Date Published: September 11, 2012
Publisher: Hindawi Publishing Corporation
Author(s): Gerard D. Henry, Caroline Jennermann, J. Francois Eid.
The inflatable penile prosthesis (IPP) has high patient satisfaction rates and good mechanical reliability rates in multiple studies. The number one patient compliant at six months is penile length. Recently, new technique for aggressive sizing of the cylinders has been published on in the literature. One IPP company has produced a new product that has longer length cylinders (XL) than those available. However, traditionally long cylinders were felt to lack axial rigidity. Therefore, a prospective, multicenter, central IRB-approved, monitored study was performed on the new product to address these concerns. At 2 centers, a total of 17 patients underwent surgical implantation of these new XL cylinders. These patients were questioned for patient satisfaction and tested for axial rigidity using a Fastsize Erectile Quality Monitor. The results showed excellent patient satisfaction rates and great axial rigidity with the Fastsize Erectile Quality Monitor. The XL cylinders appear to give the IPP surgeon the ability to use longer cylinders with good patient satisfaction and great axial rigidity.
Scott et al.,  who introduced the first inflatable penile prosthesis (IPP), first suggested implantation of serially larger cylinders to enlarge the penis. Although overall patient satisfaction with the IPP is high [2, 3] the most common complaint among IPP patients 6 months postoperatively is penile shortening [4, 5]. Recently, Henry et al. reported a new length measurement technique that resulted in more patients being implanted with larger cylinders, with satisfaction rates comparable to standard measurement techniques . Longer cylinders allow surgeons the option of using more of the cylinder rather than more of the rear-tip extenders (RTEs), giving the patient a more natural appearing penis in erection and in flaccidity. The traditional Titan IPP line offers cylinder sizes up to 22 cm, but recently larger sizes (24 cm, 26 cm, and 28 cm) have been reintroduced. Titan XL large cylinders, made of bioflex, are developed to meet the needs of those subjects with larger penis sizes and revision subjects needing a cylinder size greater than 22 cm. However, in the past, concerns of the lack of axial rigidity have been bought up when using longer cylinders and whether this would affect patient satisfaction.
A total of 17 patients were enrolled in the long cylinders study. Implantation dates ranged from 2/11/2009 to 10/16/2009 with baseline assessment dates from 9/21/2009 to 6/10/2010. All assessments were within the study-specified time range of 90 to 365 days after implantation (minimum 99 days, maximum 309 days, median 208 days). Of the 17 subjects enrolled, one did not meet inclusion criterion #3 (the subject received an implant or revised implant with a Titan IPP cylinder size of greater than or equal to 24 cm within the last year). No implant characteristics, rigidity measurements, or physician feedback data were available for this subject. Only the medical history and subject questionnaire data are available. These results are excluded from the summaries below. The demographic data (age, height, weight, and body mass index) are given in Table 1.
Results have varied among studies evaluating postoperative penile length, both flaccid  and erect,  and the relation to subjective treatment satisfaction among patients with IPP. Yet, the most common etiology of erectile dysfunction for a patient receiving an IPP is prostate cancer, and both radiation and radical prostatectomy have to be shown to shorten the penis [10, 11].
The new XL cylinders appear to give the prosthetic urologist the ability to use longer cylinders with apparently good patient satisfaction and great axial rigidity. Prosthetic urologists should feel more comfortable with placing longer cylinders (greater than 22 cm) in terms of minimal buckling when using the new XL cylinders and carefully showing the patient to apply more pumps during inflation.