The
Physics
ARES-XL girth and length options at the time of penile implant surgery is based on the physics of the Tunical Expansion Procedure (TEP) described by Dr. Paulo Egydio. While his technique involves a circumcision (subcoronal) incision and is intended to be used with malleable penile implants, his description of the physics (described below) is sound.
Rationale for the ARES-XL:
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High volume penile implant surgeons (those who perform greater than 50 implants per year) account for <1% of all urologists. Accordingly, 75% of inflatable penile implant surgeries in the United States are done by urologists who perform 4 or fewer implant operations per year. Studies have shown that surgeon experience is directly correlated with higher patient satisfaction scores (Congrosso et al), longer penile cylinder lengths, shorter surgical times, and less prosthetic complications (infection, erosion, poor positioning) (G. Henry et al).
Additionally, the #1 complaint for patients who have healed appropriately after penile implant surgery is the perceived loss of penile length.
ARES-XL was designed to address both the complication risks associated with surgical inexperience as well as dissatisfaction associated with penile length loss. ARES-XL surgeons are specifically chosen because of their expertise in penile implant surgery. They are all thoroughly vetted by their peers for their ability to maximize length and girth during their surgeries, and also evaluated on their ability to adhere to ARES-XL recommendations and technically perform ARES-XL adjunctive procedures. They are certified by the Hismeros Centers of Excellence.
The Physics:
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Placement of the IDEAL implant with Length and Girth Preservation:
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The length of the internal erectile bodies are measured at the time of penile implant, thus allowing your surgeon to determine the perfect size of the penile implant cylinders to be placed. A surgeon has the option of choosing a longer cylinder (which often times has an associated larger potential girth) or choosing a shorter cylinder (with less girth) but adding more plastic tips (rear tips) at the end to make it fit better.
Inexperienced surgeons are often overly conservative in their implant sizing and often rely on smaller implants with excessive rear tips. This is a major contributor to reduced post-operative penile length or girth. Additionally, over-dilation of the erectile bodies, in which the cylinders are placed, may contributes to decreased engorgement of the tip (glans) of the penis during sexual stimulation. This maneuver can diminishing the sexual experience and satisfaction.
ARES-XL surgeons are experts who are specifically trained in an “erectile tissue preservation ” approach to both maximize your penile length and girth at the time of implant sizing, but also preserve blood flow within these erectile bodies and accordingly preserve glans enhancement and maximize your sexual experience after recovery.
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ARES-XL: Length and/or Girth enhancement
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Anatomic factors that limit penile length and girth are dictated by the tunica albugenia, neurovascular bundles and the urethra. The erectile bodies are covered by a strong non-elastic wrapping (tunica albuginea) that limits their expansion. Additionally, there are nerves located on the back layer of the penile shaft (neurovascular bundle). The channel you void through (the urethra) is a third and separate body on the underside of the penis that can limit your penis’s ability to stretch.
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Inflatable penile implants, particularly the Coloplast Titan implants, not only have a standard girth, but also have the ability to expand an additional 5-6mm per cylinder (remember, you will have two cylinders).
Image from Egydio et al's article descibed above illustrating corporal slits allowing for "mesh like" expansion of the corporal bodies
Here is a chart of the expandability of the Coloplast Titan cylinders:
Cylinder Length
16 cm
18 cm
20 cm
22 cm
24 cm
26 cm
28 cm
Girth
14.8 mm
15.8 mm
15.8 mm
16.9 mm
17 mm
17 mm
17 mm
Max Girth
19.3 mm
20.6 mm
20.6 mm
22 mm
22.1 mm
22.1 mm
22.2 mm
The ARES-XL procedures for penile enhancement involves creation of strategically placed slits within the tunica albuginea, creating a “mesh like” expansion that can be expanded when sizing the penile implant. This will allow your surgeon to place a longer (and girthier) implant, sized up to the limitation of the neurovascular bundle and the urethra. For length expansion, the neurovascular bundle is carefully micro-dissected off the underlying tunical layer and freed, allowing additional slits to be placed under it.
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The mesh like expansion also allows the implant to continue to stretch horizontally, up to the maximum girth of the penile implant placed.
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