Dr. J. Francois Eid has
performed more internal penile implant surgeries than anyone in the
world and has built a reputation for excellence in the treatment of
erectile dysfunction (ED). After examining the latest generation of
Inflatable Penile Prosthesis (IPP) and Artificial Urinary Sphincter
(AUS) technologies from American Medical Systems (AMS) and Coloplast
Corporation, reviewing pertinent studies, and drawing on his 20 years
of experience performing penile prosthesis surgery and overseeing his
patients’ recuperation and subsequent training in operating the
devices, Dr. Eid has high praise for the recent improvements. Updates
have been made to the IPP pumps offered by both AMS and Coloplast, as
well as to the CX and LGX cylinders offered by AMS. Also, AMS has
added an antibiotic coating to its AUS.

Momentary Squeeze (MS) Pump - AMS

AMS’s Momentary Squeeze (MS) Pump was first introduced nearly two
years ago, and Dr. Eid has implanted it with great success in patients
suited to the CX-cylinder and LGX-cylinder versions. (The LGX model
offers the potential for increased penile length in patients
complaining of penile shortening after radical prostatectomy.) Both
cylinders now feature redesigned proximal ends. At only 9.5mm in
diameter, the ends allow for significantly easier insertion for
patients with fibrotic proximal corporal bodies.

The MS Pump’s advantages include a smaller profile (which enables a
more discreet placement) and one-touch deflation. However, this
quality can result in operational difficulties with inflation (more
difficult to get a hold of within the scrotum) and deflation (small
button can initially be difficult to find). In addition, its new
lockout valve has the advantage of preventing auto-inflation
(potentially embarrassing and/or painful), but can at times make it
difficult to initiate inflation. For these reasons, Dr. Eid
recommends this pump for the younger patient with an average-sized
penis.

Tactile Pump (700 CX Series) - AMS

“The AMS 700 CX Series with the Tactile Pump remains my prosthesis of
choice for the older patient where pump concealment is not an issue,”
says Dr. Eid. “This pump is large, easily palpable, remains the
softest to inflate and has a very large deflation footprint, which is
quickly recognized by the patient.” The Tactile pump is not available
with the LGX cylinders.

Titan Pump - Coloplast

The FDA approved the improvements to the pump component of the
Coloplast Titan prosthesis in July 2008. Although the cylinders and
reservoir remain the same as the previous model, the pump now
features a one-touch-release (OTR) deflation valve — easy for
patients to locate and operable with one hand. In addition, the pump
offers a non-bulky, low-profile size; enhanced silicone for higher
threshold “tear strength” (likely to result in increased product
durability, an issue with previous versions); and an overall
simplicity likely to decrease repeat office visits, phone calls, and
repeat training time. From a hospital standpoint, intraoperative
prep of the device provides for easier priming of the implant system
(the removal of excess air prior to filling) and may reduce slightly
the overall intraoperative time.

“This remains a great device for the patient with a larger penis,”
says Dr. Eid, “as these are the only cylinders that will expand to
22mm girth.” In addition, only Titan cylinders are available in
lengths of 24cm, 26cm and 28cm.

Although the pump is easily identified and operated by patients, the
small size of the deflation valve sometimes requires a longer learning
curve.

In a recent study (”Evaluation of Three Penile Prosthesis Pump
Designs in a Blinded Survey of Practitioners,” Urologic Nursing,
2008), 32 medical professionals, all familiar in teaching the
operation of penile implants to patients, reviewed currently
available penile pumps. The blindfolded reviewers, examining the
pumps under time constraints through mock scrotal sacs, were asked to
rate device:

— ease of location of deflation valve
— ease of inflation
— ease of deflation, and
— anticipated ability to train patients in clinical setting.

The Titan OTR pump design performed very well and “consistently
demonstrated a significant advantage in subject preference.”
(Quallich, Ohl & Dunn, 2008, p. 5).

Artificial Urinary Sphincter - AMS

AMS has improved the AUS by coating the device surface with
inhibizone. This is the same antibiotic coating (Rifampin and Minocin)
currently available on the IPP that has dramatically reduced infection
rates since its introduction in 2001. In combination with Dr. Eid’s
self-developed “no-touch” surgical technique, which eliminates direct
and indirect contact between the prosthesis and the patient’s skin
(the origin of most infections), he believes the new coating will
offer additional protection against the most common pathogens
responsible for sphincter infections.

Dedicated to Patient Education

Dr. Eid has developed a website http://www.urologicalcare.com
dispelling common misconceptions about penile implant surgery. Having
performed over 3,000 penile implant surgeries (the most worldwide),
Dr. Eid knows what a remarkable and positive difference the treatment
can make in a man’s life. Between retaining a normal penis look and
feel, employment of multiple techniques for preventing infection, and
steady diminishment of pain until it is completely gone within 2-4
weeks, penile implant surgery has proven to be an effective treatment
for many men, resulting in normal, healthy and productive lives.

About J. Francois Eid, M.D, and urologicalcare.com

Dr. Eid is the director and founder of Advanced Urological Care in
New York City. He is also a Clinical Associate Professor of Urology
at Cornell University. Dr. Eid is one of the foremost specialists in
urological prosthetic reconstruction and performs over 300 internal
penile implants per year. Dr. Eid leads workshops on penile
prosthesis surgeries worldwide. More information about Dr. Eid and
his expertise with erectile dysfunction treatment, penile prosthesis
implantations and artificial urinary sphincters can be found on his
website, http://www.urologicalcare.com.

Urologicalcare.com

Men who experience erectile dysfunction between the ages of 40 and 49 are twice as likely to develop heart disease than men without dysfunction, according to a new Mayo Clinic study.

Researchers also found that men with erectile dysfunction have an 80 percent higher risk of heart disease.

“The highest risk for coronary heart disease was in younger men,” says researcher Jennifer St. Sauver, Ph.D. The study was published in the February 2009 issue of Mayo Clinic Proceedings. The results suggest that younger men and their doctors may need to consider erectile dysfunction a harbinger of future risk of coronary heart disease — and take appropriate steps to prevent it, says Dr. St. Sauver.

“The importance of the study cannot be overstated,” writes Martin Miner, M.D., in an editorial in the same issue of Mayo Clinic Proceedings. The results “raise the possibility of a ‘window of curability,’ in which progression of cardiac disease might be slowed or halted by medical intervention,” writes Dr. Miner, who practices at the Men’s Health Center, Miriam Hospital, Providence, R.I.

Erectile dysfunction is common, and prevalence increases with age. It affects 5 to 10 percent of men at age 40. By age 70, from 40 to 60 percent of men have the condition.

Dr. St. Sauver says researchers wanted to learn more about the connections between age, cardiovascular disease and erectile dysfunction. Two previous studies, both published in 2005, laid groundwork for the Mayo Clinic study. One found that erectile dysfunction predicted an increased risk of heart disease, but the erectile dysfunction of the study participants was not assessed with an externally validated questionnaire and cardiac events were not subjected to standardized review for diagnostic accuracy [Thompson et al, JAMA, 2005]. The second predicted that future cardiovascular disease would be higher in younger men with erectile dysfunction, but wasn’t able to follow the men to determine if heart disease developed [Ponholzer et al, Eur Urol, 2005].

For the Mayo Clinic study, the investigators identified 1,402 men who lived in Olmsted County, Minn., in 1996 and did not have heart disease. Every two years for 10 years, these men were assessed for urological and sexual health.

Answers to questions from the Brief Male Sexual Function Inventory, a statistically validated questionnaire, were used to determine erectile dysfunction. The baseline prevalence of erectile dysfunction in study participants was: 2.4 percent in men aged 40-49; 5.6 percent in men aged 50-59; 17 percent in men aged 60-69 and 38.8 percent in men 70 years and older. Those initial data and the increasing incidence of erectile dysfunction over time were linked to data from a long-term study of heart disease in Olmsted County residents, led by Veronique Roger, M.D., Mayo Clinic cardiologist.

Over 10 years of follow-up, researchers found that men with erectile dysfunction were 80 percent more likely to develop coronary heart disease compared to men without erectile dysfunction. The highest risk of new heart disease was seen in the youngest study participants who had erectile dysfunction. In men 40 to 49 years old when the study began, the number of new cases in men with erectile dysfunction was more than 50-fold higher than in men without erectile dysfunction. Statistically, that’s a cumulative incidence of 48.52 per 1,000 person years in those with erectile dysfunction compared to 0.94 per 1,000 person years in those without erectile dysfunction.

In men in their 50s, 60s and 70s, the total incidence of new cases of heart disease also was higher in those with erectile dysfunction. However, the differences were not as striking as those seen among the 40- to 49-year- olds.

“In older men, erectile dysfunction may be of less prognostic importance for development of future heart disease,” says Dr. St. Sauver.

This study did not determine reasons for the increased risk of heart disease among men with erectile dysfunction. Some have theorized that erectile dysfunction and coronary artery disease may be different manifestations of the same underlying disease process. A buildup of plaque that can block arteries around the heart may plug the smaller penile arteries first, causing erectile dysfunction. Alternatively, arteries may lose elasticity over time, contributing to heart disease. This arterial stiffening may affect the smaller penile arteries first.

Other Mayo Clinic researchers were: Brant Inman, M.D.; Debra Jacobson; Michaela Mc Gree; Ajay Nehra, M.D.; Michael Lieber, M.D.; Dr. Roger; and Steven Jacobsen, M.D., Ph.D.

A peer-review journal, Mayo Clinic Proceedings publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research and clinical epidemiology. Mayo Clinic Proceedings is published monthly by Mayo Foundation for Medical Education and Research as part of its commitment to the medical education of physicians. The journal has been published for more than 80 years and has a circulation of 130,000 nationally and internationally. Articles are available online at http://www.mayoclinicproceedings.com.

To obtain the latest news releases from Mayo Clinic, go to http://www.mayoclinic.org/news. MayoClinic.com (http://www.mayoclinic.com) is available as a resource for your health stories.

Mayo Clinic
http://www.mayoclinic.com