Pseudo-coffin #2

[Shesgottahaveit]

My Dr. Left me semi inflated and bound up for first week. I had a post op catheter for one day only. After 7 day we met and he deflated me with instx not to touch it for another 5 weeks. So my first inflation was 6 weeks post op and for me I think that was about perfect.

The last stitch dropped out the night before. Although it was uncomfortable to inflated the first few days, with lots of bruising on my balls, it got better and better and I can now easily inflate several times per day, which I do to get as much stretching as possible.

I am disappointed with smaller length and girth but adjusting. Had sex in a hot tub last night with wife. So there are definitely advantages.

Good luck to all on this journey.

[wallyworld]

Thanks for the information that Dr Eid updated his procedure. Obviously progress is good and requires change so no surprise that his process continues to evolve. That said, I wonder what prompted that change? Purely proactive for even more surety with future results? Or was he running into some small percentage of results he wasn't happy with because of waiting too long in that 8 week window?

It'll be interesting to hear what AMS's position is on this topic. I'm two weeks post implant and my Doc has me waiting 4 more weeks before cycling so I'm caught between ignoring what a preeminent surgeon is doing versus being a good patient with a Doc who has done exceptionally well by me; zero loss of length and fully functioning bladder and bowel after prostatectomy. I can't blame him for the ED 'cause that started 20 years before him with MS.

Mark

[navy6587]

All...MOST interesting reading and discussion. In light of my upcoming implant this Thursday (11/8), I will wait until my post-op appointment with Dr. Ellen on 11/15 to put the pseudo-coffin issue to him. While I'm not obsessed with size I am not about to give him an erect pre-op 6.5" specimen only to lose several inches by not cycling prior to, let's say, the third or fourth week. I need to find and read the Coloplast Operating Room surgical guidance and be prepared for him. I also will request the surgical notes immediately following the surgery (after I wake up) prior to leaving the Ambulatory Surgical Center.

Thanks for posting this important issue.

Edd

[rancherejim]

Maybe all the Doc's are different. I am 6 months post op. I was inflated for one week ,then deflated and was just there till the six week check-up. The Doc then said to inflate once a day for one hour for a few months. At four months I checked in with him and he said I didn't need to cycle anymore, just use it like a normal penis. I took his advise and everything is fine except not being able to climax very easy but I don't think that has anything to do with the implant.
Just FYI, my size is a little larger than before the surgery and the girth is quite a bit more than before.

[wallyworld]

Just wrapping this up with a report of what Jamie at AMS told me today about late cycling and the dreaded "coffin effect". First, my call was only the second time she had heard of the "coffin effect". The first was the day before my call to her. I sent her the link that one of our members had posted.

In short, AMS's position seems to be that the reservoir being properly encapsulated is more important than the cylinder encapsulation. The stated reason was that if the reservoir is only partially full when the capsule is formed around it, there is the potential for the capsule to create undesirable pressure on the reservoir when it is full. This pressure has the potential to create a constant partial erection and/or auto inflation. Fixing this is difficult and involves surgery.

As far as the penis encapsulation goes, the thought is that this can be remedied by stretching the penis through exercises and cycling. This would seem to run counter to the position taken by the "coffin effect" article.

So ideally, as someone posted earlier, both the cylinders and the reservoir would be full as the capsule forms. Since this isn't possible AMS seems to feel that the reservoir capsule be given priority. I did point out that Dr. EId used to wait 4-6 weeks but is now recommending immediate cycling. Jamie's only comment was that it is in the patient's best interest to follow their Doctors advice.

As for me, while II'm a little nervous waiting the six weeks, I'm going to follow my Dr's advice and "not touch the fucking thing" as he requested. Jamie said that I can call her for exercises if I have difficulty cycling or concern over the length when I start cycling. She is an absolute pleasure to talk to.

Mark

[Lost Sheep]

In July, 2016 I found this article. I recommend anyone interested in this subject to read the full article thoroughly.

Most interesting is the high dropout rate (and the reason for it).

I also wonder how much pre-op stretching by application of a Vacuum Erection Device (V.E.D) would have reduced the dropout rate or increased the effectiveness of early activation.

Other studies have been done, experiencing a similar dropout problem. I guess it depends heavily on how much you want it and what you will endure to get it.

Pre-op prep as well as post-op treatment are both important, in my opinion.

This article refers to the differences that early activation vs no early activation of the inflatable prosthesis
Title" Pseudo-capsule “coffin” effect: How to prevent penile retraction after implant of three-piece inflatable prosthesis
Authors: Enrico Caraceni, Lilia Utizi, Giovanni Angelozzi; Department of Urology, Civitanova Marche Hospital, Italy.
Short Summary: http://www.ncbi.nlm.nih.gov/pubmed/25017596
Longer summary: http://www.ncbi.nlm.nih.gov/pubmed/25017596
with this sentence: "The result is a penis bigger in flaccid state but smaller in erect phase, when early activation is not performed"
Full article: https://www.researchgate.net/publicatio ... prosthesis

This article was obviously translated from the original Italian, so there may be some grammar issues to overlook.

[Dave52]

In July, 2016 I found this article. I recommend anyone interested in this subject to read the full article thoroughly.

Most interesting is the high dropout rate (and the reason for it).

I also wonder how much pre-op stretching by application of a Vacuum Erection Device (V.E.D) would have reduced the dropout rate or increased the effectiveness of early activation.

Other studies have been done, experiencing a similar dropout problem. I guess it depends heavily on how much you want it and what you will endure to get it.

Pre-op prep as well as post-op treatment are both important, in my opinion.

This article refers to the differences that early activation vs no early activation of the inflatable prosthesis
Title" Pseudo-capsule “coffin” effect: How to prevent penile retraction after implant of three-piece inflatable prosthesis
Authors: Enrico Caraceni, Lilia Utizi, Giovanni Angelozzi; Department of Urology, Civitanova Marche Hospital, Italy.
Short Summary: http://www.ncbi.nlm.nih.gov/pubmed/25017596
Longer summary: http://www.ncbi.nlm.nih.gov/pubmed/25017596
with this sentence: "The result is a penis bigger in flaccid state but smaller in erect phase, when early activation is not performed"
Full article: https://www.researchgate.net/publicatio ... prosthesis

This article was obviously translated from the original Italian, so there may be some grammar issues to overlook.

Lost
This is exactly why the choice of a well educated up to date surgeon is paramount to attaining the results that we are all looking for. When I told my local urologist that Dr Eid. recommended that his patients begin cycling on the third day post op he thought that was crazy. His statement was it will be to painful and that is not what is in the manual {AMS]of the only implant he uses. According to him and most low volume implant doctors they will only go by the recommendations of the rep they need to help them with the surgery. I will be seeing my local urologist Friday morning who graciously offered to remove the 3 little sutures that now on day 12 post implant are the only evidence left from the surgery.
Dave

[DougAnd]

This is very interesting. I need to watch the AMS video yet again but I'm pretty sure it says to cycle for a few minutes the first week and then gradually increase each week after. Could be wrong anyone else get that video after surgery?

[DougAnd]

Yep first week inflate and immediately deflate then increase gradually until six weeks then inflate fully for 15 minutes and deflate daily for 6 months.
As per you doctor's instructions. so it's not hurting the implant or its function to do this.

[LeRoastBeef]

Penile size after prosthesis implant, “the pseudo-capsule coffin effect”: how to prevent penile retraction after implant of three-component inflatable prosthesis
Enrico Caraceni1, Giovanni Angelozzi1, Lilia Utizi1
1 A.S.U.R. Area Vasta 3, U.O. di Urologia (Civitanova Marche)
Objective
Following 3-component implantation of a penile prosthesis, some patients are dissatisfied with their penile length. This may be due to the procedure per se or pre-existing risk factors (neglected priapism, Peyronie’s disease, radical prostatectomy, or overhanging supra pubic fat) or psychological reasons in relation to unrealistic expectations of the implant. We suppose that a too small pseudo-capsule due to a late prosthesis activation can reduce the available space into the pseudo-capsule (coffin effect of the pseudo- capsule) in order to create a constriction, a kind of inextensible wall, which prevents the system to expand later. On the other hand we believe that there is a true dimensional lack of the penis caused by the “Coffin Effect”. This effect justifies the patient’s complaint about the too small penile size after three-component penile implant .
We try to identify the presence or absence of penile retraction after implant with three-component prosthesis and the possible opportunity to prevent it without use of other device before or after the operation, but simply activating the prosthesis immediately after implantation
Methods and results
Forty-six patients who have had penile prosthesis implanted were enrolled in this study: studied retrospectively and operated between 1998 and 2012 with three-piece inflatable penile prosthesis ( AMS 700 CX o LGX). 27 patients did the first activation prosthetic four weeks after surgery (NEA group) and 19 Patients have activated the prosthesis for the first time immediately after surgery (DEA group) . Length and girth of the penis was detected before ( in DEA group) and after the surgical procedure.
Penile length was measured with the prosthesis activated and deactivated from the pubic bone to the urethral meatus along the dorsum of the shaft (erect and flaccid state) and expressed in centimeters to two decimal place and the circumference was measured in the middle third of the penis and expressed in the same way .
The average post implant dorsal length of the erect penis was found in the group NEA equal to 11.70 cm and ± 1.4 s.d. ( range 9-15 cm) , in the group DEA equal to 14.98 ± 1.7 s.d. (range 12-19 cm ) with a difference corresponding to 3.28 cm more for the group with early activation (DEA).
In the Early Activation Group (DEA), the average length of pre-operative stretching (14.57 cm) is almost identical to the average length in post operative erection (14.98cm).
The Pseudo-Capsule determines the dimension of the penis and the prosthesis can only move inside the pseudo-capsule forward during activation, and backward when deactivated like a sliding door. The result is a penis bigger in flaccid state but smaller in erect phase, when early activation is not performed
Discussion
Our data clearly confirm a true dimensional lack of implanted penis in the NEA group. This finding is no present in the DEA patient . The reduction in length of the penis in patients implanted seems real: 11.70 cm in the NEA group. The cause of the phenomenon is the pseudo-capsule that arrests the potential prosthesis and penis elongation. The creation of a too narrow pseudo-capsule
the 'coffin effect' which is produced by the late activation of the prosthesis is the cause of the missing extension of the penis after implantation. In addition to this, the penis is less elastic, that is to say that it presents a lower dimensional excursion between flaccid state and erect state. The Implanted penis in NEA group appears not only smaller in erection but also with a lower circumference and less variation in length between the flaccid and the erect. This effect related to the pseudo-capsule is also present in the DEA group even if with a smaller dimension. Our data demonstrate ,as far as we know for the first time in literature, that it is the pseudo-capsule, through the “coffin effect” and not the prosthesis to determine the final size of the penis and its elasticity.
The timing of activation seems to be the key to prevent this “Coffin effect” phenomenon.
The early activation is identified also as the best technique to maintain the length of the pre implant erect penis after the prosthetic hydraulic implant.
If the LGX implant is not activated early it does not provide any advantage over the CX in terms of dimensions.