Cases from practice

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Patient K., 34 years old, with bilateral varicocele

The patient applied by phone with complaints of infertility in marriage for three years. He received Ivanissevich’s operation in Poltava eight years ago, but he began to note a repeated increase in veins after two years.

For the surgical treatment of varicocele recurrence and right-sided varicocele, he traveled from Poltava to Kharkiv to be treated by Prof. Knigavko A.V.

The patient underwent surgery on both sides. In the patient’s spermogram, there was a moderate decrease in mobility, but a pronounced agglutination was determined. After that, drugs that stimulate fertility were prescribed: Tribex, Carliv, Enat.

3.5 months after the operation, the patient’s wife was diagnosed with a desired pregnancy.

Patient M., 33 years old, was admitted to the andrology department with complaints of infertile marriage and deterioration of potency.

The patient cannot maintain the hardness of his erection for a long time. During the examination, pronounced reflux of 11.2 cm / s in the spermatic cord and venous leakage from the penis was established. In the spermogram, there is a moderate decrease in the number and motility of spermatozoa, pronounced agglutination, and many degenerative sperm cells.

The patient underwent a modified Marmara operation, with an intersection of pathological shunts and ligation of one of the dorsal veins of the penis.

Sexual function improved immediately after surgery; after five days, the elasticity and hardness of the penis during contact increased significantly, the duration of sexual intercourse increased.

Patient L., 29 years old, Marmara surgery revision.

Dr. Knigavko was contacted by a patient from Nikolaev, where he underwent Marmara surgery for bilateral varicocele. According to him, the operation was carried out from scrotum access without a microscope.

In the control study, a relapse of varicocele on the left is noted. And on the right, the deterioration of arterial function, indicative of damage to the artery. The patient’s spermogram demonstrates oligostenozospermia.

Our clinic performed Marmara microsurgery under a microscope with 24-fold magnification. During the operation, veins with pathological blood flow were bandaged.

After the operation, Dr. Knigavko prescribed 3-month drug therapy. The spermogram improved.

Coloplast Titan Implantation

Even though the three-piece Rigicon inflatable implant is available in Ukraine, and we successfully install them, other brands of prostheses such as the Coloplast Titan and Boston Scientific (AMS) do not have a representative office in Ukraine, and, as a result, we cannot install these implants with a lifetime warranty.

If Coloplast prostheses are needed, we fly with the patient to Moscow and install them there.

The operation is conducted by Konstantin Menshchikov, one of the best urologists-implantologists in Russia.

In October 2020, A. V. Knigavko traveled to Moscow for surgery with patient P., 45 years old.

After a severe proctological operation, the patient has erectile dysfunction. Plus, due to neglected Peyronie’s disease, plaque occupied most of his penis. At the initial evaluation, the length of the penis was 9 cm. If the prosthesis were placed in that state, only the problem of erectile dysfunction would go away, but the size would remain the same. Therefore, in Ukraine, we gave him a ligamentotomy and procedures to lengthen and enlarge the penis. He achieved an increase in length to 16-17 cm.

Regarding the operation for which we flew to Moscow, the installation of the Coloplast implant was complicated because it was necessary to dissect the plaque, which would make it possible to implant a prosthesis 23 cm long (15 cm working length). When the edema resolves and the prosthesis is implanted, you can expect 17 cm — this is an excellent result in such a problematic initial situation.

Also, within the framework of this trip, Knigavko A. V. took part in two more difficult operations:

1st operation:

The first 26 cm three-component Coloplast prosthesis implanted in Russia

After implantation, the working part of the penis is 18cm. With the addition of the 1 cm head, the total working length is 19 cm. The entire length of the prosthesis is 26 cm.

Even though the operation was more difficult than installing a prosthesis of a shorter length, Dr. Knigavko performed everything in the best possible way. The patient was released to the hotel the next day.  A couple more days of dressing, and he will fly home.

2nd operation

A man of 60 years. Fifteen years ago, an American AMC prosthesis was installed.  The prosthesis failed because one of the shells burst. Due to financial constraints, the patient chose a one-component prosthesis Coloplast. (27 cm length,13 mm diameter).

протез Coloplast

Patient V., 38 years old. Thin penis, less than 3cm in diameter (~10cm circumference)

The patient came to us for a consultation after his second divorce, the cause of which was the dissatisfaction of his spouse with their sex life.

Physiologically, for a woman to get pleasure, the volume of the penis is more important than its length. This is due to the location of sensitive nerve receptors at the entrance to the vagina.

The patient was offered several options for thickening the trunk of the penis, of which he chose the installation of a matrix implant with stem cells. The operation was planned successfully. After the rehabilitation period (3 weeks), he resumed sexual activity. I am satisfied with the results.

Patient M., 32 years old. The length of the penis in a state of erection is 10 cm.

After five years of married life, intimate relations with his wife began to fade. The use of medications and a visit to a sex therapist did not help; the husband began to suspect his wife’s infidelity and alcohol abuse, exacerbating potency problems. The marriage was on the verge of collapse. Lengthening the penis surgically with ligamentotomy was the only way out.

After surgery to lengthen the penis and 3-month use of the extender, the length of the penis in a calm state reached 10 cm and in an erect state 16 cm. After treatment, the patient’s wife admitted that for the first time in her married life, she experienced an orgasm during sexual intercourse.

Patient K., 32 years old, has the length of the penis in a calm state of 4.5 cm and is in an erect state of 11 cm. The thickness of the penis is 2.5 cm in diameter or 8 cm in circumference.

In a clinic in the Dnieper, the patient underwent a procedure of thickening the penis by introducing hyaluronic acid gel «Juvéderm.» The introduction of 10 ml of gel cost $ 1200 but thickened only 6 mm in diameter or 2 cm in circumference.

A year later, the gel wholly dissolved, and the problem returned.

In our clinic, the patient underwent a complex operation to thicken the penis — a silicon implant «Penuma» was installed under the skin. A ligamentotomy with plastic surgery of the skin of the foam-abdominal region was performed, which increased the penis from 2 cm in diameter to 4.5 cm in diameter or 14.5 cm in circumference and almost 4 cm in length, up to 9 cm in a calm and 13.5 cm in an erect state.

A month later, the patient was able to restore his sex life.