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I receive in Florence, Prato and Milan

Florence
Matteotti Medical Group
Viale Giacomo Matteotti, 42
50132 - Florence (FI)
Telephone: 055 570224
Florence Castello
Villa Donatello
Via Attilio Ragionieri, 101
50019 - Sesto Fiorentino (FI)
Telephone: 055 50975
Prato
Studi Medici Life
Viale della Repubblica, 141
59100 - Prato (PO)
Telephone: 0574 583501
Milan
Columbus Clinic Center
Via Michelangelo Buonarroti, 48
20145 - Milan (MI)
Telephone: 02 480 801

Andrological Surgery

SURGERY

Andrological

The surgical experience of Dr. Andrea Cocci is the result of training with great masters of national and international urology and andrology. The constant guidance of Prof. Giulio Nicita, Prof. Marco Carini and Prof. Sergio Serni trained him in uro-oncological surgery during his specialist training course at the University of Florence. Under the guidance of Prof. Hashim Hashim and Prof. Marcus Drake studied urogynecological surgery in particular in the treatment of prolapses and incontinence. Subsequently he undertook a year of surgical fellow at the University London College together with Prof. David Ralph in learning andrological surgery. He undertook the prestigious “robotic curriculum” at the Orsi Academy tutored by Prof. Alexandre Mottrie and in the treatment of tumors of the upper excretory tract through a course at the Fundación Puigvert under the guidance of Prof. Albert Breda. He has in-depth knowledge of the surgery of transsexualism and the surgical reassignment of acquired sexual characteristics under the guidance of Dr. Nim Christopher. He has deepened prostatic hypertrophy surgery through a large series of cases in the use of new laser surgery techniques.

He is the referent of penile surgery in particular in the correction of penile curvature. He introduced together with Dr. Nicola Mondaini the use of enzymatic cutters in Italy for the treatment of the curved penis.

Frequently Asked Questions (FAQ)

The duration is usually between 20 and 30 minutes, if the minimally invasive surgical technique is used, with suprapubic access.

The stitches applied must be removed 7/10 days after the procedure. At that time you will be given the next instructions. As soon as the patient is able to fully use the device without discomfort, sexual activity can begin (6 to 8 weeks).

The prosthesis normally lasts 15 years, on average, but a duration of up to 18-20 years is recorded. The prosthesis includes a lifetime replacement warranty.

The sensitivity remains unchanged. The patient has the same sensations that he had before the procedure, which means that he will also have a normal orgasm.

It depends on the general condition of the patient. However, an overnight stay is recommended.

The preference is on spinal anesthesia, since the latter results in prolonged pain relief after the even after surgery. It is also very safe and easy for the anesthetist to perform. However, this surgery can also be performed under general or epidural anesthesia. The decision is left to the anesthesiologist and the patient.

The body does not reject the device unless it is infected. The risk of infection is very low (only 1%). If infected, the device must be completely removed, the patient will need to take antibiotics. The device will be replaced with another temporary hard implant.

Circumcision is not necessary, indeed it is not recommended. Only do what is strictly necessary and indicated. Less is more in the case of penile surgery.

Rigid implants reached their peak in the 1970s before the introduction of inflatable devices. They remain the implant of choice with urologists who perform a very limited number of implants per year. Semi-rigid prostheses have various drawbacks which do not, on the other hand, concern inflatable prostheses. Semi-rigid implants can result in less than optimal erections, and the penis tends to rotate. Such implants also result in a hardly flaccid penis which can be difficult to hide. Since the device is not as flexible as an inflatable pump, a larger cut is required on the penis to insert it, and with it the possibility of bleeding, bruising, infection, and area of numbness is greater. The pain and discomfort caused by surgery are much more pronounced with a rigid device than with an inflatable one. The pain lasts much longer, 4 to 6 weeks after the procedure. Finally, rigid implants are more likely to extrude through the skin several years later, since they are always hard and therefore exert constant pressure on the glans. Over time, the flesh of the glans beyond the tip of the device becomes thinner and loses sensation. Prof. Antonini prefers to reserve the use of this device for patients who are unable to operate the pump, either due to severe arthritis or neurological disorders, or for those undergoing revision in case of infection, to act as a stent temporary in order to maintain the length and girth of the penis. A penis with an inflatable implant looks and feels normal, while a penis with a rigid penile prosthesis looks and feels abnormal.

In general, you will be able to perform any physical activity without any limitations. Obviously, some precautions are advised as with any other procedure. If it comes to cycling, the patient will have to replace the bicycle seat with a wider one, with a recess in the middle. Swimming is no problem.

Erection, orgasm and ejaculation are three independent functions. Men who are impotent due to vascular causes continue to orgasm and ejaculate on a flaccid penis. Therefore, the restoration of erection with the prosthesis, in such individuals, will allow them to continue to have orgasm and ejaculation. Some patients have become fathers thanks to the prosthesis. Patients suffering from ED following radical prostatectomy or radiation therapy lose the ability to have an erection and ejaculate. In that case the patients will have erection and orgasm but no ejaculation.

Clinical experience shows that it is preferable to perform penile prosthesis first, followed by urinary sphincter surgery.

Diabetic men have fewer infections than non-diabetics. The reason for this fact is unknown. One possible explanation would be that diabetics have reduced blood flow to the penis, so they bleed less during surgery. A collection of blood in the scrotal cavity increases the risk of infection and this is less likely in patients with impaired circulation.

Replacement in expert hands is much easier and involves much less inconvenience. It will be up to the surgeon to figure out if the device is malfunctioning or broken.

The patient should return 4 to 8 weeks after surgery to learn how to activate the device. They will first be taught how to deflate the device. Once he succeeds, he will learn how to inflate the device. It is not unusual for patients to need several visits before learning how to use it. Once the points have been removed, a DVD and a brochure on the use of the device will be delivered. The patient will have to watch the video and the brochure before the next visit. He should not try to learn how to use the device on his own before consulting with his doctor. The partner is always welcome.

The size of the erection with the implant is that of the flaccid penis taken by the glans and stretched as far as possible. A penis with an implant will never be as small/short or soft as a penis without an implant.

After a radical prostatectomy, a man will be able to have an orgasm without ejaculation. The fluid that normally flows out of the penis during orgasm is produced in the prostate and seminal vesicles, organs that are completely removed during radical prostatectomy. Also, a vasectomy is performed during the prostatectomy so that there is no leakage of sperm inside the body.

Peyronie’s disease is a term used to describe the presence of scar tissue in the penis. Scar tissue forms as a result of damage to the erectile tissue. Lack of blood flow, injury to the erectile nerves, and direct trauma to the penis are the most common causes of penile tissue damage. This disorder is quite common as a result of diabetes. Scarring in this situation is always permanent and irreversible unlike scarring following a fracture or trauma to the penis (in patients with normal blood flow to the penis). Therefore, no medical treatment has been shown to be effective in removing scar tissue from the penis in men with diabetes. Penile scarring affects the function (elasticity) and anatomy of the penis. Blood collection during an erection depends on tissue function and an intact penile anatomy. Any changes to the penile tissue will result in venous leakage during an erection.

What are the possible risks, side effects and complications of penile implants? Infections, erosion of the prosthesis through the skin, urethra and small intestine, colon, or lesions to the arteries or veins of the lower limbs, transient severe pain in the surgical area and mechanical problems of the implant. Another consequence of implantation is a loss of the remaining spontaneous erectile capacity. Patients who have functional spontaneous erections should be aware of this fact. Other general risks inherent in any type of surgery, such as a bad reaction to anesthesia, pneumonia if the procedure is performed under general anesthesia, phlebitis, or other dangers from pre-existing heart problems are other potential complications. Additionally, the need for additional surgery may arise if there is a complication or dissatisfaction after the initial implant.

In the event that an infection should arise after insertion of the prosthesis, the patient must be hospitalized and the device completely removed. A recovery procedure with simultaneous and immediate reinsertion of another device in parallel with the removal of the infected device may or may not be possible. This operation is performed in order to avoid the shrinkage and scarring of the penis, which occurs following an infection of the penile prosthesis. If the type of bacteria causing the infection cannot be identified, the patient will need 2-3 weeks of intra-venous antibiotics. If you do not immediately re-insert another device, a second implant may be placed in the future. However, in addition to resulting in a much shorter penis, the surgery is much more difficult and at a higher risk of patient dissatisfaction. In view of the fact that infections are rare, reimplantation after an infection should only be performed by highly experienced doctors and not by doctors with little or no experience.

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    I receive visits at the structures in Milan, Florence and Prato.

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    Florence | Matteotti Medical Group

    Viale Giacomo Matteotti, 42
    50132 – Florence (FI)
    Telephone: 055 570224

    Florence Castello | Villa Donatello

    Via Attilio Ragionieri, 101
    50019 – Sesto Fiorentino (FI)
    Telephone: 055 50975

    Prato | Studi Medici Life

    Viale della Repubblica, 141
    59100 – Prato (PO)
    Telephone: 0574 583501

    Milan | Columbus Clinic Center

    Via Michelangelo Buonarroti, 48
    20145 – Milan (MI)
    Telephone: 02 480801

    Dr. Andrea Cocci

    urologist and andrologist

    The decision to dedicate my professional life to urology and in particular to andrological and reconstructive surgery is the result of a deep passion for anatomy , the art of surgery and in general the diagnostic-therapeutic process which leads to the recovery of the patient. Oncological pathology, infertility, erectile dysfunction, penile diseases or simply prostate disorders irreparably afflict not only the individual but also the couple dimension.

    I receive in:
    Florence, Milan, Prato

    Dr. Andrea Cocci
    Urologist e andrologist

    I am fully convinced that listening to the patient, understanding their needs, evaluating their expectations is the only way to establish a successful and satisfying therapeutic program for both the doctor and the patient.