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a large penile size. 

Titan Pump – Coloplast

The FDA approved the improvements to the pump component of the Coloplast Titan prosthesis in July 2008. Although the cylinders and reservoir remain the same as the previous model, the pump now features a one-touch-release (OTR) deflation valve — easy for patients to locate and operable with one hand. In addition, the pump offers a non-bulky, low-profile size; enhanced silicone for higher threshold “tear strength” (likely to result in increased product durability, an issue with previous versions); and an overall simplicity likely to decrease repeat office visits, phone calls, and repeat training time. From a hospital standpoint, intraoperative prep of the device provides for easier priming of the implant system (the removal of excess air prior to filling) and may reduce slightly the overall intraoperative time.

“This remains a great device for the patient with a larger penis, as these are the only cylinders that will expand to 22mm girth.” In addition, only Titan cylinders are available in lengths of 24cm, 26cm and 28cm.

Although the pump is easily identified and operated by patients, the small size of the deflation valve sometimes requires a longer learning curve.

In a recent study (“Evaluation of Three Penile Prosthesis Pump Designs in a Blinded Survey of Practitioners,” Urologic Nursing, 2008), 32 medical professionals, all familiar in teaching the operation of penile implants to patients, reviewed currently available penile pumps. The blindfolded reviewers, examining the pumps under time constraints through mock scrotal sacs, were asked to rate device:

--  ease of location of deflation valve
--  ease of inflation
--  ease of deflation, and
--  anticipated ability to train patients in clinical setting.

The Titan OTR pump design performed very well and “consistently demonstrated a significant advantage in subject preference.” (Quallich, Ohl & Dunn, 2008, p. 5).

After displaying the various models, many of my patients will favor the AMS 700 with LGX cylinders and other features described below

Durability

LGX cylinders are as durable as the CX, the most popular IPP cylinder in the world.²

Controlled Expansion

Designed to allow for up to 15-20% elongation, depending on patient’s anatomy.²

Unrivaled Technology

The only penile implant that provides controlled length girth expansion.

Three more reasons to choose LGX:

• Momentary Squeeze Pump with Lock-out Valve and Deflation Button
• InhibiZone® creates a Zone of Inhibition, effective against the bacteria commonly associated with IPP infections³
• Parylene—coded reservoir designed to mitigate cylinder fatigue and improve reservoir durability

This product is not for men with active urinary infections or active skin infections in the region of surgery; with known sensitivity to silicone or the antibiotic rifampin or tetracyclines; with lupus erythematosus; taking warfarin, thionamides, isoniazid and halothane; or with renal disease. Implanting a penile prosthesis is likely to damage or destroy any remaining natural ability to have an erection.

Montorsi F., et al; “AMS Three-Piece Inflatable Implants for Erectilie Dysfunction: A Long-Term Multi-Institutional Study in 200 Consecutive Patients”; Eur Urol 2000; 37: 50-55

1. Data on file at AMS
2. Carson CC 3rd. Efficacy of antibiotic impregnation of inflatable penile prostheses in decreasing infection in original implants. J Urol. 2004 Apr;171(4):1611-4.

to attack.

The World Health Organization declared three years ago that circumcision should be part of any strategy to prevent HIV infection in men. The organization based its recommendation on three randomized clinical trials in Africa that found the incidence of HIV was 60 percent lower in men who were circumcised. Although this “research evidence is compelling,” wrote the WHO panel assigned to the topic, there was little evidence explaining how circumcision might reduce a man’s risk of acquiring HIV.

Now comes an answer in a new study, published in the January 6 issue of PLoS ONE, which found that there are gross changes in the penis’s microbiome following circumcision, suggesting that shifts in the bacterial environment could account, in part, for the differences in HIV infection. Families of anaerobic bacteria, which are unable to grow in the presence of oxygen, are abundant before circumcision but nearly disappear after the procedure. The researchers suspect that in uncircumcised men, these bacteria may provoke inflammation in the genitalia, thereby improving the chances that immune cells will be in the vicinity for HIV viruses to infect.

“We never knew that there were that many anaerobic bacteria on the uncircumcised penis before [this study],” says Ronald Gray, a reproductive epidemiologist at Johns Hopkins Bloomberg School of Public Health and one of the lead authors on the current study. According to a 2006 survey, 56.1 percent of boys in the U.S. are circumcised. In its recommendation, the WHO panel stated that circumcision efforts would be most beneficial in parts of the world where less than 20 percent of boys are circumcised.

Gray, who is also working with one of the three randomized clinical trials on which WHO based its recommendation, adds that, “If we can show that these anaerobic bacteria are associated with HIV, then one could develop microbicides?antiseptics or targeted antibiotics ?that might provide protection.”

In the current study Gray and his colleagues compared the microbiota of 12 HIV-negative Ugandan men ages 15 to 49 before and after they were circumcised. It was important to limit the study to HIV-negative participants because infection itself can throw off the bacterial environment of the penis, says Lance Price, a research director at the Translational Genomics Research Institute in Flagstaff, Ariz., and co-author on the study. The team collected swabs from an area between the head and shaft of the men’s penises before and one year after circumcision. Then the researchers performed polymerase chain reaction analysis of a gene that is shared by, although not identical in, numerous bacterial families. The analysis allowed for identification of different bacterial families as well as abundance counts.

At 12 months after circumcision, the microbiome’s predominant bacterial population had shifted from anaerobic to aerobic, which require oxygen to grow. Whereas the researchers detected similar number of bacteria belonging to aerobic families in circumcised and uncircumcised samples, they found that the abundance of anaerobic family members plummeted after circumcision. As the authors wrote, this decrease makes sense because there is an oxygen-deprived area under the foreskin that is lost after circumcision.

I was circumcised at birth, but have a lot of loose skin around my penis.  It is very unsightly when penis is flaccid but not so evident when erect as I’m quite large.  ost importantly, having this extra skin, aside from being unsightly, effects my sexual performance as I believe I’m not as sensitive as if the skin wasn’t there (ie extra layer of skin exists and is still somewhat loose when erect).  I have a hard time climaxing during sex.  I believe if the skin were removed, my penis would be more attractive and have greater sensitivity.

Jason

Hi Jason,

Thank you for your interest in what we do.  Sensitivity may or may not be effected after circumcision.  The party line is that there is no change.   You know your penis best.

There is a medication that may tip you over into orgasm more easily and we can discuss that during your consultation.  The medication is pirmarily used for Parkison’s patients, buit has that side reaction.  So this would be an “off-label” usage.

We have performed over 5000 cosmetic circumcisions in the past 35 years and usually do several cases every week.

Harold M. Reed, M.D.
305-865-2000

Ali from Pakistan

iam 36  yeas olad man.In trumatic accidant my penis cuuted .now iwant to construct it.

Ali from Pakistan

Hi Ali,

In Europe a phalloplasty can be obtained for $15,000 to $30,000.  A completed phalloplasty requires several stages and the likelihood that all stages will proceed without any complication or produce a perfect result without revisions is quite remote. 

Anticipate revisions and discuss with your intended surgeon what you may reasonably expect as related to his/her technique.  Please confer if you wish with Dr. Stanley Monstrey in Gent, Belgium or Dr. Sava Perovic or Dr. Miroslav Djordjevic in Belgrade,  Serbia (djordjevic@uromiros.com).  All are excellent surgeons.

Dr. Monstrey does an excellent forearm flap.  I have personally seen each do this surgery
several times.
 
An ideal phalloplasty will produce a phallus that looks upon close inspection to be a penis with good glans (head) formation and a corona (rim).  The phallus must be completely sensate and beyond that orgasmically sensate.  Within the phallus shall be a urinary channel of decent caliber so the patient can void urinating from the glans as with normal males. 

Additionally there needs to be a mechanism for producing a penetrable erection.  Alternatives include: an inflatable penile prosthesis carrying a 50% complication rate and in genetic males having an average survival of 6 to 8 years (less in transgendered patients); or a semi-rigid prosthesis (possibility of extrusion from continued pressure); or a bacculum (silicone rod) which is inserted into a special channel just for sex.

Many dance steps to go through.  Also there will be a noticeable deforming harvesting scar which represents the donor site, could be in the forearm, back, lower abdomen, or thigh. 

We do not perform primary phalloplasty but will do revisions.

Sincerely,

Harold M. Reed, M.D.

305-865-2000

I am interested in penis lengthening and possible eventual girth enhancement. I had testicle implants with a west coast doctor and have been ‘stretching’ with some results, however I’d like to make my testicles hang lower. I also have somewhat of a ‘turkey neck’. I would like to know if you can relax the chords on my testicles to make them hang lower and would also like to know what you can do for the ‘turkey neck’. I’d like to know if I can do either of these in conjunction with penis lengthening. Thanks.  Parmuth

Hi Parmuth,

Thank you for your interest in what we do and your excellent clinical presentation.

Several thoughts come to mind.

If the doctor has entered the membrane that surrounds your testicles, this type of surgery frequently results unfortunately in adhesions that bind and fixate the testes  in one position.

That is why our implants are placed in front and below the testes.  We have also noted degradation of testicular function if entry is made into the testicular membrane, the tunica vaginalis.

Peno-scrotal webs are fairly easy to correct.  Please avoid the Z-plasty incision, as this looks like the “mark of Zorro” when it heals

Please review the attached letter and do visit our web-site.  Look at all the documents and photos.  If you feel I am the doctor for you or my level of expertise could provide the best advice that you are seeking, then please initiate a consultation over the phone with our office.

Harold M. Reed, M.D.
305-865-2000

I believe I have some infertility problems associated with a varicose vein on my scrotum. I was also interested in lengthening at the same time. Do you perform this operation?  Can you do both at the same time? And what are the prices and payment options?   Thank you.

Donald

Good afternoon Donald,

A varicose vein on your scrotum would not produce infertility but a varicocele, (similar to many varicose veins) surrounding your spermatic cord could.

Please review the attached on phalloplasty and penile enlargement, length and girth.

In that a well performed varicocelectomy may result in some discomfort after surgery and lead you to procrastinate on early use of traction, I would suggest you have the more important operation for you done first.

Best wishes,

Harold M. Reed, M.D.

Greeting Dr. Reed, I underwent circumcision as an adult over 10 yrs ago and have never been satisfied with the result. It is uneven and with still too much skin over the glans. There is even scarring that makes me feel self-conscious when undressing or showering at the local gym. I was very excited to hear about your services and pray you might be able to help me.  Please advise how best to proceed from here. I have already had a circumcision so I’m familiar with the procedure and well acquainted with its dangers. Is the appointment subject to a phone interview? Do you need photos documenting my current condition? I understand there is a consent form but I am unable to locate or download it from your website. I also understand there is a hotel nearby that your office recommends. I would appreciate any information you could povide.

Ramondo

 

Hi Ramondo,

We have performed over 5000 cosmetic circumcisions in the past 35 years and usually do several cases every week.

We have done sons of physicians, brothers, religious circumcisions, men who have not seen the heads of their penis for 20 years! This is your circumcision and we do it the way you want with respect to 4 parameters.
 
Please don’t be like the patient who writes: “Dr. Reed I just got circumcised two days ago and my result was not what i expected. I was wondering when i recover can i get a consultation with you.” Photos sent and received (unspoken comment “disaster zone”)
 
Be assured we will show you every courtesy,
 
All the best,
 

Harold M. Reed, M.D.
305-865-2000

Re: Is it too late for my 17 year old son to have a circumcision safely?

Hi John,

Got tremendous mileage out of my circumcision, outlived 5 cars, 2 houses, 12 sets of Michelin tires and 3 wives. But next time, it won’t be neonatal, I’ll be going for intrauterine. Let’s spare the ceremony, parental anguish, and of ourse indecent exposure.

Oh yes, I remember it like it was yesterday, I saw the tired look on the night time delivery crew, the washed out expression on my Dad’s face who had been up all night. I remember telling them all to go home. By that time I had already completed a toe and finger count and got 19 1/2, one toe was slightly folded
over. But they paid me no mind, all they heard was wah, wah ,wah. Which I attribute to some anesthesia given to my Mom but spilled over into my blood stream, so naturally I couldn’t talk properly.

Anyway in the next life it will be intra-utero…. where do I sign?

Robert (plan on a 2nd childhood) Colebrook

Had a very wonderful Greek patient here 2 days ago with retractable phimosis, but cracked and was painful after sex so much, that he needed a week to recover every time he penetrated.  Time for cosmetic circumcision.

Yes, by touching and looking at the white inner skin, I can tell exactly how much is inflamed and non-elastic.  This definitely has to be removed, otherwise the problem will recur.  With careful approximation, was able to do this without a lower V-cut.  He wanted the frenulum preserved, and that’s OK.  It was not hard, cord-like and fibrotic. 

Seen the next day at the office with his beautiful girlfriend and is doing well.  Not pain whatsoever.

Harold M. Reed, M.D.

305-865-2000