Titan® OTR A Guide to Penile Implant The Titan® OTR penile implant 2 Erectile dysfunction - a common problem Erectile dysfunction (or impotence) is the inability to achieve an erection sufficient for sexual activity. If you experience this, you should be aware that millions of men are in the same situation. One in four men over the age of sixty experience some degree of erectile dysfunction. Although it is common, men rarely discuss the subject of erectile dysfunction spontaneously and objectively. What is the solution? There are many different treatments available. Oral therapy, intraurethral therapy, injection therapy and vacuum devices can all be successful treatment options. As an alternative, a highly effective and satisfying option is a penile implant. Every year, approximately 20,000 men worldwide reclaim their sexual relationships by using this device. 3 How the penile implant works Fluid is moved into the penile cylinders from the reservoir by squeezing the pump bulb in the scrotum repeatedly. The pump has a one-way valve that is manually deactivated. As the fluid fills the cylinders, they inflate causing an erection which can be maintained for as long as desired. A flaccid state is reinstated when the one-way valve, which is located in the pump, is manually deactivated allowing fluid from the cylinders to return to the reservoir. Your healthcare professional will show you how to work your pump. To implant the device, an incision is made at the base of the penis through which the two cylinders are placed. The reservoir is located in your abdominal area next to your bladder. It simply holds the fluid necessary to fill the cylinders to create the erection. Erect The Reservoir Flaccid 2 Cylinders Scrotum The Pump o inflate Erect Surgical procedure 4 Momentarily depress Flaccid the deflate valve button Grasp andSs The Titan® OTR implant is inserted surgically under general or epidural anaesthesia. The operation lasts approximately one to two hours. At the end of the operation, your surgeon leaves the implant slightly inflated and covers your penis with a bandage. The Hospital stay is generally very short, about one to two days, but your surgeon will advise you on this as necessary. How to obtain an erection The pump is located in the scrotum. It is bulb shaped, ribbed and about the size of a walnut. To move the fluid from the reservoir into the cylinders, the pump is squeezed firmly a few times until an erection is achieved. Pump (ribbed) Scrotum To return Flaccid to a relaxed state Squeeze pump to inflate Ere To return to a flaccid state, just squeeze the deflate valve buttons once. This action deativates the pump’s one-way valve and enables the fluid to return to the reservoir. To achieve a flaccid state more quickly, squeeze the penis gently with the hand after depressing the deflate valve buttons. If any problems are encountered during the use of this device, or any pain or discomfort are experienced, please contact your doctor immediately. Release bar Scrotum 5 Erect Momentarily depress the Grasp and squeeze. Momentarily depress the Grasp and squeeze. deflate valve button Erections and how they work The penis has two chambers within it called the Corpora Cavernosa, which extend from the Glans (head of the penis) deep into the pelvis. The insides of these chambers are composed of sponge-like tissue and have the ability to gain blood volume and grow in size. During non-sexual activity, the arteries that supply blood to the penis are normally constricted. This allows sufficient blood to maintain healthy tissue. Fig. 1 Corpora cavernosa When sexual stimulation occurs, the brain sends signals to trigger a hormonal response that allows arteries to relax (vasodilate). Relaxed arteries allow more blood to enter the corpus cavernosum faster than the blood can leave through the veins. As the corpus cavernosum fill and grow in size, the veins also get compressed, allowing less blood to leave. This chain reaction event continues until an erection is achieved and maintained. When the brain stops sending signals, the hormones diminish and the arteries go back to their normal constricted state. The erection goes down because the volume of blood leaving the penis is greater than the volume of blood entering it. The erection becomes inadequate or impossible if brain signals are absent or only minimal (neurological conditions), when the blood flow is inadequate (vascual conditions), or the erectile tissue is damaged. 6 Fig. 2 Fig. 3 The Titan® OTR penile implant The Titan® OTR inflatable penile prosthesis is a self-contained hydraulic system made of bioflex, a durable yet supple material. The Titan® OTR consists of four parts: two penile cylinders, a pump, and a reservoir. The system is connected with silicone tubing and filled with sterile saline during the implantation process. The components are implanted within these areas: penile cylinders into the corpora cavernosa (one each side), the pump into the scrotum, and the reservoir into lower abdominal area next to the bladder. Once the device is implanted, it is hidden entirely within the body. It is not visible and the penis appears relaxed and normal. The Titan® OTR penile implant is designed to closely mimic the characteristics of a normal erection. Reservoir 2 Cylinders Release bar Pump 7 Questions and answers > Risk of infection As with any type of implant or surgery there may be a risk of infection. If you notice an increase in pain, redness or swelling after the operation please contact your surgeon. > Will my penis look normal ? Yes, your penis will look normal. > Will the implant show? No, all parts ot the penile implant are placed inside your body, and should be invisible to the naked eye. The size is adjusted to fit your body. > Will my partner experience anything different? Your partner should have the same sensation as during a natural erection. > Will I feel a different sensation? The sensations you feel will be the same as those you felt before the operation. > How long will I have to stay in bed after the operation? You may be required to stay in Hospital. This is usually between 1-2 days, but you will need to discuss this further with your surgeon. 8 > Does it hurt? After the operation, some areas may be painful or uncomfortable (swelling) and it is normal to experience some bruising. Your surgeon will prescribe appropriate pain relief to help you. Normally this disappears in about a fortnight. Il you notice an increase in pain, redness or swelling after the operation, you should contact your surgeon immediately. > Will the length or diameter of my penis be increased after the operation? No. Your surgeon chooses the size of Titan® OTR implant to fit your anatomy. The implant does not make your penis longer or wider. > When will I be able to resume sexual activity? You must not use the implant for four to six weeks. With agreement from your doctor, you can start inflating and deflating the device two to three weeks after surgery, when any pain has disappeared. It is normal for the first inflation to be painful – please discuss this with your surgeon. > Will I still ejaculate? Yes, you will have the same type of ejaculation as before the operation, and orgasm will be the same. The reproductive function is preserved. Radical prostatectomy patients will not ejaculate. > Do you get involuntary erections? You may have a feeling of an erection due to remaining activity of your natural erectile tissue. The risk of auto-inflation (when the implant involuntarily inflates) is virtually eliminated by the lock-out valve fitted to all Titan® OTR implants. However, general movement can cause the implant to fill slightly. If auto-inflation occurs, please contact your surgeon. > Will I have any urinary problems? No. Penile implants should have no effect on your urinary function. > What technical problems can occur with the implant, and how do you solve them? The components of the implants are extremely reliable. The Titan® OTR implant is made of a material called Bioflex, which is resistant to abrasion and durable over time. Occasionally however, complications may occur if there is a device malfunction. If this happens, the components may need to be partially or completely replaced. > Will my implant interfere with radiological examinations (e.g. MRI)? Your implant will show up on X-rays. The device is also classified as MRI-compatible. This means that it has been tested not to interfere within certain limits of MRI energy. The Titan Instructions For Use (IFU) describes the limits that will not cause interference during MRI scans. Titan® OTR does not interfere with security screening detectors. Important advice • Please follow the instructions in this manual and those given to you by your surgeon. • Be sure to contact your surgeon, if you have any problems inflating or deflating the implant. • Never use intracavernous injections once you have been fitted with a penile implant. 9 Your own notes 10 - 100359 With thanks to Mandy Spillings – Nurse Practitioner – UCLH hospitals Coloplast and Titan® OTR are registered trademarks of Coloplast A/S. Supris™ is a trademark of Coloplast A/S. Durasphere® is a registered trademark of Carbon Medical Technologies, Inc. Durasphere is manufactured by Carbon Medical Technologies, Inc., and distributed by Coloplast Corp. ©2008-04. All rights reserved. Coloplast Corp., Minneapolis, MN USA. Any licensed images are for illustrative purposes only. Any persons depicted are models. Coloplast and Titan® OTR are registered trademarks of Coloplast A/S. All rights reserved Coloplast A/S, 3050 Humlebæk, Denmark. February 2010 Holtedam 1 DK-3050 Humlebæk Denmark www.coloplast.com