Friday, August 26, 2011
IMPROPER IMPLANT SIZING
It has recently come to my attention that some doctors are not implanting the AMS 700 LGX properly. They are not putting in a full length implant with the rear tip extenders, when needed, to fit the corpora's. This will quickly lead to problems.
This is a copy of an email I received recently regarding implanting an AMS 700 LGX or a Titan. Also a responce from Todd Doran of Dr. Milam's staff at Vanderbilt. The only editing I did was the doctors name.
This is how some doctors give the LGX a bad name. Be aware and put it on the list of questions you ask your doctor.
Jack
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Hi Jack,
Did you say you'd be seeing Dr. Milam soon? I wonder if you could ask him a certain question for me?
When I talked toDr. Mxxxxxxx, he said he could do either a Titan or a AMS700LGX, but he said if he put in an AMS700LGX, he'd have to put one in that was shorter than the corporas (because of the expansion in length).
I wondered if you might be able to ask Dr. Milam if he does the same thing, or something different, such as filling the corporas, which is what would be done with the Titan,I believe.
I just wonder if all doctors do this ,or only Dr. Mxxxxxxx, or what.
----------------------------------------------------------------------
Responce from Todd Doran MS PA-C
Here's the bottom line regarding RTE/corporal length, etc. Dr. Milam's philosophy is to measure the corporal length from rear tip to distal tip. We then place a cylinder that equals that length but sometimes RTE are used because the cylinders typically come in 2 cm increments and I can add RTE in 0.5 cm increments so we have infiinite possibilities to accomplish the goal. Here's an example-pt measures 15 cm so we place a 15 cm LGX cylinder with no rear tip because it's available in that size. We'd add 1.5 cm RTE if corporal body was 16.5 cm since next cylinder size is 17 cm. Hope that clarifies a simple concept that is complex for pts to understand and another concept that is misconstrued by surgeons and patients. The advantage of an LGX is that if you need 0.25 cm which is unavailable then we know that the expansion properties will achieve the desired goal where a Titan or CX wouldn't. That's our philosophy. Never agree with placing a device that's too short or too long, you're setting yourself up for disappointment right out of the box.
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
Wednesday, August 24, 2011
Implant Protocal Helps Reduce Penile Shortning
Larry was kind enough to send me the article from the October 2009 Issue of Urology Times.
Included is the update and VED exercise I used developed on the peyroniessociety.org forum. A personal comment. IT Works.
Implant protocol helps reduce penile shortening Pre-procedure use of vacuum device can restore penis to original length, data shows
Publish date: Oct 1, 2009
By: Mac Overmyer
Source: Urology Times
Key Points
The average length of virgin implants and rear tip extenders grew 5.5 cm during the period that the protocol was used.
Daytona Beach, A new noninvasive vacuum protocol for erectile dysfunction patients using an inflatable penile prosthesis can prevent penile shortening, according to results of a study presented at the AUA annual meeting in Chicago.
Cylinder length of a penile prosthesis reflects the length of the penis at the time of the procedure. Penile shortening associated with implants is not an insignificant problem. The average length of implanted cylinders has increased 5.5 cm in patients who have undergone the new protocol.
"There is no question that overall implant length has grown anywhere from 3 to 5 centimeters," said study co-author Martin Dineen, MD, of Atlantic Urological Associates, Daytona Beach, FL. "The vacuum protocol in our hands has virtually eliminated patient complaints of penile shortening."
Dr. Dineen and co-author Steven Wilson, MD, of the Institute for Urologic Excellence, Indio, CA, credit Thomas Sellers, a physician's assistant working in Dr. Dineen's practice, with identifying and refining the protocol.
"It [the initial idea] came from listening to non-implant patients who were using vacuum devices for erections," Sellers said. "They were telling me that they thought they were getting larger. The key to the idea came when I started having the patients mark the device with a felt marker where the end of their penis reached. That is how the protocol was created."
Under the protocol, patients anticipating an implant are instructed to use a vacuum device once daily for 10 minutes, beginning 2 months before the scheduled procedure. Patients with Peyronie's disease should use it twice daily.
"Those who were using it for around 10 minutes without the constriction bands seemed to be getting the most length," Sellers said. "Those who were using it longer did not appear to be gaining any additional length, and those who were using it for a shorter period were not getting as much of a return as they might be."
Sellers and the doctors caution that patients should be told that while they may regain their original length or a length close to it, they should not expect any gains beyond their original length.
After implant surgery, the penile implant is left 50% erect for 2 days and then deflated to 25% for 9 to 14 days. Following that exercise, patients are advised to inflate the device daily for 2 months.
Dr. Dineen and Sellers conducted a review of cylinder sizes they have implanted beginning in 2002, the year the protocol was initiated, through December 2008. the average length of virgin implants and rear tip extenders grew 5.5 cm (from 18.4 cm to 23.89 cm), an increase that reflects both expanding use and modification of the protocol over those 6 years.
High rate of compliance
"When a patient does not have an erection for a long time... the tissues foreshorten," Dr. Dineen said. "The idea behind the pump is that it stretches these tissues back to their normal length gradually. I explain it to patients as having their arm in a cast for 8 weeks. It is a bad idea, a painful idea, to stretch it back out immediately after the cast is taken off."
Despite the rigors of the protocol's schedule, patient compliance is more than 95%, Sellers estimates.
"Having [patients] mark the cylinder every week allows them to see their penis growing longer," he said. "These become motivated patients."
The protocol is now a standard aspect of therapy for patients anticipating an implant in Dr. Dineen's practice. Dr. Wilson uses the protocol only in patients who voice a concern about penile length. He says he feels that patient motivation is important for compliance. An independent, randomized, prospective trial designed to test these initial data is under way.
Drs. Dineen and Wilson are consultants/advisers for American Medical Systems, which provided funding for the study and manufactures the implant used by the researchers.
Penile Implant Protocol Update
Tom Sellers (physician's assistant), an assistant to Dr. Martin Dineen, MD of Atlantic Urological Associates, one of the two researchers involved with the Penile Implant Protocol Study published in Urology Times) (2009), telephoned me on 7-19-2011 after receiving a letter regarding my questions about their protocol being used for patients prior to revision surgeries to replace their old implants. Here is what I was told about the protocol:
1. Through further studies, the protocol is now only needed to be used for 3-4 weeks, as opposed to 2 months prior to surgery. It was found that one month was sufficient. The results achieved should be nearly the same.
2. The Penile Implant Protocol is just as effective for those patients having revision surgeries, as those who are having first-time penile implant surgery.
Prior to First-Time Penile Implant and Penile Implant Revision Surgery:
3. The new Penile Implant Protocols are as follows:
· Use the VED twice a day, holding for 10 min. when fully erect.
· Allow a minimum of one hour between use of the VED.
· Use the VED for 3-4 weeks minimum, but no longer than 2 months.
· Upon first use of the VED, when fully erect, mark on the outside of the clear plastic vacuum tube the length of the penis. This first mark will be used for comparison to subsequent length gains in the penis.
· Weekly take a measurement and mark a new line on the clear plastic vacuum tube (same day of week), marking out the steady progress being made.
· With limited penis sensation (quadriplegic and paraplegics), pump up the VED until a normal full erection is achieved, then stop.
· Gradually continue to increase the vacuum pressure to stretch the penile tissues and rehabilitate them. Again, continue to bring yourself to full erection, then stop.
· The vacuum pump may bruise the blood vessels just below the surface of the skin, which may cause petechiae (very tiny spots beneath the skin) when you first begin using your System. This is a response to placing the penis under vacuum pressure too long, too quickly or after a long period of inactivity. If this happens, discontinue use of the System until discoloration completely disappears – about five to seven days.
· There could also be some blisters appear upon the penis or water appear just under the surface skin of the penis. If this happens, reduce the amount of vacuum suction being used for a while.
After First-Time Penile Implant and Penile Implant Revision Surgery:
4. The new Penile Implant Protocols continues:
· After implant surgery, the penile implant is left 50% erect for 9 days. Following that exercise, patients are advised to inflate the penile implant device daily for 3 months, for 1 hour duration. Add extra pumping every few minutes to increase the stretch.
This protocol should aid in bringing a patient's penis size to near their normal erect size. This is highly advantageous outcome for the patient in that a maximized length and width of a penile implant can be chosen by the surgeon during surgery.
Surgery should be performed by a doctor who has done a lot of penile implant surgeries and revisions. It should be done at a Center of Excellence.
There are many types of VED's available for purchase. Manual pumps are better most usually than those that are battery or electric powered.
A patient recommended high-quality VED is from a company named Firma Medical (www.firmamedical.com). A moderate priced $199 VED Classic model (no prescription needed) was offered as a good option. It has the greatest suction and ease of use, compared to other VED's.
--------------------------------------------------------------------------
This is the VED exercise I used starting in 2005. It was developed by men with peyronies on the peyroniessociety.org forum.
VED EXERCISE
FOR
ED, PEYRONIES, CORPORAL FIBROSIS AND VENOUS LEAKAGE
RECOMMENDED BEFORE PENILE IMPLANT SURGERY FOR A BETTER OUTCOME
The theory behind this exercise is the more fresh blood you can get to your penis the healthier it becomes.
As some of you know the instructions that come with the VED can be vague. Old Man at Peyroniessocitey.org developed this exercise to me.
NEVER PUMP TO THE POINT OF PAIN OR EXCESS PRESSURE!! I did at first and caused a bruise on my penis that took weeks to heal. With this more is not better. Also hair can be a problem getting a good seal. Some of us just keep it trimmed back and others shave around the penis, what ever works for you. Do Not use a constriction ring for exercise.
VED for exercise. Every day.
Start with a good seal and pump to about 80% erect. Hold for 15-20 seconds then release for 15-20 and repump, (do not break seal). Do this for about 5 minutes.
Over the next 5 minutes pump up to a 100% erection using the pump hold and release for 15-20 second method. Do Not Break The Seal.
The next 5 minutes keep pumping to 100% erection using the pump, hold and release. Cautions do not over pump to the point of pain. After about a month you should start to see results.
No you don’t need a stopwatch, approximate times are fine.
VED for sex.
Start by properly placing the constriction ring on the cylinder. Get a good seal and pump to about 80% erection using pump and hold about 5 times. Then increase to about 90% erection and place the constriction ring.
Constriction Rings.
Constriction ring fit is a personal thing what may be right for me will not work for you. It will not be comfortable the first few times you use it. Trial and error are the only way to find which ring holds you best. Do not use over 30 minutes.
IMHO Osborn makes the best constriction rings. I had severe venous leakage and corporal fibrosis so I had to use the Osborn D ring. (Very tight.)
Any questions just let me know.
Jack
7/29/11 Footnote: In response to questions and comments from others I added this footnote. Remember I am a layperson and not affiliated with any doctor, hospital, or device manufacture. Just my own personal research and opinion.
I recommend this exercise for at least a couple of months before implant surgery. It will help keep your penis healthy and you will have a better outcome. Dr. Milam told me to keep up the exercise until about 2 days before my surgery and be careful not to hurt myself.
If you have read my story I call “One Mans Journey” it tells of my 10day hospital stay and recovery where I did not use the VED for almost a month. It looked like I had lost all the progress I had made with the VED exercise. When I was able to start back using the exercise within a week I had recovered the gains I had made.
Included is the update and VED exercise I used developed on the peyroniessociety.org forum. A personal comment. IT Works.
Implant protocol helps reduce penile shortening Pre-procedure use of vacuum device can restore penis to original length, data shows
Publish date: Oct 1, 2009
By: Mac Overmyer
Source: Urology Times
Key Points
The average length of virgin implants and rear tip extenders grew 5.5 cm during the period that the protocol was used.
Daytona Beach, A new noninvasive vacuum protocol for erectile dysfunction patients using an inflatable penile prosthesis can prevent penile shortening, according to results of a study presented at the AUA annual meeting in Chicago.
Cylinder length of a penile prosthesis reflects the length of the penis at the time of the procedure. Penile shortening associated with implants is not an insignificant problem. The average length of implanted cylinders has increased 5.5 cm in patients who have undergone the new protocol.
"There is no question that overall implant length has grown anywhere from 3 to 5 centimeters," said study co-author Martin Dineen, MD, of Atlantic Urological Associates, Daytona Beach, FL. "The vacuum protocol in our hands has virtually eliminated patient complaints of penile shortening."
Dr. Dineen and co-author Steven Wilson, MD, of the Institute for Urologic Excellence, Indio, CA, credit Thomas Sellers, a physician's assistant working in Dr. Dineen's practice, with identifying and refining the protocol.
"It [the initial idea] came from listening to non-implant patients who were using vacuum devices for erections," Sellers said. "They were telling me that they thought they were getting larger. The key to the idea came when I started having the patients mark the device with a felt marker where the end of their penis reached. That is how the protocol was created."
Under the protocol, patients anticipating an implant are instructed to use a vacuum device once daily for 10 minutes, beginning 2 months before the scheduled procedure. Patients with Peyronie's disease should use it twice daily.
"Those who were using it for around 10 minutes without the constriction bands seemed to be getting the most length," Sellers said. "Those who were using it longer did not appear to be gaining any additional length, and those who were using it for a shorter period were not getting as much of a return as they might be."
Sellers and the doctors caution that patients should be told that while they may regain their original length or a length close to it, they should not expect any gains beyond their original length.
After implant surgery, the penile implant is left 50% erect for 2 days and then deflated to 25% for 9 to 14 days. Following that exercise, patients are advised to inflate the device daily for 2 months.
Dr. Dineen and Sellers conducted a review of cylinder sizes they have implanted beginning in 2002, the year the protocol was initiated, through December 2008. the average length of virgin implants and rear tip extenders grew 5.5 cm (from 18.4 cm to 23.89 cm), an increase that reflects both expanding use and modification of the protocol over those 6 years.
High rate of compliance
"When a patient does not have an erection for a long time... the tissues foreshorten," Dr. Dineen said. "The idea behind the pump is that it stretches these tissues back to their normal length gradually. I explain it to patients as having their arm in a cast for 8 weeks. It is a bad idea, a painful idea, to stretch it back out immediately after the cast is taken off."
Despite the rigors of the protocol's schedule, patient compliance is more than 95%, Sellers estimates.
"Having [patients] mark the cylinder every week allows them to see their penis growing longer," he said. "These become motivated patients."
The protocol is now a standard aspect of therapy for patients anticipating an implant in Dr. Dineen's practice. Dr. Wilson uses the protocol only in patients who voice a concern about penile length. He says he feels that patient motivation is important for compliance. An independent, randomized, prospective trial designed to test these initial data is under way.
Drs. Dineen and Wilson are consultants/advisers for American Medical Systems, which provided funding for the study and manufactures the implant used by the researchers.
Penile Implant Protocol Update
Tom Sellers (physician's assistant), an assistant to Dr. Martin Dineen, MD of Atlantic Urological Associates, one of the two researchers involved with the Penile Implant Protocol Study published in Urology Times) (2009), telephoned me on 7-19-2011 after receiving a letter regarding my questions about their protocol being used for patients prior to revision surgeries to replace their old implants. Here is what I was told about the protocol:
1. Through further studies, the protocol is now only needed to be used for 3-4 weeks, as opposed to 2 months prior to surgery. It was found that one month was sufficient. The results achieved should be nearly the same.
2. The Penile Implant Protocol is just as effective for those patients having revision surgeries, as those who are having first-time penile implant surgery.
Prior to First-Time Penile Implant and Penile Implant Revision Surgery:
3. The new Penile Implant Protocols are as follows:
· Use the VED twice a day, holding for 10 min. when fully erect.
· Allow a minimum of one hour between use of the VED.
· Use the VED for 3-4 weeks minimum, but no longer than 2 months.
· Upon first use of the VED, when fully erect, mark on the outside of the clear plastic vacuum tube the length of the penis. This first mark will be used for comparison to subsequent length gains in the penis.
· Weekly take a measurement and mark a new line on the clear plastic vacuum tube (same day of week), marking out the steady progress being made.
· With limited penis sensation (quadriplegic and paraplegics), pump up the VED until a normal full erection is achieved, then stop.
· Gradually continue to increase the vacuum pressure to stretch the penile tissues and rehabilitate them. Again, continue to bring yourself to full erection, then stop.
· The vacuum pump may bruise the blood vessels just below the surface of the skin, which may cause petechiae (very tiny spots beneath the skin) when you first begin using your System. This is a response to placing the penis under vacuum pressure too long, too quickly or after a long period of inactivity. If this happens, discontinue use of the System until discoloration completely disappears – about five to seven days.
· There could also be some blisters appear upon the penis or water appear just under the surface skin of the penis. If this happens, reduce the amount of vacuum suction being used for a while.
After First-Time Penile Implant and Penile Implant Revision Surgery:
4. The new Penile Implant Protocols continues:
· After implant surgery, the penile implant is left 50% erect for 9 days. Following that exercise, patients are advised to inflate the penile implant device daily for 3 months, for 1 hour duration. Add extra pumping every few minutes to increase the stretch.
This protocol should aid in bringing a patient's penis size to near their normal erect size. This is highly advantageous outcome for the patient in that a maximized length and width of a penile implant can be chosen by the surgeon during surgery.
Surgery should be performed by a doctor who has done a lot of penile implant surgeries and revisions. It should be done at a Center of Excellence.
There are many types of VED's available for purchase. Manual pumps are better most usually than those that are battery or electric powered.
A patient recommended high-quality VED is from a company named Firma Medical (www.firmamedical.com). A moderate priced $199 VED Classic model (no prescription needed) was offered as a good option. It has the greatest suction and ease of use, compared to other VED's.
--------------------------------------------------------------------------
This is the VED exercise I used starting in 2005. It was developed by men with peyronies on the peyroniessociety.org forum.
VED EXERCISE
FOR
ED, PEYRONIES, CORPORAL FIBROSIS AND VENOUS LEAKAGE
RECOMMENDED BEFORE PENILE IMPLANT SURGERY FOR A BETTER OUTCOME
The theory behind this exercise is the more fresh blood you can get to your penis the healthier it becomes.
As some of you know the instructions that come with the VED can be vague. Old Man at Peyroniessocitey.org developed this exercise to me.
NEVER PUMP TO THE POINT OF PAIN OR EXCESS PRESSURE!! I did at first and caused a bruise on my penis that took weeks to heal. With this more is not better. Also hair can be a problem getting a good seal. Some of us just keep it trimmed back and others shave around the penis, what ever works for you. Do Not use a constriction ring for exercise.
VED for exercise. Every day.
Start with a good seal and pump to about 80% erect. Hold for 15-20 seconds then release for 15-20 and repump, (do not break seal). Do this for about 5 minutes.
Over the next 5 minutes pump up to a 100% erection using the pump hold and release for 15-20 second method. Do Not Break The Seal.
The next 5 minutes keep pumping to 100% erection using the pump, hold and release. Cautions do not over pump to the point of pain. After about a month you should start to see results.
No you don’t need a stopwatch, approximate times are fine.
VED for sex.
Start by properly placing the constriction ring on the cylinder. Get a good seal and pump to about 80% erection using pump and hold about 5 times. Then increase to about 90% erection and place the constriction ring.
Constriction Rings.
Constriction ring fit is a personal thing what may be right for me will not work for you. It will not be comfortable the first few times you use it. Trial and error are the only way to find which ring holds you best. Do not use over 30 minutes.
IMHO Osborn makes the best constriction rings. I had severe venous leakage and corporal fibrosis so I had to use the Osborn D ring. (Very tight.)
Any questions just let me know.
Jack
7/29/11 Footnote: In response to questions and comments from others I added this footnote. Remember I am a layperson and not affiliated with any doctor, hospital, or device manufacture. Just my own personal research and opinion.
I recommend this exercise for at least a couple of months before implant surgery. It will help keep your penis healthy and you will have a better outcome. Dr. Milam told me to keep up the exercise until about 2 days before my surgery and be careful not to hurt myself.
If you have read my story I call “One Mans Journey” it tells of my 10day hospital stay and recovery where I did not use the VED for almost a month. It looked like I had lost all the progress I had made with the VED exercise. When I was able to start back using the exercise within a week I had recovered the gains I had made.
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