PENILE PROSTHESES

Penile prostheses are devices placed inside the penis to help men with erectile dysfunction achieve an erection and are a recommended treatment for men with erectile dysfunction after other treatments have failed. Penile prostheses should be considered if the patient has tried all treatments (tadalafil group drugs or intracavernosal treatments) but still has not regained sufficient erection for sexual activity.

PROSTHESIS TYPES

Penile prosthesis types are of two types, inflatable and semi-rigid (bendable). Inflatable prostheses, the most widely used type of penile prosthesis, can be inflated to create an erection and deflated after intercourse.

Three-piece inflatable prostheses contain a fluid-filled reservoir (water tank) placed under the abdominal wall, a pump placed in the scrotum, a relief valve, and two inflatable cylinders in the penis. Every part of it is inside the body. From the outside, it is not understood that the patient has a prosthesis. Three-piece inflatable braces create the most natural and hard erection. The two-piece inflatable prosthesis does not require a reservoir but provides a less rigid erection than a three-piece implant. Semi-rigid dentures have fewer parts and require an easier surgical procedure. However, the penis is always a little hard and can be difficult to control in clothes. It needs to be bent towards the body to hide.

WHAT EXPECTS THE PATIENT AT THE PHASE OF INSERTING THE PENILE PROSTHESIS?

Before penile/penile prosthesis surgery:

Medical history: Your doctor will ask some questions about your past and present health status. The surgeries you have had, the medications you have used, and the treatments you have used for erectile dysfunction will be noted. All these questions and answers will remain confidential.

Physical examination: You must undergo a comprehensive urological examination to decide that a Penile/Penile prosthesis is the most appropriate treatment for you. Patients who have been given a prosthesis decision should not have active skin disease before surgery, especially in the genital area.

It is important that before the surgery in patients who are decided to have penile / penile prosthesis surgery, diabetes patients should keep their sugar levels under control, smoking cessation, those who use blood thinners should stop taking their medication under the supervision of a doctor, and if necessary, use another medication on the recommendation of a doctor. After the patient is hospitalized for the operation, intravenous antibiotics will be given to prevent infection before the surgery, and the genital area will be cleaned immediately before the operation to reduce the risk of infection.

Penile/penile prosthesis surgery:

General anesthesia or regional (spinal anesthesia) can be applied for the surgery. The duration of the surgical procedure can usually vary between 45 minutes and 1 hour. Urinary tract catheter and surgical drain can be applied to the patients after the surgery. The catheter is usually removed the next day, and the surgical drain is removed in 2-3 days. The maximum stay in the hospital is 3 days. Antibiotics and painkillers will be prescribed for you to use when you are discharged from the hospital. During the recovery period, the penile/penile prosthesis is left semi-inflated and remains so until 1 week after you go to the doctor's control. When you go to the control after 1 week, your doctor will teach you to operate the pump and you will be asked to inflate and deflate until the day you have intercourse.

Athletic suspension panties are worn for 10 days. You are allowed to take a bath 2-3 days after the operation. The stitches do not need to be removed as they will dissolve on their own. There may be mild pain and swelling in the penis and scrotum for 1-2 weeks after the surgery. Again, heavy exercises and heavy lifting should be avoided for 6 weeks after the surgery. After penile prosthesis, sexual intercourse is allowed after 4-6 weeks. Ejaculation and orgasm similar to physiological conditions are provided in patients with penile / penile prosthesis as in normal sexual intercourse.

PENIS CURVE

Penile curvature is the bending of the penis down, up or to the side during an erection when it should normally be straight.

WHAT CAUSES PENIS CURVE?

Penile curvatures may be congenital (penile curvature) or later in adulthood (Peyronie's disease).

Congenital penile curvature (Penile curvature): The cause of congenital penile curvature is not yet known, but there are some theories put forward. In the structure of the penis; There are two spongy tissues (corpus cavernosum) containing blood vessels that provide erection, and a spongy tissue (corpus spongiosum) in which the urinary tract (urethra) is located. When there is growth retardation or disproportionate growth in one of these spongy structures from birth, the penis bends towards the underdeveloped side during erection. Mostly this curvature is downwards, but it can be sideways and rarely upwards. Adult penile curvature (Peyronie's disease): Adult curvature of the penis (Peyronie's disease), named after the French surgeon who first described the disease; usually after the age of 50,

HOW IS PENIS CURVED TREATED?

In the presence of a curvature angle of more than 30 degrees, which makes it difficult to have sexual intercourse, or in patients who apply for personal aesthetic concerns, surgical treatments (surgery) are applied as the only option. The penis length is usually longer than normal in patients presenting with congenital penile curvature. For this reason, penile shortening techniques (Nespit, plication surgeries) are mostly applied in the opposite direction of the underdeveloped side (curvature direction) with 85% success in experienced hands. After surgical treatment, patients usually stay in the hospital for one day, are called for wound healing after 7-10 days and can have sexual intercourse after six weeks. However, after surgical treatments; more than expected shortening of the penis, feeling of numbness in the penis, erectile dysfunction,

PENIS EXTENSION

The suspensory ligament is the name given to the ligament that suspends the penis from the pelvis. These ligaments allow the penis to point upward during an erection. With the cutting of these ligaments, the inner part of the penis protrudes and an elongation of approximately 2-4 cm is achieved. Since the penis will be more horizontal while erect, the penis appears a little longer when erect. During the operation, 90-95% of the ligament should be cut and the penis should be completely released. It is very important not to damage the veins in the back of the penis. It is a risk-free surgery when performed by experienced hands.

P - SHOT

PRP is the abbreviation of Platelet Rich Plasma. In general, it is the plasma liquid obtained from the person's own blood by some special processes, containing special growth factors that enable wound healing, new tissue formation, new vessel formation or the former flexibility of the vessels. As in other organs, PRP provides the renewal of the cells of the special vascular structures that fill the blood and trap the blood in the penis and the formation of new vessels. By providing cell and tissue regeneration and rejuvenation in the penis, the amount of blood filled into the penis increases and it is observed that the penis is fed more, nerve tissues work more effectively, its sensitivity increases, the quality of erection increases and there are positive changes in its size.

TESTES PROSTHESIS

Testicular prosthesis are artificial prostheses placed in the testis in cases where the testis is removed for any reason or does not develop at all.

VARICOSELECTOMY – MICRO VARICOSELECTOMY

Surgery should not be considered primarily in patients with pain, whose spermogram parameters are not impaired, in whom varicocele is detected, due to the risk that pain may persist in the postoperative period. Patients recommended to have surgery; Patients with abnormal spermogram examination can be listed as patients who cannot have children despite having a child in the previous period, and patients with high-grade varicocele due to the possibility of worsening over time. Varicocelectomy surgery can also be performed in patients whose pain in the testicles and inguinal region is not relieved by other methods. In the treatment, the skin tissue in the groin area on the side where varicocele disease is detected is opened with an incision of approximately 3-4 cm. The veins leading to the testis are revealed. The veins that have lost their properties by expanding are tied and rendered unusable. At this stage, the artery (artery) that carries clean blood to the testis, the lymphatic vessels that provide the lymph flow of the testis and the vas deferens, which is responsible for carrying the sperm from the testis, are carefully protected. Performing the surgery with a microscopic method increases the chance of surgical success and reduces the possibility of possible complications. If the lymphatic vessels are not carefully separated from the ligated veins during the operation; In the postoperative period, a situation that manifests itself with the accumulation of lymphatic fluid around the testicular tissue called “Hydrocele” may occur. In the period after varicocele surgery, daily activities can be performed after a day of rest. It is possible to return to active sexual life after about 2 weeks and to heavy work life and exercise after about 4 weeks. In the postoperative period, follow-up is performed with a spermogram every 3 months. In patients with improvement in spermogram parameters in the 6th month of the operation, the findings regarding the improvement become more evident in the 9th and 12th months, but in the cases that still do not improve at the 6th month, no further improvement should be expected in the following period and additional treatment options should be evaluated.

EXCISION OF EPIDYDY CYST AND SPERMATIC CORD CYST

Epididymal cyst does not disappear on its own. However, in most cases, it does not cause a problem to the patient. Therefore, the basic principle in epididymal cysts is to keep the patient under follow-up with annual routine examinations if the cyst does not cause any symptoms in the patient. In a group of patients, it is a better choice to remove the cyst from the body. Because the cyst may have grown. The growing cyst can also cause problems such as pain, infection, bleeding, pressure on the semen, and therefore infertility. The size of epididymal cysts can reach 10-15 cm. The treatment of epididymal cyst is surgery. There is no drug treatment for this type of cyst. It is a surgery with a high success rate when performed by experienced urologists. The operation is performed through a small incision on the scrotum. The cyst is reached and the epididymal cyst is cut and removed from the body. It is very important not to damage the semen channels during the operation. The patient is usually discharged 1 day after the operation. It is recommended to rest at home for up to 1 week.

HYDROCEL – SPERMATOCELE

The male reproductive organ, the testis, is surrounded by a protective sheath in the form of a double-layered membrane. There is some liquid between these two layers. Hydrocele is a condition where there is more fluid than normal between the sheaths surrounding the testicles. It is also known as swelling of the bags, water collection, water hernia among the people. Normally, 0.5-1 ml between the testis and these membranes to ensure the lubrication of the testis. While there is fluid, this amount is 100–200 ml in hydrocele formation. sometimes it can even reach much larger volumes. In hernia-free hydroceles seen in childhood, it is expected until 2 years of age for treatment. If there is no improvement in this period, it is corrected surgically. Hydroceles associated with hernia should be surgically corrected as soon as the diagnosis is made. It is usually done through an incision to be made over the bag containing the testicles. With this incision, the fluid inside is drained and the space created by this fluid is removed by different methods in order to prevent recurrence. Performing this surgery through as small an incision as possible will keep the healing process and the surgical wound after healing more aesthetically pleasing.

ORCHIPEXY (UNDESCENDED TESTES SURGERY)

Undescended testis is called “cryptorchidism, hidden or undescended testicles”. Although this condition is generally rare, it is usually seen in preterm infants. If the testicle does not descend on its own, it will need treatment. The aim of the treatment is to prevent the problems that may occur in the sperm and hormone structure and to reduce the risk of testicular cancer, which is 7-14 times more common than normal people in the future. The surgery should be performed around the age of 1 or within the first 18 months at the latest. The main treatment for an undescended testis is surgical removal of the testis into the scrotum (orchidopexy). Almost 100% success is achieved with this surgery. If a testicle has not fully descended into the scrotum in the first 6 months, surgery must be performed within the next 1 year. delayed treatment, may increase the risk of future testicular cancer and/or infertility. Surgery for a palpable testis is done through two incisions: one is made in the area where the testis is located, and the other is in the area where the testicles will be inserted into the scrotum. Laparoscopic examination may be required for non-palpable testis, it is the best way to locate the testis, general anesthesia is required for this. If necessary, complete removal or normal positioning of the testis can be performed by laparoscopy.

RENAL CYST EXCISION

The diagnosis of kidney cyst is made by radiological screening methods. They are often diagnosed incidentally. The patient encounters a kidney cyst from the results of ultrasonography (USG), computed tomography (CT) or magnetic resonance (MRI) imaging for other purposes. In cases where the cyst does not enlarge and press, surgical intervention is not required. However, the cysts that have grown and put pressure on the surrounding organs should be evacuated by tearing the wall. In the treatment, the regrowth of the evacuated cyst vesicle is prevented by drug injection method. As the current treatment method, excision of the cyst with laparoscopic surgery is preferred.

Treatments applied in kidney cyst:

Puncture-Cyst discharge: Under the guidance of ultrasonography, the inside of the cyst is emptied with a needle and drugs are given to prevent the formation of cysts again. Surgical removal: Large and symptomatic cyst may require surgical treatment. The cyst is removed by laparoscopic surgery. In laparoscopy, a few small holes are made in the patient's body and the cyst is removed by entering with a camera.

TREATMENT OF KIDNEY STONES

Since large-sized and shaped stones that block the urinary canal cannot pass spontaneously, surgery is required. The stones are broken and collected with the help of laser by entering the urinary canal completely endoscopically without incision. It is for the benefit of the patient to have the operation in a center where flexible devices that can reach the stones in the kidney, which have the ability to bend, with the possibility of the urinary tract stone to escape back to the kidney with the effect of water. Larger stones in the kidney can be cleaned with endoscopic devices sent through a 1-2 cm incision from the side of the patient. The duration of hospitalization for urinary tract stones is 1 day, and the patient can return to social and business life the next day.

TUR PROSTATECTOMY (SURGICAL TREATMENT FOR BENEFICIAL PROSTATE GROWTH)

Complaints such as intermittent urination, frequent urination, burning during urination, weakness in urine pressure, waking up with urge to urinate, feeling of not being able to urinate completely after urinating, and a sudden feeling of urination are signs of benign prostate enlargement, and patients who do not benefit from drugs undergo prostate surgery. must. This operation is completely endoscopic without incision and the hospital stay is 1-3 days. Contrary to the general belief, the risk of urinary incontinence after surgery is almost non-existent and the operation does not affect the erection condition.

INTERNAL URETROTOMY (SURGICAL TREATMENT FOR URINARY TREATMENT)

Urinary canal strictures should not be forgotten in complaints such as very thin urine pressure and difficulty urinating. Urinary tract stenosis may develop due to many reasons such as previous urinary tract infections, urinary catheters inserted in previous operations. With endoscopic operations, the stenosis can be removed with a 1-night stay in the hospital.

TUR BLADDER (ENDOSCOPIC TREATMENT IN BLADDER CANCER)

A transurethral resection of the bladder tumor (TUR-MT) is the first and most important step in the treatment of bladder cancer. The aim of TUR-MT is to make the correct diagnosis and completely eliminate all visible tumors. This surgery is very important for the pathological diagnosis of cancer, its extent and treatment planning. 70-75% of bladder cancers at first admission are superficial cancers and TUR-MT is their first-line treatment. The aim of TUR-MT is to remove cancer cells and surrounding tissues up to the muscle layer of the bladder wall. It is a closed endoscopic surgery performed by entering the urinary canal under general or local anesthesia. There may be some bleeding and pain when urinating after the procedure. You can usually go home the next day and return to your normal daily life within a week or two.

URINARY INCONTINENCE SURGERY – URETHRA STRAP SURGERY

Incontinence is the involuntary leakage of urine and disturbs the patient socially and hygienically. Stress incontinence is a form of involuntary urinary incontinence, which is seen in situations such as coughing, sneezing, straining, standing up and moving, and is frequently encountered in women. Stress incontinence is more common in women who have had a difficult vaginal delivery, those who have had multiple deliveries, and those who are obese (overweight). The incidence of urinary incontinence increases in postmenopausal women. The severity of the disease can vary from person to person. There are 2 very high surgical methods in "stress type" urinary incontinence. These are TOT and TVT (transvaginal tape application and transobturator tape application) surgeries. Both surgeries usually require a one-night hospital stay and the duration of the operation is 1 hour. The basic principle in TOT and TVT surgeries, It is to lift the bladder neck, which is in a position that droops down from the normal, with special suspension materials and hang it to the pelvis bone with a vaginal intervention. In the post-TOT/TVT period, the patients should pay attention to, avoiding sexual intercourse for 6 weeks, avoiding heavy lifting for at least 2 weeks, avoiding anything that will increase intra-abdominal pressure such as constipation, Consuming vegetables, fruits, whole grain foods, Drinking sufficient amount of fluid (your urine). should be clear or slightly yellow)

CYSTOCEL – RECTOCELE (SURGERY FOR PROJECTION OF ORGAN FROM THE VAGINAL AREA)

It is the situation where the organs in the hip bone come out of the vagina due to the weakness and insufficiency of the muscle and connective tissue. Pelvic organ prolapse (drooping) is classified according to the area that protrudes into the vagina. sagging treatment istanbul

1- CYSTOCEL: It is the sagging of the urinary bladder due to the weakness in the anterior wall of the vagina.

2- 2- RECTOCELE: It is the sagging of the large intestines due to the weakness in the posterior wall of the vagina.

3- 3- TOTAL PROLAPSUS: The uterus is when the cervix is ​​completely protruding from the vagina.

4- 4- CAF PROLAPSU: It is the protrusion of the top of the vagina in patients who have previously had their womb removed.

It is performed vaginally with spinal anesthesia or general anesthesia. Excess vaginal parts hanging on the Urine Bag are released and excised. The torn vesico-vaginal fascia is repaired and vaginal mucosal tissue integrity is restored. If stress urinary incontinence is present simultaneously, TOT operation is added to cystocele repair. You will be asked to stay for 1 night for this surgical operation to be performed in a hospital environment. There will be no need for long-term hospitalizations in your surgery performed with dissolving stitches. The procedure should be done after menstruation. Because it would not make much sense to perform surgical intervention in the vagina, which has become open to infection, during menstruation.

GENITAL WARTS (CONDYLOMA) SURGICAL TREATMENT  

The most precise and correct treatment of genital warts caused by HPV microorganism is to excise (remove) the warts and burn them. Since the probability of relapse is very high even after this treatment, a special treatment for 3 weeks should be planned after the operation. With this treatment, the risk of recurrence is reduced by 95%.

APPLICATION OF BOTOX INTO THE BLADDER (IN DRUG-RESISTANT URINE INCONTINENCE)

It is the treatment that we have achieved very successful results, applied to patients who do not benefit from the drugs in urinary incontinence before they can reach the toilet with a sudden sense of urination. The procedure is daily and does not require hospitalization.

G-SHOT O-SHOT

It is a non-surgical treatment for women who have orgasm problems for various reasons. It is made with various mesotherapy products and PRP. It is performed in outpatient conditions without the need for anesthesia. No hospitalization or follow-up is required. After the procedure, the patient can continue his daily life. Its effect begins to be seen within 2-3 HF. It does not require dressing and extra care.

LABIOPLASTY

It is the most performed genital plastic surgery in the world. It can be done to anyone who has problems with their lip structures, whether they have a sexual life or not. There is no need to stay in the hospital after the procedure. It is done with anesthesia and in the operating room. There is no process such as suture removal and there is no scar. Wound care and dressing are explained by the physician after the procedure. It facilitates orgasm in women with closed clitoris. Post-operative sensation does not decrease, on the contrary, it increases sexual readiness.

CLITHEROPLASTY

This surgery, also called clitoris aesthetics, facilitates orgasm in women with orgasm problems. Increases sexual pleasure. It is done in the operating room with anesthesia. Processing time is short. There will be no trace. It is sewn aesthetically. No stitching is possible. Wound care and dressing is explained by the physician. There is no need to stay in the hospital after the surgery.

PERINOPLASTY

 It is an operation to remove stitch marks left from birth or scars that were previously formed due to various diseases. It is also the process of narrowing and correcting the vaginal entrance. It is done in the operating room with anesthesia. Does not require hospitalization. Since stitches will be stitched aesthetically, there is no suture removal process and there is no scar. The patient can return to his daily life in two or three days. The patient is informed by the physician about the information about wound care and dressing, and the rules that should not be followed.

Genital area bleaching process

 It is performed in outpatient conditions without the need for anesthesia. In the procedures performed with cream, the result becomes visible immediately after the procedure. It takes 1 month for the tissues to fully reach their own color. How to care after the procedure is explained by the doctor. If PRP is added to the bleaching process, the lightening rate will be higher and a more vibrant, younger image is obtained. We recommend that you use the follow-up cream regularly.

VAGEN RESTRICTING

This procedure is done to increase the pleasure of sexual intercourse more, and it is performed in 1 hour in operating room conditions. The operation is performed aesthetically without leaving any scars and there is no need for suture removal. The patient can return to his social life after 2 days.