Long-term mechanical reliability of AMS 700 series inflatable penile prostheses: comparison of CX/CXM and Ultrex cylinders.

PURPOSE: Recently, we have noted an increasing incidence of revisions being performed in patients implanted with the length and girth expanding AMS 700 Ultrex* inflatable penile prosthesis. This observation prompted us to compare the long-term mechanical reliability of the AMS Ultrex inflatable penile prosthesis versus the girth-expanding AMS 700 CX* or CXM* inflatable penile prosthesis in men with organic erectile dysfunction. MATERIALS AND METHODS: Using chart review, mailed questionnaires and telephone interviews, we obtained accurate followup on 111 of 142 (78.2%) patients with CX/CXM implanted between June 1986 and September 1995, and on 152 of 179 (84.9%) patients implanted with Ultrex between October 1989 and September 1995. The CX/CXM and Ultrex groups were compared with regard to 3 end points: 1) mechanical failure caused by any malfunctioning component, 2) device failure caused by any cylinder complication and 3) cylinder aneurysms/leaks. RESULTS: Followup ranged from 1.0 to 112.0 months for the CX/CXM group (mean 47.2 months), and 0.7 to 71.5 months for the Ultrex group (mean 34.4 months). CX/CXM versus Ultrex group comparison demonstrated 10 CX/CXM mechanical failures (9.0%) versus 26 Ultrex failures (17.1%), p = 0.001; 5 CX/CXM cylinder complications (4.5%) versus 13 Ultrex cylinder complications (8.6%), p = 0.0292; and 3 CX/CXM cylinder aneurysms/leaks (2.7%) versus 9 in the Ultrex group (5.9%), p = 0.0162. Kaplan-Meier estimates demonstrated significantly decreased mechanical survival in all 3 categories for Ultrex inflatable penile prosthesis versus CX/CXM inflatable penile prosthesis. CONCLUSIONS: Although Ultrex cylinders provide length and girth expansion, Ultrex cylinders exhibit an increased mechanical failure rate at shorter followup compared with CX/CXM cylinders. This increased propensity for Ultrex cylinder problems should be closely monitored.

AMS 3-piece inflatable penile prosthesis implantation in men with Peyronie's disease: comparison of CX and Ultrex cylinders.

PURPOSE: We compared the ability of the CX and Ultrex cylinders to straighten the penis in men who received a 3-piece AMS 700 series inflatable penile prosthesis for erectile dysfunction and erectile deformity due to Peyronie's disease. MATERIALS AND METHODS: The records of 34 and 38 patients receiving devices CX and Ultrex cylinders, respectively, were reviewed. RESULTS: All 34 patients receiving the CX cylinders achieved complete penile straightening with cylinder inflation and bending alone. In 10 of 38 patients receiving the Ultrex cylinders complete straightening with cylinder inflation and bending could not be achieved, and simultaneous corporoplasty was necessary. CONCLUSIONS: Girth expanding CX cylinders have better penile straightening properties than girth and length expanding Ultrex cylinders. We recommend use of CX cylinders for 3-piece AMS 700 series inflatable penile prosthesis implantation in men with Peyronie's disease.

Efficacy of the vacuum constriction device in patients with corporeal venous occlusive dysfunction.

OBJECTIVES: The vacuum constriction device (VED) is an effective nonsurgical treatment for erectile dysfunction. Its efficacy in specific patient groups, however, has not been extensively studied. Only one study to date has examined the use of the VED in patients with corporeal veno-occlusive dysfunction (CVOD). This study used a mailed questionnaire and no statistical analysis of the data. The purpose of this study was to examine the efficacy of the VED in patients with documented CVOD. METHODS: From 1989 to 1992, 294 patients chose to use a VED as treatment for erectile dysfunction. All patients were evaluated with a thorough history and physical examination, hormonal testing, glucose tolerance testing, and nocturnal penile tumescence studies. Ninety-eight patients underwent additional vascular testing. When seen in follow-up, patients were asked to assess erection quality and overall satisfaction with the device. RESULTS: Fifty patients had documented CVOD (33 by cavernosometry, 16 by ultrasound, and 1 by cavernosography). Twenty-eight patients (56%) were satisfied, 13 patients (26%) were unsatisfied, and in 9 patients (18%) satisfaction could not be determined. Thirty-eight patients (76%) achieved an erection of at least 7 on a scale of 1 to 10. There was no relationship between the severity of disease (as measured by cavernosometry) and the rating of erection (Kruskal-Wallis test, P = 0.77) or satisfaction with the device (Fisher's exact test, P = 0.95). CONCLUSIONS: The VED is an acceptable nonsurgical treatment for patients with erectile dysfunction secondary to CVOD regardless of severity. Its success rate is comparable to other therapeutic modalities such as injection therapy.