- Email: [email protected]
Penile prosthesis im importance
Mary Van Poole, RN
Penile prosthesis in impotence Impotence is generally described as the persistent inability to attain and sustain an erection sufficient to allow orgasm and satisfactory ejaculation during heterosexual coitus. An extensive review of the literature reveals that this enigma has plagued man since the beginning of time' and is no respecter of race, creed, or color. Organic erectile impotence is a common complaint of men with diabetes mellitus; peripheral vascular disease; postoperatively aortic, prostatic, and rectal surgery; urethral, pelvic nerve, and spinal injuries; and priapism.2 Approximately 90% of the males with complaints relating to impotence are psychogenic in origin. Detailed history, physical examination, appropriate laboratory studies, and consultations will classify the etiology of impotence as organic or psychogenic. Psychotherapy is indicated in the latter group. In the patient with organic impotence,
Mary Van Poole, RN, is assistant director of operating rooms, N o r t h Carolina Baptist Hospital, WinstonSalem, NC. She is a graduate of North Carolina Baptist Hospitals School of Nursing. She is secretary of the A O R N Board of Directors.
it is essential that he understand that the prosthesis serves only as a stent or crutch which enables insertion of the penis into the vagina and that it assists, but does not replace, other factors that are necessary for satisfactory copulation. He must feel that this aspect of his life is sufficiently important enough to him to warrant the calculated operative risk and possible complications. The success of this procedure cannot be measured by the technical result alone; the subjective opinion of the patient and his partner is the final test. Surgical experience in the treatment of organic sexual impotence has resulted in numerous modifications of the penile prosthesis and its site of placement within the phallus, thereby greatly improving the restoration of erectile ability in the impaired penis. The urologic surgeon a t this institution has adopted the prosthesis described as Small-Carrion3with apparent success. This prosthesis consists of a medical-grade silicone exterior with a silicone sponge interior. This model appears to have the ideal qualities of a penile prosthesis giving adequate width, length, and a consistency similar to the erect penis. The prosthesis is available in four lengths: 12 cm, 13.3 cm, 14.5 cm, and 15.8 cm. The proper size prosthesis
AORN Journal, August 1975, Vol 22, No 2
207
is selected at the time of surgery. Case reports. Case No 1. Fifty-fouryear-old male with onset of impotence following radical perineal prostatectomy for carcinoma of the prostate. The patient continued to have a desire for intercourse and was admitted to North Carolina Baptist Hospital for penile prosthesis. Past history: partial gastrectomy, spinal fusion, T & A, and appendectomy. Physical examination: within normal limits. Patient was seen in consultation by the psychiatry department which reported no contraindication to surgery. With the patient in the dorsal lithotomy position, under satisfactory level of general anesthesia, the external genitalia was prepped with 3% hexachlorophene and draped in a sterile manner. A urethral catheter was inserted into the bladder before the procedure and was removed at the completion of surgery. A vertical incision was made underneath the scrotum and extending for approximately 1%inches (3.8 cc) through the skin and subcutaneous tissue down to the bulbocavernosus muscle. The bulbocavernosus muscle was split exposing the urethra and the right crura. The corpus cavernosum on the right side was then opened with sharp dissection and the cavernosum was then dilated with Hegar dilators through a #11 French. The penis was then measured, and an appropriate silicone penile prosthesis was chosen. The prosthesis was inserted into the corpus cavernosum without difficulty and the distal end positioned at the point of the insertion of the crus on bone. The left corpus was opened and dilated in likewise fashion and a prosthesis of equal size was inserted without difficulty. The corpus cavernosum on the left and right was closed with interrupted sutures of 3-0 chromic catgut. The subcutaneous tissue was approximated with 4-0 chromic catgut and the
208
skin with interrupted sutures of 4-0 catgut. The patient tolerated the procedure well. There were no complications. The patient did well postoperatively and was afebrile at the time of discharge. Postoperative follow-up. This patient was readmitted to North Carolina Baptist Hospital seven days following his penile transplant. Current history revealed that two days prior to this admission he developed perineal pain and difficulty with urination. A Foley catheter was inserted in the office on the day of admission, and he was felt to have a periurethral hematoma causing his difficulty in voiding. Hospital course: He was placed on Sitz bath and pain medication and his Foley catheter was left indwelling. His pain decreased during his hospitalization, and his catheter was removed four days later, at which time he voided with a good stream without straining. Urine culture was no growth. Final diagnosis: Postimplant of penile prosthesis and periurethral hematoma. Patient discharged on Phenaphen #3 to return in one week for follow-up office visit in office. Approximately seven months postoperative at this time, the patient has continued to do well and both he and his wife are pleased with the procedure. Case No 2. Fifty-two-year-old male with onset of impotence of approximately three years duration following open perineal prostatic biopsy. The patient has been unable to maintain an erection. Physical examination was within normal limits. Laboratory data was within normal range, and after consultation it was decided that this patient was a good prospect for a penile prosthesis. The patient was subsequently admitted to the North Carolina Baptist Hospital and underwent the above de-
AORN Journal, August 1975, Vol 22, No 2
scribed surgical procedure and implantation of the Small-Carrion penile prosthesis without difficulty. This patient is currently five months postoperative and has had a smooth benign course of recovery. The patient and his wife are satisfied with the surgery and he continues to be asymptomatic as regards infection. Comment. Since this is a relatively new technique and our patients have not been followed extensively, no significant statements can be made regarding the long-term feasibility of these implants.
However, we have good reason to believe that this particular prosthesis is a vast improvement and, indeed, may prove to be invaluable in the future treatment of organic sexual impotence. 0 Notes 1. The Holy Bible: Genesis 203. 2. F B Scott, W E Bradley, G W Timm, “Management of erectile impotence: Use of implantable inflatable prostheses.”Urology, 2 (July 1973) 80-82. 3. M P Small, H M Carrlon, J A Gordon, “SmallCarrion penile prosthesis: New Implant for management of impotence,” Urology, 5 (April 1975) 479.
NHI passage unlikely this year More than 670 practitioners attended the American Society of Oral Surgeons’ (ASOS) 1975 clinical congress on correction of maxillary and midfacial deformities in St Louis. Sen Thomas F Eagleton (D-Mo), speaking at the Oral Surgery Political Action Committee luncheon, sald that because of the “multiplicity of proposals” it is unlikely, in his opinion, that Congress can pass a National Health Insurance (NHI) bill this year. “What this all points to Is national health insurance becoming a major issue in the 1976 presidential campaign. The evolutionary process which this issue has gone through in recent years has refined questions (on NHi) to the point where they can be put to the candidates with considerable specificity. And while the 1976 presldential campaign is cieariy not going to be a referendum on this issue, the candidates’ position on NHI will presumably have a bearing on the position taken on this issue by the administration in offlce In 1977,” he said. Eagleton said that just because Congress is unlikely to pass an NHI bill
this session does not mean that the ASOS and other interested parties should decrease their legislative efforts, since what is done now will affect the bill passed. Another speaker was Seymour J Kreshover, DDS, director of the National Institutes of Health’s (NIH) National Institute of Dental Research (NIDR). Dr Kreshover called for dentists to close the gap between basic research and applied clinical practlce as a means of improving dental care delivery systems. Dr Kreshover stressed that too many practitioners seem to feel that NlDR makes grants only for basic research, not clinical investigation. This simply is not true, he said. As an example, he cited NIDR’s program on craniofaclal anomalies, in which oral surgeons must be major contrlbutors. He said NlDR has 71 projects on craniofaciai anomalies, of which 41 are clearly clinical or clinically oriented research. The average award for these 41 projects, he sald, Is over $100,000. The other 30 projects are geared toward basic research, and grants to them average about $53,000.
AORN Journal,August 1975, Vol 22, NO 2
209
Penile prosthesis in impotence Impotence is generally described as the persistent inability to attain and sustain an erection sufficient to allow orgasm and satisfactory ejaculation during heterosexual coitus. An extensive review of the literature reveals that this enigma has plagued man since the beginning of time' and is no respecter of race, creed, or color. Organic erectile impotence is a common complaint of men with diabetes mellitus; peripheral vascular disease; postoperatively aortic, prostatic, and rectal surgery; urethral, pelvic nerve, and spinal injuries; and priapism.2 Approximately 90% of the males with complaints relating to impotence are psychogenic in origin. Detailed history, physical examination, appropriate laboratory studies, and consultations will classify the etiology of impotence as organic or psychogenic. Psychotherapy is indicated in the latter group. In the patient with organic impotence,
Mary Van Poole, RN, is assistant director of operating rooms, N o r t h Carolina Baptist Hospital, WinstonSalem, NC. She is a graduate of North Carolina Baptist Hospitals School of Nursing. She is secretary of the A O R N Board of Directors.
it is essential that he understand that the prosthesis serves only as a stent or crutch which enables insertion of the penis into the vagina and that it assists, but does not replace, other factors that are necessary for satisfactory copulation. He must feel that this aspect of his life is sufficiently important enough to him to warrant the calculated operative risk and possible complications. The success of this procedure cannot be measured by the technical result alone; the subjective opinion of the patient and his partner is the final test. Surgical experience in the treatment of organic sexual impotence has resulted in numerous modifications of the penile prosthesis and its site of placement within the phallus, thereby greatly improving the restoration of erectile ability in the impaired penis. The urologic surgeon a t this institution has adopted the prosthesis described as Small-Carrion3with apparent success. This prosthesis consists of a medical-grade silicone exterior with a silicone sponge interior. This model appears to have the ideal qualities of a penile prosthesis giving adequate width, length, and a consistency similar to the erect penis. The prosthesis is available in four lengths: 12 cm, 13.3 cm, 14.5 cm, and 15.8 cm. The proper size prosthesis
AORN Journal, August 1975, Vol 22, No 2
207
is selected at the time of surgery. Case reports. Case No 1. Fifty-fouryear-old male with onset of impotence following radical perineal prostatectomy for carcinoma of the prostate. The patient continued to have a desire for intercourse and was admitted to North Carolina Baptist Hospital for penile prosthesis. Past history: partial gastrectomy, spinal fusion, T & A, and appendectomy. Physical examination: within normal limits. Patient was seen in consultation by the psychiatry department which reported no contraindication to surgery. With the patient in the dorsal lithotomy position, under satisfactory level of general anesthesia, the external genitalia was prepped with 3% hexachlorophene and draped in a sterile manner. A urethral catheter was inserted into the bladder before the procedure and was removed at the completion of surgery. A vertical incision was made underneath the scrotum and extending for approximately 1%inches (3.8 cc) through the skin and subcutaneous tissue down to the bulbocavernosus muscle. The bulbocavernosus muscle was split exposing the urethra and the right crura. The corpus cavernosum on the right side was then opened with sharp dissection and the cavernosum was then dilated with Hegar dilators through a #11 French. The penis was then measured, and an appropriate silicone penile prosthesis was chosen. The prosthesis was inserted into the corpus cavernosum without difficulty and the distal end positioned at the point of the insertion of the crus on bone. The left corpus was opened and dilated in likewise fashion and a prosthesis of equal size was inserted without difficulty. The corpus cavernosum on the left and right was closed with interrupted sutures of 3-0 chromic catgut. The subcutaneous tissue was approximated with 4-0 chromic catgut and the
208
skin with interrupted sutures of 4-0 catgut. The patient tolerated the procedure well. There were no complications. The patient did well postoperatively and was afebrile at the time of discharge. Postoperative follow-up. This patient was readmitted to North Carolina Baptist Hospital seven days following his penile transplant. Current history revealed that two days prior to this admission he developed perineal pain and difficulty with urination. A Foley catheter was inserted in the office on the day of admission, and he was felt to have a periurethral hematoma causing his difficulty in voiding. Hospital course: He was placed on Sitz bath and pain medication and his Foley catheter was left indwelling. His pain decreased during his hospitalization, and his catheter was removed four days later, at which time he voided with a good stream without straining. Urine culture was no growth. Final diagnosis: Postimplant of penile prosthesis and periurethral hematoma. Patient discharged on Phenaphen #3 to return in one week for follow-up office visit in office. Approximately seven months postoperative at this time, the patient has continued to do well and both he and his wife are pleased with the procedure. Case No 2. Fifty-two-year-old male with onset of impotence of approximately three years duration following open perineal prostatic biopsy. The patient has been unable to maintain an erection. Physical examination was within normal limits. Laboratory data was within normal range, and after consultation it was decided that this patient was a good prospect for a penile prosthesis. The patient was subsequently admitted to the North Carolina Baptist Hospital and underwent the above de-
AORN Journal, August 1975, Vol 22, No 2
scribed surgical procedure and implantation of the Small-Carrion penile prosthesis without difficulty. This patient is currently five months postoperative and has had a smooth benign course of recovery. The patient and his wife are satisfied with the surgery and he continues to be asymptomatic as regards infection. Comment. Since this is a relatively new technique and our patients have not been followed extensively, no significant statements can be made regarding the long-term feasibility of these implants.
However, we have good reason to believe that this particular prosthesis is a vast improvement and, indeed, may prove to be invaluable in the future treatment of organic sexual impotence. 0 Notes 1. The Holy Bible: Genesis 203. 2. F B Scott, W E Bradley, G W Timm, “Management of erectile impotence: Use of implantable inflatable prostheses.”Urology, 2 (July 1973) 80-82. 3. M P Small, H M Carrlon, J A Gordon, “SmallCarrion penile prosthesis: New Implant for management of impotence,” Urology, 5 (April 1975) 479.
NHI passage unlikely this year More than 670 practitioners attended the American Society of Oral Surgeons’ (ASOS) 1975 clinical congress on correction of maxillary and midfacial deformities in St Louis. Sen Thomas F Eagleton (D-Mo), speaking at the Oral Surgery Political Action Committee luncheon, sald that because of the “multiplicity of proposals” it is unlikely, in his opinion, that Congress can pass a National Health Insurance (NHI) bill this year. “What this all points to Is national health insurance becoming a major issue in the 1976 presidential campaign. The evolutionary process which this issue has gone through in recent years has refined questions (on NHi) to the point where they can be put to the candidates with considerable specificity. And while the 1976 presldential campaign is cieariy not going to be a referendum on this issue, the candidates’ position on NHI will presumably have a bearing on the position taken on this issue by the administration in offlce In 1977,” he said. Eagleton said that just because Congress is unlikely to pass an NHI bill
this session does not mean that the ASOS and other interested parties should decrease their legislative efforts, since what is done now will affect the bill passed. Another speaker was Seymour J Kreshover, DDS, director of the National Institutes of Health’s (NIH) National Institute of Dental Research (NIDR). Dr Kreshover called for dentists to close the gap between basic research and applied clinical practlce as a means of improving dental care delivery systems. Dr Kreshover stressed that too many practitioners seem to feel that NlDR makes grants only for basic research, not clinical investigation. This simply is not true, he said. As an example, he cited NIDR’s program on craniofaclal anomalies, in which oral surgeons must be major contrlbutors. He said NlDR has 71 projects on craniofaciai anomalies, of which 41 are clearly clinical or clinically oriented research. The average award for these 41 projects, he sald, Is over $100,000. The other 30 projects are geared toward basic research, and grants to them average about $53,000.
AORN Journal,August 1975, Vol 22, NO 2
209