title: Does tunica anatomy matter in penile implant?
abstract: BACKGROUND
  Overall prosthesis survival is important in penile implant, which remains the final viable solution to many patients with refractory erectile dysfunction (ED). This paper is to retrospectively study the role of the anatomy of tunica albuginea (TA).
  
  
  METHODS
  From March 1987 to March 1991 while the TA was regarded as a circumferential single layer, 21 organically ED men, aged from 27 to 77, received penile prosthesis implantation and were allocated to conventional group. From August 1992 to March 2013 while the tip of Hegar's dilator was categorically directed medial-dorsally during corporal dilatation derived from newfound TA as a bi-layered structure with a 360° complete inner circular layer and a 300° incomplete outer longitudinal coat, 196 ED males, aged from 35 to 83, underwent penile implant and were categorized to advanced group. The model of prosthesis was recorded. Prosthesis loss rate and survival time were analyzed and the follow up period ranged from 22.4-26.4 (average 24.3) years and 0.4-20.6 (average 15.8) years to the conventional and advanced group respectively.
  
  
  RESULTS
  To the conventional and advanced group, the number of inflatable and rigid type prosthesis used were 2, 19 and 15, 181 respectively, whereas the prosthesis loss was encountered in 50.0% (1/2), 15.8% (3/19) and 0.0% (0/15), 0.6% (1/181) respectively. And the prosthesis survival time were 5.1-6.3 (5.7) years, 1.3-26.4 (15.2) years and 6.1-16.2 (11.2) years, 0.4-20.6 (15.3) years to the conventional and advanced group respectively. Statistical significance was noted on prosthesis loss in groups (P=0.01) while the Mentor Acuform stood out in prosthesis survival.
  
  
  CONCLUSIONS
  Anatomy-based managing maneuver appears to deliver better surgery success in penile implant. Tunica anatomy is significant in performing implant surgery.
authors.affiliation: 1 Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology and National Taiwan University, Taipei, Taiwan ; 2 National Taiwan University Hospital, Jin-Shan Branch, New Taipei, Taiwan ; 3 Department of Medical Informatics & Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Geng-Long
authors.initials: GL
authors.lastname: Hsu
authors.affiliation: 1 Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology and National Taiwan University, Taipei, Taiwan ; 2 National Taiwan University Hospital, Jin-Shan Branch, New Taipei, Taiwan ; 3 Department of Medical Informatics & Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Heng-Shuen
authors.initials: HS
authors.lastname: Chen
authors.affiliation: 1 Microsurgical Potency Reconstruction and Research Center, Hsu's Andrology and National Taiwan University, Taipei, Taiwan ; 2 National Taiwan University Hospital, Jin-Shan Branch, New Taipei, Taiwan ; 3 Department of Medical Informatics & Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Sheng-Jean
authors.initials: SJ
authors.lastname: Huang
keywords: Tunica albuginea in human penis (TA in human penis); penile implant; prosthesis extrusion; prosthesis loss
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