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BackTable / Urology / Article
Coloplast Titan vs AMS 700 Penile Implant Devices
Quynh-Chi Dang • Jun 13, 2021 • 13.3k hits
Erectile dysfunction (ED) patients who have had minimal or no success with medication and vacuum constriction devices are possible candidates for penile implant surgery. The two most common three-piece inflatable penile prosteheses availabe in the United States are the Coloplast Titan and AMS 700. There are considerations for both devices on which one is the optimal penile implant, mainly the age of the patient.
We’ve provided the highlight reel in this article, but you can listen to the full podcast below.
The BackTable Urology Brief
• The Coloplast Titan penile implant and the American Medical Systems (AMS) 700 penile implant are two types of inflatable penile prosthetics. Both contain three parts: 2 cylinders, a reservoir, and a pump and release valve.
• Dr. Clavell recommends inserting a Coloplast Titan in young patients, as it results in a harder and wider erection, and an AMS 700 for older patients, as it is easier to deflate.
• It is important to adjust the Coloplast Titan to fit each ED patient’s unique anatomy. Reservoir placement, pump placement, and cylinder length can all be adjusted to minimize complications and maximize patient comfort.
• Dr. Clavell prefers the newer method of ectopic, or alternative, reservoir placement because of the lower risk of injury in the retroperitoneal space. Furthermore, he avoids using rear tip extenders in the cylinders in order to make the implant feel more comfortable and natural.
Table of Contents
(1) Coloplast Titan vs AMS 700 Penile Implants
(2) Ectopic Placement of the Coloplast Cloverleaf Reservoir
(3) Coloplast Titan Pump & Cylinder Adjustments
Coloplast Titan vs AMS 700 Penile Implants
For men who are not able to resolve their erectile dysfunction (ED) with medication or a vacuum constriction device, penile implant surgery is a possibility. Dr. Clavell prefers to give his ED patients a three-piece device for ease of access and the most natural feel. Currently, there are only two inflatable three-piece penile prostheses available in the United States: Coloplast Titan series and the American Medical Systems 700 (AMS 700) from Boston Scientific. Dr. Clavell recognizes that both devices are good choices but notes that the Coloplast Titan may be better for younger patients because it produces a harder and wider erection, while the AMS 700 may be ideal for older patients because of the accessibility of the deflate button.
[Dr. Jose Silva]
...Let's talk about the patient that fails medications, they fail the vacuum, they fail everything. So you end up doing a prosthesis. What type of implant do you use? What company? What brand? Coloplast? AMS, or Boston Scientific? How do you decide which way to go?
[Dr. Jonathan Clavell]
I use both. Both companies hate me for that. I'm a consultant with both companies. I have great relationships with both territorial managers from both companies here. They actually even get along, which is great for me. There's no tension here, at least here in my office, or in the OR.
Basically, I use both companies equally. I really don't have a preference between one or the other. I do try to always use a three-piece as long as I can, unless the guy doesn't have hands to pump it up. I know there's many surgeons out there who are worried about, for example, a transplant patient who has a pelvic kidney and they're worried about injuring it with a reservoir. I try with all my might to be able to get them a three-piece just to give them the most natural device that they actually can.
Usually, whenever they come in specifically asking for a penile prosthesis, I show them both. I tell them, "This is the AMS. This is the Coloplast. These are two great cars. You're comparing a Mercedes to a BMW. You're going to have a great car regardless. But of course, they have their specific features that you really want to know about before you get yourself into this."
Most guys are going to ask, "Oh, Doc, you're the expert. Which one would you recommend for me?” If they’re younger, sometimes I tend to go with a Coloplast because again they want something that will give them a really, really hard erection.” They really don't care how it feels when it's flaccid.
For older guys, I usually go with Boston Scientific, just because it's easier for them to find that deflate button because of the shape of that pump. And then guys who have really big phalluses, I try to give them a Coloplast because again it has more girth.
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Ectopic Placement of the Coloplast Cloverleaf Reservoir
The three-piece inflatable penile implant works through three parts: the fluid-filled reservoir traditionally located under the abdomen in the prevesical Space of Retzius, two inflatable cylinders within the penis, and a pump and release valve in the scrotum. To induce an erection, the pump is squeezed and the reservoir fluid travels to the cylinders and inflates them. To deflate the implant, the release valve is opened and the fluid travels back to the reservoir.
In some cases, the prevesical space may be a hostile environment for the reservoir, especially for patients who have had previous surgeries in or near that anatomical region. For this reason, Dr. Clavell chooses to go with an ectopic (otherwise known as “alternative”) placement of the reservoir in all of his penile implant cases. The Coloplast Titan reservoir is called the Cloverleaf Reservoir because of its shape, which minimizes the risk of auto-inflation. To avoid palpation and patient discomfort, Dr. Clavell underfills the Cloverleaf Reservoir with 125 mL of fluid.
[Dr. Jose Silva]
In terms of patients, you mentioned the patients with kidney transplants, post-radiation, and inguinal surgery. What about ectopic placements? The Conceal Reservoir? What are your thoughts on that?
[Dr. Jonathan Clavell]
I am all about ectopic placement. Most of my latest research is actually on ectopic placement, and if Paul Perito listens to this podcast, he's probably going to ding me for it. He hates the word ectopic. The word we use is alternative reservoir placement.
But anyways, post-radiation, I'm really not that concerned. Of course, post radical surgery in the pelvis, post pelvic surgery--either cystectomy, prostatectomy--once that retroperitoneal space in the pubic area in the pelvic area is compromised, we want to avoid that space. You don't want to injure anything down there. Usually for those, the ectopic is definitely recommended. For me personally, I always do alternative reservoir placement. I go ectopic for all of them, be it the Conceal Reservoir or even with the Coloplast Cloverleaf.
What I usually do, for example, is in order to avoid palpation, I always use the 125 mL--basically the large Cloverleaf reservoir. I underfill it so you don't have a big ball there because again, if you use a 75, most implants are going to require somewhere between 50 and 70 cc. You're going to have a small ball right there.
Palpation is very minimal and patients really are not really bothered by it. They probably complain about it for about a week and you just tell him, "You're going to have some lower abdominal pain for a few days," but they're probably mostly focused on their penile pain.
Coloplast Titan Pump & Cylinder Adjustments
Two more Coloplast Titan penile implant surgery complications is that the pump may not fit in the scrotum, and the cylinders may be too short for the penis. To resolve the pump placement issue, Dr. Clavell cuts the tubing, utilizes the multiple connectors available, and repositions the pump to fit in the scrotum. To resolve the cylinder length issue, different Coloplast Titan sizes are available and can be used. Furthermore, Dr. Clavell recommends using more length from the tubing and avoids using rear tip extenders, as they can make the implant feel unnatural.
[Dr. Jose Silva]
That's great advice. When I have gone ectopic, I have never gone bigger, thinking bigger is going to be more noticeable. But definitely, if you under-inflate, it should be nicer in that sense to palpation.
Let’s say you're doing the procedure, specifically with the Coloplast, which has the pump connected to the cylinders. Sometimes the pump is longer and maybe doesn't fit on the scrotum. It's already open. You don't want to go ahead and open another prosthesis. Has that happened to you? Or have you seen it?
[Dr. Jonathan Clavell]
Yes. Definitely. There are some guys that have tiny scrotums and really tight scrotums especially those guys who have been on testosterone for decades. You really have no space to place a pump. The good thing about these devices is that they have multiple connectors. So I just cut the tubing and then just reposition it to whatever is good for the patient. I've done that several times.
The other thing about that is the way to avoid that is basically trying to avoid the rear tip extenders. The good thing is now, for both companies, they have longer tubings. As long as the edge of that proximal corpora on the bottom is within the single digits, it's 9 or 10 cm or below, you should have enough length that you can even avoid using a rear tip. And now we know that the extra rigidity is a lot better in the penis. It feels more natural for them if we avoid those rear tip extenders.
[Dr. Jose Silva]
Is there a situation where you go the other way around and actually put extenders instead of just going big?
[Dr. Jonathan Clavell]
Yeah. For guys who are really deep and for these obese guys-
[Dr. Jose Silva]
For 10 or 11 and deeper and then a little bit outside?
[Dr. Jonathan Clavell]
Not even 10, 11. I've had guys who have 14 or 15 cm, and for those guys, there's no way you'll be able to avoid rear tip extenders. For those, I undersized the cylinder and just added a little bit more rear tip. But again, those situations are rare. Most important thing is that whenever you're doing your dissection make sure that you go very, very low to do that.
[Dr. Jose Silva]
Good. I have had patients that come to me and they complain that it's not rigid. Obese patients, like you mentioned, they don't have the actual erection. That's what most likely happened: instead of just using some extender, they went down, and now they have just a little bit coming on the outside and they don't get that extension or that erectile sensation.
Podcast Contributors
Dr. Jonathan Clavell
Dr. Jonathan Clavell is a high-volume prosthetic urology surgeon and assistant professor of urology at UT Health Science Center Houston.
Dr. Jose Silva
Dr. Jose Silva is a board certified urologist practicing in Central Florida.
Cite This Podcast
BackTable, LLC (Producer). (2021, June 2). Ep. 8 – Men's Sexual Health [Audio podcast]. Retrieved from https://www.backtable.com
Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.
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