"Blasting through" the coffin/capsule scar tissue?

[DonBecker54]

In another thread, a poster said that Dr. Eid will sometimes put a revision patient under a mild anesthesia and use a great deal of force to pump the cylinders through scar tissue that formed from the first implant. The "blasting through" as I understand it would help increase size.

Does anyone have any knowledge of or experience with this?

[TANGERINE]

this "blast through" procedure only works if there is a coffin pseudocapsule. If, for some reason, the implant is not fully expanding, then the "blast through" procedure will perhaps be needed. I suspect that there is a time window on this procedure, likely BEFORE two months. Also, as mentioned on the other post, this might only work for titan since the AMS cylinders are more complex (more elegant) and might not tolerate the huge pressures needed to break away the coffin capsule. ?

Dr Ed Karpman has published a case on his experience with "capsular contraction" (also known as coffin capsule or CC) Where he had installed a wonderful AMS implant with 7 inch penis. The patient broke his hand, did not tell his surgeon, and 3 months later had an s shape deformity which required revision and DOWNSIZING of cylinders to a 6 inch size !

Here are a couple excerpts from the Karpman article:

"Our case represents an argument for early and aggressive inflation of the IPP postoperatively; perhaps in the future, after more research evidence is accumulated, adjuvant medications to prevent TGF-B1-mediated CC could be used in the early postoperative period. For now, a growing trend in IPP surgery is to implement a maximum inflation protocol in the early postoperative period to optimize penile length. There is discussion on increases in length after implantation of length-expanding cylinders coupled with a maximum inflation protocol. The urologic literature has demonstrated that the tunica albuginea responds favorably to gradual mechanical forces applied to it in the form of vacuum erection and traction devices for preoperative penile stretching and for the treatment of Peyronie's disease. An appropriately sized IPP may have the same effect as a vacuum erection or traction device on the penis."

Also, here is where he discusses the "blast through" procedure:
"More subtle cases of CC may result in penile shortening without obvious S-shaped deformity. Attempts at conservative management should be tried with aggressive inflation/cycling of the implant in the office or in the operating room under sedation. Milder cases of S-shaped deformity can resolve with repeated and aggressive patient cycling of the implant. However, more severe cases require surgical revision. Because we do not know for sure when the dense fibrous capsule around the cylinders becomes incapable of morphologic change from repeated inflation, we encourage all of our patients, especially those implanted with length-expanding cylinders, to start cycling their implants starting at 1 week after surgery and continue to do so daily for the first 3 months postoperatively."

[TANGERINE]

oops, forgot to include the reference:

Capsular Contraction with S-Shaped Deformity of Nonlength-Expanding Inflatable Penile Prosthesis Cylinders: Management and Prevention Strategies
Edward Karpman, MD, FACS*

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4184503/

[DonBecker54]

Thanks, Tangerine. I was hoping that I might get more of a return to my pre-op size if scar tissue could be "blasted through". I guess not.

[JayGould]

Well they say implant is the best way to fix Peyronie's Disease. So if it can straighten a crooked penis because of scar tissue, then it must be "blasting through" it?

[DonBecker54]

The implant "straightens" the penis by making each side the same length. It doesn't stretch the side with the scar tissue, but rather doesn't expand as much the side without the scar tissue.

[JayGould]

The implant "straightens" the penis by making each side the same length. It doesn't stretch the side with the scar tissue, but rather doesn't expand as much the side without the scar tissue.

So that side will just be thinner than the other?

Kill me.

[DonBecker54]

Not thinner. Shorter. The scar tissue prevents the affected section of the Tunica from stretching. When an erection happens naturally, the side with the scar tissue doesn't expand to its full length, while the side without scar tissue does. That's what causes the bend. A surgical method of treating Peyronie's is to stitch the unaffected side so that it expands to the same length as the scarred side. The penis is straight, but shorter.

With the implant, the cylinders are going to expand to roughly the same length.

[JayGould]

Not thinner. Shorter. The scar tissue prevents the affected section of the Tunica from stretching. When an erection happens naturally, the side with the scar tissue doesn't expand to its full length, while the side without scar tissue does. That's what causes the bend. A surgical method of treating Peyronie's is to stitch the unaffected side so that it expands to the same length as the scarred side. The penis is straight, but shorter.

With the implant, the cylinders are going to expand to roughly the same length.

Well for me the scar tissue hinders the left side of my penis in expanding in width as well, resulting in both a loss of length and girth.

[alibaba]

Well for me the scar tissue hinders the left side of my penis in expanding in width as well, resulting in both a loss of length and girth.

I think that is a good description. I had a bit of an hour glass taper in the bends of my last implant.