Sizing the LGX

[ArtFirn]

When implanting the AMS 700 LGX does ( or should ) the surgeon determine the overall corporeal space , ex: 20.5 cm and assemble an implant to that size or deduct some length due to up to 18% increase in the implants maximum length and use an implant of about 17 cm and allow the implant to eventually stretch to 20.5 cm. What do you think would be the results or consequences of either of these methods?
Would it be safer to err on the short side ?

[rlm1818]

Art --

I asked essentially the same question, different wording, here: viewtopic.php?f=6&t=987&p=6241#p6241 As you can see, no answers.

I also asked in the yahoo penile implant forum. There were some replies there, though I'm not convinced they were correct. You would have to sign in over there to view the replies, and then search for the topic "Questions about LGX".

I also emailed AMS directly with the question about terminology, but they never condescended to answer.

If you read page 10 of the AMS operating room manual ( http://www.amselabeling.com/DAM_IFU/5610.pdf ) I interpret this to mean they recommend implanting an LGX that is 2 cm longer than the measured size of the cavernosa. What I think that means, though I'm still looking for clarification, is that if they measure the cavernosa at 19 cm, they would implant an LGX whose fully inflatable length is 21cm. I assume the uninflated length would be 17 or 18 cm.

[ArtFirn]

rlm
Ya, I see your post now and you are asking the same thing. I am quite surprised that no one offered up an opinion at least.
Thx.
ArtF

[Beezer]

After a brief read through the pdf, it looks like the cylinders are sealed and come in various lengths, 12 cm, 15 cm, 18 cm, 21 cm. They are not assembled and sealed by the surgeon. In order to customize the length, the surgeon attaches rear tip extenders and they are stackable and come in 0.5 cm, 1.0 cm, 1.5 cm stackable, 2.0 cm, 3.0 cm, 4.0 cm, 5.0 cm, 6.0 cm in their own tray. So if you are in between an 18 and 21, the surgeon would use the 18 cm model and then stack rear tip extenders on to get to the right length, say 2.0 cm for a total length of 20 cm.

This way the front most tip is always at the front most portion of the penis, the rear end is what is adjustable. I hope that helps.

BTW, I'm considering an implant, nearly 12 months post op for RRP and not much happening naturally. Using injections and oral drugs at the moment but might want something more travel friendly and spontaneous.

[dmikesaw]

My view is that they will always err on the side of shorter, rather than longer due to the possibility of erosion/lawsuit/redo. Just my 2 cents....

[rlm1818]

Hi Beezer --

AFAIK, your statements about sizing are correct. However, I don't see that they address the issue that ArtFirn raises. The issue, if I understand it, is that the LGX can expand lengthwise, generally quoted as 15-20%. So, if the measured size of the patient's cavernosa is 19cm, does the surgeon implant an LGX that (with RTEs if needed) can expand to a maximum size of 19cm? Or does he place an LGX that has a minimum size of 19cm which can then expand to 22 or 23 cm? Or something in between?

The AMS manual, cited above, would be clearer on this point if the terminology was clearer. Does an 18cm LGX (one of the standard sizes as you point out) refer to an LGX that has a maximum size of 18cm, or an un-inflated size of 18cm expandable up to 21+ cm?

[ArtFirn]

rlm1818 has identified what I was trying to say. I also think a surgeon will tend to go shorter and hope that the implant expands out to fill up the area and not result in the "floppy head", while at the same time reducing the chance of the cylinders buckling. I would suspect this would be most common in the less experienced doctors.

[Beezer]

Here is your answer from page 17 of the PDF.

"Assess the cylinder length for satisfactory fit within corpora
cavernosa by ensuring that the distal tip is snugly under glans, the
cylinder lies within the corporotomy, and the proximal end is
firmly against the crus. If not satisfactory, remove cylinder, adjust
length as needed, re-implant."

So there is no "room" so to speak for the inflation cylinders to slide for proximally and distally, thus the ned for accurate measurements operatively. I am assuming most guys would want the LGX so as they inflate they would also see lengthening rather than a fixed length and only girth increase, seems n=more natural. I would suspect the experience of the surgeon to size the LGX model more accurately so buckling doesn't occur is more critical than with CX models. Also, it seems that a Penoscrotal incision is preferred to avoid damage to nerves which can result in loss of sensation.

Here's some good reading: http://www.flinturology.com/pitfalls.shtml