A. Who needs a penile prosthesis? Patients with impotence who do not take oral medication well or are ineffective, or ED patients who cannot tolerate the side effects of medication. Second, who is not suitable for penile prosthesis? 1.Severe fibrosis of penile corpus cavernosum and abnormally short penis. 2, there are serious systemic diseases, such as diabetes, heart, lung, kidney, liver and other serious failure, advanced malignant tumors, or systemic hemorrhagic diseases, serious neuropsychiatric diseases and other uncontrolled. 3.Persons suffering from active infection, especially genitourinary tract infection, which is not controlled. 4, Those who suffer from obvious lower urinary tract diseases, such as urinary disorders, urethral stricture, benign prostatic hyperplasia leading to a significant increase in residual urine, or those who have severe neurogenic bladder and need transurethral surgery. Third, the preparation before surgery 1, check to note the presence of hypertension, diabetes, heart, cerebrovascular disease, serious lung disease, the presence of urinary tract obstruction, urethral injury, urinary tract infection, etc., and take appropriate measures to control. 2, clearly inform the patient that the morphology, elasticity and size of the cavernous white membrane may limit the expansion of the diameter of the white membrane, and that the surgery is automatically aborted if expansion is not possible. 3.Advise the patient not to ride a bicycle with straddling exercise after surgery. The activity may damage the penile support body and require reoperation for replacement. 4. Apply prophylactic antibiotics 1 day before surgery, thoroughly clean the perineum and prepuce cavity, and prepare the skin. Anesthesia and position 1.Epidural anesthesia, general anesthesia can be used as needed. 2.Take a lying position with the buttocks slightly padded (mainly to facilitate the expansion of the distal penile corpus cavernosum during the operation) and the legs slightly apart, which can make the scrotal area of the penis more clearly exposed and facilitate the expansion of the distal penile corpus cavernosum during the operation. V. Surgical steps 1. Preoperative insertion of F16 double-lumen catheter facilitates intraoperative identification of the urethral corpus cavernosum and urination after anesthesia. Straighten the penis to facilitate accurate positioning of the incision. 2.Longitudinal incision is made under the penile-scrotal junction, and some surgeons choose transverse incision. However, the longitudinal incision is easier to dissect the corpus cavernosum, and the incision should not be too small, which affects the surgical field. 3, along the incision layer by layer separation of fascia to both sides of the penile corpus cavernosum white membrane, after a clear exposure is the appropriate location of the white membrane incision. 4.After reserving 2-3 stitches of sutures on each side of the white membrane, the reserved sutures can avoid the stitches from piercing the cylinder when the incision is closed and improve surgical safety. 5, the white membrane incision is about 125px from the root of the penis foot, the white membrane incision is high, easy to cause the connection tube convex to, touch the penis body surface affect sexual intercourse, but also may cause the connection tube folding caused by drainage failure and had to operate again, the height of the white membrane incision is related to the success or failure of the operation, pay special attention. The high incision causes the connection tube to fold, which will affect the use of prosthesis 6, dilator near the outside of the white membrane cavity from small to large gradually fully expand the cavernous body (the correct use of dilator helps surgical safety), the sum of the proximal and distal length of the cylinder length, (measured ratio of about 1/3 proximal, 2/3 distal), the expansion is not sufficient, choose the cylinder is short, easy to cause the head of the penis collapse. Inadequate expansion causes the head of the penis to collapse 7, flush the white membrane cavity bruises, test the urethra for damage, such as damage to the urethra on one side can only install a single cylinder, both sides of the damage to prevent infection surgery can only be aborted, waiting for the right time for implantation. 8.Exclude the air in the fluid pump valve and cylinder assembly, use the guide needle of the needle threader to pass through the white membrane cavity from 1 to 50 px outside the urethral orifice, tract the cylinder to the distal end, the angle of the cylinder connecting tube must face upward, put the tail into the proximal end, place the cylinder must be flat and avoid distortion (no distortion is an important part of the success of the operation), both sides place The same method is used on both sides. Placement of the cylinder 9. Placement of the fluid sac: push the spermatic cord away, find the external ring opening and enlarge it, reach the retropubic space of the rectus abdominis muscle via the posterior inguinal canal fascia (the accuracy of the placement of the retropubic space is related to whether the operator will induce a natural erection after surgery), feed the fluid sac with fingers or toothless oval forceps, trim the excess connecting tube as needed, and then fill the fluid sac with sterile saline, which must be tested after accurate placement. Placement and filling of fluid bladder 10.Connect the fluid pump valve and the fluid bladder, make sure that the joint will not fall off (the joint is directly related to the success or failure of the operation, so special attention should be paid to this point), then test the erection and retraction effect more than twice, and confirm that the erection and retraction effect is good. 11.After the test is complete, the reserved 3-stitch suture is knotted to close the white membrane incision and the fluid pump valve is placed in the anterior subsarcoid space in the middle of the scrotum (. 12.The drainage tube is led from both sides of the abdominal wall (the placement of the drainage tube is related to the safety of the operation and is placed on both sides of the abdominal wall as far as possible), the penis is placed in a semi-erect position and the incision is closed by layers of sutures. VI. Postoperative treatment 1. Maintain two broad-spectrum antibiotics for 7 to 10 days, with more than 2 to 3 days of sedation and 5-7 days of oral administration. 2. Remove the urinary catheter and pressure bandage within 24 hours after surgery, put the penis in atrophy, and remove the drainage after the bruise is drained. 3. Advise the patient that if there is strong pain 3 weeks after the operation, the possibility of infection should be carefully considered and promptly checked and disposed of. 4. Instruct the patient to master the operation of the fluid pump valve, and instruct him to practice the operation by himself after 2 weeks, and to have sexual intercourse after 6 weeks.