Penile prostheses or penile implants are an effective treatment and an increasingly desirable option for men with Erectile Dysfunction (ED). Both types of hydraulic inflatable devices have hollow cylinders that are implanted within the erection chambers of the penis.
This is the simpler of the two types of inflatable devices, accounting for approximately 15% of penile implants used worldwide. The most commonly used inflatable device is the 3-piece inflatable implant, accounting for approximately 75% of penile implants. One major difference between the hydraulic, inflatable prosthesis and the semi-rigid malleable implant is that the inflatable prosthesis has a more natural feel since it allows for control of rigidity and size. The pros and cons of each treatment option should be carefully discussed with the treating physician to make the best-informed choice and to ensure that the patient has realistic expectations about treatment results. If you have questions regarding prostate cancer, our board-certified team of urologists has the answers.
We offer innovative, personal and high-quality urologic care for patients in Citrus, Lake, Marion and Sumter counties. It is estimated that more than 800,000 cases of BCC will occur in the United States this year. The most common causative factor in the induction of BCC is ultraviolet (UV) light, specifically ultraviolet B (UVB, 290-320 nm). Although the exact mechanism of BCC propagation is unknown, it is believed that basal cell carcinomas arise when mutations that control cell growth via the hedgehog pathway activate immature pluripotential cells in the epidermis. The natural progression of untreated BCC is slow growth with progressive invasion and destruction of adjacent tissues.
An indurated yellow to white plaque with an indistinct border and an atrophic surface characterizes morpheaform or sclerosing BCC (Fig. Clinical diagnosis of BCC is confirmed by performing a biopsy of the suspected lesion for histopathologic interpretation. According to the American Academy of Dermatology (AAD) Guidelines of Care, electrodesiccation and curettage (ED&C) is best suited for primary lesions, but it may be useful in some recurrent lesions.
Primary nonmorpheaform basal cell carcinomas are more friable than surrounding normal skin and are initially debulked with a curette. According to the AAD Guidelines of Care, cryosurgery is useful in treating primary lesions and some recurrent lesions. Larger and morpheaform lesions require wider and potentially deeper surgical margins for complete histologic resection.
According to the AAD guidelines, Mohs micrographic surgery (MMS) is particularly efficacious in dealing with recurrent tumors in certain anatomic locations, with tumors that have been present for a long time and have become relatively large, and with certain subtypes including large, nodular, and morpheaform BCCs.
The procedure is predicated on histologically inspecting the entire perimeter and undersurface of the excised specimen to ensure a tumor-free margin.
The AAD guidelines state that radiation is useful for definitive treatment of primary tumors and some recurrent cancers and for palliation of inoperable tumors.2 This modality is useful for treating elderly patients who are not suitable candidates for surgical procedures.
According to the AAD guidelines, laser surgery is a recognized and evolving therapy that may be used to vaporize superficial and multiple basal cell carcinomas.
Other modalities such as retinoids, imiquimod, 5-fluorouracil, immunotherapy (IL-1, IL-2, interferon alfa-2b, and interferon gamma), and photodynamic therapy have been used with varying success. Squamous cell carcinoma (SCC) is a malignant tumor arising from the keratinocytes in the epidermis or its dermal appendages.
Like BCC, exposure to UV radiation is the most common cause of SCC in fair-complected persons. The incidence of SCC doubles with each 8 to 10 degrees decline in latitude (proximity to the equator). Additional variables that put SCC in the high-risk category include cause (scar, chronic ulcer, sinus tract, radiation dermatitis) and rapid growth pattern.
Actinic keratoses are premalignant skin lesions that result from chronic sun exposure and are found chiefly on the face, ears, dorsal hands, and forearms. The transformation may be heralded by the development of erosion, induration, inflammation, or enlargement.
Options for treatment include cryosurgery, ED&C, topical fluorouracil, photodynamic therapy, dermabrasion, chemical peel, and laser resurfacing. Well-demarcated erythematous, scaly, slowly enlarging plaques that can occur on any part of the body characterize Bowen's disease or SCC in situ (Fig. Keratoacanthomas can also mimic invasive SCC with regard to rapid growth pattern and clinical characteristics. Therefore, a method of removal that ensures adequate depth for histopathologic review is important. Verrucous carcinoma can occur on the soles, glans penis, scrotum, vulva, scalp, face, back, nail beds, or larynx. As with BCC, a total body examination of the skin is the only screening test available for cutaneous SCC.
A variety of surgical and nonsurgical therapeutic modalities provide effective treatment of SCC. According to the AAD guidelines, ED&C may be suitable for small primary lesions on sun-exposed skin.
ED&C is a process used to sequentially scrape the tumor away followed by destruction of an extra margin of normal skin by electrodesiccation performed up to three times to maximize the possibility of complete removal.
The main drawbacks with ED&C are that there is no tissue available for histologic evaluation to ensure tumor-free resection. This modality uses liquid nitrogen to destroy the tumor by lowering the temperature to tumoricidal levels. During treatment, it is important to include a rim of 3 to 4 mm of normal tissue beyond clinically visible margins of the tumor. According to AAD guidelines, this surgical procedure is useful for primary and recurrent tumors.
The wound is closed primarily with side-to-side closure, flaps, or grafts or is allowed to heal by second intention. According to AAD guidelines, MMS is particularly efficacious in dealing with some recurrent and some primary tumors that display risk factors associated with aggressive biologic behavior (Box 1).
The Mohs procedure offers the highest cure rates for patients with high-risk, primary, or recurrent SCC.
MMS uses horizontal frozen sectioning of the tumor to provide a view of 100% of the peripheral and deep margins of the specimen to ensure tumor-free planes. SCCs that have lymph node involvement are additionally treated with radiation and lymph node dissection. Cases involving distant metastases may be treated with systemic chemotherapy or other biologic response modifiers. According to AAD guidelines, this modality is useful for definitive treatment of primary tumors in select patients and some recurrent cancers. Photodynamic therapy employs a photoactive compound applied to the SCC lesion followed by photoirradiation. Patients with SCC are at risk for developing other malignancies such as cancers of the respiratory organs, buccal cavity, pharynx, small intestines (in men), non-Hodgkin's lymphoma, and leukemia.


As with all skin cancer treatment, therapy should be carefully tailored to the specific lesion and influenced by the medical status of the patient. Apply a broad-spectrum sunscreen, one that protects against UVA and UVB rays with a SPF 15 or higher.
For people with sensitive skin, chemical-free sunblocks containing titanium dioxide or zinc oxide, which also afford broad-spectrum coverage, can be used.
Wear protective clothing including a wide-brimmed hat, sunglasses, long-sleeved shirt, and long pants. Avoid reflective surfaces such as water, snow, and sand that can reflect up to 85% of the sun's damaging rays. Patients with a history of skin cancer deserve a full skin examination on a regular basis, perhaps every 6 months, coupled with education about ultraviolet sun exposure and the regular use of sunscreen.
Immunosuppressed patients have a higher incidence of skin cancer, especially squamous cell carcinoma, which can be more aggressive, with appreciable morbidity and mortality.
Basal cell carcinomas display extensive abnormalities in the hemidesmosome anchoring fibril complex. Long-term recurrence rates in previously untreated (primary) basal cell carcinomas: Implications for patient follow-up. Men are eligible for implants if they have an established medical cause for ED, fail to respond to non-surgical treatments (such as oral medications, vacuum devices and injection therapy) and are motivated to have surgery to improve erectile function. Men should avoid this device if they have a spinal cord injury, diabetes or penile irradiation. In order to create an erection these inflatable devices use a pump to transfer fluid (saline) into the cylinders via tubing.
In the two-component penile prosthesis, one component is the paired cylinders and the second component is the fluid-filled internal pump located inside the scrotum.
This device has paired cylinders and a small scrotal pump, but in addition this device also has a fluid reservoir behind the abdominal wall muscles that is filled with saline solution. The semi-rigid devices have the advantage of being the simplest of the penile implants and are the cheaper option. To schedule a consultation with Advanced Urologists, please call (855) 298-CARE or contact our office today. This tumor is believed to arise from the pluripotential primordial cells in the basal layer of the epidermis and less often from the outer root sheath of the hair follicle or sebaceous gland or other cutaneous appendages.1 Although BCCs grow slowly and rarely metastasize, they can cause extensive tissue destruction through direct extension, leading to significant patient morbidity if untreated. The annual incidence in Americans is 146 cases per 100,000 people.2 Although the incidence of BCC increases with advancing age, it is becoming more common in younger adults. It has been shown that UVB induces characteristic DNA mutations in the skin called pyrimidine dimers. This most often occurs through inactivation of the tumor suppressor gene PTC (patched), located on chromosome 9. The typical lesion is a small pearly (waxy) nodule with a central depression and rolled border containing dilated blood vessels. It is characterized by multiple BCCs of the face, follicular atrophoderma of the extremities, localized or generalized hypohidrosis, and hypotrichosis. Among the clinical subtypes of BCC, small nodular or superficial BCCs respond to most treatment options; large nodular ulcerative or morpheaform lesions can require more aggressive therapy. It is especially useful in certain areas of the body and in patients with multiple lesions.1 Superficial and small nodular BCCs respond well to liquid nitrogen cryosurgery.
The laser can also be used in lieu of a scalpel for excisional surgery to provide for improved hemostasis. Chemotherapy used in the treatment of metastatic disease may have a role in treating patients with multiple lesions or as adjunctive therapy in patients being treated with radiation.
Prevention and education are also integral parts of the total care of a patient with BCC.6 Daily sunscreen application, sun-protective clothing, and sun avoidance during peak hours are essential. Any exposure to UV radiation produces mutations in the DNA by forming thymidine dimers in the p53 tumor-suppressor gene. They are usually multiple, discrete, flat or raised, verrucous or keratotic, pigmented, erythematous or skin-colored. Keratoacanthomas usually start out as a 1-mm flesh-colored macule or papule and grow to as large as a 2.5-cm nodule with a keratin-filled crater in only 3 to 8 weeks (Fig.
Options for therapy include observation, surgical excision, ED&C, topical or intralesional 5-fluorouracil, cryosurgery, radiation, and MMS. A physical examination of a patient with SCC should always include a thorough examination of the areas of lymphatic drainage. In select patients, curettage used alone or in conjunction with cryosurgery or ionizing radiation is an acceptable treatment method. According to the AAD guidelines, it is especially useful in patients with bleeding disorders. The advantages are that tissue can be assessed microscopically, the wound heals rapidly, and the cosmetic result is good. For tumors that have a high risk of recurrence and are larger than 2 cm, a 6-mm margin is recommended. The laser excises tissue in a bloodless fashion because the laser seals small blood vessels during the treatment, while also allowing margin control by histopathologic evaluation.
Because there is a 30% risk of having a second primary SCC within 5 years after therapy for the first malignancy, skin cancer patients should have a total body examination once or twice yearly.
This is crucial, because excessive sun exposure in the first 18 years of life increases a person's chances of developing melanoma.
Due to their heavy immunosuppressive regimens, theyare at risk for developing both internal and cutaneous malignancies.
The malleable penile implant requires surgical insertion of a pair of flexible rods within the erection chambers of the penis. Compression of the pump results in rigidity by transferring fluid from the back part of the cylinders and pump into the middle portion. One disadvantage to consider is that a constantly rigid penis that resembles neither normal erection nor flaccidity can makes it difficult to conceal under tighter fitting clothing as well as presenting an increased risk for device erosion. On a preventive health note, it has been estimated that regular application of sunscreen with a sun protection factor (SPF) of 15 or greater for the first 18 years of life would reduce the lifetime incidence of nonmelanoma skin cancers by 78%.
An Australian study showed that the incidence of BCC is higher in men, but the incidence in women has been steadily increasing.3 Factors such as excessive, chronic sun exposure, indoor tanning, fair complexion, prior exposure to ionizing radiation, exposure to chemical cocarcinogens such as arsenic, and genetic determinants are significant risks factors.
The p53 tumor suppressor gene is responsible for arresting the cell cycle so that any induced mutations can be repaired by the cell. When metastasis has occurred, the site of the primary lesion has most often been on the head and neck.
It manifests as a small, pearly dome-shaped papule with surface telangiectasias and a typical rolled border.
They often manifest as several scaly, dry, round-to-oval erythematous plaques with a threadlike raised border on the trunk and extremities.
This subtype has all the characteristics of the nodular-ulcerative variety plus brown or black pigmentation from melanin. However, when the lesion is believed to be a morpheaform BCC, a deep shave, punch biopsy, or incisional biopsy is recommended to obtain a sufficient tissue sample for correct interpretation.


It is less effective in the cure of recurrent lesions or in the morpheaform subtype because of indistinct margins.
Postoperatively, the surgical margins of the specimen are examined histologically for assessment of adequate tumor removal. Defects after MMS can be closed immediately, or a delayed repair may be performed in select cases. The age-specific incidence among persons older than 75 years is approximately 10 times that rate.
Mutations in p53 result in a nonfunctional protein that cannot repair a mutated keratinocyte. However, this rate might actually be much higher, especially in immunocompromised patients such as organ transplant recipients. The most common sites affected are the scalp, dorsal hands, ears, lower lip, neck, forearms, and legs.
Because even the most astute physicians can make incorrect clinical diagnoses, most biopsies of all suspected nonmelanoma skin cancers should be adequate to allow proper diagnosis and treatment. ED&C is less effective in curing recurrent lesions that have associated scar tissue. ED&C is not advisable for treating tumors on the face because the tumor can extend along the hair follicles beyond the reach of the curette.
It is also a good alternative in patients for whom other forms of surgery are contraindicated or who refuse other forms of surgery. Radiation is not used for treatment of verrucous carcinoma because some evidence suggests that the metastatic potential may be enhanced.
Oral and topical retinoids are being evaluated for therapeutic and chemoprophylaxis management.
It is important that men talk to their doctor about the advantages and possible risks of having the surgery.
The rods have an outer coating of silicone and inner stainless steel core or interlocking plastic joints.
To end the erection with a two-component prosthesis, the penis is gently bent down for 5-10 seconds at its mid-shaft, resulting in the fluid being returned to the fluid-filled pump. With these three-component devices, a larger volume of fluid is pumped into the cylinders for an erection by squeezing the concealed pump in the scrotum several times in order to move the fluid from this concealed reservoir into the cylinders that are in the penis. Although nonmelanoma skin cancers (basal and squamous cell carcinomas) are the most common types of malignancies in humans, melanoma ranks as the sixth most common cancer in men and the seventh most common in women. In BCC, the same UV light–induced pyrimidine dimer mutations have also been found in the p53 tumor suppressor gene. The sites of BCC metastasis in order of frequency are the regional lymph nodes, lung, bone, skin, liver, and pleura. BCC has five clinicopathologic subtypes: nodular-ulcerative, superficial, pigmented, morpheaform (sclerosing), and basosquamous.
This variety has an aggressive growth pattern, and invasion of muscle, nerve, and bone may be seen. The wound defect can be closed primarily with side-to-side closures, flaps, or grafts, or it may be allowed to heal by secondary intention. Radiation therapy is contraindicated for morpheaform BCC or recurrent BCC tumors regardless of pathologic subtype. The development of ulceration or induration can portend transformation into invasive SCC, which occurs in up to 5% of cases. In most cases, solitary keratoacanthomas involute over 2 to 6 months, often healing with scarring.
Clinically SCC manifests as an enlarging indurated erythematous papule, nodule, or plaque with scale (Fig. Tumors that extend into the subcutaneous tissues histologically or are found to have clinically invaded the subcutaneous fat at the time of treatment are less likely to result in cure when treated with this method.
This procedure replaces the spongy tissue (corpora cavernosum) inside the penis with rigid, semi-rigid, or inflatable cylinders depending on which type of penile implant is chosen. Although the number of nonmelanoma skin cancers is staggering, both basal cell and squamous cell carcinomas have a better than 95% cure rate if detected and treated early. This mutated p53 gene is nonfunctional and leads to dysregulation of the cell cycle, with resultant unlimited cell proliferation (cancer). Differential diagnosis of this lesion includes sebaceous hyperplasia, squamous cell carcinoma, verruca vulgaris virus, molluscum contagiosum, intradermal nevus, appendageal tumors, amelanotic melanoma, and stasis ulcers (when located on the shins).
Differential diagnosis of superficial BCC includes eczema, psoriasis, and Bowen's disease.
The main disadvantages include a hypopigmented scar, prolonged healing, pain during the procedure, and risk of recurrence. Keratoacanthomas are generally found on sun-exposed areas such as the central face, dorsal hands, arms, and legs, although they can occur anywhere on the body including the mucosa. These patients should be screened before transplantation to assess their risk of developing skin cancer, and they must be educated regarding safe sun protection measures and skin self examination.
This type of implant produces a constant penile rigidity that merely needs to be lifted up or bent into the erect position to achieve an erection and have intercourse or in the downward position for urination. The advantage of this device is that it is easier to deflate and may be a better device for older men or men with poor manual dexterity. When the erection is no longer desired, a release valve on the pump (in the scrotum) is simply pressed to transfer the fluid back into the reservoir and out from the cylinders, causing the penis to become flaccid.
Differential diagnosis of morpheaform BCC includes scarring and localized superficial scleroderma (morphea). Treatment of facial lesions with this modality is not advocated because of the risk of deep invasion in embryonal fusion planes, the difficulty of adequate curettage in the sebaceous skin of the nose, and poor cosmetic appearance. Although keratoacanthomas might ultimately involute, the duration of regression is unpredictable. Ulceration and crusting occur later, followed by possible invasion of underlying structures and development of regional lymphadenopathy.
After the procedure, when a man desires an erection he can produce a rigid erection on demand that enables him to have sexual intercourse. The disadvantage of this device is that in the flaccid state it always contains some fluid and thus the penis will always appear “full” (similar to the penile form after a man has a hot shower). Treatment options include excision, ED&C, photodynamic therapy, imiquimod, cryosurgery, 5-fluorouracil, and MMS. Malleable penile implants can be bent in more than one place to create the desired erection. Patients usually note the presence of a firm nodule growing either inward or outward with ulceration. Three malleable devices exist at this time: AMS Malleable 650, Dura-II devices, and the Mentor Acu-Form prosthesis.



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