[Fabrication of a unit implant prosthesis. Combined implant surgery and guided tissue regeneration at an extraction site].
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Relatively few complications have been reported for cochlear implant surgery in spite of a recent report detailing a complication rate of 11.8 percent. This report highlights both the surgical and nonsurgical complications we have encountered that have resulted in either replacement of the implanted prosthesis or compromise of the sound processing strategy employed by the external unit. These complications make a strong argument for the use of preoperative, intraoperative, and postoperative radiologic examinations. Since the complications reported herein have not been attributed to the implant device proper, we feel cochlear implantation remains a safe and effective procedure for those patients who are untreatable by traditional methods.
The surgical techniques for penile prosthesis implantation are well known and standardized. Multicomponent hydraulic prosthesis offer, without any doubt, the best guarantees in terms of function and aesthetic results. Nevertheless their insertion is sometime troublesome and a superficial knowledge of the technical problems may lead to complete and disappointing failures. In the present work the Authors report their personal experience with various types of penile prosthesis and describe in details, the different maneuvers which are needed for their correct implantation. Some variation of the original technique will be also described. The results obtained will also be described.
An implant-supported prosthesis is often secured to the underlying gold cylinders by retaining screws. There must be access to these screws from the oral surface of the prosthesis. Conventional preparation of this access is from the oral surface. This approach is difficult because the underlying gold cylinder is obscured. It may be damaged by a rotary cutting instrument as the access is prepared above it, because the cylinder cannot be seen during the preparation. Alternatively, the access hole may be unnecessarily enlarged in an attempt to find the cylinder. This loss of structure may weaken the prosthesis. A new approach, using 18-gauge stainless steel wire as a rotary cutting instrument, permits preparation of the access chamber from the intaglio surface of the prosthesis. This reduces risk of damage to the gold cylinder and is less destructive to the overlying material.
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A precise fit at the prosthesis attachment interface is necessary to assure atraumatic loading of the implant fixture. The required high degree of frame accuracy can be more difficult to achieve when a single fixed prosthesis uses different root form implant systems for support. Two clinical protocols are described for these fixed implant prostheses. The first protocol uses a semiprecision attachment for the restorations. The second protocol uses a modified abutment system and a one-piece frame design.
PURPOSE: Erectile dysfunction today has a number of effective treatment options. This review was undertaken to examine the contemporary role of penile prosthesis implantation in the treatment of this disorder. MATERIALS AND METHODS: A MEDLINE search was performed on the topic of penile prostheses and implants. Current literature was reviewed with regard to types of penile implants, issues related to prosthesis implantation, results, and patient/partner satisfaction. RESULTS: Mechanical failure rates for early penile prostheses, especially the inflatable type, were unacceptably high. Advances in both prosthesis design and implantation techniques have resulted in increased device survival with 5-year actuarial survival rates free of mechanical failure ranging from 86.2 to 93.6%. Recent reviews of implant recipients show 83 and 85% satisfaction and for partners 70 and 76% satisfaction. CONCLUSIONS: When systemic therapy for erectile dysfunction fails, men have a variety of other options to choose from. Penile prosthesis implantation is an option that is feasible for nearly every man with this disorder. Current device survival rates and patient and partner satisfaction rates are high.
PURPOSE: This study was undertaken to evaluate the results and complications of penile prosthesis implantation in patients with erectile dysfunction caused by Peyronie's disease. MATERIALS AND METHODS: Men undergoing surgical intervention for erectile dysfunction caused by Peyronie's disease at the University of North Carolina School of Medicine were reviewed. Patients included 30 men aged 29-64 (mean = 49.6) with a duration of Peyronie's disease from 12-72 months (mean = 31.4 months). All men had palpable Peyronie's plague, significant penile curvature and plaque formation. All patients underwent implantation of AMS 700CX penile prostheses from 1993 to 1997. RESULTS: Penile straightening was carried out using modeling in 28 (93%) while plaque incision was necessary in 2 men (7%). All patients had a resultant straight penis with functional penile implant. There were no patients who suffered penile prosthesis infection and no mechanical malfunctions were observed during the follow-up. CONCLUSIONS: Penile prosthesis implantation with modeling is a safe, simple, effective technique for straightening penile curvature in patients undergoing implantation of penile prosthesis for Peyronie's disease. Penile prosthesis implantation is a safe, effective, low morbidity method for restoring potency in men with male erectile dysfunction and Peyronie's disease.
Four types of implant superstructures were screwed onto implant bodies, and the strains created around the implant bodies were compared and analyzed within the IMZ Implant System. Three IMZ implants were embedded in the center of a polyurethane block (30 x 40 x 30 mm), and a total of 16 superstructures was fabricated by 4 methods: 1-piece cast, 1-piece cast/split soldering, soldering, and passive fit. Six strain gauges were placed on the surface of the block 1 mm apart. Three embedded implants were numbered, and a fixed partial denture was placed on these implants and screwed by a torque wrench using 14.5 Ncm torque. This procedure was repeated 7 times for each fixed partial denture, and each created strain was measured when the last screw was tightened. In all fixed partial dentures, strains were produced around the implant bodies when screws retaining the prosthesis were tightened, and the strain was relieved with unscrewing. The magnitude of strain was greater with the 1-piece cast method or the section/solder method than with the soldering and passive-fit methods. Of the 2 soldering methods, when the screw on the middle implant was tightened before those on the terminal 2 implants, the magnitude of strain was lower with the soldering method than with the 1-piece cast/split soldering method. When the order of screw tightening was changed, there were significant differences in the magnitude of strain at each gauge with the soldering method. With the passive-fit method, no differences in the magnitude of strain attributable to the order of screw tightening could be detected. The magnitude of strain produced around a screw-retained implant prosthesis was significantly lower with the passive-fit method when compared to the other 3 fabricating methods. Furthermore, the implants prepared by the passive-fit method were not affected by the order of screw tightening.
Dysfunction of a prosthesis implanted in tricuspid position is a severe complication that may develop with minimal symptoms. A patient who presented clinical manifestations of heart failure for two weeks due to obstruction of a mechanical prosthesis in tricuspid position is described. Fibrinolytic treatment was given unsuccessfully, therefore prosthetic replacement was performed. In the removed prosthesis, a fibrotic pannus which developed in the strut and disc was seen. We review the clinical manifestations, the diagnosis and treatment of the dysfunction of a prosthesis implanted in tricuspid position.
PURPOSE: We evaluated the long-term results of penile prosthesis implantation during the last 10 years. Special considerations were examined concerning Asian corporeal diameter, device survival and sociocultural factors influencing patient-partner satisfaction. MATERIALS AND METHODS: We followed 331 patients who underwent penile prosthesis implantation from December 1985 to May 1996. Surgical data, postoperative complications and information from a survey on satisfaction are reported. RESULTS: The most prevalent corporeal diameter in our patients was 11.0 to 11.5 cm. Postoperatively wound infection was the most serious surgical complication. The 5-year device survival was similar in the malleable and inflatable types except for a poorer outcome with the self-contained inflatable Hydroflex penile prosthesis. Overall patient satisfaction with surgery was 86.6%. CONCLUSIONS: Penile prosthesis implantation still has its place as definitive therapy in some patients with uncorrectable erectile dysfunction. In Taiwanese society more consideration of prosthesis selection, surgical preparation and patient-partner counseling is the basis for further success in the future.
When an implant is lost, it is sometimes desirable to replace it to ensure adequate support of the prosthesis. Such an addition may necessitate a costly and time-consuming remake procedure. A technique is offered that, in some circumstances, may allow incorporation of the newly placed implant into the existing restoration.
Today most men with erectile dysfunction (ED) can be effectively treated with less invasive means than penile prosthesis implantation. Nevertheless, there remain men who do not respond to simple treatments such as systemic medication and who either do not respond to or reject intermediate treatment such as penile injection therapy. For these men, penile prosthesis implantation remains a reasonable option. This review discusses types of penile prostheses, how to choose among prosthesis types, key features of implant techniques, infection management, penile reconstruction related to prosthesis implantation, and patient and partner satisfaction.
INTRODUCTION: Penile prosthesis implantation in men who have fibrotic corpora as the result of ischemic priapism or previous removal of an infected penile prosthesis poses a significant challenge to the implanting surgeon. We describe a new technique, corporeal excavation, to meet this challenge. TECHNICAL CONSIDERATIONS: The operative approach is through an inverted T penoscrotal incision that affords exposure of nearly the entire corpus cavernosum on each side. Extended corporotomies are made on the ventral aspect of each corpus cavernosum, and a plane of dissection between the fibrotic corporeal tissue and the inner surface of the tunica albuginea is established, resulting in core removal of nearly all fibrotic intracorporeal tissue. Cylinders are laid into the empty corporeal bed, and the tunica albuginea is closed primarily. Nine patients were identified who had undergone this procedure. The operative notes and medical records were reviewed, and telephone interviews were done for follow-up when patients had not been recently seen in the clinic. CONCLUSIONS: Successful outcomes were achieved in all 9 patients. Corporeal excavation permits penile prosthesis implantation in men with severe intracorporeal fibrosis usually resulting from priapism or previous removal of infected penile prostheses.
The ultrasonic diagnosis as a method of recognising postoperative subprosthetical breast pathological changes (respectively of simulated tumor recidivs and implanted breast prosthesis) located near the thorax and therefore difficult to detect by external palpation and mammography examination have been described in a follow-up study, and further possibilities of application suggested.
The patient was a 66-year-old man who had undergone implantation of a penile prosthesis for organic erectile dysfunction 7 years prior to consulting our hospital with a complaint of gross hematuria. Since a pedunculated, superficial tumor 1 cm in diameter was noted lateral to the left ureteral orifice, transurethral resection of the bladder tumor (TURBT) was performed. In this patient, we were able to insert the sheath with no difficulty, and the surgical procedure was done smoothly, resulting in complete resection of the tumor. However, the location of the tumor in the anterior or posterior wall of the bladder predicted difficulty of the tumor resection. Therefore, we consider it important to sufficiently evaluate the feasibility of complete TURBT before surgery and to thoroughly examine the patient for benign prostatic hyperplasia and bladder cancer, which can cause difficulty with post-implantation ransurethral procedures, and to perform transurethral surgery before implantation, if prosthesis implantation is planned.
The development of effective systemic therapy for the treatment of erectile dysfunction has resulted in a significant increase in the number of men presenting for treatment. Not all men with erectile dysfunction will respond to systemic therapy; those who fail may be candidates for penile prosthesis implantation if second and third lines of treatment also fail or are rejected by the patient and his partner. Penile prosthesis implantation continues to play a role in the treatment of erectile dysfunction. There is a potential for the number of penile prosthesis implantation procedures to actually increase. The ideal penile prosthesis is a three-piece inflatable device that permits good penile flaccidity and increases in size and becomes rigid with inflation.
Currently, the prosthesis of choice for patients undergoing penile prosthesis surgery is a three piece inflatable device, as this provides optimal inflation and deflation when compared to a one or two piece prosthesis. However, prior pelvic surgery or radiation therapy can obliterate the retropubic space and make placement of the reservoir required for a three piece prosthesis difficult. We report a novel location for reservoir placement in a man who had undergone multiple pelvic surgeries after suffering a severe pelvic crush injury.