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Small-carrion penile prosthesis
0022-5347/02/1672-119010 THEJOUm'~ALOFUROLOGY ~ Copyright© 2002 by A.~mmc~'~UROLO~XCAL ASSOCIATION,Isc.®
Vol. 167, 1190, February 200~
Printedin U.S.A
SMALL-CARRION PENILE PROSTHESIS New Implant for Management of Impotence MICHAEL P. SMALL, M.D., HERNAN M. CARRION, M.D., AND JULIAN A. GORDON, M.D. From the Department of Urology, University of Miami School of Medicine, and Veterans Administration Hospital, Miami, Florida (Urology, 5: 479-486, 1975: permission to reprint article not granted)
ABSTRACT--The etiology of impotence and a review of various techniques in treatment are dis. cussed. A perineal surgical approach with a new type of paired sponge-filled silicone prostheses is described. The prostheses are inserted into previously dilated corpora cavernosa. Of the initial 31 patients, excellent results were obtained in 27, and a good result in 1. Of the 3 patients with initial serious complications, adequate functional results were attained in 2. The distinct advantages and potential complications using the Small-Carrion penile prosthesis and surgical technique are discussed.
EDITORIAL COMMENT It has been almost 30 years since the introduction of effective penile implants. Mike Small and colleagues used the sponge filled semirigid type and almost simultaneously F. Brantley Scott and his associates developed the inflatable type. Prior to this, effective treatments of erectile dysfunction were nonexistent. Psychogenic or environmental impotence was assumed to account for 90% of the cases. Changing attitudes towards sexual matters with more open discussion and acceptance oi treatment in the early 1970s led to interest in studying the mechanisms of developing an erection. Today through advances in diagnosis we know that the majority of cases of erectile dysfunction have a physical basis with impairment of blood flow, or innervation of the erectile apparatus or hormonal aberration. Small's sponge filled silicone coated device was an attempt to provide an erection rigid enough for penetration yet concealable during daily activities. His perineal approach to avoid a noticeable penile scar was commendable. The progress made in the last 30 years and the knowledge of the erectile process, the development of effective oral medications and the advances in improving reliability of penile implants have been remarkable. In 1972 one could not at all conceive of the variety of treatments we have today. As the therapies become less invasive more patients will opt for treatment, and yearly the number of patients presenting for treatment grows. The less invasive the treatment the more patients will opt for it as a way of managing the problem. Penile implants have been the most invasive t r e a t m e n t and as effective medications have been developed implants have taken a smaller piece of the therapeutic pie for erectile dysfunction, currently accounting for less than half of 1% of treatments used. The number of implants placed since sildenafil was introduced has actually declined to about 15,000 annually from a peak of almost double that number a decade ago. Fewer urologists are placing implants as the number entering practice each year has declined, early retirement has become more common and the post-war baby boom generation is now entering the age when urology services will be needed more often. Urologists seem to be focusing more on traditional urological areas, such as stones, prostate, infection, incontinence, cancer and so forth. There is still an i m p o ~ a n t role for penile implants in patients refractory to other treatments, and the trend is currently for surgeons interested in this area to treat these patients, especially difficult implant cases. Hopefully a group of dedicated young urologists interested in erectile dysfunction and experienced in implant placement will carry on the tradition established by Small, Scott and the other pioneers who began this field 30 years ago.
John J. Mulcahy Department of Urology Indiana Cancer Pavilion Indianapolis, Indiana
1190
Vol. 167, 1190, February 200~
Printedin U.S.A
SMALL-CARRION PENILE PROSTHESIS New Implant for Management of Impotence MICHAEL P. SMALL, M.D., HERNAN M. CARRION, M.D., AND JULIAN A. GORDON, M.D. From the Department of Urology, University of Miami School of Medicine, and Veterans Administration Hospital, Miami, Florida (Urology, 5: 479-486, 1975: permission to reprint article not granted)
ABSTRACT--The etiology of impotence and a review of various techniques in treatment are dis. cussed. A perineal surgical approach with a new type of paired sponge-filled silicone prostheses is described. The prostheses are inserted into previously dilated corpora cavernosa. Of the initial 31 patients, excellent results were obtained in 27, and a good result in 1. Of the 3 patients with initial serious complications, adequate functional results were attained in 2. The distinct advantages and potential complications using the Small-Carrion penile prosthesis and surgical technique are discussed.
EDITORIAL COMMENT It has been almost 30 years since the introduction of effective penile implants. Mike Small and colleagues used the sponge filled semirigid type and almost simultaneously F. Brantley Scott and his associates developed the inflatable type. Prior to this, effective treatments of erectile dysfunction were nonexistent. Psychogenic or environmental impotence was assumed to account for 90% of the cases. Changing attitudes towards sexual matters with more open discussion and acceptance oi treatment in the early 1970s led to interest in studying the mechanisms of developing an erection. Today through advances in diagnosis we know that the majority of cases of erectile dysfunction have a physical basis with impairment of blood flow, or innervation of the erectile apparatus or hormonal aberration. Small's sponge filled silicone coated device was an attempt to provide an erection rigid enough for penetration yet concealable during daily activities. His perineal approach to avoid a noticeable penile scar was commendable. The progress made in the last 30 years and the knowledge of the erectile process, the development of effective oral medications and the advances in improving reliability of penile implants have been remarkable. In 1972 one could not at all conceive of the variety of treatments we have today. As the therapies become less invasive more patients will opt for treatment, and yearly the number of patients presenting for treatment grows. The less invasive the treatment the more patients will opt for it as a way of managing the problem. Penile implants have been the most invasive t r e a t m e n t and as effective medications have been developed implants have taken a smaller piece of the therapeutic pie for erectile dysfunction, currently accounting for less than half of 1% of treatments used. The number of implants placed since sildenafil was introduced has actually declined to about 15,000 annually from a peak of almost double that number a decade ago. Fewer urologists are placing implants as the number entering practice each year has declined, early retirement has become more common and the post-war baby boom generation is now entering the age when urology services will be needed more often. Urologists seem to be focusing more on traditional urological areas, such as stones, prostate, infection, incontinence, cancer and so forth. There is still an i m p o ~ a n t role for penile implants in patients refractory to other treatments, and the trend is currently for surgeons interested in this area to treat these patients, especially difficult implant cases. Hopefully a group of dedicated young urologists interested in erectile dysfunction and experienced in implant placement will carry on the tradition established by Small, Scott and the other pioneers who began this field 30 years ago.
John J. Mulcahy Department of Urology Indiana Cancer Pavilion Indianapolis, Indiana
1190