Maximizing Rigidity Factor of Inflatable Penile Prosthesis IPP

Maximizing “Rigidity Factor” of Inflatable Penile Prosthesis (IPP) Results in Better Artificial Erection ] Cordon, Billy H. , Eid, J. Francois Lenox Hill Hospital, New York City, New York Introduction It is well established that the inflatable penile prosthesis (IPP) more closely mimics expansion of the corporal bodies during erection compared to the malleable prosthesis. Classic teaching regarding placement of IPP supports the Aim In order to highlight that use of RTEs disregards the benefits of providing the crus with inflatable cylinders, we Method § The 3 -piece Coloplast Titan® IPP was analyzed. notion of using rear tip extenders (RTE) to improve mechanical survival by allowing tubing to come through the corpora more directly to the pump. Results § Current IPP cylinder design is a hybrid of a rigid an inflatable implant. § Adding RTEs increase the noninflatable portion of implant. § A Titan cylinder has a 5 cm rigid noninflatable portion. propose a novel concept “Rigidity Factor, ” (RF) and argue that avoidance of RTEs is preferred when possible with an expectation of higher long-term patient satisfaction. § We defined Rigidity Factor for a given cylinder as a ratio between the live (inflatable) portion of cylinder over the total length. Rigidity Factor: Ratio of inflatable live portion of inflatable cylinder over total cylinder length with and without RTE Adding a 2 cm Rear Tip Extender will decrease the ratio of live cylinder to total length and therefore decrease the rigidity factor for that cylinder. Conclusions In normal erection, full expansion of the corpus cavernosum produces an erection well buttressed to the pelvic ramus. Loosening over time of the pseudocapsule over the rigid portion of the implant will leads to instability, droop and wobble of erection. Use of RTEs in our experience will with time lead to diminished erection quality. Despite lack of objective data proving this observation, which would be difficult and impractical, we affirm that RTEs should be avoided in order to maximize penile implant support. This is in contrast to classic teaching. § For a given cylinder length there is a maximum Rigidity Factor. Use of RTEs decreases the Rigidity Factor. Rigidity Total Cylinder Live Cylinder Factor Length Maximum 1 cm RTE 2 cm RTE 3 cm RTE 28 cm 23 cm 0. 82 0. 78 0. 75 0. 71 26 cm 21 cm 0. 81 0. 77 0. 73 0. 61 24 cm 24 cm 19 cm 0. 79 0. 75 0. 71 0. 67 22 cm 22 cm 17 cm 0. 77 0. 73 0. 68 0. 64 20 cm 15 cm 0. 75 0. 7 0. 65 0. 6 Maximizing inflatable length leads to higher Rigidity Factor and may improve durability of high quality artificial erection and subsequently patient satisfaction. 28 cm 20 cm Maximizing RF leads to high quality artificial erection. Titan XL 26 cm depicted.