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.

Dr. G. Garaffa (London) and group compared 129 patients who had correction of Peyronie’s by insertion of an inflatable penile implant versus 80 of those who had a semi-rigid rod type implant.  Despite revision surgery in 18 of the first group versus 8 in the second group, the satisfaction rate for inflatables was higher 86% versus 72%.   Our experience has been after you show an inflatable model on the desk top versus a semi-rigid rod almost all patients will opt for an inflatable after learning of the pros and cons.   

Harold M. Reed, M.D.

How well did they fare?  A paper by Drs. M. Zanoni and Steve Wilson et al.

During revision surgery for clinically non-infected implants, cultures were positive for 70% of non-coated, and 60% of coated.  Thus the authors concluded that culture positive implants as a simple test (unrelated to why revision surgery was being performed) obtained at the time of revision surgery occurred in the majority of non-coated as well as coated implants

Harold M. Reed, M.D.

by Dr. Ohl and group, University of Michigan, a multi-centered study.   Mentor’s one touch is a catch up to the AMS (American Medical Systems), MS or momentary squeeze  valve.  At 6 months the Titan satisfaction rate is reported to be 76% meaning somewhat/or very satisfied.

I do believe more table top demonstrations of how the implant works in the doctor’s office are needed before surgery.

Harold M. Reed, M.D.

by Debo and group, a multi centered study.  Average time for re-intervention for implant malfunction was 50 months, a little over 4 yours.  Average time for re-intervention for infection was 18 months which occurred in 11%, and a patient dissatisfaction rate of 34%.

This study is of course at variance with what manufacturers say.  Their classic explanation is if the Doctors don’t tell us, how are we to know.   I do believe our experience is quite a bit better than that, but our office is not a training center.  Last week, I  removed an implant that had been implanted in May, 1987, the implant had been operational for 22 years.  Patient did receive radiotherapy afterwards for prostatic carcinoma.

Harold M. Reed, M.D.

 I asked for the Ultimate AMS I was given the step down with out my conscent. Ilost 2′ and some Dimension. The Pump leaks and partially fills when its deflated. Can I get back my inches and a better girth?    Rudy

Good morning Rudy,

Thank you for your interest in what we do.  Hope you can relate to our gallery of “ups and downs.”   Have been doing implants since 1975, and probably have done over 2000.

Fortunately your AMS product has a life-time warranty applicable to any treating physician.

We have been known to perform some magic in situations such as yours, but you do need to be seen at the office so I can best advise you.

Please understand it may be as simple as revising some technical errors during your previous installation, but you do need to have this reversed ASAP as scar contracture will make it more difficult to regain the length loss.

Also bear in mind any operation is associated with risk.  The experience of your urologist and his focus to the problems at hand will help minimize this.

You may wish to initiate a consultation over the phone by sending us your name, address, and phone number in an envelope along with a check for 250.

All the best,

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

Looking back at 9 patients who had Peyronie’s and underwent installation of an inflatable penile implant and simultaneous modeling to correct penile curvature, that is to say, bending of the inflated or erect penis in the opposite direction to correct for angulation, the incidence of mechanical malfunction that followed was 33.3%. Admittedly a small group for a study, but in the control group, the incidence of mechanical malfunction was 4.3%, after a mean followup of about 19.6 months. Reported by Dr. Christopher DiBlasio and group from Memphis, TN. at the April 2009 AUA meeting.

Harold M. Reed, M.D.
Penile Implant and Phalloplasty Surgeon

I have Diabetes, and had two stents (2 little tubes in one of my arteries) placed in 01/2004. I asked my insurance, and they want to know if the operation last more than one day or there is a hospitalization involved. My Insurance is Aetna. And I have to pay the Copay of $250.00. I live in California. Do you have any clinic here?
Because the Peyronies (Developed right after the operation of 2 stents in 2004) I’ve lost sizeAnd because the Diabetes I lost hardness and I prefer the prosthesis than lengthness Operation.
Thanks
Victor

Good afternoon Victor,

We would love to take care of you, but we are no longer under contract with Aetna.  Aetna may pay out of network.

Our only office is in the greater Miami area.

Thanks for visiting our web site on Peyronie’s disease and penile curvature http://www.penisdoctor.com/peyronies.htmPerhaps you can relate to the befores and afters posted in the gallery.  

We are doing several Peyronie’s patients every month.  One memorable patient from Ohio was done with a length gain of 1 1/4″ immediately on the table.  When the patient arrived in the recovery room and said to me, “how did I do,” I drew the urtains around his bed and pulled back his sheets and blanket and said, “look.”  An approving smile came across his face.

With post operative use of a vacuum erection device, he’ll even do better than that over the course of the next 6 months. Correcting penile curvature is one of the mainstays of our practice and the enjoyment we derive is making two people happy.  We see patients from all over the orld who seek remedy because of functional or cosmetic disabilities.

My knowledge is updated yearly by attending the AUA meetings.  At any lecture dealing with Peyronie’s you’ll find me sitting very attentively in the audience. 

While our surgical success rate is better than 95%, we do recommend a trial of conservative therapy for at least 6 months as this may often produce a sufficient enough resolution to make you a happy man.  But have you had this without success?

When your travel plans include the Miami - Ft. Lauderdale area please avail yourself of a proper urological consultation.

Or call our office to verify insurance coverage.  Anne is very knowledgeable.  We can even make a conference call with your company to verify your benefits.

If you are over 40 and are on medications other than hormones, please call the office before scheduling surgery, as a letter of medical clearance will most likely be needed.

If you are a smoker, you must stop completely for 2 months before surgery and please never again.  Smoking causes vaso-spasm, impairs wound healing, produces excessive scarring, tissue necrosis, irritates and inflames pulmonary membranes and enhances anesthetic risk.

This goes also for any products containing nicotine or nicotine like agents including nicorette gum, nicotine patches, Nicotrol inhalers, and second hand smoke.   Again not for 8 weeks before and not for 8 weeks afterwards.  Hopefully never again.

No aspirin or aspirin products, blood thinners such as Plavix, Coumadin, no anti-inflammatory drugs such as Motrin, Advil, Alleve, or Cox 2 inhibitors such as Celebrex or Vioxx for
a week before surgery.  No Vitamin E or excessive alcohol or spices for a week before surgery as this may promote bruising.  Bruising can be reduced (many believe) with Bromelain 500 mg 1 twice a day, Arnica montana dose 30C (take 4 small tablets sublingually, 4 times a day),
vitamin C 500 mg (3 times a day) starting 1 week before surgery.

Sincerely yours,

 

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America

305-865-2000

 

Jill Stein
November 01, 2007
AMS 700 Series devices elicit high degree of patient satisfaction 

PARIS ?Early results suggest that patients like the newly modified AMS 700 series inflatable pump penis prosthesis. 

The findings are based on a six-month follow-up of 32 men diagnosed with organic erectile dysfunction who underwent implantation of an AMS 700 series penile prosthesis with the new Momentary Squeeze Pump. Findings were presented here at the Soci?t? Internationale d’Urologie 29^th Congress. 

Overall, there was a high degree of satisfaction with respect to ease of inflation and deflation of the device as documented by patient questionnaires, said principal investigator Ajay Nehra, MD, professor of urology at Mayo Clinic College of Medicine in Rochester, Minn. ?Developments in the field of biosynthetic materials have allowed physicians the use of artificial/mechanical devices to replace malfunctioning or damaged body parts and organs,? Dr. Nehra pointed out in a poster presentation. ?These devices, or prostheses, are not compatible with long-term error-free function and are limited to minimal local tissue reaction. They have replaced earlier attempts at using tissue from donor areas and even xenografts in substituting damaged organs.? 

Historically, penile prosthetic surgery did not become popular until the early ’70s with the introduction of the first inflatable penile prosthesis and paired semirigid intercorporeal sponge-filled silicone implants followed by the flexirod prosthesis.   

As for the hydraulic devices that are used today, modifications have resulted in significant improvements in overall mechanical failure rates. Recently, the FDA approved additional modifications in the AMS 700 series. Specifically, changes were made to the scrotal pump to ease deflation. In addition, angulation changes were made in the exit tubing of the penile cylinders to ease proximal and distal positioning. A new feature was added to the pump’s fluid to resist flow into the deflated cylinders caused by pressure on the fluid-filled reservoir with auto-inflation. 

Of the study participants, 29 had primary placement of the device, and three underwent explant of malfunctioning penile prosthesis and immediate re-implant of an AMS 700 MS prosthesis. There have been no cases of infection.      

Fifteen of 19 patients who completed the questionnaire six months after surgery said that they were very satisfied with the device, two re-ported being moderately satisfied, and two described themselves as somewhat dissatisfied. 

All 19 respondents agreed that it was easy to find the device for inflation of the cylinders. Eighteen patients agreed or tended to agree that it was easy to hold the pump while inflating, and 18 reported that there was a reasonable amount of force required to inflate the device. Sixteen reported that they could inflate the device with relative ease. 

Eighteen respondents felt that the force required to initiate deflation was reasonable. Nineteen reported that the amount of time required to hold the deflation button to deflate the device was reasonable, and all of them stated that the amount of time required to actually deflate the device was reasonable. Seventeen stated that the overall ease of deflating the prosthesis was either very easy or easy.