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Dr. Garber is a Urologist specializing in the following areas:

- Penile Implants / Impotence
- Prostate microwave treatment
- Prostate laser vaporization
- Cryo (freezing) prostate cancer
- CyberKnife® Treatment of Prostate Cancer
- Other Male Urologic Disorders

Penile Implant Surgical Procedure

Figure 1

Coloplast Titan Figure 1

Coloplast Titan® inflatable penile implant. Two inflatable cylinders are placed into the penile erection chambers (corpora cavernosa). These cylinders are available in a wide range of sizes. During the implant procedure, the penis is stretched to its maximum length, and each erection chamber is measured. Dr. Garber then installs the largest cylinders that the erection chambers will accommodate. A pump mechanism is placed in the scrotum, and a fluid reservoir is placed in front of the bladder. The device is filled with sterile saline, and the connection is made. The patient squeezes the pump bulb to transfer fluid from the reservoir into the cylinders, creating an erection. After sexual activity is finished, he squeezes the release pads, allowing the fluid to leave the cylinders and return to the reservoir. The penis then becomes flaccid (soft). Courtesy of Coloplast Corporation, Minneapolis, Minnesota, USA, www.us.coloplast.com

Figure 1A

Coloplast Titan Figure 1

Dr. Garber has access to the latest penile implant components, often before they are available to the general public. This is a photo of the latest Coloplast Titan® inflatable penile implant. This is a high-tech device with many advanced features, including:

  1. PVP coating. This hydrophilic coating decreases bacterial adherence. We also soak the device in an antibiotic solution just prior to implantation. The antibiotic molecules adhere to the coating, and published studies show that this reduces the risk of infection by roughly 50%.
  2. Soft-tip cylinders. The cylinder tips are now modified with a soft silicone cap, which increases patient and partner comfort, and provides better support to the head of the penis (the glans).
  3. Zero-degree input tubing. The input tubing now exits the cylinder at a zero degree angle. This makes the cylinders easier to install.
  4. CL Cloverleaf reservoir. This new reservoir configuration can be easier to install than the prior version.
  5. Bioflex® cylinders. Bioflex is a proprietary polyurethane derivative; it is much stronger and more durable than the silicone cylinders made by other manufacturers.
  6. Touch one-touch release pump®. This is the newest pump available from Coloplast, and was released in the first quarter of 2014. The Touch pump has a one-touch release mechanism, but is smaller and less noticeable than the prior OTR pump. Dr. Garber was one of the first in the U.S. to use this new pump, and has found that men prefer its smaller size.
  7. Lock-Out Valve. The reservoir lock-out valve minimizes the risk of auto-inflation (partial filling of the implant cylinders which occurs due to increases in intra-abdominal pressure).
  8. Pre-connected cylinders and pump. The 2 cylinders and pump are pre-connected, so the entire device only requires 1 connection (between the pump and reservoir) for complete assembly.
Courtesy of Coloplast Corporation, Minneapolis, Minnesota, USA, www.us.coloplast.com

Figure 1B

AMS Ambicor  Figure 1B

American Medical Systems (AMS) Ambicor implant. Two inflatable cylinders are placed in the penile erection chambers, and a pump is placed in the scrotum, in between the testicles. No intra-abdominal fluid reservoir is needed. The patient squeezes the pump bulb to inflate the implant and create an erection. After sexual activity is finished, he bends the implant cylinders for approximately 10 seconds, allowing the implant to deflate and the penis to become flaccid. (Courtesy of American Medical Systems, Inc., Minnetonka, Minnesota, USA, www.americanmedicalsystems.com

Figure 2

Penile Implant Surgery Figure 2

A roughly one inch incision is marked on the upper scrotum.

Figure 3

Penile Implant Surgery Figure 3

The urethra is seen in between the forceps; the left and right erection chambers are on either side of the urethra.

Figure 4

Penile Implant Surgery Figure 4

The left erection chamber is opened, dilated, and measured, in preparation for cylinder placement.

Figure 5

Penile Implant Surgery Figure 5

The right erection chamber is likewise opened, dilated, and measured.

Figure 6

Penile Implant Surgery Figure 6

The optimal-size cylinders and pump are selected and prepared.

Figure 7

Penile Implant Surgery Figure 7

The cylinders have been inserted into the left and right erection chambers. The urethra is in the midline and is unharmed.

Figure 8

Penile Implant Surgery Figure 8

The reservoir is about to be inserted where it will not be felt or appreciated by the patient.

Figure 9

Penile Implant Surgery Figure 9

The reservoir is filled with sterile saline; the connection between the reservoir and pump is about to be created.

Figure 10

Penile Implant Surgery Figure 10

The connection has been made, and the cylinders and reservoir have already been installed. The implant has been inflated.

Figure 11

Penile Implant Surgery Figure 11

The pump has been installed in between the testicles, and is under the skin at the bottom of the scrotum.

Figure 12

Penile Implant Surgery Figure 12

The procedure is complete and the skin is closed. The implant is deflated.

Figure 13

Penile Implant Surgery Figure 13

When the implant is inflated, it produces an excellent erection. When the incision heals, it will be nearly invisible. The patient will learn how to inflate and deflate the implant 4-6 weeks post-operatively.

Penile Implant Surgery by Dr. Bruce B. Garber, MD, FACS

Dr. Bruce B. Garber

8815 Germantown Ave
Suite 34
Philadelphia, PA 19118

215-247-3082 Phone
215-247-3085 Fax
bgarber@comcast.net Email