Posts Tagged ‘inflatable penile prosthesis’

2-Piece Penile Prosthesis for Erectile Dysfunction

April 21, 2018

Andrew Siegel MD  4/21/2018

Penile prostheses are surgically implanted devices that create on-demand penile rigidity to enable sexual intercourse. There are two major types: semi-rigid and inflatable.  Today’s entry explores a third option, a 2-piece unit that can be considered a hybrid between the simple 1-piece semi-rigid device and the more complex 3-piece inflatable device.  (All images are courtesy of AMS Men’s Health Boston Scientific).

The semi-rigid penile prosthesis is a 1-piece device that always remains rigid and is bent upwards for sex and bent downwards for concealment purposes. It consists of two malleable rods that are implanted within the erectile chambers through a small incision.

Advantage: simple, effective, no dexterity required, no need for control pump or reservoir, “ever-ready” for sex.   Disadvantage: always rigid, concealment can be tricky, 24-7 erection can make the tip of the penis sore.                                                                              

The inflatable penile prosthesis (IPP) is 3-piece device designed to mimic a normal erection, with the capacity to inflate and deflate via a self-contained hydraulic system. The inflatable cylinders are implanted within the penile erectile chambers. A control pump is implanted in the scrotum for easy access and the fluid-containing reservoir is implanted behind the pubic bone or behind the abdominal muscles. Erections are obtained by pumping the control pump several times, which transfers fluid from the reservoir to the cylinders and voila, a rigid erection is obtained that will remain so until the deflate mechanism on the control pump is used to transfer the fluid back from the cylinders to the reservoir.

Advantage: closes mimics normal erection, highly effective, concealment not issue Disadvantage: more complex and although well-engineered, has higher malfunction rate than semi-rigid alternative, requires dexterity.

Ah, but there is a third option that is somewhat of a hybrid between the 1-piece malleable rods and the 3-piece inflatable device. It is an inflatable 2-piece unit that offers the benefits of the 3-piece device with the simplicity of the 1-piece device. By eliminating the reservoir as a separate component, it provides advantages to both the patient as well as the implanting urologist. It is called the Ambicor and is a product of the American Medical Systems Men’s Health division of Boston Scientific.

AMS Ambicor product imageThe Ambicor device (see image above)  incorporates the reservoir into the inner part of the inflatable cylinders as opposed to a separate reservoir with the 3-piece device. The Ambicor cylinders are composed of inner and outer silicone tubes with a woven fabric in between.  The Ambicor is a pre-filled hydraulic device comes in 3 different widths and in an assortment of lengths, so that any man can be appropriately sized.

Operating the Ambicor: Inflation is achieved by compressing the pump implanted into the scrotum, which transfers fluid from the built-in reservoirs in the proximal cylinders (seated in the deep, inner penis) to the distal part of the cylinders (seated in the external, outer part of the penis). The device is deflated by simply bending the cylinders for 10 seconds or so, which triggers a release valve that returns the fluid from the distal cylinders to the proximal cylinders.

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The Ambicor is particularly advantageous in certain circumstances: patients who have had extensive abdominal/pelvic surgery in whom implanting an abdominal reservoir might present challenges and complications; those with poor manual dexterity, since it is easier to inflate and deflate than the 3-piece alternative; and patients with kidney transplants or anticipated transplants in the future (kidney transplants are positioned in  the pelvis, close by to where the reservoirs of penile prostheses are placed).  The Ambicor is not ideal in patients with Peyronie’s disease or scarred, short penises (less natural appearance when deflated because the firm tip of device does not deflate) or long and narrow penises (in this situation there is less support on the axis of the penis that can cause buckling and trigger deflation).

Advantage: mimics normal erection, effective, limited dexterity required, no abdominal reservoir required.  Disadvantage: spontaneous deflation (from triggering deflation mechanism during sex), spontaneous inflation when there is scarring of erectile chambers, not ideal in those with short penises or long and narrow penises.

Bottom line: When simpler measures fail to cure ED, penile prostheses are an excellent option. The surgical implantation is an outpatient procedure done under anesthesia that requires only a small incision.  The different prostheses vary in design and complexity (1, 2 and 3-components), but all aim to give the user a reliable erection on demand. The Ambicor, manufactured by American Medical Systems Men’s Health division of Boston Scientific, can be considered a hybrid between the simple but limited functionality of the 1-piece semi-rigid device and the complex and greater functionality of the 3-piece inflatable device. In appropriately selected patients the Ambicor has proven to be reliable and user-friendly with high rates of patient and partner satisfaction.  

Wishing you the best of health,

2014-04-23 20:16:29

A new blog is posted weekly. To receive a free subscription with delivery to your email inbox visit the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.

Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:

MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health

THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health 

PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food

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These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.

Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD PelvicRx

 

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Peyronie’s Disease: Not the Kind of Curve You Want

May 23, 2015

Andrew Siegel MD  5/23/15

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(Thank you, Pixabay, for above image)

Peyronie’s Disease is an inflammatory condition of the penis that causes curvature and an uncomfortable or painful erection. It is not uncommon– 65,000-120,000 cases per year in the USA–with only a small fraction of those who have the disease actually seeking treatment. Although it can occur at any age, it most commonly is seen in 50-60 year-olds. Essentially, it is scar tissue in a bad location, which sabotages the ability to obtain a straight and rigid erection, resulting in a dramatic interference with one’s sexual and psychological health.

Why Is Penile Curvature Called Peyronie’s Disease?

Most people assume that Peyronie’s disease is named after poor Monsieur Peyronie, who not only was afflicted with the disease, but also was further disgraced by having the disease named after him. The truth of the matter is that Peyronie’s disease is named after the French surgeon, de la Peyronie, who first described it in 1743.

How Do You Know If You Have Peyronies?

Peyronie’s Disease causes fibrous, inelastic “plaques” of the sheath surrounding the erectile chambers that reside within the penis. This results in deformities of the penis during erections, including the presence of a hard lump(s), shortening, curvature and bending, narrowing, a visual indentation of the penis described as an hour-glass deformity and pain with erections as well as less rigid erections.  Penile pain, curvature, and poor expansion of the erectile chambers contribute to difficulty in having a functional and anatomically correct rigid erection suitable for intercourse. The curvature can range from a very minor, barely noticeable deviation to a deformity that requires “acrobatics” to achieve vaginal penetration to an erection that is so angulated that intercourse is impossible. The angulation can occur in any direction and sometimes involves more than one angle, depending on the number, location and extent of the scarring. Although the scarring is physical, it often has psychological ramifications, causing anxiety and depression.

What Causes It And What Can You Expect In The Future?

The underlying cause of Peyronies is unclear, but is suspected to be penile trauma—perhaps associated with excessive bending and buckling from sexual intercourse—that activates an abnormal scarring process. During acute Peyronies, erections are painful and there is an evolving scar, curvature and deformity. The chronic phase occurs up to 18 months or so after initial onset and at which time the pain and inflammation resolve, the curvature and deformity stabilize, and often erectile dysfunction is noted. Peyronie’s regresses in about 15% of men, progresses in 40% of untreated men, and remains stable in 45% of men. Many men become very self-conscious about the appearance of their penis and the limitations it causes, and they may avoid sex entirely.

Is Peyronie’s Treatable?

Treatment options include oral medications, topical agents, injections of medications into the scar tissue, shock wave therapy, and surgery. Upon initial diagnosis, most men are started on oral Vitamin E, 400 IU daily, as this has the potential to soften the scar tissue causing the plaque. Many of the aforementioned treatments are not particularly effective because scar tissue is a challenging problem. Erectile dysfunction can be often be managed with ED medications.

Xiaflex—a.k.a. collagenase—derived from the clostridium bacteria, is the newest treatment for Peyronies. It has been used for years for Dupuytren’s contracture, a similar situation to Peyronie’s that occurs on the hand, causing a scarring of the tissue beneath the skin of the palm and fingers, making it very difficult to straighten one’s fingers. Xiaflex functions as a “chemical knife” by dissolving collagen, the main constituent of scar tissue. It is typically used for men with an angulation of 30 degrees or more. It is injected directly into the scar tissue after which the area is massaged and modeled to disrupt the scar tissue and mold the penis. One course of treatment may involve as many as eight injections. Injection of this medication can be highly effective, but is not without side effects including bruising, swelling, pain and possibly rupture of the erectile chamber of the penis causing a penile fracture.

If there is an unsatisfactory response to conservative managements, a penile implant may be appropriate. This can manage the dual problems of erectile dysfunction and penile angulation. If erections are adequate, but angulation prevents intercourse, options include doing a “nip and tuck” opposite the plaque in an effort to make expansion more symmetrical. Although this technique is effective in improving the angulation, it does so at the cost of penile shortening. Other more complex procedures involve incising or removing the scar tissue and using grafting material to replace the tissue defect.

Bottom Line: When scar tissue occurs on an area of the body that moves, expands or acts as a channel, it affects function as well as form. Thus a scarred elbow can impact mobility, scarred lungs can disturb breathing, a scarred bile duct can cause jaundice and scarred erectile chambers can cause Peyronie’s. The good news is that mild Peyronie’s does not need to be treated and if more severe forms occur that interfere with one’s quality of life, there are effective means to treat it.  

Resources:

www.peyroniesassociation.org

www.askaboutthecurve.com

www.menshealthPD.com

Wishing you the best of health and a great Memorial Day weekend!

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

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A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Kindle, iBooks, Nook, Kobo) and paperback: http://www.MalePelvicFitness.com

Co-founder of Private Gym: http://www.PrivateGym.com–available on Amazon and Private Gym website

The Private Gym is a comprehensive, interactive, follow-along exercise program that provides the resources to properly strengthen the pelvic floor muscles that are vital to sexual and urinary health. The program builds upon the foundational work of Dr. Arnold Kegel, who popularized exercises for women to increase pelvic strength and tone. This FDA registered program is effective, safe and easy-to-use: The “Basic Training” program strengthens the pelvic floor muscles with a series of progressive “Kegel” exercises and the “Complete Program” provides maximum opportunity for gains through its patented resistance equipment.