Patent Publication Number: US-2019183650-A1

Title: Mechanical impotence treatment apparatus

Description:
The present invention relates to a male sexual impotence treatment apparatus, comprising an adjustable restriction device implantable in a male patient, who suffers from sexual impotence, for directly engaging a portion of the normal penile tissue or the prolongation thereof of the patient, and an operable adjustment device implantable in the patient for adjusting the restriction device to temporarily contract said portion of the normal penile tissue or the prolongation thereof to restrict the blood flow leaving the penis, when the patient desires to achieve erection. 
     Male sexual impotence is a widespread problem. Many different solutions to this problem have been tried. A main solution currently practised and disclosed in for instance U.S. Pat. Nos. 5,437,605 and 4,841,461 is to implant a hydraulic inflatable/contractible silicon prosthesis in the cavities of the corpora cavernosa of the patient&#39;s penis. In fluid connection with this prosthesis is a reservoir implanted in the scrotum. By manual pumping action the prosthesis is filled with fluid from the reservoir to effect errect condition or is emptied of fluid, which returns to the reservoir, to effect flaccid condition. 
     However, there are several more or less severe disadvantages of this main solution. Above all, the penis is more or less damaged by the operation and it is practically impossible to reverse the operation. Another disadvantage is that rather strong forces act against this implanted prosthesis resulting in a significant risk of the prosthesis being broken. A further disadvantage is that hard fibrosis created around the reservoir over time may cause malfunction of pumping components. Thus, the created fibrosis will sooner or later become a hard fibrotic layer which may make it difficult to pump the reservoir. Yet a further disadvantage is that the use of hydraulic fluid always entails a risk of fluid leaking from the prosthesis. Furthermore, it is a rather complicated task to manually pump the reservoir when erection is desired. 
     Another solution to achieve erection is to restrict the blood flow leaving the penis. For example, U.S. Pat. No. 4,829,990 discloses two hydraulically operated inflatable cuffs wrapped around the respective crura. Again, a disadvantage of such a solution is that it entails a risk of hydraulic fluid leaking from the cuffs. 
     Another example of the solution to restrict the penile blood flow is found in U.S. Pat. No. 4,828,544, which discloses an artificial fistula system surgically implanted and providing a primary fistula between the femoral artery and the femoral vein and a secondary fistula for leading blood from the primary fistula to the penis. An inflatable balloon engages the primary fistula between the secondary fistula and the vein. The balloon is in fluid connection with a manually compressible reservoir implanted in the scrotum. Besides the risk of fluid leaking from the balloon, a further disadvantage of this latter example is that it requires delicate surgery. 
     A main disadvantage of the solution to restrict the penile blood flow is the fact that the venous blood vessel system is rather complex and it is difficult to restrict the veinplexa. 
     Yet another solution is to inject a substance in the vein system to achieve erection. However, injections are painful and complicated for the patient. 
     The prime object of the present invention is to provide a male sexual impotence treatment apparatus in which the risk of liquid leaking from implanted hydraulic components of the apparatus is substantially reduced or completely eliminated. 
     A further object of the invention is to provide a male sexual impotence treatment apparatus, which does not require surgical implantation of any fistula system. 
     Another object of the invention is to provide a male sexual impotence treatment apparatus, which does not require the use of an injection needle. 
     These objects are obtained by an apparatus of the kind stated initially, which is characterised in that the adjustment device is adapted to mechanically adjust the restriction device. 
     The restriction device preferably is non-inflatable. 
     Preferably, the adjustment device adjusts the restriction device in a non-invasive manner. Furthermore, the adjustment device may adjust the restriction device in a non-manual manner and/or in a non-magnetic manner, i.e. magnetic forces may not be involved when adjusting the restriction device. 
     Furthermore, as opposed to prior art impotence treatment devices the adjustment device of the invention preferably is non-manually operated, i.e. not operated by manual forces or manipulated by touching the skin of the patient, such as by manually compressing a fluid containing balloon implanted in the scrotum. Instead the apparatus of the invention may further comprise a powered operation device for operating the adjustment device. 
     In the various embodiments hereinafter described the restriction device generally forms an at least substantially closed loop. However, the restriction device may take a variety of different shapes, such as the shape of a square, rectangle or ellipse. The substantially closed loop could for example be totally flat, i.e. thin as seen in the radial direction. The shape of restriction device may also be changed during use, by rotation or movements of the restriction device in any direction. 
     A physical lumen, such as the corpus cavernosum, crura of the penile tissue or the prolongation thereof, is often easier to restrict by contracting at least two opposite or different side walls of the lumen against each other. The expression “penile tissue and the prolongation thereof” should be understood to mean the penile tissue extended inside the human body and following the pathway of the blood flow leaving the penis i.e. one or several exit veins from the penis, corpus cavernosum, crura or the prolongation thereof. Thus, the restriction device may be designed to perform such a contracting effect of the opposite walls also of a exit vein in the penile prolongation. 
     Alternatively, the restriction device may comprise an adjustable cuff, a clamp or a roller for bending the vein, corpus cavernosum, crura or the prolongation thereof to restrict the blood flow therein. Such a cuff, clamp or roller may also be utilised for squeezing the vein, corpus cavernosum, crura or the prolongation thereof against human material inside the body of the patient or against implanted structures of the apparatus. 
     Preferably, the restriction device comprises an elongated restriction member and forming means for forming the restriction member into at least a substantially closed loop around said portion of the tissue, wherein the loop defines a restriction opening, whereby the adjustment device adjusts the restriction member in the loop to change the size of the restriction opening. 
     The restriction device may be implanted in the base of the patient&#39;s penis or the prolongation thereof and preferably may engage the corpus cavernosum, crura or the prolongation thereof of the penis. However, there are several alternative positions of the restriction device that give more or less satisfactory restriction of the blood flow leaving the penis. Thus, as a first alternative the restriction member may extend around both corpora cavernosa or crura of the penis as a single unit. As a second alternative the restriction device may comprise two elongated restriction members extending around respective corpora cavernosa or crura of the patient. As a third alternative the elongated restriction member may encircle one of the exit veins from the penis. As a fourth alternative the restriction device may comprise several restriction members extending around respective exit veins from the penis. 
     The adjustment device may be incorporated in the restriction device as well as be controlled by hydraulic means. 
     In accordance with a preferred first adjustment principle, the adjustment device mechanically adjusts the longitudinal extension of the elongated restriction member in a loop form. 
     In a preferred embodiment of the invention utilising the first adjustment principle, the restriction member comprises a main portion and two elongated end portions, and the adjustment device establishes longitudinal relative displacement between the end portions of the restriction member, so that the size of the restriction opening is adjusted. The forming means may comprise any suitable known or conventional device capable of practising the desired function, such as a spring material forming the elongated restriction member into the loop, so that the restriction opening has a predetermined size, and the adjustment device may adjust the restriction member against the spring action of the spring material. In other words, the restriction member may comprise a spring clip. The spring material may be integrated in the restriction member. 
     Preferably, the adjustment device comprises a movement transferring member, suitably a drive wheel, in engagement with at least one of the end portions of the restriction member and operable to displace the one end portion relative to the other end portion of the restriction member. The drive wheel may advantageously be in engagement with both of the end portions of the restriction member and be operable to displace said end portions relative to each other. An elongated flexible drive shaft may be operatively connected to the drive wheel, for transferring manual or motor generated power from a location remote from the restriction member. In its simplest embodiment, the drive wheel may comprise a pulley in frictional engagement with the restriction member. As an alternative, a gear rack may be formed on at least one of the end portions of the restriction member and the drive wheel may comprise a gear wheel in mesh with the gear rack. Other suitable known or conventional mechanisms may also or alternatively be used as the adjustment device. 
     The movement transferring member may alternatively comprise at least one cylinder and a piston, which is movable therein and is connected to one of the end portions of the restriction member, the piston being operable to longitudinally displace the one end portion of the restriction member relative to the other end portion of the restriction member. Alternatively, the movement transferring means may comprise two interconnected cylinders and two pistons in the respective cylinders connected to said end portions, respectively, of the restriction member, the pistons being operable to longitudinally displace the end portions of the restriction member relative to each other. Other known or conventional devices also or alternatively can be used as the movement transferring member. 
     A motor, which is fixed relative to the main portion of the restriction member and has a rotating drive shaft operatively connected to the movement transferring member, may be positioned relative to the elongated restriction member such that the drive shaft extends transverse thereto. Alternatively, the motor may be positioned relative to the elongated restriction member such that the drive shaft extends substantially tangentially to the loop of the restriction member. 
     In another embodiment of the invention utilizing the first adjustment principle, the elongated restriction member is longitudinally resilient and the adjustment device comprises a contraction device for longitudinally contracting the resilient restriction member. Preferably, the elongated restriction member comprises a substantially non-resilient main portion and an end portion forming an elongated helical spring, which is contractible by the contraction device. The contraction device may suitably comprise an elongated flexible pulling member connected to the main portion of the restriction member and extending through the helical spring to contract the helical spring against an arresting member, which is fixed relative to the main portion of the restriction member. The pulling member may extend in an elongated tube joined at one end thereof to the arresting member, so that a motor remote from the restriction member may be attached to the other end of the elongated tube and pulls the pulling member through the tube to contract the helical spring. 
     In yet another embodiment of the invention utilizing the first adjustment principle, the elongated restriction member comprises an elongated helical spring having a free end, and a body to which the spring is nonrotatably secured at its opposite end. The adjustment device rotates the helical spring in one direction to enlarge the coils of the helical spring to longitudinally contract the spring and to rotate the spring in the opposite direction to reduce the size of the coils of the spring to longitudinally extend the spring. As a preferred alternative, the restriction member comprises a further elongated helical spring having a free end and nonrotatably secured to the body at its opposite end, and the adjustment device comprises a drive shaft having two opposite end portions connected to the springs, respectively, at their free ends, the helical coils forming left and right hand helices, respectively. The adjustment device may alternatively comprise a gearing having an input shaft and two opposite aligned output shafts connected to the helical springs, respectively, at their free ends, the input shaft being connected to said output shafts so that the output shafts rotate in the opposite directions upon rotation of the input shaft, the helical coils forming the same helices. 
     In accordance with a second adjustment principle, the adjustment device mechanically adjusts the restriction member so that at least a portion of a radially innermost circumferential confinement surface formed by the restriction member is substantially radially displaced. 
     In one embodiment of the invention utilizing the second adjustment principle, the restriction member comprises an elongated voltage responsive element forming part of the confinement surface and capable of bending into a bow in response to a voltage applied across the element, the radius of curvature of the bow being adjustable by changing the level of the voltage. 
     In another embodiment of the invention utilizing the second adjustment principle, the adjustment device changes the diameter of an elastic annular element of the restriction member, which forms the confinement surface. Preferably, the forming means comprises a substantially rigid outer annular element coaxially surrounding the elastic annular element, and the adjustment device comprises means for pulling the elastic annular element radially outwardly towards the outer annular element to expand the elastic annular element. For example, the pulling means may comprise a plurality of threads secured to the elastic annular element along the circumference thereof and running from the elastic annular element via guide members attached to the outer annular element. 
     In yet another embodiment of the invention utilizing the second adjustment principle, the forming means comprises a substantially rigid outer annular element, and the restriction member comprises an elongated helical spring extending internally along the outer annular element and contacting the latter. The helical spring forms part of the circumferential confinement surface and has a free end. The restriction member further comprises a body to which the spring is nonrotatably secured at its opposite end. The adjustment device rotates the helical spring in one direction to enlarge the coils of the spring to contract the circumferential confinement surface and rotates the spring in the opposite direction to reduce the size of the coils of the spring to expand the circumferential confinement surface. As an alternative, which is preferred, the restriction member comprises two elongated helical springs forming part of the circumferential confinement surface and connected to the body of the restriction member. The adjustment device rotates each spring in one direction to enlarge the coils of the spring to contract the circumferential confinement surface and rotates the spring in the opposite direction to reduce the size of the coils of the spring to expand the circumferential confinement surface. 
     In accordance with a third adjustment principle, the restriction member comprises at least two separate elements, at least one of which is pivoted so that it may turn in a plane in which the restriction member extends, and the adjustment device turns the pivoted element to change the size of the restriction opening. Preferably, the restriction member comprises a plurality of separate pivoted elements disposed in series, each pivoted element being turnable in the plane, and the adjustment device turns all of the pivoted elements to change the size of the restriction opening. For example, the pivoted elements may comprise lamellae arranged like the conventional adjustable aperture mechanism of a camera. 
     In accordance with a fourth adjustment principle, the adjustment device folds at least two foldable frame elements of the restriction member towards each other. Preferably, the foldable frame elements comprise two substantially or partly semi-circular frame elements which are hinged together so that the semi-circular elements are swingable relative to each other from a fully open state in which they form part of a circle to a fully folded state in which they form part of a semi-circle. The same principal may be used with the swingable parts mounted together in one end and not in the other end. Alternatively, the restriction device may comprises two preferable rigid articulated clamping elements positioned on opposite sides of a vein like the blades of a scissor, and the adjustment device turns the clamping elements toward each other to clamp the vein, corpus cavernosum, crura or the prolongation thereof between the clamping elements, thereby restricting the blood flow in the vein, corpus cavernosum, crura or the prolongation thereof. 
     In accordance with a fifth adjustment principle, the adjustment device turns the restriction member around a longitudinal extension thereof, the elongated restriction member being elastic and varying in thickness as seen in a cross-section therethrough. Suitably, the elongated restriction member comprises an elastic belt. 
     In accordance with a sixth adjustment principle, the adjustment device changes the size of the restriction opening such that the outer circumferential confinement surface of the restriction member is changed. 
     In accordance with a seventh adjustment principle, the adjustment device changes the size of the restriction opening such that the outer circumferential confinement surface of the restriction member is unchanged. 
     In accordance with an eighth adjustment principle, the elongated restriction member may be flexible, and the adjustment device pulls a first portion of the flexible restriction member from a second portion of the flexible restriction member opposite the first portion in the loop to squeeze a vein, the corpus cavernosum, the crura or the prolongation thereof between two opposite lengths of the elongated flexible restriction member to restrict the blood flow in the vein, corpus cavernosum, crura or the prolongation thereof. 
     In accordance with a ninth adjustment principle, the restriction device comprises two rigid elements on opposite or different sides of a vein, the corpus cavernosum, the crura or the prolongation thereof, and the adjustment device decreases the distance between the rigid elements to squeeze the vein, corpus cavernosum, crura or the prolongation thereof between the rigid elements, thereby restricting the blood flow in the vein, corpus cavernosum, crura or the prolongation thereof. 
     In accordance with a tenth adjustment principle, the restriction device bends or rotates a portion of a vein, the corpus cavernosum, the crura or the prolongation thereof to restrict the blood flow in the same. For example, the restriction device may comprise at least two bending members, such as cylindrical or hour-glass shaped rollers, positioned on opposite or different sides of the vein and displaced relative to each other along the vein, corpus cavernosum, crura or the prolongation thereof, and the adjustment device may move the bending members against the vein, corpus cavernosum, crura or the prolongation thereof to bend the latter to restrict the blood flow in the vein, corpus cavernosum, crura or the prolongation thereof. Suitably, the displacement members may comprise rollers. The restriction device may also rotate a portion of the esophagus or stomach. The bending or rotating members may take any shape. With the prolongation of the corpus cavernosum or crura should be understood the penile tissue extended inside the human body and following the pathway of the blood flow leaving the penis. 
     Alternatively, the two bending members one placed more distal than the other may be rotated in opposite direction relative to each other. With interconnecting material for example flexible bands between the holding members a restriction will occur between the bending members when they are rotated. 
     The restriction device may in all applicable embodiments take any shape and be either hydraulic or non-inflatable. 
     In all of the above-described embodiments of the invention the adjustment device is conveniently operated by any suitable motor, preferably an electric motor, which may be fixed directly to or be placed in association with the restriction device, or alternatively be located remote from the restriction device, advantageously in the abdomen or subcutaneously. In the latter alternative the motor is advantageously connected to the adjustment device by a flexible power transmission conduit to permit a suitable positioning of the motor in the abdomen of the patient. The motor may be manually activatable, for example by an implanted switch. 
     In some of the above described embodiments of the invention, however, the adjustment device may conveniently be operable by a hydraulic operation device, which preferably is manually activatable. The hydraulic operation device may advantageously include hydraulic servo means to facilitate manual activation. As an alternative, the hydraulic device may be powered by an electric motor, which may be manually activatable or controlled by remote control means. The components of such a hydraulic operation device may be placed in association with the restriction device and/or be located at a suitable place in the abdomen or subcutaneously. 
     More specifically, a reservoir may be provided containing a predetermined amount of fluid for supplying the hydraulic operation device with fluid. The reservoir defines a chamber for the predetermined amount of fluid and the hydraulic operation device changes the size of the chamber. The hydraulic operation device may comprise first and second wall portions of the reservoir, which are displaceable relative to each other to change the size of the chamber of the reservoir. The first and second wall portions of the reservoir may be designed to be displaceable relative to each other by manual manipulation thereof, preferably to permit manual pushing, pulling or rotation of any of the wall portions in one direction. Alternatively, the wall portions may be displaceable relative to each other by magnetic means (such as a permanent magnet and magnetic material reed switch, or other known or conventional magnetic devices), hydraulic means or electrical control means such as an electric motor. The magnetic means, hydraulic means, or electrical control means may all be activated by manual manipulation, preferably using a subcutaneously located manually manipulatable device. This control may be indirect, for example via a switch. 
     The hydraulic operation device may operate the adjustment device with fluid from the reservoir in response to a predetermined first displacement of the first wall portion of the reservoir relative to the second wall portion of the reservoir, to adjust the restriction device to release the tissue, and to operate the adjustment device with fluid from the reservoir in response to a predetermined second displacement of the first wall portion of the reservoir relative to the second wall portion of the reservoir, to adjust the restriction device to restrict the blood flow leaving the penis. In this embodiment, no pump is used, only the volume of the reservoir is varied. This is of great advantage compared to the solution described below when a pump is used to pump fluid between the reservoir and the adjustment device because there is no need for a non-return valve and it is still possible to have fluid going both to and from the reservoir. 
     As an alternative, the hydraulic operation device may comprise a pump for pumping fluid between the reservoir and the adjustment device. The pump may pump fluid both to and away from the adjustment device, or hydraulic means controlling the adjustment device. A mechanical manual solution is proposed in which it is possible to pump in both directions just by pushing an activating member in one direction. Another alternative is a pump pumping in only one direction and an adjustable valve to change the direction of fluid to either increase or decrease the amount of fluid in the reservoir. This valve may be manipulated manually, mechanically, electrically, magnetically, or hydraulically. Any kind of motor could of course be used for all the different operations as well as wireless remote solutions. The pump may comprise a first activation member for activating the pump to pump fluid from the reservoir to the adjustment device and a second activation member for activating the pump to pump fluid from the adjustment device to the reservoir. The activation members may be operable by manual manipulation, preferably to permit manual pushing, pulling or rotating thereof in one direction. Suitably, at least one of the activation members is adapted to operate when subjected to an external pressure exceeding a predetermined magnitude. 
     Alternatively, at least one of the first and second activating members may be operable by magnetic means, hydraulic means or electrical control means such as an electric motor. The magnetic means, hydraulic means, or electrical control means may all be activated by manual manipulating means preferably located subcutaneously. This activation may be indirect, for example via a switch. 
     Advantageously, especially when manual manipulation means are used, a servo means could be used. With servo means less force is needed for operating the adjustment device. The term “servo means” encompasses the normal definition of a servo mechanism, i.e. an automatic device that controls large amounts of power by means of very small amounts of power, but may alternatively or additionally encompass the definition of a mechanism that transfers a weak force acting on a moving element having a long stroke into a strong force acting on another moving element having a short stroke. The servo means may comprise a motor, preferably an electric motor, which may be reversible. 
     Alternatively, a reverse servo may be employed. The term “reverse servo” is to be understood as a mechanism that transfers a strong force acting on a moving element having a short stroke into a weak force acting on another moving element having a long stroke; i.e. the opposite function of the above-defined alternative mechanism of a normal servo mechanism. A first closed hydraulic system that controls another closed hydraulic system in which hydraulic means of the adjustment device is incorporated may be used. Minor changes in the amount of fluid in a smaller reservoir of the first system could then be transferred by the reverse servo into major changes in the amount of fluid in a larger reservoir in the second system. In consequence, the change of volume in the larger reservoir of the second system will affect the hydraulic means of the adjustment device. For example, a short stroke that decreases the volume of the smaller reservoir will cause the larger reservoir to supply the adjustment device with a large amount of hydraulic fluid, which in turn results in a long mechanical adjustment stroke on the restriction device. The great advantage of using such a reverse servo is that the larger volume system could be placed inside the abdomen or retroperitoneum where there is more space and still it would be possible to use manual manipulation means of the smaller system subcutaneously. The smaller reservoir could be controlled directly or indirectly by a fluid supply means. The fluid supply means may include another small reservoir, which may be placed subcutaneously and may be activated by manual manipulation means. Both the servo and reverse servo may be used in connection with all of the various components and solutions described in the present specification. 
     Preferably, the reverse servo comprises hydraulic means and a main fluid supply reservoir and eventually an additional fluid supply reservoir. Both reservoirs define a chamber containing hydraulic fluid, and the hydraulic means comprises first and second wall portions of the main fluid supply reservoir, which are displaceable relative to each other to change the volume of the chamber of the main fluid supply reservoir. The hydraulic means may control the adjustment device indirectly, e.g. via an increased amount of fluid in the main fluid supply reservoir, in response to a predetermined first displacement of the first wall portion of any of the reservoirs relative to the second wall portion of the reservoir to restrict the blood flow leaving the penis, and to control the adjustment device in response to a second displacement of the first wall portion of any reservoir relative to the second wall portion, to indirectly adjust the restriction device to release the penile tissue. The wall portions of the reservoirs may be designed to be displaceable relative to each other by manual manipulation thereof or be displaceable relative to each other by manually pushing, pulling or rotating any of the wall portions of the reservoir in one direction. Alternatively, the wall portions of the main fluid supply reservoir may be displaceable relative to each other by magnetic means, hydraulic means or electric control means including an electric motor. 
     The magnetic means, hydraulic means, or electrical control means may all be activated by manually manipulated means preferably located subcutaneously. This control may be indirect for example via a switch. 
     Even in the broadest embodiment of the invention the adjustment device may comprise a servo means. The servo means may comprise a hydraulic operation means, an electrical control means, a magnetic means, mechanical means or a manual manipulation means. The hydraulic operation means, electrical control means, mechanical means or magnetic means may be activated by manual manipulating means. Using a servo system will save the use of force when adjusting the adjustment device which may be of importance in many applications, for example when a battery cannot put out enough current although the total energy in the battery is more than enough to power the system. 
     In accordance with a preferred embodiment of the invention, the apparatus comprises implantable electrical components including at least one, or only one single voltage level guard and a capacitor or accumulator, wherein the charge and discharge of the capacitor or accumulator is controlled by use of the voltage level guard. As a result, there is no need for any implanted current detector and/or charge level detector for the control of the capacitor, which makes the apparatus simple and reliable. 
     All solutions may be controlled by a wireless remote control for controlling the adjustment device. The remote control may advantageously be capable of obtaining information related to the blood flow leaving the penis or the blood pressure or other important physical parameters and of commanding the adjustment device to adjust the restriction device in response to obtained information. With the wireless remote control the apparatus of the invention is conveniently controlled by the patient when he so desires, which is of great advantage compared to the prior art procedures. With the remote control the apparatus of the invention is conveniently controlled to adjust the implanted restriction device, which controls the blood flow leaving the penis. The restriction device may be operable to open and close the blood flow passageway formed by the penile exit veins. The restriction device may steplessly control the cross-sectional area of the passageway. 
     The apparatus may further comprise a pressure sensor for directly or indirectly sensing the pressure against the restriction device and the restriction device may control the blood flow in response to signals from the pressure sensor. The pressure sensor may be any suitable known or conventional pressure sensor such as shown in U.S. Pat. Nos. 5,540,731, 4,846,181, 4,738,267, 4,571,749, 4,407,296 or 3939823; or an NPC-102 Medical Angioplasty Sensor. The adjustment device preferably non-invasively adjusts the restriction device to change the size of the cross-sectional area. 
     The adjustment device and/or other energy consuming components of the apparatus may be energised with wirelessly transmitted energy from outside the patient&#39;s body or be powered by an implanted battery or accumulator. 
     The apparatus may further comprise an implanted energy transforming device for transforming wireless energy directly or indirectly into kinetic energy for operation of the restriction device. The energy transforming device may, preferably directly, transform the wireless energy in the form of sound waves into electric energy for operation of the restriction device. Suitably the energy transforming device comprises a capacitor adapted to produce electric pulses from the transformed electric energy. 
     The apparatus of the invention may further comprise an energy transfer means for wireless transfer of energy from outside the patient&#39;s body to the adjustment device and/or other energy consuming implantable components of the apparatus. The energy transfer means may be adapted to intermittently transfer the energy, preferably electric energy, in the form of a train of energy pulses for direct use in connection with the energising of the energy consuming components of the apparatus. An implanted capacitor having a capacity less than 0.1 μF may be used for producing the train of energy pulses. 
     A motor may be implanted for operating the adjustment device, wherein the energy transfer means is adapted to directly power the motor with transferred energy. Alternatively, or in combination with the motor, a pump may be implanted for operating the adjustment device, wherein the energy transfer means is adapted to transfer wireless energy in the form of electromagnetic waves for direct power of the pump. Preferably, the pump is not a plunger type of pump, but may comprise a peristaltic or membrane pump. 
     The energy transfer means preferably transfers wireless energy in the form of electromagnetic waves. However, for safety radio waves may be excluded. 
     Alternatively, the energy transferred by the energy transfer means may comprise an electric field or a magnetic field. 
     Most preferred, the energy transferred by the energy transfer means comprises a signal. 
     Preferably, the wireless remote control comprises a separate signal transmitter or receiver and a signal receiver or transmitter implanted in the patient. For example, the signal transmitter and signal receiver may transmit and receive a signal in the form of digital pulses, which may comprise a magnetic or electric field. Alternatively, which is preferred, the signal transmitter and signal receiver may transmit and receive an electromagnetic wave signal, a sound wave signal or a carrier wave signal for a remote control signal. The receiver may comprise an implanted control unit for controlling the adjustment device in response to a control signal from the signal transmitter. 
     The apparatus of the invention may further comprise an implanted energiser unit for providing energy to energy consuming implanted components of the apparatus, such as electronic circuits and/or a motor for operating the adjustment device. The apparatus may comprise an external energy transmitter for transmitting wireless energy, wherein the energiser unit is adapted to transform the wireless energy into electric energy. An implanted electric motor may operate the adjustment device and the energiser unit may be adapted to power the electric motor with the electric energy transformed from the wireless energy. 
     The energiser unit may comprise a battery and a switch operable by the wireless energy transmitted by the external transmitter, for connecting the battery to the implanted energy consuming components of the apparatus in an “on” mode when the switch is powered by the wireless energy and to keep the battery disconnected from the energy consuming components in a “standby” mode when the switch is not powered. 
     The control unit may power such an implanted motor with energy provided by the energiser unit in response to a control signal received from the signal transmitter. Any known or conventional signal transmitter or signal receiver that is suitable for use with a human or mammal patient may be provided as the signal transmitter or signal receiver of the invention. 
     Generally, all the signals mentioned above may comprise electromagnetic waves, such as infrared light, visible light, laser light, micro waves, or sound waves, such as ultrasonic waves or infrasonic waves, or any other type of wave signals. The signals may also comprise electric or magnetic fields, or pulses. All. of the above-mentioned signals may comprise digital signals. The control signals may be carried by a carrier wave signal, which in an alternative embodiment may be the same signal as the wireless energy signal. Preferably a digital control signal may be carried by an electromagnetic wave signal. The carrier wave or control signal may be amplitude or frequency modulated. 
     The motor may be any type of motor, such as a pneumatic, hydraulic or electric motor and the energiser unit may power the motor with pressurized gas or liquid, or electric energy, depending on the type of motor. Where the motor is an electric motor, it may power pneumatic or hydraulic equipment. 
     The energiser unit may comprise a power supply and the control unit may power the motor with energy from the power supply. Preferably, the power supply is an electric power supply, such as a battery, and the motor is an electric motor. In this case, the battery also continuously powers at least part of the circuitry of the signal receiver in a standby mode between the adjustments, in order to keep the signal receiver prepared for receiving signals transmitted from the signal transmitter. 
     The energiser unit may transfer energy from the control signal, as the control signal is transmitted to the signal receiver, into electric energy for powering the implanted electronic components. For example, the energiser unit may transfer the energy from the control signal into a direct or alternating current. 
     In case there is an implanted electric motor for operating the adjustment device the energiser unit may also power the motor with the transferred energy. Advantageously, the control unit directly powers the electric motor with electric energy, as the energiser unit transfers the signal energy into the electric energy. This embodiment is particularly simple and does not require any recurrent invasive measures for exchanging empty power supplies, such as batteries, that is required in the first embodiment described above. The motor may also be directly powered with wirelessly transmitted electromagnetic or magnetic energy in the form of signals, as the energy is transmitted. All the various functions of the motor and associated components described in the present specification may be used where applicable. 
     For adjustment devices of the type that requires more, but still relatively low, power for its operation, the energiser unit may comprise a rechargeable electric power supply for storing the electric energy obtained and the control unit may power the electric motor with energy from the rechargeable electric power supply in response to a control signal received from the signal transmitter. In this case, the rechargeable power supply can be charged over a relatively long time (e.g. a few seconds up to a half hour) without powering the electric motor. 
     The electric power supply suitably comprises an inexpensive simple capacitor. In this case, the electric motor may be a stepping motor. In all embodiments the motor may preferable be able to perform a reversing function. 
     The signal transmitter may transmit an electromagnetic signal and the energiser unit may draw radiant energy from the electromagnetic wave signal, as the latter is transmitted to the signal receiver, and transfer the radiant energy into electric energy. 
     Alternatively, the energiser unit may comprise a battery or accumulator, an electrically operable switch adapted to connect the battery to the signal receiver in an on mode when the switch is powered and to keep the battery disconnected from the signal receiver in a standby mode when the switch is not powered, and a rechargeable electric power supply for powering the switch. The control unit may power the electric motor with energy from the battery in response to a control signal received from the signal transmitter, when the switch is in its on mode. Advantageously, the energiser unit may transform wave energy from the control signal, as the latter is transmitted to the signal receiver, into a current for charging the rechargeable electric power supply, which suitably is a capacitor. Energy from the power supply is then used to change the switch from off (standby mode) to on. This embodiment is suited for adjustment devices of the type that require relatively high power for their operation and has the advantage that the electronic circuitry of the signal receiver does not have to be powered by the battery between adjustments. As a result, the lifetime of the battery can be significantly prolonged. The switch may be switched manually or by the use of magnetic or electric energy. 
     As an example, the signal transmitter may transmit an electromagnetic wave signal and the energiser unit may draw radiant energy from the electromagnetic wave signal, as the latter is transmitted to the signal receiver, and may transfer the radiant energy into said current. The energiser unit suitably comprises a coil of the signal receiver for inducing an alternating current as the electromagnetic wave signal is transmitted through the coil and a rectifier for rectifying the alternating current. The rectified current is used for charging the rechargeable power source. 
     Alternatively, the signal transmitter and receiver may solely be used for a control signal and a further pair of signal transmitter and receiver may be provided for transferring signal energy to implanted components. By such a double system of signal transmitters and receivers the advantage is obtained that the two systems can be designed optimally for their respective purposes, namely to transmit a control signal and to transfer energy from an energy signal. Accordingly, the apparatus may further comprise an external energy transmitter for transmitting wireless energy, wherein the energiser unit comprises a battery and an operable switch for connecting the battery to the signal receiver in an “on” mode when the switch is powered and for keeping the battery disconnected from the signal receiver in a “standby” mode when the switch is not powered, and the external energy transmitter powers the switch. Suitably, the energy transmitter may directly power the switch with the wireless energy to switch into the “on” mode. As should be realized by a skilled person, in many of the above-described embodiments of the invention the adjustment device may be operated by control means or manual manipulation means implanted under the skin of the patient, such as a pump, an electrical switch or a mechanical movement transferring means. In the manual embodiment it is not necessary to use a motor for operating the adjustment device. 
     In embodiments including hydraulic transmission means, an injection port connected to the hydraulic means may be provided for enabling, normally single, once-and-for-all, calibration of the amount of fluid in the hydraulic system. 
     In all embodiments a motor may be operatively connected to the adjustment device. A reversing device may be implanted in the patient for reversing the motor. The adjustment device preferably adjusts the restriction device in a non-manual manner without the patient touching his skin. 
     The adjustment device may be adapted to hydraulically adjust the restriction device by using hydraulic means which is devoid of hydraulic fluid of the kind having a viscosity that substantially increases when exposed to heat or a magnetic field, i.e. the hydraulic fluid would not become more viscous when exposed to heat or influenced by magnetic forces. 
     All the above-described various components, such as the motor, pump and capacitor, may be combined in the different embodiments where applicable. Also the various functions described in connection with the above embodiments of the invention may be used in different applications, where applicable. 
     All the various ways of transferring energy and controlling the energy presented in the present specification may be practised by using all of the various components and solutions described. 
     The invention also provides a method for treating male sexual impotence, comprising surgically implanting in the body of a male patient suffering from sexual impotence an adjustable restriction device which directly engages a portion of the normal penile tissue of the patient to affect the blood flow leaving the penis and the prolongation thereof, and when desired to achieve erection, mechanically adjusting the restriction device to temporarily restrict the blood flow leaving the penis. 
     The method may further comprise implanting the male sexual impotence treatment apparatus in the base of the patient&#39;s penis or its prolongation, preferably implanting an restriction device engaging the corpora cavernosa, crura or the prolongation thereof as a single unit or engaging the two corpora cavernosa or crura or the prolongations thereof separately. The method may comprise implanting the restriction device engaging one or both of the crura of the penis. 
     As a modification, the method may further comprise implanting the restriction device engaging at least one of the exit veins from the penis. 
     The invention provides another method for treating male sexual impotence, comprising the steps of: placing at least two laparascopical trocars in the body of a male patient suffering from sexual impotenc, inserting a dissecting tool through the trocars and dissecting an area of the penis and abdominal or peritoneal surroundings, placing at least one adjustable restriction device in the dissected area engaging the penile tissue or the prolongation thereof, and adjusting the restriction device to restrict the blood flow leaving the penis when the patient wishes to achieve erection. 
     The method may further comprise mechanically adjusting said restriction device in a non-manual manner. The restriction device may engage (a) both of the corpora cavernosa, the crura of the penis or the prolongation thereof as a single unit; or (b) one of the exit veins from the penis. 
     Alternatively, the method may further comprise implanting (a) a further adjustable restriction device, wherein the two restriction devices engage the two corpora cavernosa, the crura of the penis or their prolongations, respectively, as separate units; or (b) several restriction devices engaging respective exit veins from the penis. 
     The method may further comprise implanting a source of energy in the patient and providing a control device for controlling the source of energy from outside the patient&#39;s body to supply energy to the restriction device. 
    
    
     
       The invention is described in more detail in the following with reference to the accompanying drawings, in which 
         FIG. 1  is a schematic sectional view of a preferred first embodiment of the male sexual impotence treatment apparatus in accordance with the invention; 
         FIGS. 2 and 3  are cross-sectional views taken along the lines II-II and III-III, respectively, of  FIG. 1 ; 
         FIGS. 4 and 5  schematically show two alternative designs of the embodiment of  FIG. 1 ; 
         FIG. 6  schematically illustrates a motor arrangement for the design according to  FIG. 5 ; 
         FIG. 7  is a schematic sectional view of a second embodiment of the apparatus in accordance with the invention; 
         FIG. 8  schematically illustrates a hydraulic transmission conduit for the embodiment of  FIG. 7 ; 
         FIG. 9  is a schematic sectional view of a third embodiment of the apparatus in accordance with the invention; 
         FIG. 10  is a modification of the embodiment of  FIG. 9 ; 
         FIG. 11  is a schematic view of a fourth embodiment of the apparatus in accordance with the invention; 
         FIGS. 12 and 13  are enlarged details of the embodiment of  FIG. 11 ; 
         FIG. 14  is a cross-section along the line XIV-XIV of  FIG. 11 ; 
         FIG. 15  is a schematic view of a fifth embodiment of the apparatus in accordance with the invention; 
         FIG. 16  is an enlarged detail of  FIG. 15 ; 
         FIG. 17  is a cross-section along the line XVII-XVII of  FIG. 15 ; 
         FIGS. 18 to 21  are schematic sectional views of a sixth, seventh, eighth and ninth embodiments, respectively, of the apparatus in accordance with the invention; 
         FIGS. 22 and 23  illustrate a fully open and a reduced restriction opening, respectively, of the embodiment of  FIG. 21 ; 
         FIG. 24  is a schematic view of a tenth embodiment of the apparatus in accordance with the invention; 
         FIG. 25  is an enlarged detail of the embodiment of  FIG. 24 ; 
         FIGS. 26 and 27  illustrate a fully open and a reduced restriction opening, respectively, of the embodiment of  FIG. 24 ; 
         FIG. 28  schematically illustrates a cushion arrangement for protecting the tissue of the patient; 
         FIG. 29A-D  is a block diagram of four different principal embodiments of the invention; 
         FIG. 30A-D  are cross-sectional views of a pump mechanism according to  FIG. 29C , which pumps fluid in opposite directions by mechanically pushing a wall portion in only one direction; 
         FIG. 31  is a cross-sectional view of a reservoir having a variable volume controlled by a remote control motor, in accordance with a particular embodiment of the principal embodiment shown in  FIG. 29B or 308 ; 
         FIG. 32  is a cross-sectional view of a reservoir having a variable volume adjustable by manual manipulation, in accordance with a particular embodiment of the principal embodiment shown in  FIG. 29B or 29D ; 
         FIG. 33A  is a front view of a hydraulic, pneumatic or mechanical reverse servo system in accordance with a particular embodiment of the principal embodiment shown in  FIG. 29D ; 
         FIG. 33B  is a cross-sectional view taken along line VB-VB of  FIG. 33A ; 
         FIG. 34  is a block diagram illustrating remote control components of the apparatus of the invention; 
         FIG. 35  is a schematic view of a circuitry used for the system of the block diagram of  FIG. 34 ; 
         FIGS. 36A and 36B  are schematic views of an eleventh embodiment of the apparatus in accordance with the invention; 
         FIGS. 37A and 37B  are schematic views of a twelfth embodiment of the apparatus in accordance with the invention; 
         FIG. 38  is a schematic view of a thirteenth embodiment of the apparatus in accordance with the invention; 
         FIGS. 39A, 39B and 39C  are a schematic front view and schematic sectional views, respectively, of a fourteenth embodiment of the apparatus in accordance with the invention; 
         FIGS. 40A through 44B  are five modifications of the embodiment of  FIGS. 39A-39C ; 
         FIG. 45  illustrates the apparatus of the invention with a restriction device implanted around the corpus cavernosum of a patient; and 
         FIG. 46  illustrates the apparatus of the invention with two restriction members implanted around respective exit veins from the penis of a patient. 
     
    
    
     Referring to the drawing figures, like reference numerals designate identical or corresponding elements throughout the several figures. 
       FIGS. 1-3  show a preferred embodiment of the male sexual impotence treatment apparatus of the invention comprising a restriction device having an elongated restriction member in the form of a circular resilient core  2  with two overlapping end portions  4 , 6 . The core  2  defines a substantially circular restriction opening and is enclosed in an elastic soft hose  8  except at a releasable and lockable joint  10  of the core  2 , which when released enables application of the core  2  with its hose  8  around a tissue of a patient, such as the corpus cavernosum or one or more exit veins from the patient&#39;s penis. The materials of all of these elements are bio-compatible so that the patient&#39;s body will not reject them. A mechanical adjustment device  12  for mechanically adjusting the longitudinal extension of the core  2  to change the size of the restriction opening comprises a drive wheel  14  in frictional engagement with the overlapping end portions  4 , 6  of the core  2 . The drive wheel  14  is journalled on a holder  16  placed in the hose  8  and provided with two counter pressure rollers  18 , 20  pressing the respective end portions  4 ,  6  of the core  2  against the drive wheel  14  to increase the frictional engagement therebetween. An electric motor  22  is connected to the drive wheel  14  via a long flexible drive shaft  24  and is moulded together with a remote controlled power supply unit  26  in a body  28  of silicone rubber. The length of the flexible drive shaft  34  is selected so that the body  28  can be placed in a desired position in the patient&#39;s body, suitably in the abdomen. 
     When the patient wishes to achieve erection, he controls the power supply unit  26  to power the electric motor  22  to turn the drive wheel  14  in one direction to reduce the diameter of the core  2 , so that the penile tissue is squeezed and the blood flow leaving the penis is restricted. When the patient wishes to regain flaccid condition of his penis, he controls the power supply unit  26  to power the electric motor  22  to turn the drive wheel  14  in the opposite direction to increase the diameter of the core  2 , so that the tissue is released. 
     Alternatively, a rack gear may be formed on one of the end portions  4 , 6  of the core  2  and the drive wheel  14  may be replaced by a drive gear wheel connected to the other end portion of the core  2  and in mesh with the rack gear. 
       FIG. 4  shows an embodiment of the invention which is identical to the embodiment of  FIGS. 1-3 , except that the motor  22  is encapsulated in a lateral protrusion  30  of the hose  8  so that it is fixed to the core  2  and has a short drive shaft  32  onto which the drive wheel  14  is mounted, and that the motor  22  is positioned relative to the circular core  2  such that the drive shaft  32  extends radially thereto. 
       FIG. 5  shows an embodiment of the invention which likewise is identical to the embodiment of  FIGS. 1-3 , except that the motor  22  is encapsulated in the hose  8  so that it is fixed to the core  2  and has a short drive shaft  32 , and that the motor  22  is positioned relative to the core  2  such that the drive shaft  32  extends substantially tangentially to the circular core  2 . There is an angular gearing  34  connecting the drive shaft  32  to the drive wheel  14 . 
       FIG. 6  shows a suitable arrangement for the motor  22  in the embodiment of  FIG. 5 , comprising a first clamping member  36  secured to one end portion of the core  2  and a second clamping member  38  secured to the other end portion  6  of the core  2 . The motor  22  is secured to the first clamping member  36  and is operatively connected to a worm  40  via a gear transmission  42 . The worm  40  is journalled at its opposite ends on holders  44  and  46 , which are rigidly secured to the clamping member  36  and the motor  22 , respectively. The second clamping member  38  has a pinion in mesh with the worm  40 . When the motor  22  is powered the worm  40  rotates and will thereby pull the end portion  6  of the core  2  in one or the opposite longitudinal direction, so that the diameter of the substantially circular core  2  is either increased or decreased. 
       FIG. 7  shows an embodiment of the invention in which the elongated restriction member comprises a core  48  and a helical spring  50 . A spring contracting means in the form of a flexible pulling member  52 , i.e. a string, wire or cable, is connected to the core  48  at one end thereof and extends through the helical spring  50 . A hydraulic motor in the form of a cylinder/piston unit  54  is adapted to pull the flexible pulling member  52  to contract the helical spring  50  against an arresting member  56 , which is fixed relative to the core  48 . A tube  58  hinged to the arresting member  56  extends between the cylinder/piston unit  54  and the arresting, member  56 , the flexible pulling member  52  running through the tube  58  and being connected to the piston of the cylinder/piston unit  54 .  FIG. 8  shows a similar embodiment in which a hydraulic transmission conduit  59  is provided between two piston-cylinder assemblies  54 , for use as the hydraulic motor/device in  FIG. 7 . 
       FIG. 9  shows an embodiment of the invention in which the restriction member comprises two elongated helical springs  60  and  62  having free ends, and a body  64  to which the springs  60 , 62  are nonrotatably secured at their opposite ends. The body  64  comprises two separate parts secured to opposite end portions of the enclosing elastic hose  8  and is designed with a releasable and lockable joint between the separate parts. An adjustment device in the form of a drive shaft  66  has two opposite end portions connected to the helical springs  60 , 62 , respectively, at their free ends. The coils of the springs  60 , 62  form left and right hand helices, respectively. A motor  68  is adapted to rotate the drive shaft  66  in one direction to enlarge the coils of the helical springs  60 , 62  to longitudinally contract the springs  60 , 62  and to rotate the drive shaft  66  in the opposite direction to reduce the size of the coils of the springs  60 , 62  to longitudinally extend the springs  60 , 62 . Thus, the elongated helical springs  60 , 62  defines a restriction opening, the size of which is increased when the springs  60 , 62  are extended and decreased when the springs  60 , 62  are contracted. 
       FIG. 10  shows an embodiment according to the invention which is identical to the embodiment of  FIG. 9 , except that the adjustment device comprises a gearing having an input shaft  72  and two opposite aligned output shafts  74  and  76  connected to the helical springs  60  and  62 , respectively, at their free ends. The input shaft  72  is connected to the output shafts  74 , 76  such that they rotate at opposite directions upon rotation of the input shaft  72 . The coils of the springs  60 ,  62  form the same helices. 
       FIGS. 11-14  show an embodiment of the device of the invention in which a hydraulic motor comprises two interconnected cylinders  78  and  80  and two pistons  82  and  84  in the respective cylinders  78 , 80 . The cylinders  78 , 80  have a common fluid supply inlet member  86 , which together with the cylinders  78 , 80  takes the shape of a Y-pipe. The restriction member comprises an elongated resilient arcuate core  88 . The adjustment device comprises two bars  90  and  92  secured to opposite ends of the core  88  and connected to the pistons  82  and  84 , respectively. The core  88  defines a restriction opening and is provided with a releasable and lockable joint  94  ( FIG. 13 ) to permit application of the core  88  around the tissue. The core  88  and the cylinders  90 , 92  are enclosed by a soft elastic hose  96  except at the joint  94  and the inlet member  86 . The hose  96  has an outer tubular wall  98  and a central coaxial inner tubular wall  100 , which is fixed to the outer wall  98  by spoke members  102  ( FIG. 14 ). The core  88  is loosely fit in the inner tubular wall  100 . By supplying fluid to or withdrawing fluid from the inlet  86  the pistons  82  and  84  will move towards or from each other, so that the restriction opening defined by the core  88  is changed by the longitudinal displacement of the bars  90 , 92 . 
       FIGS. 15-17  show an embodiment of the invention which is identical to the embodiment of  FIGS. 11-14 , except that the adjustment device comprises an elongated voltage responsive element  104  secured to the opposite ends of the core  88 , so that the core  88  and the element  104  form the restriction member. The element  104  is capable of bending inwardly into a bow in response to a voltage applied across the element  104 . The radius of curvature of said bow is adjustable by changing the level of the voltage applied to element  104 . 
       FIG. 18  shows an embodiment of the invention comprising a loop forming means in the form of a substantially rigid outer circular element  106  with a releasable and lockable joint  108 . In this embodiment the restriction member comprises an elastic inner circular element  110  formed by the innermost wall portion of an elastic hose  112  extending along the outer element  106 . The inner circular element  110  is disposed concentrically within the outer circular element  106 . The adjustment device comprises a plurality of threads  114  secured to the elastic inner element  110  along the circumference thereof and running from the inner element  110  via guide members  116  attached to the outer element  106 . By pulling all the threads  114  the inner elastic element  110  is pulled under expansion radially outwardly towards the outer element  106 . 
       FIG. 19  shows an embodiment which is identical to the embodiment of FIGURE,  9 , except that it comprises a loop forming means in the form of a substantially rigid outer circular element  118  supporting the helical springs  60 , 62 , and a soft elastic inner wall  120  extending along the springs  60 , 62 . When the motor  68  rotates the helical springs  60 ,  62  in a direction that enlarges the coils of the springs  60 , 62 , the coils are forced by the rigid outer element  118  to expand radially inwardly thereby reducing the size of the restriction opening formed by the circumferential confinement surface of the restriction member (springs  60 , 62  and body  64 ). 
       FIG. 20  shows an embodiment of the invention in which a restriction member comprises a plurality of arcuate lamellae  122  arranged like the conventional adjustable aperture mechanism of a camera. The adjustment device, not shown, is conventional and is operated by a motor  124  to adjust the lamellae  122  to change the size of an restriction opening defined by the lamellae  122 . 
       FIGS. 21-23  show an embodiment of the invention in which a restriction member comprises two semi-circular elements  126  and  128  which are hinged together such that the semi-circular elements  126 , 128  are swingable relative to each other between a fully open state in which they substantially form a circle, illustrated in FIGURE,  22  and an angular state, in which the size of the restriction opening defined by the semi-circular elements  126 , 128  is reduced, illustrated in  FIG. 23 . The adjustment device, not shown, is conventional and is operated by a motor  130  to swing the semi-circular elements  126 , 128  relative to each other. 
       FIGS. 24-27  show an embodiment of the invention in which a restriction member comprises an elastic belt  130  forming a circle and having a substantially oval cross-section. The restriction member  130  is provided with a releasable and lockable joint  132 . An elastic double walled hose  134  encloses the belt  130  except at the joint  132 . The adjustment device, not shown, is conventional and is operated by a motor  136  to turn the belt  130  around the longitudinal extension thereof between a fully open state, in which the inner broader side of the belt  130  forms a substantially cylindrical surface, illustrated in  FIG. 26 , and a reduced open state, in which the inner broader side of the belt  130  forms a substantially conical surface, illustrated in  FIG. 27 . 
       FIG. 28  schematically illustrates a cushion arrangement for protecting the penile tissue, comprising a plurality of cushions  138  disposed in series along a substantially circular holding member  140 . This cushion arrangement may be utilized in any of the above described embodiments of the invention. 
       FIGS. 29A-D  provide a block diagram of four different hydraulic transmission configurations.  FIG. 29A  shows an adjustment device  202 , a separate reservoir  204 , a one way pump  206  and an alternate valve  208 .  FIG. 29B  shows the adjustment device  202  and an adjustable reservoir  210 .  FIG. 29C  shows the adjustment device  202 , a two-way pump  212  and the reservoir  204 .  FIG. 29D  shows a reverse servo system with a first closed system controlling a second system. The servo system comprises an adjustable servo reservoir  210  and a passive adjustable fluid supply reservoir  214 . Any of the reservoirs can be the active reservoir, either the servo reservoir  210  or the fluid supply reservoir  214 . The reservoir  214  controls a larger adjustable reservoir  216 , which is used for the operation of the adjustment device  202  for changing the restriction opening of the restriction member. 
       FIGS. 30A-D  are cross-sectional views of a pump mechanism adapted to pump fluid in both directions only by mechanically pushing a separate sealing wall portion  218  in one direction.  FIG. 30A  shows a piston  220  pushed forwards against a spring  222  towards the wall portion  218  and located in a pump housing  224  conducting fluid from a right upper fluid passage  226  of the housing  224  to a left fluid passage  228  of the housing  224 . A main valve  230  is open and a nonreturn valve  232  is closed.  FIG. 30B  illustrates the first pump movement in which the piston  220  has moved forwards and reaches the wall portion  218 .  FIG. 30C  illustrates how the piston  220  moves backwards by the action of the spring  222 . The main valve  230  is now closed and the nonreturn valve  232  is open for fluid from the right upper passage  226 .  FIG. 30D  illustrates how the piston  220  is moved further downwards from its position according to  FIG. 30B  while pushing the wall portion  218  downwards against a second spring  234  that is stronger than spring  222 , so that fluid escapes from a right lower fluid passage  236 . When moving the piston  220  backwards from the position of  FIG. 30D , fluid enters the left fluid passage  228  and a valve  238  in the lower right fluid passage  236  closes. 
       FIG. 31  is a cross-sectional view of a reservoir  240  defining a chamber  242 , the size of which is variable and is controlled by a remote controlled motor  244 , in accordance with  FIG. 29B or 29D . The reservoir  240  and the motor  244  are placed in a housing  246 . The chamber  242  is varied by moving a large wall  248 . The wall  248  is secured to a nut  250 , which is threaded on a rotatable spindle  252 . The spindle  252  is rotated by the motor  244  via an angular gearing, which comprises two conical gear wheels  254  and  256  in mesh with each other. The motor  244  is powered by a battery  258  placed in the housing  246 . A signal receiver  260  for controlling the motor  244  is also placed in the housing  246 . Alternatively, the battery  258  and the signal receiver  260  may be mounted in a separate place. The signal receiver may comprise any known or conventional device which is capable of receiving a control signal and then operating the motor  244 . 
       FIG. 32  is a cross-sectional view of a reservoir  262  defining a chamber  264 , the size of which is variable and is controlled by manual manipulation. A gable wall portion  266  of an open ended inner cylindrical housing  68  is adapted to be pushed downwards to fit in a desired locking groove  270  of a plurality of locking grooves  270  on the mantle wall of the cylindrical housing  268 , to reduce the size of the chamber  64 . The inner cylindrical housing  268  is suspended by springs  272  and is telescopically applied on an outer cylindrical housing  274 . When pushing the inner cylindrical housing  268  it moves downwards relative to the outer cylindrical housing  274  causing the gable wall portion  266  to release from the locking groove  270  and move upwards relative to the inner cylindrical housing  268 . When the inner housing  268  is moved upwardly by the action of the springs  272  the size of the chamber  264  is increased. 
       FIGS. 33A and 33B  show a reverse servo means comprising a main ring-shaped fluid reservoir  276  defining a chamber  278 , the size of which is variable. Centrally positioned in the main ring-shaped reservoir  276  there is a servo fluid reservoir  280  defining a chamber  282 , the size of which is variable. The chamber  282  of the servo reservoir  280  is significantly smaller than the chamber  278  of the main reservoir  276 . The two reservoirs  276  and  280  are situated between two opposite separate walls  284  and  286 , and are secured thereto. When changing the amount of fluid in the servo reservoir  280 , the two opposite walls  284 , 286  are moved towards or away from each other, whereby the size of the chamber  278  of the main reservoir  276  is changed. 
       FIG. 34  shows the basic parts of a remote control system of the apparatus of the invention including a motor, for instance the electric motor  22 . In this case, the remote control system is based on the transmission of an electromagnetic wave signal, often of a high frequency in the order of 100 kHz-1 gHz, through the skin  330  of the patient. In  FIG. 34 , all parts placed to the left of the skin  330  are located outside the patient&#39;s body and all parts placed to the right of the skin  330  are implanted in the patient&#39;s body. 
     An external signal transmitting antenna  332  is to be positioned close to a signal receiving antenna  334  implanted in the patient&#39;s body close to the skin  330 . As an alternative, the receiving antenna  334  may be placed for example inside the abdomen of the patient. The receiving antenna  334  comprises a coil, approximately 1-100 mm, preferably 25 mm in diameter, wound with a very thin wire and tuned with a capacitor to a specific high frequency. A small coil is chosen if it is to be implanted under the skin of the patient and a large coil is chosen if it is to be implanted in the abdomen of the patient. The transmitting antenna  332  comprises a coil having about the same size as the coil of the receiving antenna  334  but wound with a thick wire that can handle the larger currents that is necessary. The coil of the transmitting antenna  332  is tuned to the same specific high frequency as the coil of the receiving antenna  334 . 
     An external control unit  336  comprises a microprocessor, a high frequency electromagnetic signal generator and a power amplifier. The microprocessor of the control unit  336  is adapted to switch on/off the generator and to modulate signals generated by the generator to send digital information via the power amplifier and the antennas  332 , 334  to an implanted control unit  38 . To avoid that accidental random high frequency fields trigger control commands, digital signal codes are used. A keypad placed on the external control unit  336  is connected to the microprocessor thereof. The keypad is used to order the microprocessor to send a digital signal to either increase or decrease the size of the restriction opening defined by the loop of the restriction member (e.g. as described above). The microprocessor starts a command by applying a high frequency signal on the antenna  332 . After a short time, when the signal has energised the implanted parts of the control system, commands are sent to increase or decrease the size of the restriction opening of the restriction member in predefined steps. The commands are sent as digital packets in the form illustrated below. 
     
       
         
           
               
               
               
               
               
             
               
                   
                   
               
             
            
               
                   
                 start pattern, 
                 Command, 
                 Count, 
                 Checksum, 
               
               
                   
                 8 bits 
                 8 bits 
                 8 bits 
                 8 bits 
               
               
                   
                   
               
            
           
         
       
     
     The commands are sent continuously during a rather long time period (e.g. 30 seconds or more). When a new increase or decrease step is desired the Count byte is increased by one to allow the implanted control unit  338  to decode and understand that another step is demanded by the external control unit  336 . If any part of the digital packet is erroneous, its content is simply ignored. 
     Through a line  340 , an implanted energiser unit  326  draws energy from the high frequency electromagnetic wave signal received by the receiving antenna  334 . The energiser unit  326  stores the energy in a power supply, such as a large capacitor, powers the control unit  338  and powers the electric motor  22  via a line  342 . 
     The control unit  338  comprises a demodulator and a microprocessor. The demodulator demodulates digital signals sent from the external control unit  336 . The microprocessor of the control unit  338  receives the digital packet, decodes it and, provided that the power supply of the energiser unit  326  has sufficient energy stored, sends a signal via-a signal line  344  to the motor  22  to either increase or decrease the size of the restriction opening of the restriction member depending on the received command code. 
     Alternatively, the energy stored in the power supply of the energiser unit may only be used for powering a switch, and the energy for powering the motor  22  may be obtained from another implanted power source of relatively high capacity, for example a battery. In this case the switch is adapted to connect the battery to the control unit  338  in an “on” mode when said switch is powered by said power supply and to keep said battery disconnected from the control unit in a “standby” mode when the switch is not powered. 
     With reference to  FIG. 35 , the remote control system schematically described above will now be described in accordance with a more detailed embodiment. The external control unit  336  comprises a microprocessor  346 , a signal generator  348  and a power amplifier  350  connected thereto. The microprocessor  346  is adapted to switch the signal generator  348  on/off and to modulate signals generated by the signal generator  348  with digital commands that are sent to implanted components of the device of the invention. The power amplifier  350  amplifies the signals and sends them to the external signal transmitting antenna  332 . The antenna  332  is connected in parallel with a capacitor  352  to form a resonant circuit tuned to the frequency generated by the signal generator  348 . 
     The implanted signal receiving antenna coil  334  forms together with a capacitor  354  a resonant circuit that is tuned to the same frequency as the transmitting antenna  332 . The signal receiving antenna coil  334  induces a current from the received high frequency electromagnetic waves and a rectifying diode  360  rectifies the induced current, which charges a storage capacitor  358 . A coil  356  connected between the antenna coil  334  and the diode  360  prevents the capacitor  358  and the diode  360  from loading the circuit of the signal receiving antenna  334  at higher frequencies. Thus, the coil  356  makes it possible to charge the capacitor  358  and to transmit digital information using amplitude modulation. 
     A capacitor  362  and a resistor  364  connected in parallel and a diode  366  forms a detector used to detect amplitude modulated digital information. A filter circuit is formed by a resistor  368  connected in series with a resistor  370  connected in series with a capacitor  372  connected in series with the resistor  368  via ground, and a capacitor  374 , one terminal of which is connected between the resistors  368 , 370  and the other terminal of which is connected between the diode  366  and the circuit formed by the capacitor  362  and resistor  364 . The filter circuit is used to filter out undesired low and high frequencies. The detected and filtered signals are fed to an implanted microprocessor  376  that decodes the digital information and controls the motor  22  via an H-bridge  378  comprising transistors  380 , 382 , 384  and  386 . The motor  22  can be driven in two opposite directions by the H-bridge  378 . 
     The microprocessor  376  also monitors the amount of stored energy in the storage capacitor  358 . Before sending signals to activate the motor  22 , the microprocessor  376  checks whether the energy stored in the storage capacitor  358  is enough. If the stored energy is not enough to perform the requested operation, the microprocessor  376  waits for the received signals to charge the storage capacitor  358  before activating the motor  22 . 
       FIGS. 36A and 36B  show an embodiment of the apparatus of the invention comprising a restriction device  402  having an elongated flexible restriction member  404 , such as a belt, a cord or the like. The flexible member  404  extends in a loop around the tissue, suitably an exit vein from the penis. (Alternatively, the flexible member  404  may comprise two separate parts on opposite sides of the vein.) One portion  404 A of member  404  is attached to a frame  408  and another portion  404 B of member  404  opposite portion  404 A in the loop of the flexible member  404  is connected to an adjustment device  410 , which is fixed to the frame  408 . The adjustment device  410  pulls the flexible member  404  in the direction from portion  404 A to squeeze the vein between two opposite lengths of the flexible member  404  to thereby restrict the blood flow in the vein  406 , see  FIG. 36A , and releases the vein from the flexible member  404  to thereby increase the blood flow in the vein  406 , see  FIG. 36B . 
       FIGS. 37A and 37B  show an embodiment of the apparatus of the invention comprising a restriction device  412  having two rigid plate or bar elements  414  on opposite sides of the vein  406 . An adjustment device  416  moves the rigid elements  412  in parallel towards each other to squeeze the vein  406  between the rigid elements  412  to thereby restrict the blood flow in the vein  406 , see  FIG. 37A , and moves the rigid elements  412  away from each other to release the vein  406 , see  FIG. 37B . 
       FIG. 38  shows an embodiment of the apparatus of the invention comprising a restriction device  418  having two rigid articulated clamping elements  420  positioned on opposite sides of the vein  406 . An adjustment device  422  turns the clamping elements  420  toward each other to clamp the vein  406  between the clamping elements  420  to thereby restrict the blood flow in the vein  406 , and turns the clamping elements  420  away from each other to release the vein  406  from the clamping elements  420  to thereby increase the blood flow in the vein  406 . 
       FIGS. 39A, 39B and 39C  show an embodiment of the apparatus of the invention comprising a restriction device  424  having three bending members in the form of cylindrical rollers  426 ,  428  and  430  displaced relative one another in a row along the vein  406  and positioned alternately on opposite sides of the vein  406 . (Alternatively, each roller  426 ,  428  and  430  may take the shape of an hour-glass.) An adjustment device  432  moves the two outer rollers  426 , 430  laterally against the vein  406  in one direction and the intermediate roller  428  against the vein  406  in the opposite direction to bend the vein to thereby restrict the blood flow in the vein  406 , see  FIG. 39B . To increase or restore the blood flow in the vein  406 , the adjustment device  432  moves the rollers  426 - 430  away from the vein  406  to release the vein from the rollers  426 - 430 , see  FIG. 39C . 
       FIGS. 40A through 44B  schematically illustrates modifications of the above embodiment according to  FIGS. 39A-39C . Thus,  FIGS. 40A and 40B  show an embodiment similar to that of  FIGS. 39A-39C  except that the bending members are oval and not rotatable.  FIGS. 41A and 41B  show an embodiment similar to that of  FIGS. 40A and 40B  except that the oval bending members are rotatable to release the vein, see  FIG. 41A , and squeeze the vein, see  FIG. 41B .  FIGS. 42A and 42B  show an embodiment similar to that of  FIGS. 39A-39C  except that the intermediate roller has a changeable diameter to release the vein, see  FIG. 42A , and squeeze the vein, see  FIG. 42B .  FIGS. 43A and 43B  show an embodiment similar to that of  FIGS. 37A-37C  except that the rigid elements are replaced by two cylindrical rollers positioned on opposite sides of the vein. Finally,  FIGS. 44A and 44B  show an embodiment substantially similar to that of  FIGS. 43A and 43B  except that the restriction device is curved to form an S-shaped curvature of the vein. 
       FIG. 45  schematically illustrates how any of the above-described embodiments of the male sexual impotence treatment apparatus of the invention may be implanted in a patient. Thus, the apparatus comprises an adjustable restriction device  434  extending around the corpus cavernosum of the patient and a motor operated adjustment device  436  for mechanically adjusting the restriction device  434  to squeeze the corpus cavernosum to thereby restrict the blood flow leaving the penis. The motor, not shown, is integrated in the adjustment device  436  and is reversible to operate the adjustment device  436  to release the corpus cavernosum from the restriction device  434 . A wireless remote control of the apparatus comprises an external signal transmitter  438  incorporated in a portable remote-control case and an implanted signal receiver  440 , which comprises a control unit for controlling the adjustment device  436  in response to a control signal, for example an electromagnetic wave signal, from the transmitter  438 . The signal receiver  440  further comprises an energiser unit which transfers energy from the control signal transmitted by the transmitter  438  into electric energy for energy consuming implanted components of the apparatus, such as the motor for operating the adjustment device  436 . The electric energy is conducted via an implanted conductor  442  from the signal receiver  440  to the motor. When the patient wishes to achieve erection, he readily uses the portable remote-control case to activate the implanted adjustment device  436  to temporarily adjust the implanted restriction device  434  to restrict the blood flow leaving his penis. 
       FIG. 46  shows an embodiment which is identical to the embodiment of  FIG. 45 , except that the restriction device comprises two restriction members  444  and  446  extending around respective exit veins from the penis. A motor operated adjustment device, not shown, is incorporated in each restriction member  444 , 446 . 
     There are a number of other conceivable alternative embodiments of the invention that give the same result as the above-described embodiments. For example, the microprocessor of the external and implanted, respectively, control unit may be replaced by discrete components. The power amplifier of the external control unit may be omitted if the signals generated by the signal generator are strong enough. Therefore the invention is to be accorded the broadest interpretation of the appended claims to encompass all equivalent structures and assemblies.