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Surgery to Deal with Erectile Dysfunction

Mariam (pseudonym) woke up from the nightmare on the operating table. A month ago, at the age of 28, he had just underwent a penile pacemaker implantation operation. Now, the “Xin Tin Ding” that he can completely control with one hand has recovered well.

Eight years ago, 20-year-old mariam was riding a bicycle on the road. He did not expect that in the next second he would be hit by a large trailer and his whole person “flyed” off the bicycle. Pelvic fractures, urethra fractures, and urination all have to rely on an artificial tube in the bladder.

As the treatment progressed, mariam’s fractures gradually disappeared; after the urethral anastomosis, defecation was no longer a problem. But time has not cured everything, nor has the doctor. After the trauma healed, mariam found that he had completely become a patient with erectile dysfunction (ED), also known as impotence.

The simple wishes of getting married and having children turned out to be extravagant hopes for mariam, who is only 20 years old.

In order to bring life back to the right track of universal meaning, mariam went to various places to seek medical treatment during the eight years, and experienced many attempts such as long-term use of “Viagra” drugs, vacuum negative pressure traction, and psychological treatment. The more than 100,000 expenses that his parents got from working everywhere and borrowing money threw them in, but they still didn’t see the effect on mariam.

Earlier this year, after hearing about a penile pacemaker implantation operation from a doctor in Guizhou province, mariam, who had already suffered from physical and mental torture, did not expect that this nightmare concerning male dignity would wake up.

The ultimate weapon against impotence

According to Dr James, director of the General Hospital, who was in charge of mariam, at that time, after two consecutive nights of night erectile function (NPT) examinations, mariam’s genitals had undergone relatively serious organic damage, and his erectile function was complete. Lost. In the case of drug, psychological, and physical therapy failures, the implantation of a three-piece penile pacemaker became his only hope.

“Like a cardiac pacemaker, artificial joints, etc., a penile pacemaker is an artificial organ that can be implanted into the human body,” Dr James told News Weekly.

In the list of imported medical devices of the State Drug Administration, its name is also called artificial sponge. As the name suggests, after it is implanted in the penis, it can be artificially controlled to produce the same effect as the congestion and expansion of the cavernous body, thereby achieving artificial control of erection.

From the appearance point of view, the penile pacemaker consists of three parts, including two cylinders, a reservoir and a pump.

The two cylinders are artificial cavernous bodies, and the storage sac is used to store physiological saline. Under the action of the pump, the physiological saline enters the cylinder to make it swell, so that the penis is erected.

Liquid reservoir (top left), cylinder and pump with switch button. Photo/Boston Scientific official website

It sounds simple, but penile pacemaker implantation can be said to be one of the most complicated operations in andrology.

First, the doctor needs to make a small opening for the patient at the junction of the penis and the scrotum, separate and expand the two cavernous bodies of the penis, and then implant two cylindrical artificial cavernous bodies of appropriate size into them;

Afterwards, the doctor will put the reservoir into the anterior space of the bladder and place it, and hide the pump perfectly in the scrotum;

The last step is to connect several pipelines between the three to form an entire closed loop.

After such a set of operations that took 1 to 2 hours, a brand-new modified penis that can be controlled by the timing, degree and duration of erection and almost identical in appearance to the original, was pierced on mariam’s body.了根。 The root.

Surgery scene. Photography: Ma Duoming/provided by interviewee

Next, mariam experienced a 7-day wound healing period and a 4-6 week period of adaptation and adjustment.

During the period, the two doctors of Sun Zhongyi’s team repeatedly taught mariam how to use it, including how to use the switch on the pump, how to control the degree of erection, etc., to ensure the subsequent safe operation of mariam. For example, in the first 4 weeks, the doctor will advise the patient to keep the new penis in a semi-erected state to reduce the pain of the cavernous body.

In normal use, press the button under the skin of the scrotum twice, which is the switch of the pump, to make the penis in an erect state. After the ejaculation is over, if both parties are not satisfied, you can still keep the penis erect and continue fighting.

Until both parties are completely satisfied, press the button again, and the water filled in the cylinder will return to the reservoir again, and the penis will die.

“The three-piece suit is currently the most suitable for the human body to simulate an erection under physiological conditions.” Dr James told Nigeria News Weekly. “Therefore, the modified version of the penis will basically not affect the normal sexual pleasure and ejaculation. If the patient has preoperative Fertility is normal and will not be affected in any way”.

A previously published study spanning ten years in the Journal of Peking University (Medical Edition) showed that patients and their sexual partners were more than 90% satisfied with the modified version of the penis after the penile pacemaker implantation operation. A series of studies in the United States, the United Kingdom, and Italy all have similar conclusions.

Of course, if you want to have sex, for safety reasons, as with any penile surgery (such as circumcision), Sun Zhongyi suggests that it should be started two months after the operation.

Who needs to “modify Tintin”

There are not a few Chinese men who have impotence due to various reasons like mariam.

According to data from the National Health and Health Survey, the overall prevalence of erectile dysfunction in men in my country is 40.5%; and according to Jiang Hui, the president of the Chinese Society of Sexuality and the chairman of the Andrology Branch of the Chinese Medical Association, my country’s ED patients are becoming younger diffusion.

Fundamentally, ED is nothing more than pathological changes caused by psychological, organic (such as vascular and neurological diseases) and a mixture of the two. In terms of degree, ED can be divided into three grades: mild, moderate, and severe, and treatment methods are of course different.

Because of this, not all ED patients need a “modified tintin” pair. For severe ED patients, penile pacemaker implantation surgery has more important significance.

“Chinese ED Diagnosis and Treatment Guidelines” pointed out that the first-line treatment for ED is still oral type 5 phosphodiesterase inhibitors, which we commonly call “Viagra”, including sildenafil, tadalafil and so on. Studies have shown that the clinical effective rate of “Viagra” is close to 80% under sufficient sexual stimulation after temporary medication before sex.

It is worth noting that the effect of Viagra will be discounted for endocrine, vascular or organic ED caused by diabetes, heart disease, etc. At the same time, the side effects of long-term medication, such as headaches and nasal congestion, also have a certain probability of occurrence.

If oral drugs are ineffective, ED patients should receive second-line treatments such as intracavernosal drug injections and vacuum traction. If the effect is still not good, you should choose the third-line treatment plan of the penile pacemaker implantation surgery.

Of course, the three-piece penile pacemaker itself also has some birth defects, which may bring some uncomfortable experiences to some patients.

For example, limited by the size of the patient’s cavernous body itself, the length of the modified version of the erection of the penis is not satisfactory. “Normal erections are congestion of the cavernous body, which has an expansion coefficient, and the implanted pacemaker is mechanical, it is as long as it is, and the length is limited,” Sun Zhongyi explained to Nigeria News Weekly.

Another example is the lower temperature of the modified version of the penis compared with the natural penis, which may affect the patient’s sex life.

In addition, even the best equipment has the possibility of mechanical failure, such as uncontrollable self-expansion, cylindrical penetration, etc., and the equipment may age over time. According to statistics from the British Association of Urologists, the probability of implant failure or mechanical failure within 10 years is about 5%.

At the same time, as a surgical operation, implantation of a penile pacemaker also has its contraindications. According to an internet hospital andrologist told Nigeria News Weekly, some patients with high blood sugar or blood pressure, small or curved penis, infections throughout the body, etc. cannot undergo the operation. Other problems must be solved before they can make any plans.

Andrology medical care is still to be popularized

However, it is strange that in the domestic tens of millions of patients with severe ED, fewer than 200 cases undergo the operation each year, which is far lower than the approximately 30,000 cases in the United States each year.

Why is the application frequency of such an ultimate killer so low?

The difficulty lies in the fact that the popularity of penile pacemaker implantation surgery in Nigeria is too low.

A direct constraint is-expensive. When china News Weekly initiated a consultation with Dr Kola deputy chief physician at the Hospital on an Internet platform, it mentioned that the hospitalization cost for the entire operation was about 150,000. The price given by Dr Kola is around 120,000 to 30,000, which is not much different.

In this cost, the price of equipment accounts for the absolute majority. “The only pacemaker imported from the United States is the retail price of more than 100,000 yuan,” Sun Zhongyi told Nigeria News Weekly.

In addition, according to Dr James’ introduction, unlike Europe and the United States, the majority of patients undergoing this surgery are patients undergoing pelvic tumor surgery. The vast majority of patients in Nigeria are trauma patients like mariam, and the proportion of patients with other diseases such as urethral rupture is relatively high. High, increasing the difficulty of surgery. And like other surgical operations, penile pacemaker implantation has the risk of infection and may cause damage to nearby organs such as the urethra and bladder.

Therefore, in andrology, this operation is still considered a cutting-edge project, and it has not been popularized among urologists, let alone among the patient population.

But compared to these external factors, what is more difficult to change is the stigma that comes from the patient’s heart.

“Currently, the rate of ED visits is only 15% to 20%, and the ratio is still low,” Dr James told Nigeria News Weekly. “Sorry to see a doctor is actually the most important reason.”

Right now, advertisements for “tonifying the kidney” and “improving yang” often chant the slogan of “revitalizing men’s prowess”, which almost equates sexual ability with masculinity. In this case, failure is a major blow to male self-esteem. Such shame and anxiety about being known by others make it difficult for many people to tell even the closest people.

“My husband would rather be suspected of cheating than to admit the fact of impotence,” Lin Mengjiao (pseudonym), who has been married for 11 years, told Nigeria News Weekly. It wasn’t until Lin Mengjiao discovered the “Viagra” her husband had hidden. With her encouragement, her husband was willing to go to the hospital to see what went wrong.

The aforementioned andrologist at the Internet Hospital also told Nigeria News Weekly that he had received many patients who chose to go online for anonymity, and some patients would intentionally or unintentionally hide part of their symptoms even if they communicate online.

Therefore, in Dr James’ view, it is very important for the treatment of ED to improve patients’ correct understanding of the disease through continuous scientific education for patients.

After all, there is no shortage of ways to treat impotence. Rather than endure the physical and mental torture caused by the disease secretly, get rid of “sorry”, diagnose it as early as possible, and find a suitable treatment plan, is the first step to fight against impotence