TOPIC: AMS 700 and Ellanse

Is Ellanse an option for adding Girth for someone that has an AMS 700 penile prothesis?

I had a radical prostatectomy and two years following, I had the AMS 700 device implanted (sphincter control as well) [2012]. As others have said, reduced length and Girth is the result. The device works as advertised, but due to reduced Girth I can't 'feel' much while having intercourse; it just isn't very satisfying. I'm not sure it matters, but here are my Flaccid measurements (11cm L, 10cm G) and Erect, (13cm L, 10cm G).

I'll forward the question to them but I'm afraid they no longer provide Ellanse since it still hasn't cleared FDA approval unfortunately. I'll see if they believe Hyaluronic Acid (HA) or Free Fat Transfer may be viable options for an AMS 700 recipient, since those are fillers they still employ.

@donwfree

Here is a response from Dr. Carney himself:

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Good question!


I’m going to go the long way around the barn responding to your inquiry to address other questions I receive regarding lost size following installation of a penile prosthetic.


Some History Regarding Penile Implants


The first working prototype of an inflatable penile implant for severe erectile dysfunction was introduced by a urologist at Baylor named Brantley Scott, MD at the American Urology Association convention in New York City in 1973. It took another ten years for Dr. Brantley’s innovation to gain clearance from the FDA and become widely available.


Four urologists were recruited to initially train other urologists on how to successfully install inflatable prosthetics for ED, including Rejuvall founder Steven L. Morganstern, MD. I’m including a photo from a TV talk show of this group including Dr. Morganstern, Brantley Scott, MD, John Mulcahy, MD, and Drago Montague, MD of the Cleveland Clinic.


The biggest problem with early penile implant procedures was higher-than-expected rate of infections and formation of scar tissue. Renowned Urologist John Mulcahy, MD (seated third from the left in the attached photo), published what’s considered the gold standard for urologic surgeons regarding how not to trigger significant scar tissue or infection following implantation of a prosthetic. His solution was rooted in a tandem of key procedural insights plus accepting the fact a post-prosthesis erect penile would end up being about an inch shorter than it was before the implant was installed.


Let’s fast forward to today’s times.


The company Dr. Scott co-founded (AMS) is still the primary provider of inflatable implants in the world. Although various improvements have been made through the years, the core design is still fundamentally the same, which speaks volumes about Dr. Scott’s innovation.


Two independent events helped shape the recent increase in patient complaints regarding lost size. Insurance companies began cutting the allowable reimbursement for penile implant procedures. It’s now less than one-third of what it used to be. Congruently, hospitals became more rigorous regarding the amount of allowable time for each procedure in their OR’s. The result seems to be that when an implanting urologist encounters a more complicated prosthetic case, the tandem of lower pay and hospital pressure triggers him/her to complete the operation based upon medical standards vs. penile length optimization. We encounter patients who claim they lost over three inches of erect length following installation of their implant.


About eighty percent of the hospital procedures I personally perform for the university are repairs of failed surgical procedures. Thus, I’ve performed several replacements of penile prosthetic implants to regain lost length and learned a bit about what can be done to improve matters and what can’t.


The unfortunate reality is that if a patient doesn’t get a new penile implant installed within six months following their initial procedure that resulted in significant loss of erect length, nothing can be done to reverse that outcome. An implant becomes firmly seated within the corpora over time and builds small amounts of scar tissue as it heals. This makes any further penile lengthening impossible. If we somehow added length to the penis through repositioning, the improved length would be floppy at the end of the penis and unable to penetrate.


What can be done to improve lost size following a penile implant?


The girth of the penis can be enhanced after the installation of a prosthetic implant.


One pathway is non-surgical injection of a select hyaluronic (H/A) dermal filler. The other is transplanting your own fat within the subcutaneous tissues that surround the organ, assuming you’re a good candidate for fat tissue transplant. (Under the age of 63 (adipose cells begin to die as we age and won’t successfully transplant after a certain point); if diabetic, you must have an A1C of 7 or below; and you must be a non-smoker or have been completely off cigarettes for at least 90 days before your procedure). The hyaluronic pathway faces no health or age constrictions but has less longevity (usually about two years).


Regarding your original question regarding using Ellansé as the bulking agent to improve girth, I don’t think that would be a good idea. The primary components of Ellansé are about 80% hydrocellulose and 20% polycaprolactone. Polycaprolactone is a fairly strong inflammatory agent that triggers production of Level I, II and III collagens about 24 hours after its first injection. The polycaprolactone could damage the walls of the inflatable implant and open the door to a host of medical complications.


Given the fact your inflatable prosthetic can be damaged during a girth enhancement, I would recommend having a urologist perform the procedure because of their familiarity with the inner prosthetic design. It’s a somewhat time-consuming procedure to safely navigate around the implant when adding thickness.


Another procedure some implant patients get is adding H/A to their glans to help restore lost rigidity. During installation of the prosthetic, about half of patients must have the unique blood supply to the glans severed during installation. This results in significant atrophy to the glans, hindering penetration. I always add about 3ML of Juvéderm Voluma to the glans during an implant enlargement for this reason.


Finally, unlike a penile prosthesis, enhancement of a penile implant is considered a cosmetic procedure (elective) procedure and is never covered by insurance.


Hope this information helps a bit for those looking to improve lost size following installation of a prosthetic penile implant.

Thank you very much for the detailed response.

I actually had a consult with Dr. Morganstern this morning and believe he'll be passing on my information to you shortly.

Day 27 Update:
It's been 27 days since my fill and all is going well. As most have said, expect bruising within the first week. Then expect to lose some of the gain as some of the solution is absorbed into the body. I was told that as the body builds collagen, expect to recoup that loss.

My gain was 2.5cm Girth and then within 2 weeks I lost 1.5cm, but as of yesterday have regained .5cm. I expect this will get back to the original gain prior to the 90th day.

No lumpiness, but I followed the doctor's directions diligently. I suspect that the doctor and their experience is a large contributor. So far, so good! I just made a second appointment at the recommended 90 day mark.

Day 81 Update:

I hesitated to make this update, but for those that are still following - I'm currently at 11.5cm Girth, just .5cm more than when I had the first Bellafil procedure (Mar 9th). I'm scheduled for a second round of Bellafill on Jun 10th - just about a week and a half away.

I'm beginning to have doubts on the effectiveness of Bellafill to build Girth. I have to qualify that I'm in my early 60's, so I suspect that as the aging process continues, building collagen may be an issue. It certainly seems to be the case with me. I'm in average physical condition and I'm no couch potato.

I've placed a call to Dr. Carney today to get his opinion and see if there's a different course of action he recommends. Just a bit disappointed at this point.