RU2254818C1 - Method for surgical therapy of penile fibroplastic induration - Google Patents

Abstract

FIELD: medicine, urology.

SUBSTANCE: the method deals with implanting a prosthesis into cavernous body through incision in area of atrioventricular groove. Implantation of prosthesis should be performed into the most affected cavernous body, for the length being above the length of sclerotic section for 0.5-1 cm.

EFFECT: higher efficiency of therapy.

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Description

The invention relates to urology and can be used in the surgical treatment of Peyronie's disease - fibroplastic induction of the protein coat of the penis, the septum between the corpora cavernosa and the deep fascia of the penis.

A characteristic sign of the disease are clearly delimited formations from surrounding tissues, located along the length from the coronal groove to the base of the penis. In most patients, sclerotic plaques are multiple, sometimes with the formation of calcium, bone tissue and cartilage in them. This leads to impaired penile function.

Conservative methods for treating Peyronie's disease are known. They are used in stages I and II of the disease and consist of taking vitamin E, intramuscular and local injection of drugs (lidase, hormones) into plaques or in various methods of physiotherapy, including paraffin baths, ultrasound laser-magnetic therapy, etc. (I.V. Karukin , I.F. Novikov et al. 2000, 2001).

However, conservative methods of treatment are often insufficient and the disease develops in stages III and IV. In these stages of the disease, the question of surgical treatment may become.

Surgical methods include radical excision of the fibrous plaque and the replacement of the defect of the cavernous body with a skin flap, the vaginal membrane of the testicle, a leaf from the broad fascia of the thigh, etc. (The book. Operational urology. A manual edited by N.A. Lopatkin, I.P. Shevtsov. - L.: Medicine, 1986).

There is a known method of treating Peyronie's disease as Nesbit surgery (see ibid.). The skin of the penis (IF) is cut circularly 1 cm proximal to the neck, move it with subcutaneous tissue to the root of the IF. Then, on the external curved surface, the fascia is dissected, separated and mobilized. Deep fascia is dissected and separated in a similar way, with the condition that the dorsal veins, arteries, and nerves are preserved. In the transverse direction, 4-6 segments are excised from the albumen through an interval of 1.5 cm. The openings of the albumen are sutured, the fascia of the prosthesis is connected with catgut ligatures. The skin and subcutaneous tissue are shifted to the neck of the glans penis and the skin wound is sutured.

Disadvantages: morbidity, complexity, shortening of the frequency converter, postoperative relapses requiring repeated interventions.

Plaques during surgery are not eliminated, which is a prerequisite for their further development.

Incomplete bilateral intracavernous prosthetics was adopted as the prototype (Zhurn. Urology, 2001, No. 6, p. 35-40, article by N. I. Tarasov “Surgical treatment of erectile dysfunction in Peyronie’s disease”).

The operation is performed without excision of fibrous plaques, provided the curvature of the prostate during an erection is not more than 40 ⁰ in combination with organic erectile insufficiency of the 2nd or 3rd degree.

The operation is carried out by providing access to the projection of the coronal groove. After bougienage of two cavernous bodies, two prostheses made of high pressure polyethylene are installed in the proximal direction in both cavernous bodies (bilateral intracavernous prosthetics). When suturing, the prosthesis is fixed to the protein membrane of the cavernous bodies of the human body.

Disadvantages: trauma in connection with bilateral prosthetics of cavernous bodies for a considerable length, limitation of indications for surgery when the penis is curved with an erection of not more than 40 °, inconvenience of the cosmetic plan when wearing the prosthesis, playing sports, on the beach, the comparative duration of the operation.

Tasks:

- reduction in morbidity,

- reduction of time of surgical intervention,

- expansion of indications for intracavernous prosthetics without excision of fibrous plaques, regardless of the angle of curvature of the IF,

- increase the effect of treatment.

The technical essence of the proposed solution is to obtain a higher positive effect of treatment. Implantation of one endoprosthesis into the cavernous body most affected by sclerosis. At the same time, the length of the shaft of the prosthesis is 0.5-1 cm longer than the length of the sclerotic portion of the protein membrane of the corpora cavernosa.

The special value of the proposed method lies in the fact that in the postoperative period, sclerotic plaques pass spontaneously. In addition, the limited prosthetics of one cavernous body does not adversely affect one's own erection.

The method is as follows.

Under local anesthesia in the area of the coronary sulcus, a transverse incision is made of the skin and fascia of the pancreas 1 cm long. At the same level, the protein membrane of the most affected sclerosis of the cavernous body is transversely cut and the cavernous tissue is exposed. Then, the cavernous body is bougiended along the axis of the IF along sclerotic plaques, the prosthesis is inserted in the proximal direction. The length of the endoprosthesis is 0.5-1 cm longer than the length of the sclerosed area. The distal end of the prosthesis is immersed in the capitate of the cavernous body and fixed to the protein membrane. The wound of the albumen and skin is sutured. The operation lasts 20-25 minutes.

The method was tested on 47 patients. A survey of long-term results (from 1 to 2 years) revealed: the tissues of the operative patients operated on are soft, elastic. Sclerotic plaques that exist before surgery are not detected by palpation and ultrasound of the penis, there is no curvature of the prostate during erection, and the erection is preserved.

Example. Patient - P., 53 years old, has been suffering from Peyronie’s disease for 3 years. With an erection, the backward bending of the IF is observed (angle of curvature 70 °). On palpation, several sclerotic plaques up to 2.5 × 1.2 cm in size with a woody density and predominant localization in the region of the right cavernous body are determined. Cavernosography revealed incomplete filling with contrast of the right cavernous body over 4.0 cm. Under local anesthesia, an implant was implanted with a length of 5.0 cm into the right cavernous body. The operation was successful. The patient was discharged from the hospital the next day. Examined after a year, sclerotic tissues during palpation and ultrasound of the penis were not detected. The patient does not show complaints.

Claims (1)

A method of surgical treatment of fibroplastic induction of the penis, including implantation of the prosthesis into the cavernous body through an incision in the area of the coronary sulcus, characterized in that the prosthesis is implanted into the most affected cavernous body by a length exceeding the length of the sclerotic area by 0.5-1 cm.