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Prosthesis Implantation (prosthesis + implantation)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Prosthesis Implantation

  • penile prosthesis implantation
    		•

    Selected Abstracts

    ORIGINAL RESEARCH,SURGERY: Penile Prosthesis Implantation in Cases of Fibrosis: Ultrasound-Guided Cavernotomy and Sheathed Trochar Excavation

    THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2007
    Osama Shaeer MD
    ABSTRACT Introduction., Implantation of a penile prosthesis into fibrosed corpora cavernosa is a difficult and risky procedure. Specialized instruments that assist safer and more efficient excavation include Otis Urethrotome and various cavernotomes, all of which operate underneath the tunica albuginea, out of sight. The blind use of such instruments can result in perforation of the tunica albuginea or injury to the urethra. Aim., This work describes the utility of ultrasonography for adding visual monitoring to any of the above-mentioned instruments, maintaining them in the mid-corpus cavernosum position to avoid perforation, and describes the application of alternative sheathed, sharp instruments that allow fast, efficient, and visually monitored drilling into fibrous tissue. Main Outcome Measures., Clinical outcome data were examined. Methods., Surgery was performed on five cases with extensive fibrosis of the penis. Initial blunt dilatation by Hegar dilators faced considerable resistance. An ultrasound probe was applied to the ventral aspect of the penis. A laparoscopy sheath was advanced under ultrasound guidance up to the fibrous tissue. A sharp laparoscopy trochar was inserted through the sheath. Its tip was oriented in the mid-corpus cavernosum by longitudinal and transverse sonography sections, as it drilled into the fibrous tissue. Laparoscopy scissors were used in the same fashion to cut fibrous tissue lumps. After full excavation, penile prosthesis was implanted. Results., All implants survived adequately. No complications occurred following implantation. Operative time ranged from 50 to 60 minutes. No difficulty was encountered at excavation. Conclusion., Ultrasound guidance can be a handy adjunct to any of the available techniques developed for excavating the fibrosed corpora cavernosa, with a possible decrease in difficulty and complication rate of the procedure. Utility of sheathed, sharp instruments guided by sonography is an alternative to the cavernotomes, allowing fast and efficient drilling into fibrous tissue. Shaeer O. Penile prosthesis implantation in cases of fibrosis: Ultrasound-guided cavernotomy and sheathed trochar excavation. J Sex Med 2007;4:809,814. [source]

    Usefulness of a malleable penile prosthesis in patients with a spinal cord injury

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2008
    Young Dong Kim
    Objectives: The usefulness of a malleable penile prosthesis was evaluated in patients with spinal cord injury (SCI) by investigating the complications and the patients' satisfaction. Methods: A total of 48 patients with a SCI, who underwent malleable penile prosthesis (AMS 600) insertion from 1990 to 2004 were evaluated by reviewing the patients' medical records and interviewing them via questionnaires. The mean patients age was 58.9 years, and the mean follow-up period was 11.7 years. In 23 patients, penile prosthesis implantation was carried out to improve urinary management and to treat erectile dysfunction (ED). Results: Complications occurred in eight patients (16.7%). Wound infections in four (8.3%). Two patients were treated with conservative management, and two were managed through prostheses removal. Other complications were erosion in two patients (4.2%), uncontrolled penile pain owing to excessive prosthesis length in one patient (2.1%), and supersonic transporter (SST) deformity in one patient (2.1%). The overall patient satisfaction rate was 79.2%. The dissatisfaction was mainly due to the complications that resulted in the removal of the prosthesis, or partner's unnatural sensation. All of the prostheses that were implanted in the patients for the improvement of their urinary management gave them the benefit of convenient urinary management, except for two patients, whose prostheses were removed. Conclusions: The insertion of malleable penile prostheses in patients with SCI is associated with low complication rates and good patient satisfaction. It is therefore still an attractive option. [source]

    ORIGINAL RESEARCH,SURGERY: Penile Prosthesis Implantation in Cases of Fibrosis: Ultrasound-Guided Cavernotomy and Sheathed Trochar Excavation

    THE JOURNAL OF SEXUAL MEDICINE, Issue 3 2007
    Osama Shaeer MD
    ABSTRACT Introduction., Implantation of a penile prosthesis into fibrosed corpora cavernosa is a difficult and risky procedure. Specialized instruments that assist safer and more efficient excavation include Otis Urethrotome and various cavernotomes, all of which operate underneath the tunica albuginea, out of sight. The blind use of such instruments can result in perforation of the tunica albuginea or injury to the urethra. Aim., This work describes the utility of ultrasonography for adding visual monitoring to any of the above-mentioned instruments, maintaining them in the mid-corpus cavernosum position to avoid perforation, and describes the application of alternative sheathed, sharp instruments that allow fast, efficient, and visually monitored drilling into fibrous tissue. Main Outcome Measures., Clinical outcome data were examined. Methods., Surgery was performed on five cases with extensive fibrosis of the penis. Initial blunt dilatation by Hegar dilators faced considerable resistance. An ultrasound probe was applied to the ventral aspect of the penis. A laparoscopy sheath was advanced under ultrasound guidance up to the fibrous tissue. A sharp laparoscopy trochar was inserted through the sheath. Its tip was oriented in the mid-corpus cavernosum by longitudinal and transverse sonography sections, as it drilled into the fibrous tissue. Laparoscopy scissors were used in the same fashion to cut fibrous tissue lumps. After full excavation, penile prosthesis was implanted. Results., All implants survived adequately. No complications occurred following implantation. Operative time ranged from 50 to 60 minutes. No difficulty was encountered at excavation. Conclusion., Ultrasound guidance can be a handy adjunct to any of the available techniques developed for excavating the fibrosed corpora cavernosa, with a possible decrease in difficulty and complication rate of the procedure. Utility of sheathed, sharp instruments guided by sonography is an alternative to the cavernotomes, allowing fast and efficient drilling into fibrous tissue. Shaeer O. Penile prosthesis implantation in cases of fibrosis: Ultrasound-guided cavernotomy and sheathed trochar excavation. J Sex Med 2007;4:809,814. [source]

    Vascular closure staples reduce intimal hyperplasia in prosthesis implantation

    ANZ JOURNAL OF SURGERY, Issue 12 2002
    Wayne J. Hawthorne
    Background: Vascular surgery, like the various other surgical specialities, has seen an increasing demand toward faster and more minimally invasive procedures. One such need is to create a reliable vascular anastomosis that is faster, easier and less damaging to the tissue. The vascular closure staples (VCS*) device provides such characteristics but, to date, no studies have investigated its effectiveness in reducing intimal hyperplasia when used for vascular prosthesis implantation. The present study evaluated its effectiveness compared with suturing of a graft in vascular prosthesis implantation. Methods: Twelve female Merino sheep underwent gelatin sealed Dacron patch graft implantation into the left and right common carotid artery. Grafts were randomly allocated so that one carotid artery and graft was anastomosed using sutures and the other with VCS*. The two techniques were compared for operation time, clip/suture numbers and blood loss during the implantation procedure. After a 4-week period, the sheep were killed and the grafts were harvested for intimal hyperplasia (IH) assessment. Results: There was a significant reduction in the amount of IH seen in the VCS* group (mean ± SD: 0.278 ± 0.079 mm2/mm) when compared with the sutured group (0.575 ± 0.331 mm2/mm) (P < 0.05). There was also significant reduction in anastomosis time (mean ± SD: 14 ± 4.4 min) and fewer points of contact (23 ± 1.4) using the VCS* compared with suturing (22 ± 3.2 min, P < 0.01; 27 ± 3.3, P < 0.05, respectively). Conclusions: In this model, the VCS* shows several distinct advantages over suturing with significant time saving at operation and, most importantly, the reduction of IH seen at 1 month. [source]

    Should being aged over 70 years hinder penile prosthesis implantation?

    BJU INTERNATIONAL, Issue 6 2009
    Amr Al-Najar
    OBJECTIVE To assess the satisfaction profiles following penile prosthesis surgery in patients with erectile dysfunction (ED) in their seventh decade of life. PATIENTS AND METHODS In all, 174 patients received, for the first time, a penile prosthesis between 1990 and 2007 in our department. Among these, 35 patients were aged ,70 years at prosthesis implantation. Of these, 18 patients were still alive at the time of follow-up. Using a telephone survey, patients were asked to answer the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) as well as the International Index of Erectile Dysfunction (IIEF). Another question in the survey was developed by the authors based on a comprehensive review of the literature, which assessed the usefulness of the device for the patient and the degree of their usage. This was formulated as follows: How many times per 2 weeks do you have a sexual intercourse? RESULTS In all, 15 of 18 patients were either very or somewhat satisfied (83%). At follow-up 11 out of 15 (73%) patients were using their prosthesis regularly. The mean IIEF and EDITS scores were 21.80 and 75.20, respectively. CONCLUSION A penile prosthesis remains a highly promising treatment in older patients with a similar satisfaction rate to those published for younger patients. Thus, the motivation of the patient and not the age of the patient should be the main determinant factor in this surgical procedure. [source]

    First percutaneous transcatheter aortic valve-in-valve implant with three year follow-up

    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2008
    Carlos E. Ruiz MD, FSCAI
    Abstract Objectives: This study was conducted to report the clinical, hemodynamic, and iconographic outcomes of the longest survivor of the global CoreValve experience. Background: Early results of percutaneous heart valve (PHV) implantation for severe symptomatic aortic stenosis (AS) have been encouraging, with mid term survival up to 2 years; however longer durability term is unknown. Although a PHV has been implanted in a degenerated surgical bioprosthesis, the feasibility of a PHV-in-PHV has not been demonstrated. Methods: A patient with severe refractory heart failure due to severe aortic regurgitation (AR) and moderate AS, underwent CoreValve prosthesis implantation. The PHV was deployed too proximal into the left ventricular outflow tract, resulting in severe AR through the frame struts. Using the first PHV as a landmark, a second CoreValve was then deployed slightly distal to the first, with trivial residual paravalvular leak. Results: The second CoreValve expanded well with proper function. Transvalvular gradient was 8 mmHg. Both coronary ostia were patent. New mild to moderate mitral regurgitation occurred due to impingement of the anterior mitral leaflet by the first PHV. NYHA functional class improved from IV to II, maintained over the past 3 years. Echocardiography at 3 years showed normal functioning CoreValve-in-CoreValve prostheses, without AR or paravalvular leaks. Transvalvular gradient was 10 mmHg. Cardiac CT showed stable valve-in-valve protheses with no migration. Conclusion: The CoreValve prosthesis has maintained proper function up to 3 years, with no structural deterioration or migration. Treating mixed aortic valve disease with predominant AR is feasible. The concept as well as durability of the first PHV-in-PHV has also been demonstrated. © 2008 Wiley-Liss, Inc. [source]

    Prevention of urethral stricture in insertion of an inflatable penile prosthesis

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 2 2008
    Sung Won Lee
    Objective: The aim of this study was to find the mechanism that causes urethral stricture with a view to preventing its occurrence after implantation of a three-piece inflatable penile prosthesis. Methods: When implanting a three-piece inflatable penile prosthesis, we draw two longitudinal lines parallel to the long axis of the proximal cylinder and the tubing leading from each cylinder into the cavernosal space, to prevent 360 degree rotation of the cylinder. Results: From September 1993 to February 2007, a total 86 three-piece penile prosthesis implantations were carried out in 70 patients. Urethral stricture occurred in 5.8% (5/86) of the prosthesis operations. Fifteen three-piece penile prosthesis reinsertions were carried out in 17.4% (15/86) of the prosthesis recipients. Conclusions: A successful outcome was achieved in the patients who received penile implantation with the three-piece penile prosthesis that were marked with longitudinal lines. The rotation of the cylinder may cause compression on the urethra from the tubing leading from the cylinder or pump crossing over the urethra and resulting in urethral stricture. The drawing of longitudinal lines at the proximal cylinder and tubing leading from the cylinder could prevent the urethral stricture induced by tubes that are twisted by rotation of the cylinder. [source]