Thin Tunica and Pressure Atrophy over Time

[RoninRiff]

I recently consulted with a highly-regarded, high-volume IPP specialist well-known to Franktalk and had an interesting discussion about an issue that does not seem to get much attention on this forum. There is a lot of focus on lifespan of the mechanical implant but not much attention paid to the patients’ soft tissue anatomy and how that may be affected by years of use. Apparently just having an implant filling the space in the cavernosa while flaccid can gradually cause pressure atrophy of the tunica. This effect can be mitigated by diligently fully deflating in between inflation cycles but, as it was explained to me, even with best practices, some tunica thinning is inevitable over time. And patients who naturally start off with thin or stretchy tunica can be particularly susceptible. The result of tunica atrophy is expansion of the penis and loss of firmness and stability of the implant erection. So, while there is a lifespan of the prosthesis, it appears there may also be a lifespan of the supportive soft tissues. My concern is that a worn out implant can be replaced with a new one…but not so with a worn out tunica. I’m wondering if any bionic brothers who have been implanted for several years or more have any experience with this to share? Has anyone experienced loss of implant rigidity and stability over time? Or gradual widening of the penis due to deterioration of the soft tissue?

[Lost Sheep]

Thanks for posing the question so well, RoninRiff.

Did your surgeon advisor give a good explanation of the difference between implants that are "Tunica Dependent" and "Tunica Independent"?

Readers of this thread
viewtopic.php?f=6&t=17508
might want to read this one when answers start coming in.

[RoninRiff]

Great question, Lost. As it was described to me, it sounds like tunica atrophy can happen over time in both tunica-dependent and tunica-independent implants. Granted, it would seem that this effect might be even more pronounced with tunica-dependent implants since a tunica-independent implant will stop expanding in girth one is reaches its limit. But even at rest in the post-implant flaccid state, the tunica is still being expanded outward more than it normally would in the pre-implant flaccid date. Post-implant flaccids are always larger than pre-implant flaccids, right? Since the tunica never gets to fully retract when flaccid after implantation, this chronically increased intracavernosal volume can gradually lead to pressure atrophy of the tunica over time. So, in theory, I suppose even if one were to never inflate their implant and remained deflated 100% of the time, this phenomenon would still occur. Thus the importance of fully deflating when not in use to minimize (but not eliminate) this effect. And certainly inflating for time intervals longer than what is recommended for regular cycling may be ill-advised as it might lead to acceleration of tunica thinning.

[Pamen116]

Great question, Lost. As it was described to me, it sounds like tunica atrophy can happen over time in both tunica-dependent and tunica-independent implants. Granted, it would seem that this effect might be even more pronounced with tunica-dependent implants since a tunica-independent implant will stop expanding in girth one is reaches its limit. But even at rest in the post-implant flaccid state, the tunica is still being expanded outward more than it normally would in the pre-implant flaccid date. Post-implant flaccids are always larger than pre-implant flaccids, right? Since the tunica never gets to fully retract when flaccid after implantation, this chronically increased intracavernosal volume can gradually lead to pressure atrophy of the tunica over time. So, in theory, I suppose even if one were to never inflate their implant and remained deflated 100% of the time, this phenomenon would still occur. Thus the importance of fully deflating when not in use to minimize (but not eliminate) this effect. And certainly inflating for time intervals longer than what is recommended for regular cycling may be ill-advised as it might lead to acceleration of tunica thinning.

I think this is a good subject as I was just asking the benefits of being inflated longer and how it relates to size increase. I’m hoping to hear from some folks that have been implanted for a while

[Tortão]

This is interesting, and a bit worrisome for young guys.

I'd love to hear more professional opinions and what people that have an implant for a long period of time (10+ years) have to say.

[RoninRiff]

Agreed. I think hearing from some guys about their experience 10-20 years out from implantation would be super valuable. From what I understand, this issue does not necessarily present itself in the first few years after implantation but could be a concern the further out one is from their index surgery. We hear a lot about how guys undergoing revision surgery usually require a larger implant than their previous one. This is often proferred in a positive light in that it indicates enlargement of the penis. However, provided the first implant was sized correctly (not undersized), requiring a larger implant at the time of revision may be an indication of the soft tissues stretching out, not necessarily a good thing if it means the tunica is getting thinner and weaker.

Because of the nature of this forum, much of the information shared tends to be about patient experience only within the first few years of surgery. Naturally, being able to access information on the patient experience 10-20 years out is very limited, but would be extremely valuable. Especially, as you say Tortao, for the younger guys who will have to manage their implants for decades to come.

[Lost Sheep]

Agreed. I think hearing from some guys about their experience 10-20 years out from implantation would be super valuable. From what I understand, this issue does not necessarily present itself in the first few years after implantation but could be a concern the further out one is from their index surgery. We hear a lot about how guys undergoing revision surgery usually require a larger implant than their previous one. This is often proferred in a positive light in that it indicates enlargement of the penis. However, provided the first implant was sized correctly (not undersized), requiring a larger implant at the time of revision may be an indication of the soft tissues stretching out, not necessarily a good thing if it means the tunica is getting thinner and weaker.

Because of the nature of this forum, much of the information shared tends to be about patient experience only within the first few years of surgery. Naturally, being able to access information on the patient experience 10-20 years out is very limited, but would be extremely valuable. Especially, as you say Tortao, for the younger guys who will have to manage their implants for decades to come.

There are medical journal studies available on the internet that address many of the questions we might have and are often shared here.

[Gt1956]

Well I do find that an interesting possibility. But on the other hand. I think that in the past that most implants were into the more senior age group. Just a non facted based opinion here. Its my guess that as the procedure has become more refined, talked about more etc. That it is working its way into the younger guys. That is a good thing in my opinion. They need them also.
So since we haven't heard about it much (?). It could be a thing. Hard to form a firm opinion in my mind.
I think it might depend just how "tendon like" the tunica truly is. I do know from my limited sports experience that tendons can be stretched but they do eventually return to their original state.
I hope some of the research obsessed members will search around on this subject. Not that the majority of senior aged men need to worry very much about it.

[Stewy78]

Very good question. I'm 33 years old and i already had 3 surgeries. Actual implant is a bit oversized from one side and doctor ( I think he's the same high volume doctor that the original poster was talking about) suggested a shortening of that side to avoid overpressure on the tunica. At this time I can't do the surgery and I'm living with my actual implant, i have some pain if I inflate over 80% but I'm able to have satisfactory sex at 75/80% inflation. I have no issues others than the pain when I'm inflated over 80%.
But being 33 yo with a slight oversized implant scares me because tunica atrophy.

[FreddyFree]

This is definitely a more frequent problem with malleable implants that never relax the tunica.

I would also assume the problem would be more prevalent with inflatable implants that push the limits of the size of the cylinders. I know I wanted the largest possible penis, so in striving for that I wanted the largest cylinders the surgeon could stuff in!

Another issue I think may cause this issue would be overuse of a VED with an inflatable.

I’m not a doctor.