choosing implants for peyronie’s disease inflatable bioflex cylinders … · 2016-05-23 ·...
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Choosing Implants for Peyronie’s DiseaseInflatable Bioflex Cylinders
Steven K Wilson, MD, FACS, FRCS (Eng)Editor-In-Chief of Video Journal of Prosthetic Urology
Disclaimer
• Consultant: Abeon, AMS, Coloplast, NeoTract, Sontec
• Patent Holder: AMS
• Stock Shareholder(directly purchased): NeoTract
I have the following relevant financial relationships to disclose
My presentation will include discussion of specific products/services
of the disclosed commercial entities
Upwards of 40% of Peyronie’s Patients with IPP’s
Need No Adjunctive Straightening Measures
Pre OP Post OP
115º 20º
Either AMS 700 CX or Coloplast Titan works well
Usage of implant will subsequently act as tissue expander
≤30º of bend will correct with daily inflation – 8-12 months
Cicatrix will correct with daily inflation – 3 months
Longer penises are more likely to not need adjuncts than shorter ones
IPP Is the Gold Standard for P. D. + E. D.At Least 60% Need Some More Straightening
“How Did You SayYou Straighten It?”
IPP & Modeling First Introduced @ ISSM 1991,
Then @ AUA 1992Wilson SK, Delk J. New Treatment for Peyronie’s Disease: Modeling … J Urol 1994; 152:1121
Wilson SK, Delk J. Long Term F/U of Treatment for Peyronie’s: Modeling …J Urol 2001; 165:825
Levine’s Study Showed Modeling Alone Is
Effective In Straightening 83% of Patients
J Sex Med 2010; 11:3775
In My Experience, IPP & Modeling
Will Correct 98% of Patients to 30º or less
With this kind of success, modeling should be first line of therapy
Critics To Modeling Decry Penis Often Not
Completely Straight At Conclusion of
Surgery
To achieve a completely straight penis immediately after IPP implantation,
physicians have implemented these procedures
1. IPP & plication Morey J Urol 2015; 193:906
2. IPP & tunical incision
3. IPP & tunical scratch Perito, Wilson; J Sex Med 2013; 10:1194
4. IPP & plaque excision and grafting Levine J Sex Med 2013; 11:3775
Bioflex Expansion Limited Only by TunicaAMS Girth Expansion Limited by Fabric to 18mm
Just Imagine only
18mm of girth in this
big boy
Competitive cylinder limited by fabric to only 18mm or 36mm for penis
Rigidity is a function of girth
Bioflex cylinders girth expansion facilitates modeling
“What is the best cylinder construction for Peyronie’s Disease
Since Modeling is done in the majority of P. D. patients?”
Cylinder
Length (cm)
Cylinder Girth (mm)
(designed)
Up to 30% increase
Cylinder Girth (mm)
11 11.2 3.4
14 11.2 3.7
16 12.2 3.9
18 12.2 3.9
Cylinder
Length (cm)
Cylinder Girth (mm)
(designed)
Up to 30% increase
Cylinder Girth (mm)
14 14.1 4.2
16 14.1 4.2
18 15.1 4.5
20 15.1 4.8
22 16.1 5.1
Coloplast Titan NB Cylinders Coloplast Standard Titan Cylinders
* Pescatori ES, Goldstein I. J Urol 149:295, 1993
Erection Rigidity Is Function of Girth Not Length*
CXR
14.5mm
Titan
Narrow
Base
17 mm
700 Series
18 mm
Titan
22+ mm
Complete Filling of Tunica Facilitates
Modeling & Cicatrix Resolution In Peyronie’s
Bioflex cylinders: allow
55 mm girth in Coloplast Titan
Two layers of silicone with
Fabric insert limit expansion
To 38 mm on AMS CX, LGX
Former Coloplast Clear Bioflex® Could
Exploit Areas of Tunical Weakness
Infection Salvage 6 mo. previously,
now Aneurysms 2º Weak Corpora
Right Distal corporoplasty for impendingCylinder erosion. Cylinder distorted repair @ 2 y.
White opaque (1998) Bioflex® much more resistant to aneurysm
New White Bioflex: Rigidity Durable to 5 Years
Wtihout Report of Aneurysm Kaufman et al J Urol 2008; 179: 406
Present Day AMS Cylinder Construction Has Problems with
Aneurysms in Longer (18, 21) Cylinders
Pre Paralyne® (2001) cylinders
Outer layer of silicone wore,
Fabric splits, inner layer aneurysms
Present day cylinders (>2002)*
Outer layer silicone intact,
Fabric splits because of trauma
Pre Paralyne modeling damaged outer layer of silicone
Now modeling not a problem for AMS cylinders in Peyronie’s
*Kaufman J Sex Med 2008; 11:2713
Coloplast Tubing Length Variable.
All AMS Cylinders Have Same Length Tubing
Cylinder
Length
(cm)
Tubing
Length-
Scrotal (cm)
Tubing
Length-
Infrapubic
(cm)
14 8.5 16
16 8.5 16
18 10.5 16
20 12.5 16
22 12.5 16
24 Tubing cut to
length
26 Tubing cut to
length
28 Tubing cut to
length
Cylinder
Length
(cm)
Tubing
Length-
Scrotal (cm)
Tubing
Length-
Infrapubic
(cm)
12 8.5 16
15 8.5 16
18 8.5 16
21 8.5 16
Coloplast Titan AMS CX & LGX
Coloplast: More sizes & coincident increased tubing length as cylinder gets longer
AMS: Fewer sizes, constant length tubing forces use of lots of RTE
The fewer the length of RTE, means more penile rigidity
More rigidity, more Peyronie’s straightening effectiveness.
If RTE’s Omitted with Longer AMS Cylinders
– High Riding Pumps Result
All AMS cylinder lengths have 8.5 cm tubing.
Tubing length with 18 and 21 cm cylinders without RTE use … Too short
Bioflex is the best cylinder
construction for Peyronie’s and
modeling for these reasons: more
sizes, tunica dependent girth, & longer
tubing in longer cylinders means less
rear tip extenders.
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