Three Piece Penile Implant : Penile Erection almost simulating natural erection

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

Post-enterocystoplasty massive bleeding because of Arteriovenous malformation from bowel arteries : A very Rare Case

A 65 year old man presented to us with frank hematuria of 1 day duration. he was known case of small capacity bladder with hemorrhagic cystitis with no apparent reason.He was operated in 2002 for clam cystoplasty. He was apparently alright for 8 years just to land up in emergency department with gross total hematuria.He is known case coronary artery disease and hypertension on medication.He was on ecosprin when he came for hematuria.Immediately ecosprin was stopped.He was supported with irrigation,tranexa and cystoscopy and evacuation followed by alum irrigation.After this surgery he was fine for 2 days then suddenly he had bout of frank hemturia causing fall of Hb from 13 TO 10 GM% and BP to fall from 130/80 mm Hg to 70/30 mmHg.He was immediate taken up for cystoscopy and clot evacuation again with institution of proper blood support and plasma expander support.The bladder base region had angry looking globular mass? Rest of the bladder mucosa and the intestinal mucosa was normal.The clots were removed with resectoscope and cautery and ellicke evacuator.A three way Foleys catheter was introduced wnd alum irrigation was started..The urine effluent was clear.AFTER THE CLOT EVACUATION WAS DONE BILATERAL ANGIOEMBOLISATION WAS CARRIED OUT SELECTIVELY ON ANTERIOR DIVISION OF INTERNAL ILIAC ARTER USING SELDINGERS TECHNIQUE.

The both iliac arteries anterior divison was blocked with gel foam mixture viscous with the contrast,

The process of Angioembolisation of the internal iliac artery --the end result of the embolisation is seen as the disapperance of the terminal branches of the vesical arteries.The next plan was if the patient bleeds again then abdominal exploration.The patient again bleede after 5 days; again the bleed was torrential causing drop in hematocrit.

The patient was taken up for CT Angiography which showed a big arteriovenous malformation on the dome of the bladder feeded by superior mesenteric arteries.

the mesenteric artery being very crucial one the angioembolisation of it was not taken into consideration thinking of the sequele of catastrophe of mistaken blockage of main trunks.


The exploratotry laparotomy was performed.The adhesiolysis was performed.The dome of the bladder was thickened with multiple serpigenious vessels .This part of the bladder was excised and bladder was closed with Suprapubic tube in situ.

The abdomen was closed in layers with drain in pelvis.The post-operative period was uneventful with no episode of hematuria till 3 weeks post-operatively.

Free camp update

First date of the Free Consultation camp for Male Infertility and Prostatic problems in general population was a great success with 78 patients visiting the Hospital and checked by the experts here.They got investigations at subsidised rates and medications for 15 days free of the cost.
Dr Ramesh Ramayya(CEO and Chairperson),Dr Vishwabhar Nath(Clinical Director),Dr Naveenchandra Acharya(Consultant Urologist),Dr Mahesh Sable(Medical Superitendent) supervised and managed the camp activities.

Press Conference by Dr Ramayyas Urology and Nephrology Hospital

Dr Ramayyas Hospital arranged a press conference to spread awareness about the forthcoming health camp about male infertility and prostate problems in people.

Dr Vishwanbhar Nath(Clinical Director of Dr Ramayyas Hospital) and Dr Naveenchandra Acharya(Urologist and Andrologist)briefed about the male infertility and prostate issues to the conference.

The camp will be held at the Dr Ramayyas Hospital premises on 26 and 27 Th June from 10-4 pm.

Mitomycin C for prevention of bladder tumor recurrence

A 30 year old lady presented with history of hematuria and dysuria. There was no history of comorbidities.

There was no history of prior surgical intervention .

On evaluation her USG showed left lateral wall space occupying lesion 3x2 cm and positive urine cytology for malignancy.

She was taken up for Trans-Urethal Bladder tumor resection with Continuous wave Holmium Laser.The Mitomycin C is a 334-kD alkylating agent that inhibits DNA synthesis. The drug is usually instilled weekly for 6 to 8 weeks at dose ranges from 20 to 60 mg.
One review found a 38% reduction in tumor recurrence with MMC.
Optimization of MMC delivery can result in halving of the recurrence rate in some studies. This can be achieved by eliminating residual urine volume, overnight fasting, using sodium bicarbonate to reduce drug degradation, and increasing concentration to 40 mg in 20 mL.