PATIENT INFORMATION: Urogenital System Implants

What … for? (Indications)

Urinary tract implants help at

  • female/male stress urinary incontinence (SUI), treatment by bladder string surgery)
  • urinary retention
  • overactive bladder in patients who have failed or could not tolerate more conservative treatments (Sacral Neuromodulation) and
  • Postprostatectomy incontinence (PPI)
  • Injection of an implantable material to reduce flow at incontinence

urisex 04 string surgery
principle of string surgery

Sex organ implants (only male) help at

  • Erectile dysfunction
  • Micropenis and
  • Repair after removal of testicels

Penile Implants (types)

    • Non inflatable penile implant
    • Two-Piece inflatable penile implant
    • Three-piece (multicomponent) inflatable penile implant

principle of string surgery

Numbers

No reliable statistic numbers.
Penile prosthesis: 20000-30000 devices annualy worldwide (Urology Team, P.A.)

Times   n/a

Contraindications

  • behavioral
    Quite a number of incontinence as well as penis problems don´t need surgical intervention and may be treated on a psychological basis Considering the following facts:
    · One in three women who have had a baby experience loss of bladder control.
    · One in five children wet the bed at some time.
    · One in 100 adults never achieve bladder control at night.
    · One in 20 adults experience bladder and bowel control problems
  • medical
    • Incontinence: Severe incontinence is not likely solved with sling procedures, bladder disorders, inadequate tissue integrity at the bladder neck or urethra, active urinary tract infection, pure urge incontinence, prior radiation therapy, cancer.
    • Bladder Neurostimulation is not indicated at mechanical obstruction, prostatic hypertrophy, cancer, urethral stricture, no adequate response to test stimulation, unability to operate the tool.
    • Penis implants: They are not indicated at psychogenic reasons, diseases of the lower urinary tract, internal erosion or adhesion, low reliability for follow-up care.
  • during surgery      n/a

Risks

  • during surgery
    • nerv cutting
  • short term
    • infection, hemorrhage, urethral obstruction, stress urinary incontinence, urge incontinence, urinary retention
  • long term
    • sling rejection, perforation
    • chronic infection, tearing of skin, scarring, permanent loss of sexual function, loss of sensation in the penis, impotence
    • malfunction of implant, penis implants may stay for 4-8 years
  • restrictions
    • sling surgery: 2-3 days in hospital, 2-4 weeks recovery period, obstipation possible
    • penis implant: pain for about 4 weeks. oral medication, driving is prohibited, no sexual activity for 6 weeks.

Failures    n/a, too many varieties

Material

  • autologous
    • fascia lata
      • fresh frozen/freeze dried
      • solvent-dehydrated
      • irradiated
    • fat
  • allogenic
    • human dermis
    • bovine collagen
    • porcine collagen
      • Fortagen® CuffPatch™
  • xenogenous
    • porcine dermis
    • porcine small intestinal mucosa
  • alloplastic
    • silicone
    • polymethylsiloxane
    • polyethylene (Marlex®)
    • polypropylen (Prolene®)
    • acellular collagen matrix (Pelvicol®)
    • polyglactin 900 (Vicryl mesh)
    • expanded polytetrafluoroethylene PFTEe (Gore-Tex)
    • polyethylene terephthalate (Mersilene)
    • hydroxyapatite (Coaptite®)
    • belladerm matrix graft (penis widening)
    • titanium beads with magnetic cores (effectiveness has not been demonstrated)
    • implantable bladder pacing system, bladder stimulator

Statistics

  • Incontinence surgery: 80-85% success rate (Comiter CV)
  • Bladder stimulation/Sacral Nerve Stimulation (SNS)/Percutaneous Tibial Nerve Stimulation (PTNS): 63-64% success rate (Anthem)
  • Penis implant: n/a

Literature

Medical societies    see here 

Criticism

Selected Patient Information

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