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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