Inflatable Penile Prosthesis (IPP) technology undergoes continuous improvement. After examining the latest generation of IPP and Artificial Urinary Sphincter (AUS) technologies from American Medical Systems (AMS) and Coloplast Corporation, reviewing pertinent studies, and drawing on his 20 years of experience performing penile prosthesis surgery and overseeing his patients' recuperation and subsequent training in operating the devices, Dr. J. Francois Eid has high praise for the recent developments. Updates have been made to the IPP pumps offered by both AMS and Coloplast, as well as to the CX and LGX cylinders offered by AMS. Also, AMS has added an antibiotic coating to its AUS.
Momentary Squeeze (MS) Pump - AMS
AMS's Momentary Squeeze (MS) Pump was first introduced nearly two years ago, and Dr. Eid has implanted it with great success in patients suited to the CX-cylinder and LGX-cylinder versions. (The LGX model offers the potential for increased penile length in patients complaining of penile shortening after radical prostatectomy.) Both cylinders now feature redesigned proximal ends. At only 9.5mm in diameter, the ends allow for significantly easier insertion for patients with fibrotic proximal corporal bodies.
The MS Pump's advantages include a smaller profile (which enables a more discreet placement) and one-touch deflation. However, this quality can result in operational difficulties with inflation (more difficult to get a hold of within the scrotum) and deflation (small button can initially be difficult to find). In addition, its new lockout valve has the advantage of preventing auto-inflation (potentially embarrassing and/or painful), but can at times make it difficult to initiate inflation. For these reasons, Dr. Eid recommends this pump for the younger patient with an average-sized penis.
Tactile Pump (700 CX Series) - AMS
"The AMS 700 CX Series with the Tactile Pump remains my prosthesis of choice for the older patient where pump concealment is not an issue," says Dr. Eid. "This pump is large, easily palpable, remains the softest to inflate and has a very large deflation footprint, which is quickly recognized by the patient." The Tactile pump is not available with the LGX cylinders.
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," says Dr. Eid, "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).
Titan Cylinders - Coloplast
Coloplast constantly looks at ways to provide the best possible implant solutions for the Serious Implanter. One of their latest product enhancements is an enhanced cylinder design for the Titan® IPP product line. Coloplast recently received FDA approval for the Titan 0-Degree, soft tip cylinders. The Titan 0-Degree, soft tip cylinders have the same Bioflex® features as the current cylinders, but has two new features:
1. zero degree angle proximal tubing which offers easier proximal placement and
2. softer molded silicone distal tip for suitable anatomic positioning.
Coloplast will conduct a market acceptance test (MAT) project to evaluate this product prior to widespread commercialization.
Artificial Urinary Sphincter - AMS
AMS has improved the AUS by coating the device surface with inhibizone. This is the same antibiotic coating (Rifampin and Minocin) currently available on the IPP that has dramatically reduced infection rates since its introduction in 2001. In combination with Dr. Eid's self-developed No-Touch Surgical Technique, which eliminates direct and indirect contact between the prosthesis and the patient's skin (the origin of most infections), he believes the new coating will offer additional protection against the most common pathogens responsible for sphincter infections.
Positive Impact on Patients’ Lives
Having performed over 3,000 penile implant surgeries (the most worldwide), Dr. Eid knows what a remarkable and positive difference the treatment can make in a man's life. Between retaining a normal penis look and feel, employment of multiple techniques for preventing infection, and steady diminishment of pain until it is completely gone within 2-4 weeks, penile implant surgery has proven to be an effective treatment for many men, resulting in normal, healthy and productive lives.