Choosing Implants for Peyronie’s Disease

Inflatable Bioflex Cylinders

Steven K Wilson, MD, FACS, FRCS (Eng)

Editor-In-Chief of Video Journal of Prosthetic Urology
 Disclaimer

I have the following relevant financial relationships to disclose

• Consultant: Abeon, AMS, Coloplast, NeoTract, Sontec
• Patent Holder: AMS
• Stock Shareholder(directly purchased): NeoTract

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

115º 20º

Pre OP Post OP

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 Say
You Straighten It?”

IPP & Modeling First Introduced @ ISSM 1991,

Then @ AUA 1992
Wilson 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
 In My Experience, IPP & Modeling
Will Correct 98% of Patients to 30º or less

J Sex Med 2010; 11:3775

Levine’s Study Showed Modeling Alone Is

Effective In Straightening 83% of Patients

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
“What is the best cylinder construction for Peyronie’s Disease
Since Modeling is done in the majority of P. D. patients?”

Bioflex Expansion Limited Only by Tunica

AMS 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
 Erection Rigidity Is Function of Girth Not Length*

14.5mm 17 mm 18 mm 22+ mm

CXR Titan 700 Series Titan

Narrow
Base

Coloplast Titan NB Cylinders Coloplast Standard Titan Cylinders

Cylinder Cylinder Girth (mm) Up to 30% increase Cylinder Cylinder Girth (mm) Up to 30% increase
Length (cm) (designed) Cylinder Girth (mm) Length (cm) (designed) Cylinder Girth (mm)
11 11.2 3.4 14 14.1 4.2
14 11.2 3.7 16 14.1 4.2
16 12.2 3.9 18 15.1 4.5
18 12.2 3.9 20 15.1 4.8
22 16.1 5.1

* Pescatori ES, Goldstein I. J Urol 149:295, 1993

 Complete Filling of Tunica Facilitates
Modeling & Cicatrix Resolution In Peyronie’s

Two layers of silicone with Bioflex cylinders: allow

Fabric insert limit expansion 55 mm girth in Coloplast Titan
To 38 mm on AMS CX, LGX
 Former Coloplast Clear Bioflex® Could
Exploit Areas of Tunical Weakness

Infection Salvage 6 mo. previously, Right Distal corporoplasty for impending

now Aneurysms 2º Weak Corpora Cylinder 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 Present day cylinders (>2002)*

Outer layer of silicone wore, Outer layer silicone intact,
Fabric splits, inner layer aneurysms Fabric splits because of trauma

*Kaufman J Sex Med 2008; 11:2713

Pre Paralyne modeling damaged outer layer of silicone

Now modeling not a problem for AMS cylinders in Peyronie’s
 Coloplast Tubing Length Variable.
All AMS Cylinders Have Same Length Tubing
Coloplast Titan AMS CX & LGX
Cylinder Tubing Tubing Cylinder Tubing Tubing
Length Length- Length- Length Length- Length-
(cm) Scrotal (cm) Infrapubic (cm) Scrotal (cm) Infrapubic
(cm) (cm)

14 8.5 16 12 8.5 16
16 8.5 16 15 8.5 16
18 10.5 16 18 8.5 16
20 12.5 16 21 8.5 16
22 12.5 16
24 Tubing cut to
length
26 Tubing cut to
length
28 Tubing cut to
Coloplast: More sizes & coincident increased tubing length as cylinder gets longer
length
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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