The ultimate operation to deal with erectile dysfunction: male medicine in China still needs to be popularized

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You have to rely on the bladder to open a tube to urinate. After urethral anastomosis, Lu Zhi found that he had become a patient with erectile dysfunction (ED), with many attempts such as drugs, vacuum negative pressure traction, psychotherapy and so on. At the beginning of this year, I heard from a doctor in Guizhou that after the implantation of a penile pacemaker, after two consecutive nights of nocturnal erectile function (NPT) examination, Lu Zhi's genitals had experienced relatively serious organic damage, and the implantation of a three-piece set of penile pacemakers became his only hope. The effect such as cavernous hyperemia and swelling can be controlled manually. Under the action of the pump, normal saline enters the column to make it swell, and the doctor needs to make a small opening at the junction of the penis and the scrotum. Then two cylindrical artificial caverns of the right size are implanted into them, and the timing, degree and length of the erection can be controlled by themselves and the appearance of the modified penis is almost the same.

Text /Shi Shengxu

Lu Zhi (a pseudonym) woke up on the operating table. A month ago, the 28-year-old had a penile pacemaker implanted, and now the new Tintin, which he can control with one hand, has recovered well.


Eight years ago, 20-year-old Lu Zhi was cycling on the road and had no idea that he would be hit by a big trailer and flew off his bike. Pelvic fracture, urethral rupture, micturition have to rely on the bladder to open an artificial tube.


With the progress of treatment, Lu Zhi's fracture gradually disappeared, and after urethral anastomosis, defecation was no longer a problem. But time doesn't cure everything, and neither do doctors. After the wound healed, Lu Zhi found that he had completely become an erectile dysfunction (ED) patient, commonly known as impotence.


The simple wish of getting married and having children has become an extravagant hope for Lu Zhi, who is only 20 years old.


In order to get life back to the right track of universal significance, Lu Zhijun went to see a doctor many times over the past eight years, and experienced many attempts such as long-term use of Viagra drugs, vacuum negative pressure traction, psychotherapy, and so on. The more than NT 0,000 spent by his parents working around and borrowing money is thrown in, but he still hasn't seen any effect on Lu Zhi.


After hearing from a doctor in Guizhou earlier this year that the penis pacemaker had been implanted, Lu Zhi, who had been tortured physically and mentally, did not expect that this nightmare about male dignity would wake up.


The ultimate weapon against impotence


According to Sun Zhongyi, director of urology at Shenzhen University General Hospital, who operated for Lu Zhi, at that time, after two consecutive nights of nocturnal erectile function (NPT) examination, Lu Zhi's genitals had experienced relatively serious organic damage, and erectile function had been completely lost. In the case of drug, psychological and physiotherapy failure, the implantation of a three-piece penile pacemaker became his only hope.


"like pacemakers and artificial joints, penile pacemakers are also artificial organs that can be implanted into the human body," Sun Zhongyi told China Newsweek.


In the list of imported medical devices from the State Drug Administration, it is also called artificial sponge. As the name implies, after it is implanted into the penis, the erection can be artificially controlled by artificially controlling the effect of congestion and swelling of the cavernous body.


Externally, the penile pacemaker consists of three parts, including two cylinders, a reservoir and a pump.


The two cylinders are artificial cavernous bodies, and the liquid storage sac is used to store normal saline, which enters the cylinder under the action of the pump to make it dilate, thus making the penis erect.


Liquid storage sac (upper left), cylinder and pump with switch button. Photo / Boston Science official website


It sounds simple, but penile pacemaker implantation can be said to be one of the most complex operations in the male department.


First of all, the doctor needs to make a small opening at the junction of the penis and scrotum, separate and dilate the upper two cavernous bodies of the penis, and then implant two suitable-sized cylindrical artificial cavernous bodies into it.


Then, the doctor should place the fluid storage sac into the anterior space of the bladder and hide the pump perfectly in the scrotum.


The last step is to connect several pipes between the three to form a whole closed loop.


After such a 1-2-hour operation, a brand new modified penis, which can be controlled by itself and looks almost the same as the original, has taken root in Lu Zhi's body.


The scene of the operation. Photography: Mudo Ming / courtesy of interviewees


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


During this period, two doctors in Sun Zhongyi's team repeatedly taught Lu Zhi how to use the switch on the pump and how to control the degree of erection, so as to ensure that Lu Zhi can operate safely. For example, in the first 4 weeks, the doctor will advise the patient to keep the new penis in a semi-erectile state to reduce the pain in the cavernous body.


When in normal use, press the button under the skin of the scrotum twice, that is, the switch of the pump, which can make the penis in an erectile state. After the end of ejaculation, if both sides are not satisfied, you can still keep the penis in an erectile state and continue to fight.


Until both sides are fully satisfied, press the button again, the filled water in the cylinder will return to the reservoir sac again, and the penis will die down.


"at present, the three-piece set is the most suitable for the human body to simulate erection under physiological conditions," Sun Zhongyi told China News Weekly. "therefore, the modified version of the penis will not affect the normal sexual pleasure and ejaculation. If the patient's preoperative fertility is normal, it will not be affected in any way.


A cross-decade study published in the Journal of Peking University (Medical Edition) previously showed that patients and their sexual partners were more than 90% satisfied with the modified penis after penile pacemaker implantation. A series of studies in the United States, Britain, Italy and so on have similar conclusions.


Of course, if you want to have sex, for safety reasons, like any penile surgery (such as circumcision), Sun Zhongyi recommends starting two months after the operation.


Who needs "refitting Tintin"?


Like Lu Zhi, there are not a few Chinese men who cause impotence for various reasons.


According to the National Health and Health Survey, the overall prevalence rate of male erectile dysfunction in China is 40.5 percent, and according to Jiang Hui, president of the Chinese Sex Association and director of the male Science Branch of the Chinese Medical Association, ED patients in China are spreading to young people.


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


Because of this, not all ED patients need a modified Tintin. For patients with severe ED, the implantation of penile pacemaker has more important significance.


According to the guidelines for diagnosis and treatment of ED in China, the first-line treatment of ED is still oral phosphodiesterase inhibitor type 5, which is commonly known as "Viagra", including sildenafil, tadalafil and so on. Studies have shown that with enough sexual stimulation after temporary medication before sex, the clinical effective rate of Viagra is close to 80%.


It is worth noting that the role of Viagra will be reduced for endocrine, vascular or organic ED caused by diabetes, heart disease and so on. At the same time, side effects of long-term medication, such as headaches and stuffy nose, also have a certain probability.


If oral medication is ineffective, ED patients should receive second-line treatment such as penile cavernous drug injection and vacuum negative pressure traction. If the effect is still not good, we should choose the third-line treatment of penile pacemaker implantation.


Of course, the penile pacemaker three-piece set also has some congenital defects, which may bring some less comfortable experience to some patients.


For example, due to the size of the patient's cavernous body, the length of the modified erection is not satisfactory. "A normal erection is congested with the cavernous body and has a coefficient of expansion, while the implanted pacemaker is mechanical, as long as it is, and the length will be limited," Sun Zhongyi explained to China Newsweek.


For example, compared with the natural penis, the temperature of the modified version of the penis is on the low side, which may affect the patient's sex life.


In addition, no matter how good the equipment is, there is the possibility of mechanical failure, such as uncontrollable self-expansion, cylinder penetration, etc., and the equipment may age over time. According to the British Association of Urological Surgeons, the probability of implant failure or mechanical failure within 10 years is about 5%.


At the same time, as a surgical operation, the implantation of penile pacemaker also has its contraindications. Some patients with high blood sugar or blood pressure, too small or curved penis, or infection all over the body cannot undergo the operation, and other problems must be solved before making plans, according to a male doctor in an Internet hospital who told China Newsweek.


Andrology still needs to be popularized.


The ultimate operation to deal with erectile dysfunction: male medicine in China still needs to be popularized

But oddly enough, of the tens of millions of severe ED patients in China, less than 200 undergo the surgery each year, far less than about 30, 000 in the United States.


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


The difficulty is that the popularity of penile pacemaker implantation in China is too low.


A direct constraint is expensive. When China Newsweek launched a consultation with Zhang Guoxi, deputy director of andrology at Peking University Renmin Hospital on an Internet platform, it mentioned that the hospitalization cost of the entire operation was about 150000. The price given by Sun Zhongyi is about 120,000 or 30,000, which is not much different.


The price of equipment accounts for an absolute large part of this cost. "the only pacemaker imported from the United States will retail for more than NT $100,000," Sun Zhongyi told China Newsweek.


In addition, according to Sun Zhongyi, unlike most of the postoperative patients with pelvic tumors in Europe and the United States, the vast majority of Chinese patients are trauma patients like Lu Zhi, with a high proportion of other diseases such as urethral rupture, which increases the difficulty of the operation. And like other surgical procedures, penile pacemaker implantation has the risk of infection and may cause damage to the urethra, bladder and other adjacent organs.


As a result, the surgery is still at the forefront of the male department, and is not yet popular among urologists, let alone in the patient community.


But compared with these external factors, what is more difficult to change is the sense of shame that comes from the patient's heart.


"at present, the ED consultation rate is only 15% to 20%, and the proportion is still on the low side," Sun Zhongyi told China Newsweek. "Sorry to see a doctor is actually the most important reason."


At present, advertisements for "tonifying the kidney" and "invigorating the yang" often shout the slogan "revive the masculinity of men", which almost equates sexual ability with masculinity. In this case, not being able to do so is a major blow to male self-esteem, and the sense of shame and anxiety about being known to others makes it difficult for many people to speak up even to those closest to them.


"my husband would rather be suspected of cheating than admit the fact that he is impotent," Lin Mengjiao (a pseudonym), who has been married for 11 years, told China Newsweek. Until Lin Mengjiao found her husband's hidden "Viagra", with her encouragement, her husband was willing to go to the hospital to see what was wrong with her.


The male doctor of the Internet hospital also told China News Weekly that he had received many patients who chose to go online for the sake of anonymity, and that some patients would intentionally or unintentionally hide some of their symptoms even if they communicated online.


Therefore, in Sun Zhongyi's view, it is very important for the treatment of ED to improve patients' correct understanding of the disease through continuous science education.


After all, there is no shortage of ways to treat impotence, instead of secretly enduring the physical and mental torture brought by the disease, getting rid of "embarrassment", actively diagnosing as soon as possible, and finding an appropriate treatment is the first step in the fight against impotence.