Glans Necrosis Following Penile Prosthesis Implantation: Prevention and Treatment Suggestions
| Autor: | Ahmad Shamsodini, Paulo H. Egydio, Steven K. Wilson, Robert Valenzuela, Cesar Mora-Estaves, Faysal A. Yafi, David Ralph, Christopher Love, Mohamad Habous |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Prosthesis Implantation Saudi Arabia Penile Implantation Prosthesis 03 medical and health sciences Necrosis 0302 clinical medicine Postoperative Complications Risk Factors medicine Humans Glans Gangrene Ultrasonography Doppler Duplex 030219 obstetrics & reproductive medicine business.industry Incidence Australia Glans penis Penile prosthesis Middle Aged medicine.disease United Kingdom United States Surgery medicine.anatomical_structure Penile Prosthesis business Penis Brazil |
| Zdroj: | Urology. 107 |
| ISSN: | 1527-9995 |
| Popis: | Objective To examine possible etiology and treatment outcomes in 21 patients with glans necrosis following penile prosthesis implantation. Methods Glans necrosis typically presented with a dusky glans on the first postoperative day following prosthesis implantation. Results The blood supply to the glans penis consists of the dorsal arteries and the terminal branches of the spongiosal arteries. Using the cohort in our study, we compiled preoperative comorbidities and adjunctive surgical maneuvers that might compromise glans vascularity, leading to glans necrosis. Preoperative risk factors were arteriosclerotic cardiovascular disease (90%), diabetes mellitus (81%), smoking (81%), previous prosthesis explantation (57%), and previous radiation therapy (48%). The most prevalent intraoperative and postoperative factor was subcoronal incision for reasons as simple as coincident circumcision or as complex as for penile degloving (86%). Other factors detected were penile wrapping with an occlusive elastic bandage (62%), use of a sliding technique for penile lengthening (33%), and coincident distal urethral injury repair (29%). Seventeen patients (81%) managed expectantly with preservation of implanted prosthesis sustained significant glandular loss. Four patients managed with immediate prosthesis removal healed without sequelae. Conclusion Patients with preoperative risk factors undergoing penile prosthesis implantation should avoid high-risk adjunctive surgical maneuvers. Upon development of signs of glans necrosis postoperatively, in the setting of these high-risk factors, immediate implant removal may prevent subsequent glans necrosis. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect