- Email: [email protected]
Silicone Implant for Impotence
Vol. 100, NuL Pr,i,nted i11 U.S.A.
THE .JOURNAL OF UROLOGY
Copyright © 1068 by The Williams & Wilkin~ Co,
SILICONE IMPLANT FOR IMPOTENCE HARVEY LASH From the Department of Plastic and Reconslructive S-i.rgery, Palo .I/lo Jieclical Clinic, and Palo Alia Medical Research Founclalion, Palu Alto, Ca/~fornia
"\Yhen the male subject is bereaved of his erectile powers, for ,vhatever cause, the loss is frequently tragic. Recently we suggested a surgical procedure for this difficulty, 1 As our experience with this procedure has grnwn, Y\'e have become more enthusiastic about its usefulne,;s. Initially
and spreading a straight scissors m hemostat to open the tunnel. In all cases except post-priapism this segment of the tunnel is developed 1Yith ,;mprising ease. At this point, the implant sboulcl readily slide into position (part J of figure) and n. tightly hemostatic closure is begun in layers 4-zero chrnmic atraumatic catgut in the corpora and Ruck's fa,;cia with 5-zero nylou in the skill (part B of figure). Ends of the skin sutme are left long to tie onr a furacin dressing, and the entire organ is wrapped with conforming roller gauze to contrnl edema. l\Iost patients easily -void after catheter removal the following morning and are discharged from the hospital 2 days postoperatively. Skin sutures are allowed to remain 3 ,veeks (slightly longer in paraplegics) and intercomse is discouraged for 6 weeks. Early in our series of 28 cases, 1 implant ,n1s lost clue to erosion into the fossa uavicularis. Subsequently extreme caution has been taken to position the implant proximall:,·.
'l'ECHNTQUE
])]SCUSSIO'.\
Fnder general anesthesia and tourniquet control y1·ith No. 16 Foley catheter in place, a 3 cm, incision is made in the mid-clonml shaft and carried through Buck'~ fascia, care being exercised to identify and retract the dorsal neurovascular bundle. (In Pe:v-ronie's disease with one of the corpora fibrosed, the true midline will appear quite lateral.) As dissection in the midline progresses, the corpus cavernosum may become invoh-ed. At thi~ point a scissors has been most efficacious in preparing the tunnel distally, care being exercised to remain extremely dorsal 1Yithin the corpora. Since the distal cmpora rest under the dornum of the proximal glans, dissection need not be canird thrnugh the glans itself, a fac;t 1,·hich lr,;sens the likelihood of ernsion into the Iossa na\·icularis. Prnxirnall;v- dissection is facilitated by momentarily releasing the tourniquet Accepted for publication January 12, HJG8. 1 Loeffler, R. A,, Sayegh, E. S. and Lash, II.: The artificial os penis. Plast. Heconstr. Surg., 34: 71-74, HIG4,
Invariably, intelligent patients raise worthy of note. Concern over clothed appearance is common, and the patient must be assured that there is no discernible bulging. Since the implant is unattached proximally, it functions simply to prevent buckling of the penis shaft during intercourse. Those capable of partial or transient erections are concerned \\"ith possible interference of the silicone rod but this has not occurred in our experience, and other repmts concur in this. 2 The connecti,-e tissue envelope which develops arouud the implant is gossamer, as one might anticipafo by noting that histologically this extremdy inerl, material frequently fails to stimulate a giaut cell reaction. 3 However, each patient should be told that the operation carries with it the clanger of 2 Beheri, G. E.: Surgical treatmen1 of impotence. Plast. Reconstr. Snrg., 38: 92-!=J7, HJG0. 3 Lash, H., Zimmerman, D. C. and Loelner, R. A.: Silicone implant iula)- method. Pin-st_ Reconstr. Smg., 34: 75-80, 19G4.
70!=)
710
LASH
A, insertion of implant. B, surgical closure
infection which might necessitate removal of the implant. vVe have not encountered this complication. Candid discussion must also include the fact that, though this procedure presently offers great promise, the final evaluation nmst await longterm experience.
SUMMARY
Silicone implant to the penis has been successful in correction of impotence due to the inability to obtain or sustain an erection. Patients in w horn medical management has proved unsuccessful should be considered for this procedure,
THE .JOURNAL OF UROLOGY
Copyright © 1068 by The Williams & Wilkin~ Co,
SILICONE IMPLANT FOR IMPOTENCE HARVEY LASH From the Department of Plastic and Reconslructive S-i.rgery, Palo .I/lo Jieclical Clinic, and Palo Alia Medical Research Founclalion, Palu Alto, Ca/~fornia
"\Yhen the male subject is bereaved of his erectile powers, for ,vhatever cause, the loss is frequently tragic. Recently we suggested a surgical procedure for this difficulty, 1 As our experience with this procedure has grnwn, Y\'e have become more enthusiastic about its usefulne,;s. Initially
and spreading a straight scissors m hemostat to open the tunnel. In all cases except post-priapism this segment of the tunnel is developed 1Yith ,;mprising ease. At this point, the implant sboulcl readily slide into position (part J of figure) and n. tightly hemostatic closure is begun in layers 4-zero chrnmic atraumatic catgut in the corpora and Ruck's fa,;cia with 5-zero nylou in the skill (part B of figure). Ends of the skin sutme are left long to tie onr a furacin dressing, and the entire organ is wrapped with conforming roller gauze to contrnl edema. l\Iost patients easily -void after catheter removal the following morning and are discharged from the hospital 2 days postoperatively. Skin sutures are allowed to remain 3 ,veeks (slightly longer in paraplegics) and intercomse is discouraged for 6 weeks. Early in our series of 28 cases, 1 implant ,n1s lost clue to erosion into the fossa uavicularis. Subsequently extreme caution has been taken to position the implant proximall:,·.
'l'ECHNTQUE
])]SCUSSIO'.\
Fnder general anesthesia and tourniquet control y1·ith No. 16 Foley catheter in place, a 3 cm, incision is made in the mid-clonml shaft and carried through Buck'~ fascia, care being exercised to identify and retract the dorsal neurovascular bundle. (In Pe:v-ronie's disease with one of the corpora fibrosed, the true midline will appear quite lateral.) As dissection in the midline progresses, the corpus cavernosum may become invoh-ed. At thi~ point a scissors has been most efficacious in preparing the tunnel distally, care being exercised to remain extremely dorsal 1Yithin the corpora. Since the distal cmpora rest under the dornum of the proximal glans, dissection need not be canird thrnugh the glans itself, a fac;t 1,·hich lr,;sens the likelihood of ernsion into the Iossa na\·icularis. Prnxirnall;v- dissection is facilitated by momentarily releasing the tourniquet Accepted for publication January 12, HJG8. 1 Loeffler, R. A,, Sayegh, E. S. and Lash, II.: The artificial os penis. Plast. Heconstr. Surg., 34: 71-74, HIG4,
Invariably, intelligent patients raise worthy of note. Concern over clothed appearance is common, and the patient must be assured that there is no discernible bulging. Since the implant is unattached proximally, it functions simply to prevent buckling of the penis shaft during intercourse. Those capable of partial or transient erections are concerned \\"ith possible interference of the silicone rod but this has not occurred in our experience, and other repmts concur in this. 2 The connecti,-e tissue envelope which develops arouud the implant is gossamer, as one might anticipafo by noting that histologically this extremdy inerl, material frequently fails to stimulate a giaut cell reaction. 3 However, each patient should be told that the operation carries with it the clanger of 2 Beheri, G. E.: Surgical treatmen1 of impotence. Plast. Reconstr. Snrg., 38: 92-!=J7, HJG0. 3 Lash, H., Zimmerman, D. C. and Loelner, R. A.: Silicone implant iula)- method. Pin-st_ Reconstr. Smg., 34: 75-80, 19G4.
70!=)
710
LASH
A, insertion of implant. B, surgical closure
infection which might necessitate removal of the implant. vVe have not encountered this complication. Candid discussion must also include the fact that, though this procedure presently offers great promise, the final evaluation nmst await longterm experience.
SUMMARY
Silicone implant to the penis has been successful in correction of impotence due to the inability to obtain or sustain an erection. Patients in w horn medical management has proved unsuccessful should be considered for this procedure,