阴茎悬韧带释放(SLR)在阴茎假体植入(PPI)中的应用在文献中受到了有限的关注。
为了评估阴茎SLR释放的有效性和安全性,耻骨脂肪切除术(PL),与常规方法相比,在可塑PPI期间,耻骨前Z成形术(ZP)在改善性满意度方面的实用性。
在2018年8月至2020年4月之间,将61例难治性勃起功能障碍患者随机分为2组;A组包括31例通过ZP接受SLR和PL的PPI患者,B组包括30例通过阴囊切口接受常规PPI的患者。
在3个月时评估阴茎长度,使用经过验证和未经验证的工具评估PPI后长达1年的性满意度。
A组的中位手术时间高于B组(170分钟;四分位距[IQR][160-190]vs97.5分钟;IQR[90-110]P<.001)。A组的功能性和可见阴茎长度的中位数前后差异为1.5cm;IQR[0-2]和2.5cm;IQR[1-3.5],分别,而B组均为0cm;IQR[-1至0]P<.001)。A组患者在国际勃起功能满意度指数领域的得分高于B组患者(13;IQR[12-14]和9;IQR[8-10]vs11;IQR[9.5-12]和8;IQR[6.5-8.5],分别,P<.001)。此外,A组术后勃起功能障碍量表治疗满意度评分高于B组(95.40;IQR[91-97.7]vs85.20;IQR[72.7-91],分别,P<.001)。A组常见并发症为阴茎水肿(77.4%),阴茎不稳定(9.7%)和龟头麻木(9.7%)。
在PPI期间通过ZP进行SLR和PL后患者满意度的益处可能超过并发症的增加。
据我们所知,这是第一个评估单反疗效和安全性的前瞻性随机对照研究,PL,和PPI期间的ZP。然而,因为目前缺乏评估PPI后性满意度的最佳工具,我们也采用了最常用的评估工具。Further,我们的数据仅适用于有延展性的阴茎假体.
在PPI期间通过ZP的SLR和PL导致患者性满意度的实质性改善,而没有严重的并发症。FotouhElGharablyMA,GhoneimaW,Lotfi先生,etal.阴茎假体植入过程中悬吊韧带释放和阴唇切除术在改善性满意度方面的疗效:一项前瞻性随机对照试验。JSexMed2022;19:852-863。
The utility of penile suspensory ligament release (SLR) in the setting of penile prosthesis implantation (PPI) has received limited attention in the literature.
To assess the efficacy and safety of penile SLR release, pubic lipectomy (PL), and the utility of penopubic Z-plasty (ZP) during malleable PPI in improving sexual satisfaction compared to that achieved with the conventional method.
Between August 2018 and April 2020, 61 patients with refractory erectile dysfunction were prospectively randomized into 2 groups; group A included 31 patients who underwent PPI with SLR and PL via ZP, and group B included 30 patients who underwent conventional PPI via a penoscrotal incision.
Penile length was assessed at 3 months, and sexual satisfaction was assessed up to 1 year after PPI using both validated and non-validated tools.
The median operative time was higher in group A than in group B (170 min; interquartile range [IQR] [160-190] vs 97.5 min; IQR [90-110] P < .001).The median pre- to postoperative differences in functional and visible penile lengths for group A were 1.5 cm; IQR [0-2] and 2.5 cm; IQR [1-3.5], respectively, while those in group B were both 0 cm; IQR [-1 to 0] P < .001). Group A patients reported higher scores in the International Index of Erectile Function satisfaction domains than the group B patients did (13; IQR [12-14] and 9; IQR [8-10] vs 11; IQR [9.5-12] and 8; IQR [6.5-8.5], respectively, P < .001). Moreover, the postoperative Erectile Dysfunction Inventory of Treatment Satisfaction score was higher in group A than that in group B (95.40; IQR [91-97.7] vs 85.20; IQR [72.7-91], respectively, P < .001). Common complications in group A were penile edema (77.4%), penile instability (9.7%) and glans numbness (9.7%).
The benefit in patient satisfaction following SLR and PL via ZP during PPI may outweigh the incremental increase in complications.
To our knowledge, this is the first prospective randomized controlled
study to evaluate the efficacy and safety of SLR, PL, and ZP during PPI. However, because an optimal tool for assessing sexual satisfaction after PPI is lacking at this time, we alternatively adopted the most used assessment tools. Further, our data applies only to malleable penile prosthesis.
SLR and PL via ZP during PPI resulted in a substantial improvement of the patients\' sexual satisfaction without serious complications. Fotouh El Gharably MA, Ghoneima W, Lotfi MR, et al. The Efficacy of Suspensory Ligament Release and Pubic Lipectomy Via Penopubic Z Plasty During Penile Prosthesis Implantation in Improving Sexual Satisfaction: A Prospective Randomized Controlled
Trial. J Sex Med 2022;19:852-863.