Published on modernmedicine.com April 1, 2011
Implantable penile prostheses aid curvature, function in men with Peyronie's disease, erectile dysfunction
Two prostheses avoid perceived or real loss of penile length, research showsPublish date: Apr 1, 2011
By: Mac Overmyer
Source: Urology Times
In men with erectile dysfunction due to Peyronie's disease, use of a girth-expanding, length-extending implantable penile prosthesis appears to improve both erectile function and curvature while addressing the frequent problem of real or perceived shortening, researchers say.
Researchers from Vanderbilt University Medical Center, Nashville, TN, presented a study on two such prostheses at the 2010 AUA annual meeting in San Francisco. The devices—the AMS Ultrex and AMS LGX (American Medical Systems, Minnetonka, MN)—significantly improve curvature and erectile function and "contribute substantially to the patient's sexual health," said Benjamin Whittam, MD, a urologic surgery resident at Vanderbilt working with Douglas Milam, MD, and colleagues.
Dr. Whittam told Urology Times that being able to model during the implant procedure, coupled with the device's ability to enhance both girth and length, plays an important role in improving patient self-perception and subsequent sexual health.
In presenting the study, Dr. Whittam noted that some other prostheses allowed for length extension but were associated with concerns about achieving adequate rigidity for modeling and straightening. Other prostheses that allow a degree of modeling and straightening are associated with perceived or real shortening.
Of the two main types of penile prostheses, girth-expanding devices are currently supported by the Peyronie's disease literature, Dr. Whittam said. These devices include the CX (American Medical Systems) and the Titan (Coloplast, Minneapolis).
"However, neither of these has length-expanding attributes," he said. "Length- and girth-expanding devices such as the AMS Ultrex and AMS LGX are associated with risks of urethral dilation. There is also a concern that these devices might not tolerate intraoperative modeling and because of this, would not be that useful in patients with severe curves."
See Footnote
To define the potential benefits of the Ultrex and LGX, the Vanderbilt team conducted a retrospective review of 49 patients who had undergone an Ultrex or LGX implant procedure between 2006 and 2009. The patients had ED associated with penile curvature, and the average curvature was 52.9 degrees. A total of 37 patients received the AMS LGX, and 31 underwent modeling during the implant procedure.
Curvature, SHIM scores improve
The benefits associated with the device were substantial. Of 40 patients with sufficient follow-up (those who presented for activation at 6 weeks), 22 were without any residual curve, and 18 had an average residual curve of 17.7 degrees. Scores on the Sexual Health Inventory for Men (SHIM) improved from a mean of 6.97 preoperatively to 18.54 postoperatively with a mean follow-up of 7.3 months. The percentage of men able to have intercourse increased from 30.8% preoperatively to 97.3% at 7.3 months' follow-up.
There was no incidence of aneurysmal dilatation or device infection observed. One patient had a hematoma that resolved spontaneously, and one patient evidenced reduced glans support. This was resolved with a revision.
"We feel that the use of these devices allows a significant improvement in penile curvature and benefits erectile function as well as sexual health. This is now a standing clinical strategy that allows both girth expansion and length extension and is a viable therapeutic option for patients with Peyronie's disease," Dr. Whittam said.
Dr. Milam is a consultant/adviser for American Medical Systems.
-------------------------------------------------------------------------
Footnote from a email from Dr. Milam's assistant Todd Doran MS PAC 7/26/11
The argument to use a CX in severe peyronies/modeling is due to aneurysmal dilation seen in older Ultrex (predecessor to LGX) and the false belief that an LGX will accentuate the curve. We disagree with that argument and it's still a largely held belief by a lot of implanters. Remember that there are few that have the volume like Dr. Milam, especially with concurrent Peyronie's Disease. The large volume implanter peer group would be less critical in using an LGX in that setting in 2011 than 3 yrs ago even due to success and spreading of the word.
Todd
Todd J. Doran, MS, PA-C
Associate in Urologic Surgery
Vanderbilt University
Dept of Urologic Surgery
A-1302 MCN
Nashville, TN 37232
615-322-2880
I am happy to report that my case was included in the above mentioned study.
Jack
Monday, July 25, 2011
Friday, July 15, 2011
Ever consider an implant? Here's some entertainment. By LGX Man
Ever consider an implant? Here's some entertainment.
So much talk of ED. Thought I'd give you guys an encyclopedia of "the flip side". It's lengthy, it's fun! ;-)
I've been the proud owner of an AMS 700-LGX Penile Implant for nearly 7 months. It has turned out to be an amazing, life-changing product. I do notice a big difference in size now, After so many years living with ED, it had become a turtle. The new implant is 21cm. plus base extenders, which hold the whole shebang together. I've got some length and yes, it does grow your penis. Here's a truth that not many implanted men talk about. To put these new chambers into your penis, they cauterize, dilate or "hollow-out" the old corpora cavernosa. The "CC" is the part of your penis that has swollen up when sexually aroused. "used to be huh? heh" They then install the new chambers into the "dilated right thru the middle" old chambers. This is the part that causes the increase in girth, right off the bat. After working with my penis for many months, it gets BIG now. Magnum XL size in girth. I had previously been considered about normal, 6" regular. The length is worked on every day and is definitely growing. Read on...
I've followed all instructions from the doctor & manufacturer since the day I had it installed. Nowadays, I keep it inflated to the MAX twice a day for as long as I can stand it. I often go to sleep with it fully inflated. Sometimes I can stand it for an hour and other times I can go all night and have spontaneous sex. The mind once again works with the penis and there are times when the mind "just knows" that it will be having sex in the middle of the night. This is one of my improved thoughts since being implanted. Yeah … nice! I have the AMS LGX (stands for Length/Girth Expansion) and it grows. The more it’s used, the more it gets broken-in (a very good thing, kinda like an old leather jacket). After a period of uncomfortableness (based on your level of tolerance, but 1-3 months average), you will suddenly wake up one day and it will all be working again. Loss of sensation? Not necessarily. I became much more sensitive because it had never really gotten hard enough before to sense the new zones that I’m feeling nowadays. This has caused a huge boost in my self-esteem and confidence level. Before all of this happened, I had gotten to the point of using depression meds. and psych counseling. Suddenly one day I just realized: Many things in my life seem wrong. Many of them are caused by my low self-esteem. Why don't I quit bitching about it do something about it. I decided to use a proven method to fix, at least, the biggest problem. ED. It sure couldn't be much worse than where I was at, right? Those were bleak times.
I watched the chatter on the penile-implant and other discussion forums, as well as the enlightening ED chatroom,at FrankTalk.org. It's clear that people prefer one type (AMS/Titan) over the other. The debate goes on over which one is better, especially with the newer guys who do not read the backlog of postings in the message banks, and have similar new questions all the time. After the operation is done life gets back to normal and guys often just go on with their new lives. The forums go round and round.
DOCTORS AND COSTS: After a short period with my newest BFF, I could honestly say that I LOVE MY LGX I have no regrets and nothing but good things going on in my life now. So MUCH has changed! I've also met many nice men on these forums who LOVE their Titan. The key is finding the right doctor and the right implant. That begins the journey. Hopefully you have insurance as the operation can run up to around $32,000. Maybe you're lucky enough to have insurance that will cover the best of the best doctors. It seems that there are increasingly fewer of those doctors and health plans around. The "best of the best" ones are called SEXUAL FUNCTION SPECILISTS. They perform MANY of these operations per year. Some say as many as “thousands” per year. You can get lists of doctors here, just ask and a list will be sent to you. Perhaps your insurance is more limited, as was mine, and you’ll have fewer doctors to choose from. In that case you want to research each of the doctors in your plan as carefully as you can. The amount of research done is up to you. I’m part of a medical foundation on the west coast and found the doctor who had done the most work with implants for the foundation. If you ask here, you’ll get many names of doctors from satisfied IPP recipients. But guys, know when to decide! Too much research can just get you nauseous. Be informed and ask questions of us implanted guys. Believe me, I had new questions each and every day and the guys here on the forums got me through it all.
After checking out doctors, reading as much information as I could get my hands on, and reading the blogs, forums and discussion rooms, I chose to just do it and took that big chance, with great worry, trepidation and fear. Luckily, I had also developed lots of confidence in my doctor through many of his chats, tests, emails and demonstrations. He showed honest excitement to get me fitted into an implant, but had made sure that every other conceivable option was exhausted beforehand (pills, pumps, injections with various mixes). It was determined that I had venous leakage on one side, which kept my penis from staying hard. There are many theories and reasons for ED so I won’t go into it, research!
I worked on myself (swimming often) for a few months to get as healthy as I could be before I underwent surgery. My muscles and skin were toned up, and my veins were standing at attention, ready to have intravenous needles stuck in them, joy!. The operation was a success and I spent the night in the hospital so that they could remove the catheter in the morning, when needed. I was lucky, and was treated like a king all night. I was sent home to recuperate. All was fine until about the 4th day when the intensity of what I had done sunk in. This is where I learned the smart use of ice or something cold. Personally, I kept a bowl of ice water and a few white towels nearby. I had a thick towel underneath me. After wringing the towels out, I used the cold towels to wrap around my scrotum and penis, causing an immense amount of relief. Whatever your method for getting the swelling to subside, do it. Very important at this stage. Ibuprofen and other meds may be necessary, based on you.
Since my first inflation, I've been instructed to "work it" at least twice a day. For the first 2 to 4 weeks, this just meant to inflate the penis and leave it there for 10 to 20 minutes. After that, or when your doctor instructs you to ...you can start keeping it pumped to the MAX whenever you want. The material of the pump is strong and it can take whatever you want it to do. You SHOULD do this at least 2x daily for the first 18 months. It's an investment in time, but heh it's not really so bad now is it? Some days it does seem like a chore but once it's inflated, that’s usually all quickly forgotten or I leave it up and play with it. This is when you can start working on keeping your newly dilated corpora cavernosa (cc) chambers inflated or, in the case of the LGX-700, start pumping it to stretch/grow your penis. It’s pretty much the same idea as how muscles are made. Pump it! I work on keeping the LGX chambers aligned from the shaft into the GLANS. I work on keeping the shaft free of scar tissue growth. Scar tissue grows in immediately and throughout the first 2-6 months after the IPP operation, and is always a threat. You’ll know what it is when it sets in. if you don't WORK IT on a regular basis, at least for the first year to 18 months, you will regret it later. The more you work it, the better the results! Make sure the head of the penis get a full workout. Am I stressing the importance of this task guys? Talk about a wicked new set of feelings during the first few weeks! Now, when I use my penis, it's finally doing exactly what I want it to do, on command (on command of my fingers pumping it up that is) and for however long I want it to perform. I think of the daily routine as something that’s been prescribed and MUST be done. Twice a day! I have to admit that this is one chore that I’ve really grown happy to get done quite often nowadays!
KEEPING THAT PESKY PUMP IN PLACE: You need make sure that you keep that new testicle, known as the pump, adjusted to wherever it has to be in your scrotum. It's up to YOU to follow your doctor and manufacturer’s orders and get the new equipment to where it needs to eventually rest. If you have problems, get to, email or call your doctor! When it comes time to get the pump into the correct position in the scrotum, I found that taking warm showers with lots of soap or better, conditioner and working the pump (and shaft) to where it’s intended to be helped a lot. If the pump is already where it needs to be, you got very lucky but need to make sure that it stays in the proper place in your scrotum. While in the shower, pull gently on the pump and direct it to where you want it to be. You only have just so long before scar tissue forms and that pump takes up residence wherever it has ended up.
WHY I CHOSE THE LGX: My medical foundation ONLY uses the LGX. Why? Because all of the urologists from the foundation (some more skilled than others) went to a few conventions sponsored by each of the two IPP companies. Many did operations based on what type of IPP the various patients had requested. Then they compared results. The doctors at Kaiser, together, as a team, decided that the LGX-700 would be the implant of choice, and the one sponsored by the foundation. I’m not sure if this would be fair to our brother’s with a large penis, who are better suited for a Titan. Luckily, The LGX is generally suited for guys around the normal range, 6” more or less. The Titan is for the bigger guys. Both work differently, research!
After about 3-1/2 months of general aching and re-arranging, suddenly one day it all suddenly “stopped” and my new always half-stiff penis "dropped" about 20 degrees. I stood looking at it in disbelief! Yaay! I was able to get it nearly back to normal flaccid droop. The penis never gets small again, it is always a bit of a shower after one of these implants. Most guys don’t mind that too much for some reason. The chambers are just larger! Whatever pain that had remained was gone and my mind was once again free to start thinking of other things, besides JUST my penis! Guys, LGX / Coloplast Titan, either way... how comfortable are YOU to do the utmost research that you can do, get all the information that you can from the doctor and his staff, and then just do it!
FINDING DOCTORS: We can worry all we want and ask and argue and debate but let's get real. Like most things, it's the luck of the draw when finding a good doctor. If you have fantastic insurance plan, finding the best is probably a lot easier. If your insurance is limited, then you need to find the best that you can get! My LGX was FREE just because the foundation states that all that’s needed is for the urologist to state that it’s needed. Had I realized this, I probably would have approached the subject years earlier. Sticky point: The size of the implant is up to the doctor and any representative of the company that may be there assisting. Make sure that you discuss your options with the doctor that will be performing the operation. The doctor SHOULD BE giving you the proper sized implant for your particular penis. YOU HAVE ONE TIME TO GET THIS RIGHT, MAKE SURE YOU AND YOUR DOCTOR ARE IN SYNC WITH THE SIZE ISSUE. Don’t give yourself reason to complain afterward!
RETURN OF THE CORPORAS: The “corpora spongiosum" (cs), the one surrounding the urethra (around the pee canal, underneath the penis) and also the GLANS. They are supposed to (and HAVE in me) come back to life. When really "aroused", as you often will be after receiving an IPP, you'll suddenly notice that your entire shaft will become engorged. The bottom of your penis as well as the head will finally again fill up with blood as the penis is made to do naturally. This may not happen to everybody, but it WILL happen to many. Once the rest of your penis is working, eventually you will be able to have a fully hard (what many implantee's begin to think of as "natural") penis, not the oval penis that we live with for the first 18 to 24 months after the operation before the CS returns to life. Truth be told: Most guys will eventually get full use of their penis back after a length of time, living with their new implants. The confidence level can become so good that the old parts (CC) may eventually come to life and join the party! Seriously, just do it
Well, that's my story. Now I'm having lots of FUN in life. Picture the PERMANENT BIG SMILE! I hope that you'll consider the fact that it all could be a lot better just by doing it, like I did?
Now, back to the show...
So much talk of ED. Thought I'd give you guys an encyclopedia of "the flip side". It's lengthy, it's fun! ;-)
I've been the proud owner of an AMS 700-LGX Penile Implant for nearly 7 months. It has turned out to be an amazing, life-changing product. I do notice a big difference in size now, After so many years living with ED, it had become a turtle. The new implant is 21cm. plus base extenders, which hold the whole shebang together. I've got some length and yes, it does grow your penis. Here's a truth that not many implanted men talk about. To put these new chambers into your penis, they cauterize, dilate or "hollow-out" the old corpora cavernosa. The "CC" is the part of your penis that has swollen up when sexually aroused. "used to be huh? heh" They then install the new chambers into the "dilated right thru the middle" old chambers. This is the part that causes the increase in girth, right off the bat. After working with my penis for many months, it gets BIG now. Magnum XL size in girth. I had previously been considered about normal, 6" regular. The length is worked on every day and is definitely growing. Read on...
I've followed all instructions from the doctor & manufacturer since the day I had it installed. Nowadays, I keep it inflated to the MAX twice a day for as long as I can stand it. I often go to sleep with it fully inflated. Sometimes I can stand it for an hour and other times I can go all night and have spontaneous sex. The mind once again works with the penis and there are times when the mind "just knows" that it will be having sex in the middle of the night. This is one of my improved thoughts since being implanted. Yeah … nice! I have the AMS LGX (stands for Length/Girth Expansion) and it grows. The more it’s used, the more it gets broken-in (a very good thing, kinda like an old leather jacket). After a period of uncomfortableness (based on your level of tolerance, but 1-3 months average), you will suddenly wake up one day and it will all be working again. Loss of sensation? Not necessarily. I became much more sensitive because it had never really gotten hard enough before to sense the new zones that I’m feeling nowadays. This has caused a huge boost in my self-esteem and confidence level. Before all of this happened, I had gotten to the point of using depression meds. and psych counseling. Suddenly one day I just realized: Many things in my life seem wrong. Many of them are caused by my low self-esteem. Why don't I quit bitching about it do something about it. I decided to use a proven method to fix, at least, the biggest problem. ED. It sure couldn't be much worse than where I was at, right? Those were bleak times.
I watched the chatter on the penile-implant and other discussion forums, as well as the enlightening ED chatroom,at FrankTalk.org. It's clear that people prefer one type (AMS/Titan) over the other. The debate goes on over which one is better, especially with the newer guys who do not read the backlog of postings in the message banks, and have similar new questions all the time. After the operation is done life gets back to normal and guys often just go on with their new lives. The forums go round and round.
DOCTORS AND COSTS: After a short period with my newest BFF, I could honestly say that I LOVE MY LGX I have no regrets and nothing but good things going on in my life now. So MUCH has changed! I've also met many nice men on these forums who LOVE their Titan. The key is finding the right doctor and the right implant. That begins the journey. Hopefully you have insurance as the operation can run up to around $32,000. Maybe you're lucky enough to have insurance that will cover the best of the best doctors. It seems that there are increasingly fewer of those doctors and health plans around. The "best of the best" ones are called SEXUAL FUNCTION SPECILISTS. They perform MANY of these operations per year. Some say as many as “thousands” per year. You can get lists of doctors here, just ask and a list will be sent to you. Perhaps your insurance is more limited, as was mine, and you’ll have fewer doctors to choose from. In that case you want to research each of the doctors in your plan as carefully as you can. The amount of research done is up to you. I’m part of a medical foundation on the west coast and found the doctor who had done the most work with implants for the foundation. If you ask here, you’ll get many names of doctors from satisfied IPP recipients. But guys, know when to decide! Too much research can just get you nauseous. Be informed and ask questions of us implanted guys. Believe me, I had new questions each and every day and the guys here on the forums got me through it all.
After checking out doctors, reading as much information as I could get my hands on, and reading the blogs, forums and discussion rooms, I chose to just do it and took that big chance, with great worry, trepidation and fear. Luckily, I had also developed lots of confidence in my doctor through many of his chats, tests, emails and demonstrations. He showed honest excitement to get me fitted into an implant, but had made sure that every other conceivable option was exhausted beforehand (pills, pumps, injections with various mixes). It was determined that I had venous leakage on one side, which kept my penis from staying hard. There are many theories and reasons for ED so I won’t go into it, research!
I worked on myself (swimming often) for a few months to get as healthy as I could be before I underwent surgery. My muscles and skin were toned up, and my veins were standing at attention, ready to have intravenous needles stuck in them, joy!. The operation was a success and I spent the night in the hospital so that they could remove the catheter in the morning, when needed. I was lucky, and was treated like a king all night. I was sent home to recuperate. All was fine until about the 4th day when the intensity of what I had done sunk in. This is where I learned the smart use of ice or something cold. Personally, I kept a bowl of ice water and a few white towels nearby. I had a thick towel underneath me. After wringing the towels out, I used the cold towels to wrap around my scrotum and penis, causing an immense amount of relief. Whatever your method for getting the swelling to subside, do it. Very important at this stage. Ibuprofen and other meds may be necessary, based on you.
Since my first inflation, I've been instructed to "work it" at least twice a day. For the first 2 to 4 weeks, this just meant to inflate the penis and leave it there for 10 to 20 minutes. After that, or when your doctor instructs you to ...you can start keeping it pumped to the MAX whenever you want. The material of the pump is strong and it can take whatever you want it to do. You SHOULD do this at least 2x daily for the first 18 months. It's an investment in time, but heh it's not really so bad now is it? Some days it does seem like a chore but once it's inflated, that’s usually all quickly forgotten or I leave it up and play with it. This is when you can start working on keeping your newly dilated corpora cavernosa (cc) chambers inflated or, in the case of the LGX-700, start pumping it to stretch/grow your penis. It’s pretty much the same idea as how muscles are made. Pump it! I work on keeping the LGX chambers aligned from the shaft into the GLANS. I work on keeping the shaft free of scar tissue growth. Scar tissue grows in immediately and throughout the first 2-6 months after the IPP operation, and is always a threat. You’ll know what it is when it sets in. if you don't WORK IT on a regular basis, at least for the first year to 18 months, you will regret it later. The more you work it, the better the results! Make sure the head of the penis get a full workout. Am I stressing the importance of this task guys? Talk about a wicked new set of feelings during the first few weeks! Now, when I use my penis, it's finally doing exactly what I want it to do, on command (on command of my fingers pumping it up that is) and for however long I want it to perform. I think of the daily routine as something that’s been prescribed and MUST be done. Twice a day! I have to admit that this is one chore that I’ve really grown happy to get done quite often nowadays!
KEEPING THAT PESKY PUMP IN PLACE: You need make sure that you keep that new testicle, known as the pump, adjusted to wherever it has to be in your scrotum. It's up to YOU to follow your doctor and manufacturer’s orders and get the new equipment to where it needs to eventually rest. If you have problems, get to, email or call your doctor! When it comes time to get the pump into the correct position in the scrotum, I found that taking warm showers with lots of soap or better, conditioner and working the pump (and shaft) to where it’s intended to be helped a lot. If the pump is already where it needs to be, you got very lucky but need to make sure that it stays in the proper place in your scrotum. While in the shower, pull gently on the pump and direct it to where you want it to be. You only have just so long before scar tissue forms and that pump takes up residence wherever it has ended up.
WHY I CHOSE THE LGX: My medical foundation ONLY uses the LGX. Why? Because all of the urologists from the foundation (some more skilled than others) went to a few conventions sponsored by each of the two IPP companies. Many did operations based on what type of IPP the various patients had requested. Then they compared results. The doctors at Kaiser, together, as a team, decided that the LGX-700 would be the implant of choice, and the one sponsored by the foundation. I’m not sure if this would be fair to our brother’s with a large penis, who are better suited for a Titan. Luckily, The LGX is generally suited for guys around the normal range, 6” more or less. The Titan is for the bigger guys. Both work differently, research!
After about 3-1/2 months of general aching and re-arranging, suddenly one day it all suddenly “stopped” and my new always half-stiff penis "dropped" about 20 degrees. I stood looking at it in disbelief! Yaay! I was able to get it nearly back to normal flaccid droop. The penis never gets small again, it is always a bit of a shower after one of these implants. Most guys don’t mind that too much for some reason. The chambers are just larger! Whatever pain that had remained was gone and my mind was once again free to start thinking of other things, besides JUST my penis! Guys, LGX / Coloplast Titan, either way... how comfortable are YOU to do the utmost research that you can do, get all the information that you can from the doctor and his staff, and then just do it!
FINDING DOCTORS: We can worry all we want and ask and argue and debate but let's get real. Like most things, it's the luck of the draw when finding a good doctor. If you have fantastic insurance plan, finding the best is probably a lot easier. If your insurance is limited, then you need to find the best that you can get! My LGX was FREE just because the foundation states that all that’s needed is for the urologist to state that it’s needed. Had I realized this, I probably would have approached the subject years earlier. Sticky point: The size of the implant is up to the doctor and any representative of the company that may be there assisting. Make sure that you discuss your options with the doctor that will be performing the operation. The doctor SHOULD BE giving you the proper sized implant for your particular penis. YOU HAVE ONE TIME TO GET THIS RIGHT, MAKE SURE YOU AND YOUR DOCTOR ARE IN SYNC WITH THE SIZE ISSUE. Don’t give yourself reason to complain afterward!
RETURN OF THE CORPORAS: The “corpora spongiosum" (cs), the one surrounding the urethra (around the pee canal, underneath the penis) and also the GLANS. They are supposed to (and HAVE in me) come back to life. When really "aroused", as you often will be after receiving an IPP, you'll suddenly notice that your entire shaft will become engorged. The bottom of your penis as well as the head will finally again fill up with blood as the penis is made to do naturally. This may not happen to everybody, but it WILL happen to many. Once the rest of your penis is working, eventually you will be able to have a fully hard (what many implantee's begin to think of as "natural") penis, not the oval penis that we live with for the first 18 to 24 months after the operation before the CS returns to life. Truth be told: Most guys will eventually get full use of their penis back after a length of time, living with their new implants. The confidence level can become so good that the old parts (CC) may eventually come to life and join the party! Seriously, just do it
Well, that's my story. Now I'm having lots of FUN in life. Picture the PERMANENT BIG SMILE! I hope that you'll consider the fact that it all could be a lot better just by doing it, like I did?
Now, back to the show...
Subscribe to:
Posts (Atom)