Trouble Shooting - Boston Scientific AMS 700 Mode D'emploi

To cycle the device, the patient inflates and deflates the prosthesis several times. It
may be painful for the patient the first few times that he inflates and deflates the device.
However, after the postoperative healing period, the pain should subside.
Instruct the patient to inflate and deflate the prosthesis several times daily. This will
encourage maximum pseudocapsule development and reservoir capacity.
Four to six weeks postoperatively, determine if the patient is ready to use the device:
• Check the incision site to be sure that it has healed properly. There should be no
redness, swelling, or drainage. Any of these findings may indicate that an infection
is present and it should be treated promptly with antibiotics.
• Ask the patient about pain when cycling the device and observe the patient inflating
and deflating the device.
• If the patient is unable to inflate the device and you believe the tubing may be
kinked, Boston Scientific recommends trying the pull-stretch technique: the
patient's penis is pulled-stretched out, up, down and side to side 2-3 times, which
may allow the cylinders to be inflated. This technique may resolve the issue by
slightly modifying tubing placement to optimize fluid flow.
After determining that the patient knows how to operate the device and that the device
is functioning correctly, inform the patient that it is possible to have gentle intercourse.
Advise the patient not to inflate the device for long periods of time when not in use.
If the patient is familiar with injection therapies for erectile dysfunction, remind the patient
that such therapies can cause damage to the penile prosthesis, and should not be used.
The pump contains a valve that resists elevated reservoir pressure. However, there is the
possibility that the device will automatically inflate during the immediate postoperative
period and the patient may have to return to the office for deflation. Autoinflation may
occur for a variety of reasons.
If this occurs, verify that the patient is squeezing the deflation button for 4 seconds and
does not squeeze the pump bulb after this.
Evaluating Long-term Function and Placement
After the postoperative healing period, the physician should continue to have contact
with the patient at least on an annual basis to evaluate the function of the device and
to check for signs of infection or erosion. Ask the patient how the device is functioning
and if he has noticed any changes in the function, for example, cylinders losing rigidity.
If the patient is having mechanical difficulty with the device, or there is infection or
erosion present, revision surgery may be necessary.

TROUBLE SHOOTING

During Surgery
Problem
Cylinders (Refer to Figures 42 and 43)
Sized incorrectly
Difficult to inflate
Punctured
Won't inflate
Black (K) ∆E ≤5.0
What to Do
Redilate and resize. Remove the
cylinder(s) and add or subtract RTEs to
adjust the length. If unable to adjust the
length with RTEs, remove the cylinder(s)
and replace with cylinder(s) of the
appropriate size.
Squeeze the deflation button to "reset"
the lockout valve. Make the first pump
bulb squeeze hard and quick to activate
the pump (you should feel a pop). The
remaining pump bulb squeezes can be
slower.
Remove damaged cylinder(s) and
replace
• Determine that the tubing is not kinked.
If it is kinked, gently straighten it.
• Check that the cylinder has not
buckled. If the cylinder has buckled, be
sure that it has been inserted properly.
• If the cylinders still won't inflate,
remove them and replace.
• Check that all hemostats are off the
tubing.
Problem
Won't deflate
}
Deflation
Block
Pump
Deflation
Bulb
Button
Figure 42. Parts of the pump
Figure 43. Squeezing the sides of the
deflation block
Reservoirs
Won't fill
Punctured
Pump (Refer to Figures 42 and 43)
Won't inflate or deflate cylinders
Pump bulb dimpled or collapsed
18
What to Do
• Determine that the tubing is
not kinked. If it is kinked, gently
straighten it.
• Check that the tubing between the
pump and the cylinders is clear of
debris. If there is debris in the tubing,
clamp the tubing with tubing covered
hemostats, remove the connector, flush
the system, and reconnect the system.
• Check that the cylinders are properly
sized and are positioned without kinks.
• If the cylinders still won't deflate,
remove them and replace.
• Check that all hemostats are off the
tubing.
• Check that the pump is being deflated
correctly. The deflation button and
the pump bulb might have been
squeezed at the same time. Try to
resolve this issue by squeezing the
sides of the deflation block. Then,
squeeze the deflation button for
2-4 seconds. This should allow the
cylinders to deflate normally.
• If the cylinders still won't deflate,
remove the pump and replace with a
new one.
• Check that the reservoir adaptor is
not rolled over onto the reservoir. The
reservoir adaptor should follow the
tubing exit path through the fascia
layer. If this does not address the
problem, remove and replace with a
new reservoir.
• Make sure there is adequate space for
the reservoir (i.e., not in scar tissue).
Remove damaged reservoir and replace.
• Remove the pump from the scrotum
and try to inflate or deflate it outside
of the body in a basin of sterile
normal saline.
• If pump still won't inflate or deflate,
replace with new pump.
• Squeeze the deflation button to
refill the pump bulb. Reactivate the
pump with a hard, quick pump bulb
squeeze. Inflate normally.
• If this does not resolve the problem,
squeeze the sides of the deflation
block to refill the pump bulb. Then,
squeeze the deflation button for
2-4 seconds to reset the lock-out
mechanism prior to attempting
inflation. Reactivate with a hard,
quick pump bulb squeeze. Inflate
normally. Do not squeeze the
deflation button and the pump bulb at
the same time.