Peyronies and Implants

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.

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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