Solving the "Coffin Efffect" encapsulation problem

[Lost Sheep]

Two needs are conflicting when implanting an inflatable penile prosthesis. The need to prevent forming a scar tissue capsule around the reservoir and the need to prevent forming a scar tissue capsule around the penile implant's inflatable. One can lead to auto-inflation and difficulty deflating the implant. The other can lead to difficulty achieving a full-length erection.

Doctors must choose between leaving the penile cylinders inflated or the reservoir inflated. Then the patient must endure breaking up the encapsulating scar tissue beginning to grow around whichever was not inflated fully, Most of the time a compromise is made and both the reservoir and the implant are compromised (and subsequently troubled and uncomfortable).

This is most pointedly emphasized in the article: "Pseudo-capsule 'coffin effect': How to prevent penile retraction after implant of three-piece inflatable prosthesis" by Caraceni, Utizi and Angelozzi published in the Department of Urology, Civitanova Marche Hospital, Italy. They cite the advantages of early activation, but note patient tolerance of the discomfort involved is a significant limiting factor.

What do you (or your doctors, or any medical professionals) think about this idea?

When an implant is placed, leave both the reservoir and cylinders fully inflated with saline. Have a "T" fitting on the outlet side of the inflation pump in the scrotum. A drain line would run from the "T" fitting, exit the patient's body to a (closed) drain. After a time (long enough for activation of the implant to be practiced safely), the drain is opened to remove just enough saline to deflate the cylinders. Then the "T" connection is sealed off and the drain line removed.

Having the drain in the scrotum seems the simplest (from a purely plumbing perspective) but having the drain coming from the tube near the reservoir may be safer (from a surgical/antiseptic perspective).

Lost Sheep

[alibaba]

I am no doctor but had many operations including drain lines, much experience in pneumatics, hydraulics and water works and much experience in veterinary science.
1. a T is another point for failure or a leak.
2. Although there are plastics used for tissue expanders that self seal, long term I do not see that possibility working to drain through the t fitting and a needle inserted through the skin. They just do not have the life to them I think and a t would create another bulk that could be a source of irritation.
3. a T that is open through the skin till the final fluid adjustment is a major risk for infection.
4. Safe method to do that would require a second operation.
5. Sticking a needle in any part of your implant to do the deflate is not a good idea with the possibility of missing the mark and damaging a part not self sealing. That would cause the need for an open repair. Our implants are not tires on the outside. It is more like raise the hood and tear down the engine to get to the innards for a repair.
A few months ago when that study was posted I thought it was the best answer to both size issues and encapsulation of the device components I have ever read. It is very true that the pain issue is the major problem. If that can be managed the possibilities are staggering how much better satisfaction could be.

Keep on thinking. New answers to old problems only occur when someone has a new idea. Cheers.

[merrix]

Interesting post!

Another perspective:

Is this even a problem if surgery is done correctly?
Correctly, in this case, meaning doc leaving the right level of inflation post surgery, and performing the surgery in a way that swelling, pain etc post surgery is minimized and activation can be early.

Just using myself as the 'case study'. I have no auto-inflation at all. My dick is a few mm longer than pre surgery. I was left inflated to some (unknown) degree after surgery and started twice daily inflation on day 13.

Is it that simple that this problem only exists if the doc either leaves the wrong level of inflation post op, or probably more important - causes too much trauma which delays activation till several weeks after surgery? I

[Donnie1954]

Dr. should leave you partially inflated (if possible). It's maddening but I lost nothing and activation was painless.
Donnie

[strongagain]

My Doctor left me totally inflated. The first day was okay but then slowly but surely I almost went through the ceiling. I asked the doc to deflate but he wouldn't, he said that would be absolutely wrong. The nurse gave me very potent painkillers, that helped. I think on the third day he deflated a bit.

Strange, the operation took place in August 2015 and I have forgotten many details already. I didn't make any notes. After the first really painful day everything went extremely smooth. The implant became part of me.

[David_R]

Mine was partially inflated after it was put in, but I don't know how much. My inflated erection (with a naturally swollen glans when aroused) is great! My doctor is wonderful and I recommend him to everybody.

[Lost Sheep]

Interesting post!

Another perspective:

Is this even a problem if surgery is done correctly?
(Edited for brevity)
Is it that simple that this problem only exists if the doc either leaves the wrong level of inflation post op, or probably more important - causes too much trauma which delays activation till several weeks after surgery? I

Apparently often enough to be a concern. Some people form scar tissue more readily than others or sometimes excessive response to the trauma of surgery interrupts the timely "exercising" of the implant, etc.

It could be that this is a solution with more risk than benefit, but the thought is intriguing. I think the risks could be minimized. I had a post-op catheter in my shoulder for three days with little concern for infection.

Lost Sheep

[Lost Sheep]

I am no doctor but had many operations including drain lines, much experience in pneumatics, hydraulics and water works and much experience in veterinary science.
Keep on thinking. New answers to old problems only occur when someone has a new idea. Cheers.

Alibaba, I appreciate your experiences.  In engineering, in the medical aspects of veterinary science and your personal experiences with your own surgeries.  Your comments are always illuminating and welcome.
 
Yes, this may be a solution whose risks outweight the benefits.  But apparantly enough patients experience difficulty with encapsulation to warrant investigation in medical journals and a significant amount of care during implant surgeries and the recovery period.

1. a T is another point for failure or a leak.

Yes, the "T" inside the body is a point of concern.  I opine that part might be designed to allow the exit point to break away and self-seal, allowing withdrawal of the drain line to be pulled out just as a regular wound drain or cathether is.

2. Although there are plastics used for tissue expanders that self seal, long term I do not see that possibility working to drain through the t fitting and a needle inserted through the skin. They just do not have the life to them I think and a t would create another bulk that could be a source of irritation.

I hope the "T" would be minimal bulk.  If placed near the reservoir, there is usually enough space to accomodate a few cubic millimeters

3. a T that is open through the skin till the final fluid adjustment is a major risk for infection.

In the scrotum, somewhat.  In the abdomen, less so.  Three days in my shoulder was not a concern.  A week or more in the scrotum or abdomen, I think, I hope, would be manageable.  Again, is the risk worth the benefit?

4. Safe method to do that would require a second operation.

 Yes, indeed, a second operation to drain directly from a drain point (that might even be incorporated into a scrotal pump valve) or a connection at the reservoir would be one possible way to execute the concept.  Very straightforward and not requiring a drain in place.  The second operation would be minimally invasive, requiring only a local anesthetic and possibly would be an office visit sort of operation.  Not much more invasive than draining an abcess, I think.
 

5. Sticking a needle in any part of your implant to do the deflate is not a good idea with the possibility of missing the mark and damaging a part not self sealing. That would cause the need for an open repair. Our implants are not tires on the outside. It is more like raise the hood and tear down the engine to get to the innards for a repair.

My idea envisioned nothing close to the inflatable portion(s) of the implant.  That would be hydraulically and medically inadvisable. 

A few months ago when that study was posted I thought it was the best answer to both size issues and encapsulation of the device components I have ever read. It is very true that the pain issue is the major problem. If that can be managed the possibilities are staggering how much better satisfaction could be.

 Yes.  In addition to that, when I saw the study, it went a long way towards ratifying my opinion of the concept of pre-op vacuum therapy to prepare the penile tissues for the implant to retain size, ease insertion and ease post-op recovery.  This is why I posted links a few months ago when I first saw them.
 
Thanks again, Alibaba,
 
Lost Sheep.