A 35 year old man came to us with psychogenic impotence.He had tried PDE-5 inhibitors,sex therapy and psychiatric medications for a long time.
He was also tried Vacuum Erction device and intracavernosal injections but did not benefit.
Finally was given option of penile implant .He chose a three piece Mentor Coloplast Implant.The surgery was done and the device was kept in semideflated position .He was instructed to come after 6 weeks for operation of the device.
Surgery usually has one of three goals:
to implant a device that can cause the penis to become erect (Penile Implant surgery)
to reconstruct arteries to increase flow of blood to the penis (Penile revascularization surgery for patient with focal arterial stenosis-post-trauma)
to block off veins that allow blood to leak from the penile tissues (penile venous leak-particularly detected on Doppler showing persistence end-diastolic velocity more than 5 cm/sec)
Implanted devices, known as prostheses, can restore erection in many men with ED. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of introduction of Viagra but there are a group of patients who fail with medications and refuse or fail with Vacuum Erection Device. Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis. They also leave the penis in a more natural state when not inflated.
Advantages with the penile impants are:
o Good rigidity
o Freedom from medications
o Outpatient/24HR surgery
o Resume sexual activity 4-6 weeks
o No loss of ability to ejaculate or achieve orgasm
Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to perineum or fracture of the pelvis.Surgery to veins that allow blood to leave the penis usually involves an opposite procedure-intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood
Finally was given option of penile implant .He chose a three piece Mentor Coloplast Implant.The surgery was done and the device was kept in semideflated position .He was instructed to come after 6 weeks for operation of the device.
Surgery usually has one of three goals:
to implant a device that can cause the penis to become erect (Penile Implant surgery)
to reconstruct arteries to increase flow of blood to the penis (Penile revascularization surgery for patient with focal arterial stenosis-post-trauma)
to block off veins that allow blood to leak from the penile tissues (penile venous leak-particularly detected on Doppler showing persistence end-diastolic velocity more than 5 cm/sec)
Implanted devices, known as prostheses, can restore erection in many men with ED. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have diminished in recent years because of introduction of Viagra but there are a group of patients who fail with medications and refuse or fail with Vacuum Erection Device. Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. Inflatable implants can expand the length and width of the penis. They also leave the penis in a more natural state when not inflated.
Advantages with the penile impants are:
o Good rigidity
o Freedom from medications
o Outpatient/24HR surgery
o Resume sexual activity 4-6 weeks
o No loss of ability to ejaculate or achieve orgasm
Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to perineum or fracture of the pelvis.Surgery to veins that allow blood to leave the penis usually involves an opposite procedure-intentional blockage. Blocking off veins (ligation) can reduce the leakage of blood
Kegel exercises might not be as well known as ones designed to improve cardiovascular conditioning or build up muscle mass. In many ways, this is a shame since Kegel exercises can be extremely important for men to perform.
ReplyDelete“Kegels,” as they are called, help support male sexual performance. The exercises are not complex or difficult to perform and deliver result fairly quickly. Performing them as part of a weekly male enhancement routine could lead to improved performance results.
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SURGERY - XIAFLEX - ANDROPEYRONIE
ReplyDeleteIn a very few number of cases (about 13 out of 100), Peyronie's disease goes away without being treated. Many health care experts suggest treating the disease without surgery for the first 12 months after the disease is first noticed.
Men with small plaques, not much curving of the penis, no pain, and no problems with sex may not need to be treated. If you need to be treated, there are 3 choices.
1 Surgery for Peyronie's Disease :
-making the side of the penis opposite the plaque shorter
-making the side of the penis that curves longer
-placing a prosthetic device inside the penis
2 Penile Injections ( XIAFLEX® ) COST: 2 vials $2,650
Injecting a drug right into the plaque brings higher doses of the drug to the problem than when a drug is taken by mouth. Plaque injection is often used for men with acute phase disease who aren't sure they want to have surgery. The skin is often numbed before the shot to reduce pain.
Injection of CCG into collagen-containing structures such as the corpora cavernosa of the penis may result in damage to those structures and possible injury such as corporal rupture. Treatment of Peyronie's disease with intralesional therapy: Injection of collagenase is contraindicated in the treatment of Peyronie’s plaques that involve the penile urethra due to potential risk to this structure and in patients with a history of hypersensitivity to collagenase used in any other therapeutic application or application method. Injection of collagenase into collagen-containing structures such as the corpora cavernosa of the penis may result in damage to those structures and possible injury such as corporal rupture (penile fracture).
https://www.fda.gov/downloads/Drugs/DrugSafety/UCM200615.pdf
3 ANDROPEYRONIE® COST: $200
Treatment of Peyronie's disease with penile traction therapy (ANDROPEYRONIE). Penile traction therapy (PTT) is used to avoid penis shortening after prostate surgery, which can be used as penile rehab. it would be an effective and safe method Without expensive risky surgery or injections. Andromedical, a urology laboratory which has been investigating medical, non-invasive treatments to Peyronie’s disease, micropenis, post radical prostatectomy penile rehab and erectile dysfunction for 20 years. Andropeyronie is a simple, effective and non-invasive treatment of the correction of penile curvature. Andropeyronie reduces the curvature of the penis + 50%. Andropeyronie increases the length of the penis and also the girth.
https://onlinelibrary.wiley.com/doi/abs/10.1111/jsm.12400
https://www.andropeyronie.com/curved-penis-correction-peyronie/
Endo Pharmacauticals XIAFLEX has discontinued Collagenase Clostridium Histolyticum (CCH) injection in Australia and Asia, and plans to do the same to whole Europe by the end of 2019. The American laboratory has decided to withdraw it for economic reasons. As a result, the drug is no longer available except in the US and Canada. Now the only treatment options for Peyronie´s disease are surgery or Penile Traction Device (alone or combined with PRP), in the rest of the world. See official letter
ReplyDeletehttp://dupuytrenssociety.blogspot.com/2019/11/xiapex-to-be-discontinued.html
Penile prosthesis surgery, a comprehensive solution of the highest caliber for erectile dysfunction, is offered by the World Of Urology. Our professional team is consist of committed, certified urologists having years of experience. They provide patients with thorough surgical and medical treatments that meet or exceed worldwide standards.
ReplyDeleteImplanting a penile prosthesis has become the only proven method of treating erectile dysfunction in motivated men. World of Urology’s top experts is the best choice to consult if you planning to undergo penile prosthesis surgery in bangalore.
ReplyDeleteImplanting a penile prosthesis has become the only proven method of treating erectile dysfunction in motivated men. Penile Prosthesis Surgery In Bangalore World of Urology’s top experts is the best choice to consult if you planning to undergo penile prosthesis surgery in bangalore.
ReplyDeleteImplanting a penile prosthesis has become the only proven method of treating erectile dysfunction in motivated men. Penile Prosthesis Surgery In Bangalore For reliable and 100% successful penile prosthesis surgery in bangalore World of Urology, specialists are the best choice.
ReplyDeleteWhen there is a medical requirement and it is doubtful that the erectile dysfunction issue would get better on its own or with medicine, a penile implant is employed. Penile Prosthesis Surgery In Bangalore For successful penile prosthesis surgery in bangalore, you can consult doctors in the World of Urology.
ReplyDelete