Andrew Siegel MD 4/21/2018
Penile prostheses are surgically implanted devices that create on-demand penile rigidity to enable sexual intercourse. There are two major types: semi-rigid and inflatable. Today’s entry explores a third option, a 2-piece unit that can be considered a hybrid between the simple 1-piece semi-rigid device and the more complex 3-piece inflatable device. (All images are courtesy of AMS Men’s Health Boston Scientific).
The semi-rigid penile prosthesis is a 1-piece device that always remains rigid and is bent upwards for sex and bent downwards for concealment purposes. It consists of two malleable rods that are implanted within the erectile chambers through a small incision.
Advantage: simple, effective, no dexterity required, no need for control pump or reservoir, “ever-ready” for sex. Disadvantage: always rigid, concealment can be tricky, 24-7 erection can make the tip of the penis sore.
The inflatable penile prosthesis (IPP) is 3-piece device designed to mimic a normal erection, with the capacity to inflate and deflate via a self-contained hydraulic system. The inflatable cylinders are implanted within the penile erectile chambers. A control pump is implanted in the scrotum for easy access and the fluid-containing reservoir is implanted behind the pubic bone or behind the abdominal muscles. Erections are obtained by pumping the control pump several times, which transfers fluid from the reservoir to the cylinders and voila, a rigid erection is obtained that will remain so until the deflate mechanism on the control pump is used to transfer the fluid back from the cylinders to the reservoir.
Advantage: closes mimics normal erection, highly effective, concealment not issue Disadvantage: more complex and although well-engineered, has higher malfunction rate than semi-rigid alternative, requires dexterity.
Ah, but there is a third option that is somewhat of a hybrid between the 1-piece malleable rods and the 3-piece inflatable device. It is an inflatable 2-piece unit that offers the benefits of the 3-piece device with the simplicity of the 1-piece device. By eliminating the reservoir as a separate component, it provides advantages to both the patient as well as the implanting urologist. It is called the Ambicor and is a product of the American Medical Systems Men’s Health division of Boston Scientific.
The Ambicor device (see image above) incorporates the reservoir into the inner part of the inflatable cylinders as opposed to a separate reservoir with the 3-piece device. The Ambicor cylinders are composed of inner and outer silicone tubes with a woven fabric in between. The Ambicor is a pre-filled hydraulic device comes in 3 different widths and in an assortment of lengths, so that any man can be appropriately sized.
Operating the Ambicor: Inflation is achieved by compressing the pump implanted into the scrotum, which transfers fluid from the built-in reservoirs in the proximal cylinders (seated in the deep, inner penis) to the distal part of the cylinders (seated in the external, outer part of the penis). The device is deflated by simply bending the cylinders for 10 seconds or so, which triggers a release valve that returns the fluid from the distal cylinders to the proximal cylinders.
The Ambicor is particularly advantageous in certain circumstances: patients who have had extensive abdominal/pelvic surgery in whom implanting an abdominal reservoir might present challenges and complications; those with poor manual dexterity, since it is easier to inflate and deflate than the 3-piece alternative; and patients with kidney transplants or anticipated transplants in the future (kidney transplants are positioned in the pelvis, close by to where the reservoirs of penile prostheses are placed). The Ambicor is not ideal in patients with Peyronie’s disease or scarred, short penises (less natural appearance when deflated because the firm tip of device does not deflate) or long and narrow penises (in this situation there is less support on the axis of the penis that can cause buckling and trigger deflation).
Advantage: mimics normal erection, effective, limited dexterity required, no abdominal reservoir required. Disadvantage: spontaneous deflation (from triggering deflation mechanism during sex), spontaneous inflation when there is scarring of erectile chambers, not ideal in those with short penises or long and narrow penises.
Bottom line: When simpler measures fail to cure ED, penile prostheses are an excellent option. The surgical implantation is an outpatient procedure done under anesthesia that requires only a small incision. The different prostheses vary in design and complexity (1, 2 and 3-components), but all aim to give the user a reliable erection on demand. The Ambicor, manufactured by American Medical Systems Men’s Health division of Boston Scientific, can be considered a hybrid between the simple but limited functionality of the 1-piece semi-rigid device and the complex and greater functionality of the 3-piece inflatable device. In appropriately selected patients the Ambicor has proven to be reliable and user-friendly with high rates of patient and partner satisfaction.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community.
Dr. Siegel has authored the following books that are available on Amazon, iBooks, Nook and Kobo:
MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health
PROMISCUOUS EATING: Understanding and Ending Our Self-Destructive Relationship with Food
These books are written for educated and discerning men and women who care about health, well-being, fitness and nutrition and enjoy feeling confident and strong.
Dr. Siegel is co-creator of the male pelvic floor exercise instructional DVD PelvicRx
Tags: Ambicor, Andrew Siegel MD, ED, erectile dysfunction, inflatable penile prosthesis, penile prosthesis, semi-rigid penile prosthesis
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