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Prosthetic Surgery

Baylor Scott & White Center for Reconstructive Urology

 

We perform a large volume of genitourinary prosthetic surgery at the Center for Reconstructive Urology. Many of these cases are referred in from other urologists and are complicated redo cases. In other words, these surgeries are for patients who already have a penile implant or artificial urinary sphincter but are experiencing problems with the device implanted by other physicians.

Penile implants

This is a device that allows a patient to have a normal, firm erection when otherwise nothing else will work. This is a firm erection that lasts as long as he wants it, whenever he wants it. Most men will receive a three-piece inflatable penile prosthesis. The three parts are a pump that sits in the outer part of the scrotum (ball sack), the reservoir that is placed in the lower abdomen, and the paired cylinders that fill up the space in the corpus cavernosum of the penis.  

Certain clinical situations require a semi-rigid rod penile prosthesis. This is a simple but effective device that is implanted into the corporal bodies of the penis and either bends up or down. We prefer the infrapubic incision, which is a small cut in the lowest part of the abdomen just above the base of the penis. The skin is thicker here, and the incision heals very quickly. All patients undergo a three-day prep, which includes twice-daily surgical scrub at home and a daily oral antibiotic. With this regimen and strict operating room protocols, we have had NO INFECTIONS in over 20 years. The penile implant is the bottom line answer for patients who have suffered from long-standing ED and no other treatments have worked. 

Artificial urinary sphincter

This is a three-piece device that is implanted into men to control urinary leakage. In rare instances, we have also implanted these devices into women with severe, intractable urinary incontinence. The first part is the cuff that encircles the bulbar urethra (or bladder neck). The cuff applies pressure to the urethra and reforms the valve that prevents leakage. The second part is the pump. The pump is positioned in the outer scrotum and controls the entire system. The pump is deactivated at the time of surgery. The final part is the balloon reservoir that is placed into the lower abdominal wall. Fluid from the balloon filters through the pump, which then allows the fluid to travel to the cuff. At rest or in the passive state, the cuff remains full, the urethra is compressed and there is little or no leakage. When the bladder is full and it is time to pee, the patient squeezes the pump, and fluid is transferred out of the cuff and into the balloon. With the channel now open, the bladder can contract and empty in a very normal way. These patients also undergo the three-day prep before surgery mentioned above for penile implants. This is an ingenious device that has stood the test of time (over 40 years) and is a highly effective way to treat male urinary incontinence after prostate surgery, radiation therapy or other urethral trauma.   

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