Sustitución de prótesis de pene: 1990-1999 / Replacement of penile prosthesis: 1990-1999

OBJETIVO: Analizar la serie de pacientes sometidos entre los años 1990 y 1999 a sustitución de su prótesis de pene debido a la aparición de algún tipo de complicación. MATERIAL Y MÉTODOS: 85 pacientes fueron sometidos a implante, siendo utilizados 13 modelos diferentes de prótesis. En 15 de estos pacientes (17,64 por ciento) ésta tuvo que ser sustituida una vez o más. La edad media en el momento de la sustitución fue de 51,5 años. El acceso quirúrgico más frecuente fue el infrapúbico. RESULTADOS: Se realizaron en total 32 intervenciones de sustitución protésica. Las causas principales fueron: fallo mecánico (13 casos, 40,62 por ciento); infección (10 casos, 31,25 por ciento); y perforación de cuerpos cavernosos (cinco casos, 15,62 por ciento). No se observó incremento progresivo en la incidencia de complicaciones en relación con el número ordinal de la prótesis implantada. Mejores resultados globales: Mentor Mark II y AMS 700 Ultrex Plus. Actualmente sólo ocho (53,33 por ciento) de los 15 pacientes reimplantados hacen uso normal de su prótesis. CONCLUSIONES: Los pacientes sometidos a sustitución de su prótesis de pene son fuente potencial de complicaciones posteriores. Su conocimiento y correcto manejo es importante, de cara a una mejora progresiva en los resultados finales, (sobre todo si éstos -como en nuestro caso- no son aptos para el conformismo) (AU)

[Replacement of prosthesis of the penis]. / Sustitución de prótesis de pene: 1990-1999.

OBJECTIVE: To analyze the series of patients who underwent replacement of their penile prosthesis between years 1990 to 1999, due to any kind of complication. MATERIAL AND METHODS: 85 patients underwent implantation, 13 different prosthesis models being utilized. It was replaced (once or more) in 15 of these patients (17.64%). The mean age at the moment of the replacement was 51.5 years. The most frequent surgical approach was the infrapubic one. RESULTS: A total of 32 prosthesis-replacement interventions were carried out. The main causes were: mechanical failure (13 cases, 40.62%); infection (10 cases, 31.25%); and corpus cavernosum perforation (five cases, 15.62%). Progressive increase of complications incidence with regard to the ordinal number of the implanted prosthesis was not observed. Best overall results: Mentor Mark II and AMS 700 Ultrex Plus. At present day, only eight (53.33%) out of 15 reimplanted patients use their prosthesis with normality. CONCLUSIONS: Those patients who undergo replacement of their penile prosthesis are potential sources for later complications. Their knowledge and proper handling is important in order to a progressive improvement of the final results, (above all if--such as our case--these ones are not suitable for conformity).

[Treatment of erectile dysfunction using intracavernous pharmacotherapy]. / Tratamiento de la disfunción erectil mediante farmacoterapia intracavernosa.

Intracavernous injection of vasodilators has been the greatest diagnostic and therapeutical breakthrough in erectile dysfunction (E.D.). After 15 years experience, these vasodilators have demonstrated efficacy rates over 85%. This suggests that most cases of E.D. are the result of and inability of the smooth muscle to relax. This paper presents an overview of the diagnostic and therapeutic use of intracavernous vasodilating drugs. It includes an extensive review of the literature and our personal series with regard to efficacy, indications, contraindications and side-effects of these compounds. Alprostadil i.c. injection (PGE1) is an effective (> 70%) and safe treatment, and its use has been accompanied by an increased quality of life of patients, with very few side effects. Currently, PGE1 is a first choice drug in the treatment of impotence. When no response is seen, or pain develops after PGE1 administration, a number of vasoactive compounds associations can be used instead (phentolamine + PGE1, papaverine + phentolamine, and papaverine + phentolamine + PGE1). The phentolamine + VIP association has shown encouraging results. Prior to prescribe IC treatment with vasoactive drugs it is necessary to conduct a basic diagnostic study, and advise the patient. If treatment is finally accepted, the performance of adequate training and detailed medical follow-up is crucial.

[Physiology of penile erection]. / Fisiología de la erección del pene.

Penile smooth muscle tone (arterial and trabecular) regulates the hemodynamic phenomena of erection. Nitric oxide is perhaps the most important mediator of penile smooth muscle relaxation and, consequently, of erection. Detumescence of the erect penis following contraction of the smooth muscles is mediated by the adrenergic nerves, which release noradrenalin that acts on alpha 1 adrenergic receptors. Other substances such as endothelin and prostanoids appear to be implicated in maintaining penile relaxation.