The 3 – piece penile implant is appropriate for patients with severe erectile dysfunction. Common causes of severe ED include diabetes, hypertension, Peyronie’s disease, and radical prostatectomy for prostate cancer. The 3 – piece penile pump implant is the best treatment for severe ED with patient satisfaction rates well over 90%.
What Exactly Is the Implant Pump?
The implant pump is a small device that is approximately the size of a quarter. It is surgically placed in the scrotum. Some patients refer to the pump as a third testicle. The pump consists of a bulb that the patient compresses in order to inflate the implant. On the opposite side of the pump is a deflate button or release valve. The patient compresses the button after sex in order to deflate the implant. The implant pump has three tubes to which it connects. One tube goes to the implant reservoir and two tubes go to two separate penile cylinders.
How Does the Penile Pump Work?
In order to operate the implant, the patient compresses the pump that is located in the scrotum. Fluid is transferred from the reservoir to the penile pump. The penis then becomes erect. After sex, the patient compresses the release valve also located in the scrotum, and water is transferred from the cylinders back to the reservoir. The penis then becomes flaccid.
Patients must have sufficient manual dexterity in order to operate the pump. The two main implant manufacturers – AMS and Coloplast – have introduced several design modifications in order to make the pump easier to operate.
AMS Implant Pump
AMS introduced the Tactile Pump in 2004. The Tactile Pump required fewer compressions in order to inflate the cylinders. Typically the patient had to squeeze the pump 5 times in order to inflate the cylinders.
AMS MS – Momentary Squeeze – Pump
A few years later, AMS introduced the MS Pump or Momentary Squeeze Pump. The advantage of this new pump is that the patient only has to compress the deflate button once in order to deflate the cylinders. Before the MS pump was introduced, patients had to continuously compress the deflate button during device deflation.
The AMS MS Pump also has a ridged surface to make it easier to grasp and to handle. The preceding Tactile Pump had a smooth surface.
MS Pump Lock – Out Valve
The MS Pump contains a lock-out valve to prevent auto-inflation of the penile implant. Auto-inflation means that the device inflates spontaneously. This can lead to an embarrassing situation. Auto-inflation is caused by the spontaneous return of fluid from the reservoir to the cylinders. It is usually triggered by a sudden increase in abdominal pressure due to coughing, sneezing or lifting heavy weights. It tends to occur in patients that are younger and stronger. The lock-out valve effectively prevents device auto-inflation. Auto-inflation with the MS pump is a rare event.
Stiction Syndrome
Stiction Syndrome is a problem involving the MS Pump that occurs in about 2% of the patients. The device becomes difficult to inflate and to deflate and the pump bulb becomes excessively firm. Stiction Syndrome is caused by friction. As a result of friction, the valve within the pump becomes stuck to the silicone casing. This problem occurs when the device has not been used for a prolonged period of time.
The treatment of Stiction Syndrome is simple and does not require surgery. The penis is grasped and firm pressure is applied to the cylinders. At the same time, the deflate button is compressed. Fluid is forced through the pump and this causes the valve within the pump to become “un-stuck”. This maneuver is effective and can be performed by the patient without assistance.
Patient Satisfaction with the AMS MS Pump
Patients who received the AMS MS Pump were surveyed 6 months after they received the implant. Over 80% of the surveyed patients think that the pump is relatively easy to operate and excessive force is not required in order to compress the release valve.
Instructors who teach the patients how to operate the pump were also surveyed. Almost 100% of the instructors observed that the patients learned how to operate the pump quickly, and all of the patients were able to inflate and deflate the implant without difficulty.
Coloplast OTR Implant Pump
Coloplast introduced the One Touch Release Pump or OTR Pump in 2008. This pump replaced the Genesis Pump. The advantage of the OTR Pump is that the patient only has to compress the pump once in order to deflate the device. In addition, the pump has a ridged surface for ease of handling. The pump also has a highly efficient pump mechanism that requires a minimum number of compressions for device inflation.
Coloplast Lock – Out Valve
The Coloplast lock – out valve is located in the reservoir and not in the pump. This lock – out valve has reduced auto-inflation from 8% to less than 3%.
Pseudo-Malfunction of the Pump
A small percentage of patients experience difficulty inflating and deflating the implant. The bulb becomes very firm and compression of the bulb is difficult. The cause of this problem is that the valve within the pump becomes stuck to the silicone casing. In order to remedy this situation, the bulb is quickly compressed using significant force. This causes the internal valve to become “un-stuck”. Normal device inflation and deflation then results. This is very similar to the Stiction Syndrome involving the AMS MS pump.
Patient Satisfaction with the Coloplast OTR Pump
Patients who received the OTR Pump were surveyed one year after their surgery. About 75% or the patients surveyed were satisfied with deflation of the OTR Pump. This represents a significant improvement compared to the previous Genesis Pump.
Conclusions about Implant Pumps
The AMS MS pump and the Coloplast OTR pumps are equivalent. There is no evidence that either device is superior in terms of ease of use or patient satisfaction.
The Future of Implant Pumps
The next big improvement will be the development of an electronic pump that will automatically inflate and deflate the implant. The device will be activated by the I-Phone. Both Coloplast and AMS are rumored to be working on this, but a prototype is not expected for another 3 to 4 years.
Sources:
- Delk, J, Knoll, L, McMurray, J, Shore, N, Wilson, S, Early Experience with the American Medical Systems New Tactile Pump, Journal of Sexual Medicine, 2, 266-271, 2005
- Knoll, L, Henry, G, Culin, D, Ohl, D, Otheguy, J, Shabsigh, R, Wilson, S, Delk, J, Physician and Patient Satisfaction with the New AMS 700 Momentary Squeeze Inflatable Penile Prosthesis, Journal of Sexual Medicine, 6, 1773-1778, 2009
- Pastuszak, A, Lentz, A, Farooq, A, Jones, L, Bella, A, Technological Improvements in Three-Piece Inflatable Penile Prosthesis Design Over the Past 40 Years, Journal of Sexual Medicine, 12, supplement, 415-421, 2015
- Kavoussi, N, Viers, B, VanDyke, M, Pagliara, T, Morey, A, Stiction Syndrome: Non-Operative Management of Patients with Difficult AMS 700 Series Inflation, Journal of Sexual Medicine, 14, 1079-1083, 2017
- Ibid 2
- Shaw, T, Garber, B, Coloplast Titan Inflatable Penile Prosthesis with One-Touch Release Pump-Review of 100 Cases and Comparison with Genesis Pump, Journal of Sexual Medicine, 8, 310-314, 2011
- Garber, B, Khurgin, J, Stember, D, Perito, P, Pseudo-malfunction of the Coloplast Titan Inflatable Penile Prosthesis One – Touch Release Pump, Urology, 84,4,857-859, 2014
- Ohl, D, Brook, G, Ralph, D, Bogache, W, Jones, L, Munarriz, R, Levine, L, Ritenour, C, Prospective Evaluation of Patient Satisfaction and Surgeon and Patient Trainer Assessment of the Coloplast Titan One Touch Release Three Piece Inflatable Penile Prosthesis, Journal of Sexual Medicine, 9, 2467-2474, 2012