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Management of Sexual Dysfunction

I-Scope of Experience

       Having practiced most methods of surgical correction of erectile dysfunction including malleable and inflatable penile prostheses, venoligation and arterialization, I have come to propose modifications and improvements of current techniques, as well as design new approaches to yet unresolved obstacles.

      

II-Innovations

Prosthesis Implantation in a Fibrosed Penis

       This has been a challenge for the experienced surgeons. Fibrosis resulting from neglected priapism, extensive Peyronie's disease or from removal of an infected prosthesis has almost always resisted dilatation of the corpora cavernosa and prosthesis insertion. We used to forcefully probe the corpora with blunt dilators  trying to negotiate the fibrous tissue, commonly ending in perforation, not to mention the extended operative time and manipulation with a resultant increase in  infection rate. Cavernotomes improved the ease of dilatation but still retained a similarly high complication rate, being inserted blindly since the effective tip cannot be visually monitored.

       In 2006, I published the first report on

"Optical Corporotomy and Trans Corporal Resection"

comprising visually monitored excavation of the fibrosed corpora cavernosa using the cystoscope as in visual urethrotomy and as in transurethral resection of the prostate. The cystoscope monitors the blade or resection loop as they excavate the corpus cavernosum.

-O.K.Z. Shaeer and A.K.Z. Shaeer. Corporoscopic Excavation of the Fibrosed Corpora Cavernosa for Penile Prosethesis Implantation: Optical Corporotomy and Trans-Corporeal Resection, Shaeer’s Technique. J Sex Med 2007;4:218–225

 

-Shaeer O. Penoscopy: Optical Corporotomy and Resection for Prosthesis Implantation in Cases of Penile Fibrosis, Shaeer’s Technique. J Sex Med 2007;4:1214–1217

       Ultrasound-guided excavation was my sequel to  Optical Corporotomy. Published in 2007, US guided excavation allows monitoring a sheathed instrument (for example a laparoscopy trochar and sheath) or the cystoscope as they drill into the corpora cavernosa.

 

Shaeer O. Penile Prosthesis Implantation in Cases of Fibrosis: Ultrasound-Guided Cavernotomy and Sheathed Trochar Excavation. J Sex Med 2007;4:809–814

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Management of Distal Extrusion of Penile Prosthesis: Partial Disassembly and Tip Reinforcement by Double Breasting or Grafting

       Distal erosion and perforation of penile prosthesis has been reported in association with neurological impairment, diabetes mellitus and following irradiation for prostatic cancer. Once perforation occurs, re-implantation carries a higher risk of re-perforation unless adequate preventive measures are taken.


This is a description of a procedure whereby the point of perforation is exposed and repaired to restore distal support. The glans is mobilized off the tip of the corpus cavernosum and the caverno-urethral fistula is disconnected from the corpus cavernosum. The fistula is sealed by primary sutures. The perforation on the corpus cavernosum side is sealed by double-breasting or grafting. Prosthesis is re-implanted.
 

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Management of Penile Curvature  

 

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Management of Trauma to the Penis

 

 
     

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Intellectual Property Registration number 00320, Ministry of Communication, Egypt