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.

Peyronies, penile curvature affects 3% of sexually active men, and perhaps more who could care less.

Some are very creative with sexual positioning and can work around some very mind-boggling angulations.  Peyronie’s curvature which is caused by a deposition of scar tissue or plaque is also associated with erectile impairment, but not always.  For most patients there are many ways to approach Peyronie’s including medication, traction, suture plication of the larger curvature side, and insertion of a graft on the lesser involved side.

In severe cases where Peyronie’s results in severe loss of length, then many urologists would certainly consider the option of an inflatable implant, with or without insertion of graft.  As a rule of thumb, if over a 35% lysis in circumference is required to relax the tension and straighten the penis, then a graft such as Tutoplast should be employed.  Otherwise leaving an open defect may not provide enough integrity to the casing or tunica albuginea to provide sufficient axial rigidity.

Releasing plaque of course restores the lesser curvature back to the length of the uninvolved greater curvature.  For men who insist on a closer approximation of their length of yesteryear, the LGX cylinder of AMS (American Medical Systems) may be considered.  The LGX, different from its Ultrex predecessor, expands more uniformly and is not considered as prone to aneurysm formation.  Using a table top model as a demonstrator, easily a 3/8″ increase in length is obtained, but the manufacturer says could be at least twice that in some applications.

Grafting as the sole remedy for Peyronie’s has yielded a disappointing successful length restoration result rate.  Only 30% of patients, despite correction of angulation have some restoration. .  Perhaps for Peyronie’s patients, we should be thinking more of implants.  For a patient to opt for an implant is an important decision, because he will forsake forever being able to have a natural erection.  Although some tumescence does occur with implants, it is never enough should the implant be removed to provide sufficient intromission.  The patient must also accept occasional replacement as part of the deal and the 2 to 8% incidence of infection (all comers having implant surgery).  However, for most with implants, happiness is being able to never have to say “I’m sorry.”

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

Hardly a week goes by that we do not receive an inquiry from someone with “get-there-itis”.  Wants length and girth simultaneously. Please understand while some doctors do offer this, many of their practices have been bought out by businessmen who dictate their mode of operations.  Of course, this is a popular sell, but does it work as well as staged surgery?  I think not.  Most patients complain of inadequate length gains, and also some wound healing problems.  The penis does not appreciate too much simultaneous surgery.  If you have simultaneous surgery, you will not be able to apply traction for a good 6 weeks, lest you tear your incision line apart. Better to have lengthening done, if that’s what you require, use traction immediately afterwards to maintain what was accomplished in the operating room, and build upon that until you are satisfied.    Then, go on to  widening with appropriately longer strips of AlloDerm.

If you are result oriented, believe me, this is the proper way.  I have been a phalloplasty surgeon since 1986 with close to 3000 case experience since then.
 

Harold M. Reed, M.D.

Oh yes, by the way please add on peno-scrotal web recession, “I’ve got a turkey neck.”

Phalloplasty has been a preferred term used by phalloplasty surgeons because penis enlargement has been overly worked by the nutriceutical houses such as Enzyte.  It is absolutely amazing how many requests we get almost daily to do everything at once.  “I won’t hold you responsible.”  Guess what? I am responsible and who pays for the revisions and touch ups and prolonged aftercare of a complication when the penis has had too much surgery at one time.   The doctor should know better.  Patients are allowed in the eyes of the law to be impulsive, but a professional is expected to exercise prudent restraint.

Why not simultaneous surgery?  The pubis is the delta which drains the lymphatics of the penis and scrotum.   Genital swelling, which may take 6 weeks to come down, is not an optimal environment for good wound healing.  The tissues are more prone to infection, blood supply is impaired, tension can result in suture line separation.  If you have a fresh circumcision, how are you going to pull on your penis (apply traction) to maintain the added  length I gave you in the operating room and build upon that?   Failure to apply immediate traction within a day or two is a common reason for no length gain.

I’d rather not take that man’s money.  The headaches of aftercare are overwhelming and very time consuming.  Frequent panic calls 24 hours a day; rushes of daily photographs by E-mail.  If the phalloplasty befores and afters on our web-site is what the patient is looking for, let’s do it properly step by step.

Harold M. Reed, M.D.

AlloDerm has by far and away become the most popular way to enhance penile girth.  Sure we lived through the liposuctioned fat transfer years with the lumps and bumps and reabsorption and inevitable touch ups. and then dermal-fat strips for phalloplasty with the harvesting scars, our were neater than most have seen, especially those 1/2 inch wide violacious bands of Zoro on the lower mid back which fortunately the patient doesn’t have to see everyday.  “Dr. Reed, please mail me a copy of the photo you just took, I want to show it to my doctor.”

With AlloDerm you don’t have to worry about atrophy and fibrosis, as long as you don’t stack it, it’s already dead.  It is a sterile dermal matrix.  Cells of your own making will grow into it.  If a dermal-fat graft doesn’t get an optimal vascular hookup within the first five days, the final result can be anywhere from necrosis in an extreme example to length contracture with palpable tethers (fibrosis)  to fat atrophy.  I started out with a 6 1/2 penis and now have only 5 inches?

Oh, we’ll put some AlloDerm, over that.   Not such a good idea.   If there is a poor blood supply, the AlloDerm will not work.  AlloDerm always works best when it is supported on both sides by a rich vascular bed.

That is the key to tissue ingrowth.   That is the difference between a reach for the moon operation on the penis and phalloplasty performed by a phalloplasty surgeon.  Our phalloplasty pictures are available on our web-site, befores and afters.  Please be sure to click Next Photos (below each photo) for the whole gallery.

Harold M. Reed, M.D. FICS

305-865-2000

QUESTIONS: I would like to know the costs of both surgeries, how long is the recovery and before I can have sex, and also, will there be any scars or signs of surgery?
Carter

Hi Carter,

Many thanks for your E-mail inquiry and visiting our web-site
http://www.penisdoctor.com/enlargepenis.htm

I am a phalloplasty surgeon.

We hope you can relate to our phalloplasty before and after photo and phalloplasty image gallery.  Please see if the incisional areas have healed acceptably to you.  Yes, if someone looks carefully enough, there may be a trace of a scar.  We also do AlloDerm.

Our phalloplasty cost is posted on our web-site.

We hope to have the pleasure of serving you whenever your travel plans include the South Florida area.

With regards,

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

Dear Dr. Reed,

Interested in penile lengthening. What are expected erect gains? Can you perform a vasectomy as well?

Mike

Hi Mike,

Many thanks for your E-mail inquiry and visiting our web-site http://www.penisdoctor.com/enlargepenis.htm

We hope you can relate to our phalloplasty before and after photo gallery. I am a phalloplasty surgeon.

Our phalloplasty cost are posted on our web-site.

Yes, we can perform simultaneous vasectomy at a discount.

Patients who have lengthening usually leave for home the next day. You could probably return to an office environment in 3 days.

Or consultation on Thursday, surgery on Friday.  Monday, back to work.

From surgery anticipate a 3/8? increase in length and with dedicated use of traction, 8 hours a day in divided sessions, anticipate a 1/8? gain each month such that after 6 months you’ll have 3/8? plus 6 x 1/8? or 9/8?. We say about an inch longer erection in 6 months. Flaccid lengths will be corresponding longer.

Whenever you stop using traction whatever you have gained is permanently yours. If you continue, more length gains will be accrued.

We do not do simultaneous surgery, such as any combination of length, girth of shaft, girth of glans, circumcision, or pubic liposuction.

Hardly a week goes by when some disillusioned patient done elsewhere calls us for a revision. And we told you so.

Generally speaking the penis does not appreciate simultaneous surgery with a few exceptions.

With AlloDerm, we can say quite conservatively you can anticipate a 3/4? gain in circumference which is permanent as far as we know having followed patients for 8 years or so who have had AlloDerm. Most patients will do a lot better than that. AlloDerm patients must be on strict bed rest with the exception of getting up to use the commode or eating in their room for 4 days. Surgery is the zero day, and we certainly recommend you stay at the Baltic Hotel (877 622 5842) so I can see you daily as your penis will continue to swell for several days, and your dressing will be replaced often to accommodate a larger sized penis.

Mention my name for a discount.

AlloDerm is like particle board, when immersed in body fluids, it swells and swells for several days. This spreading of the collagen fibers is helpful to permit ingrowth of a capillary bed and new cells of your own making.

Early mobilization is the great enemy of good graft take. Again plan on staying in your room, stocking up on food or sending out for food. Good Italian, Greek and Chinese restaurants abound with delivery service only a telephone call away. I’ve have been known to go shopping for some patients at Publix. You won’t starve.

If you have AlloDerm surgery on Tuesday, you could be back in an office environment on the following Monday.

Most likely you will have many questions and we are available for consultation only, if that suits your purposes. Candidates who wish to schedule surgery with our facility are required to have phone consultation with a favorable response to questions of concern. Assuming this, you will be given the nod to send in a 50% deposit which is non-refundable.

If you are over 40 or are on medications, please call the office before scheduling surgery, as a letter of medical clearance may be required. If you are a smoker, you must stop completely for 2 months before surgery (girth enhancement especially) 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. However, most of our penile surgery is done under local anesthesia with IV sedation.

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.

Please no aspirin or aspirin products, 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 (Boiron brand) dose 30C (take 4 small tablets sublingually, 4 times a day), vitamin C 500 mg (3 times a day) starting 1 week before surgery. Do take these medications unless there are specific reasons why you choose not to and let’s discuss it beforehand.

Boiron brand is available at Whole Foods and on the web at http://www.vitaminshoppe.com for “pennies” and we do notice a difference. You will need 2 vials.

We hope to have the pleasure of serving you whenever your travel plans include the South Florida area.

With regards,

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

Phalloplasty is a general term derived from “phallus” or penis and “plasty” meaning to modify by plastic or reconstructive surgery.  I am a phalloplasty surgeon, one of a few phalloplasty surgeons doing these procedures in the United States.  Our office is located in a upscale pocket park community, Bay Harbor Islands (greater Miami).  We are equidistant between the Fort Lauderdale and Miami airports.  Choose whichever airport has the best fares and for added ground savings try SuperShuttle if at MIA or GoShuttle if at FLL.

Phalloplasty cost is moderate considering my 35 years of urological experience, our Quad A (AAAASF) approved surgical facility and societal memberships which include founding member and treasurer status.

Phalloplasty before and after photos are posted on our web-site http://penisdoctor.com/photo1aa.htm and you can see from these phalloplasty images, we know what we are doing.

Harold M. Reed, M.D.

Senior Member of the American Urological Association 
Founding Member of the North American Sexual Society
Member of the Society of Genito-Urinary Reconstructrive Surgeons
American Academy of Phalloplasty Surgeons (founding member and treasurer).                                                                         

 Hi Dr. Reed,

I am a 35 year old white male in good physical health
albeit a little under weight for my 5 7 frame. I am very
curious to know how many of your patients undergo 
penile enlargement for no other reason than personal
satisfaction? I ask this because I want to be bigger 
just for myself. I guess it’s like buying a Mercedes
when your old car is just fine. You just want to feel
special.  

Does this kind of thinking bother you and do you try
to discourage people like me from surgery?      

Kal  

Dear Kal,  

For most, the operation (phalloplasty, augmentation phalloplasty)  is a cosmetic one and not
medically necessary.  I believe during arousal for both
your partner and yourself, being well represented is a turn-on. 

My responsibility is to tell you, you are normal if that is
the case.  Normal is a range that includes 88% of the all measured. 

We do note however, that a good majority of our patients
are below the median and can sympathize with their wanting to catch up.    

Please see our phalloplasty before and after photos and phalloplasty images.  The phalloplasty costs are posted on our web-site.

Harold M. Reed, M.D.

Dr.Reed,

My name is Stan. I am a 55 years old and very fit.  Approx 10 years I underwent lengthening and widening with dermal grafts. I was 5 7/8 erect and 4 1/2 girth. I am now 7 X 5 3/4 midshaft. As my wife likes girth and I am tired of using the pump. I am considering girth enhancement with alloderm.  The dermal seems to have decreased from just under the head to approx midshaft.  Can alloderm be used in conjunction with already placed dermal? As I want no more than 3/4 - 1″, to take out the dermal and replace with alloderm would make my girth less than it is now.  Also, how many sheets of allo do you typically use and what is the size of a sheet. 
 
Any information would be greatly appreciated. 

 

 

 

Hi Stan, 

 

We had had experience with AlloDerm for almost 10 years now and before that we did dermal-fat grafts, and before that transfer of liposuctioned of fat (autologous fat transfer or AFT) .  As a phalloplasty surgeon I evolved into the AlloDerm because it seems to be the most predictable performer.  Liposuctioned fat transfer can result in uniform or zonal reabsorption and the formation of fibro-fatty nodules or lumps under the skin. 

Dermal-fat grafts are living and in order for them to survive as soft as one might feel under the skin before surgery, they do need to pick up a sufficient blood supply.  Otherwise they will undergo some degree of atrophy which translates into fibrosis, the lowest common denominator of wound healing before necrosis.  Fibrous grafts tend to lose of course the original girth as the fat cells die off first, but worse yet they contract and result in shortened penile length. 

AlloDerm is a cadaveric product, and has no immediate biological requirements such as early re-vascularization.  If your dermal-fat graft in the distal shaft is not bothering you, you could consider Allo-Derm placed over it.  If it is truly fibrous, I would remove it, as AlloDerm should rest between a sandwich of healthy well vascularized tissue for a good take. 

We use extra-thick AlloDerm but avoid stacking sheets as this can predispose to a wound infection.  There is no blood supply whatsoever between the layers, and all it takes is a small amount of skin bacteria  which healthy tissue can repress.  The thicker a man’s penis is when he sees me, the less impact visually one extra thick layer of AlloDerm has.  Think of “a drop in the ocean.”  For men who have not had previous girth enhancement, we say about a 3/4″ increase in circumference.

Your circumference of 5 3/4 is OK and you may wish to rest on your laurels.  Most likely with AlloDerm you will get up to 6 or more inches.  In cosmetic surgery there is an expression, “less is more,” meaning that overdoing things can lead to complications.

Please do see phalloplasty before and after photos and images on our web-site.  The phalloplasty cost is also mentioned.

 

Hope this addresses your questions.  

Best wishes,

Harold M. Reed, M.D.

305-865-2000