How do the surgeons account for the LGX 3cm length expansion?

[junk098]

Hey sexperts .

We've seen studies claiming "in the lab" the AMS LGX 700 expands 3cm in length when inflated. So do the surgeons adjust for that 3cm on the OR table?  
IE:  They do their measurement up and down and it totals 21cm. Do they throw a 21cm implant in there? or do they figure the 18cm implant will expand by 3cm to 21, so use that?

The reason I'm asking is I believe I had a very conservative surgeon.  Off the table I was fully inflated. I was never told to cycle. Never hurt to inflate. Often hurts to deflate.
I can leave it inflated for weeks, and unless the neighbors complain, there's never any issues.  Only pain is when deflating so I must do that slowly and in steps.  No floppy glans. Lost length and girth. But it works. 

And yes, for you guys that think the LGX 3cm length expansion is all marketing, my flaccid length vs fully inflated length difference is exactly 3cm. No tunica to hold anything back. What is the flaccid vs inflated difference for you guys with the CX or titan?

'Whatcha all think? 
Not sharing the name of the surgeon.

[JohnHC]

Dr Hakky told me the LGX expands by 2cm so if I wanted the LGX he would short me that amount otherwise you'd have a increased risk of erosion because of the added pressure on the glans. So I measured 23cm this revision, I have a 21cm CX with 2cm rear tips, but if I wanted LGX he would have used a 18cm LGX and 3cm rear tips as he doesn't like to use the 21cm LGX as he feels it'd be weak in the sides or floppy. So I would assume the Drs would account for that expansion somewhat and short you a little bit to keep the chance of erosion low.

[Gt1956]

JohnHC is correct. Download the AMS "owners manual". It clearly says to subtract 2cm from the measured length for the LGX. Its 2cm because not all of the implants length is expandable. I specifically asked my drs assistant that is in the sugery room if my dr does the subtraction. She denies it but I suspect he announces the size with the 2cm already subtracted. No secrets here. It IS in the manual.

[frank66665]

I have a Titan that I will change on March 4th with a CX, from deflated to inflated it increases 1 cm or maybe less, I would be curious to know how much a CX stretches

[splitpeach]

I spoke with Prof Ralph last week. He said it's a marketing sham. It's just useful for surgeons that undersize a patient. Anatomically you'd have to undersize someone to make it accommodate the inflated size.

[Mikedsy]

I have a Titan that I will change on March 4th with a CX, from deflated to inflated it increases 1 cm or maybe less, I would be curious to know how much a CX stretches

My CX 18 is 5.25 inch deflated, 6 inch inflated. So about 2 cm

[newbie443]

Hey sexperts .

We've seen studies claiming "in the lab" the AMS LGX 700 expands 3cm in length when inflated. So do the surgeons adjust for that 3cm on the OR table?  
IE:  They do their measurement up and down and it totals 21cm. Do they throw a 21cm implant in there? or do they figure the 18cm implant will expand by 3cm to 21, so use that?

The reason I'm asking is I believe I had a very conservative surgeon.  Off the table I was fully inflated. I was never told to cycle. Never hurt to inflate. Often hurts to deflate.
I can leave it inflated for weeks, and unless the neighbors complain, there's never any issues.  Only pain is when deflating so I must do that slowly and in steps.  No floppy glans. Lost length and girth. But it works. 

And yes, for you guys that think the LGX 3cm length expansion is all marketing, my flaccid length vs fully inflated length difference is exactly 3cm. No tunica to hold anything back. What is the flaccid vs inflated difference for you guys with the CX or titan?

'Whatcha all think? 
Not sharing the name of the surgeon.

My doctor measured me at 11cm up and 11cm down. I received a 21cm LGX and 1cm RTE. At my repair the doctor confirmed that I was sized correctly. As far as the expansion of the LGX it is shown in table 1 in this study: https://pmc.ncbi.nlm.nih.gov/articles/PMC5654325/ You need to scroll down a bit to find it. As you can see the LGX will expand when inflated if there is room. This backs up Boston Scientific's claim of the LGX expansion. Not only in length but in girth. And you can see the Titan will expand a bit also. Just not near as much as the LGX. Doctors have had in the past complaints of the cylinder tips being uneven in the glans. To me it seems even the Titans smaller amount of expansion is enough to make up for almost all uneven lengths if the doctor properly sizes the device. A few doctors will shorten the RTE end of the implant to make sure both cylinder tips are the same in the glans.

[junk098]

Thanks for your responses. All compelling arguments.
The "It's in the owners manual" argument sounds most plausible.
Dr Kramers response of "it will expand if there's room" is probably more what we want to hear.
So a follow-up to that, do you have pain if you leave it inflated too long, or try to push the limits?

[newbie443]

Thanks for your responses. All compelling arguments.
The "It's in the owners manual" argument sounds most plausible.
Dr Kramers response of "it will expand if there's room" is probably more what we want to hear.
So a follow-up to that, do you have pain if you leave it inflated too long, or try to push the limits?

I have not seen anything like that in a manual. Not saying it is not there just that I would like to see it. I posted a link for my information. And I would like to see the info about subtracting. I have seen in the AMS physician instructions where there are two ways to measure. But that has to do with RTE's. It has to do with the doctor either not wanting to or being unable to dilate enough down into the body for the junction of the tubing and cylinders to go down inside Crus. This other way of measuring is supposed to have this junction at the incision. You subtract but then you add back with RTE's.

Yes I do have discomfort if I keep adding pumps over time. I inflate to max and wait and then add more partial pumps.

I cannot remember where the information about the LGX only being able to expand as much as the Tunica permits came from. But it is clear that the LGX can expand well above the listed length for the devices. And much more than the Titan.

[junk098]

I found that note in the surgery instructions.

https://www.bostonscientific.com/conten ... ulti_s.pdf

See page 11. A small note between diagram 16 and 17 that reads:

Note: Measuring both directions from one of the stay sutures provides consistency.
However, when using AMS 700 LGX™ Devices, some physicians choose to measure
distally from the distal edge of a 2 cm corporotomy and proximally from the proximal
end of a 2 cm corporotomy for optimal device sizing.

Looks like a way to say "subtract 2 cms" without actually saying it.