fibrosis tissue around the prosthesis due to the body's excessive reaction against it. Foreign body perception may be felt after surgery, but this situation is not insurmountable over time. Some other complications are as follows:
1- Calcium and fluid accumulation in the prosthesis: Calcification may occur in testicular prostheses after many years due to calcium accumulation, but there is no need to do anything. Additionally, there may be fluid accumulation around the prosthesis, in this case, with a small intervention. This fluid is drained.
2- Perforation or collapse of the prosthesis: It may develop due to injury while placing the prosthesis during surgery or physical trauma after surgery.
3- Pain and Sensitivity: It can be seen after surgery, usually over time. It will go away on its own, if not, a physician should be consulted.
4- Displacement of the prosthesis: Displacement of the prosthesis by leaving the fixed area may be due to the prosthesis not being properly fixed to the scrotal socket or the development of necrosis due to disruption of circulation as a result of the pressure of the prosthesis on the skin. In this case, the patient may need re-intervention.
7- Bleeding: Bleeding and homatom (blood collection) may occur in the early period following the placement of the prosthesis; if noticed, re-intervention may be required.
8- Infection: Infection of the prosthesis. It is a serious complication that requires removal and may occur in the early and late stages of surgery. Antibiotic pressure starting a few days before the surgery is a routine practice. As with the penile prosthesis, it is necessary to pay attention to care and cleanliness during the surgery and in the early post-operative period.
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