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Urologist, J. Francois Eid, M.D., Lauds Improvements In Penile Prosthesis
And Artificial Urinary Sphincter Technologies
January 30, 2009, Dr. J. Francois Eid has performed more internal penile
implant surgeries than anyone in the world and has built a reputation for
excellence in the treatment of erectile dysfunction (ED). After examining
the latest generation of Inflatable Penile Prosthesis (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.
Eid has high praise for the recent improvements. 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.
Titan Pump - Coloplast
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).
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.
Dedicated to Patient Education
Dr. Eid has developed a website
http://www.urologicalcare.com
dispelling common misconceptions about penile implant surgery. 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.
About J. Francois Eid, M.D, and
urologicalcare.com
Dr. Eid is the director and founder of Advanced Urological Care in New York
City. He is also a Clinical Associate Professor of Urology at Cornell
University. Dr. Eid is one of the foremost specialists in urological
prosthetic reconstruction and performs over 300 internal penile implants per
year. Dr. Eid leads workshops on penile prosthesis surgeries worldwide. More
information about Dr. Eid and his expertise with erectile dysfunction
treatment, penile prosthesis implantations and artificial urinary sphincters
can be found on his website,
http://www.urologicalcare.com.
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