Revision number two switching AMS CX for Titan XL.

[RelievedofED1]

Just had my second revision yesterday with Dr Kramer. My first was an AMS CX with 21 cm with 1cm RTE developed an aneurysm. Loved it. Replaced last April with AMS CX 21 cm again with 2 cm RTEs in part to avoid having to replace my reservoir since coloplast uses a different reservoir with lockout in reservoir. After about year I regained the 1/4-1/2 inch or so of length I noticed I lost with penile implant #1. I wasn’t concerned about length as it already causes some discomfort to my petite wife as it was but measured since many here like me worried with my first that that I would lose inches. I did not. I didn’t lose length I think because Dr Kramer made sure the tips reach out all the way to the tip of my penis.

Skip to since second implant that was now 21 cm using now 2 cm RTEs . I have anatomy with what I think has more of my penis outside my not so deep crura so the tubing came off on the palpable and insertable shaft making deep penetration uncomfortable. I also had what Dr K described as Maserati scrotum lol with lots of palpable tubing. He had warned me postop that the tubing was longer since my initial pump and that might be an issue. I think he was hoping no issue and didn’t have to cut preconnected tubing to create a possible weak point.Because of the discomfort I spoke with Dr K in June and asked him about going with a 24 cm with no RTE implant and since I had also lost girth since implants could we go with a Titan XL 24. Each revision carries an increasing risk of infection and replacing the reservoir has significant risk of bleeding etc. With all that in mind I still decided to go ahead with replacement and had that done yesterday. Reservoirs can be placed under the muscle and be palpable or deeper next to the bladder in the space of Retzius. Dr K said he might have to do submuscular if difficult to remove reservoir. He didn’t have the easy choice of using the right side because I had hernia repair on the right. My original reservoir was on the left deep and fortunately it was able to be removed and replaced. My first two implants were minimally sore post op. The first revision was almost painless and i felt I could drive home the next day though I didn’t to be safe.

Now for this now post op day 1. Yesterday was a very groggy post op days I think related to two additional preop meds added this time but relatively pain free. I have some scrotal incision discomfort and different this time unlike last I have slight discomfort where the new reservoir is likely due to scar tissue rework to remove old reservoir and the larger reservoir with titan. That said I’ve only had to take Tylenol a few times. I have been icing and taking it easy mainly sleeping and bed rest most of yesterday. This AM I removed dressing and catheter I went home with yesterday. First urination without catheter easy and painless.

The next hurdle will be over the next couple of weeks when the infection risk is most likely. Hoping that doesn’t happen because even in the very capable hands of Dr Kramer it happens. Prayers for me if you are so inclined. Thanks all for being there for me and others as I’ve navigated this 8 year journey since taking the plunge. Best decision I made was to get an implant second only to my choosing Dr Kramer. Great surgeon and great and caring human being. As a physician myself, I’ve worked with many docs and he is in the top tier on all counts. Hope this helps some of you who are wrestling with the decisions I’ve made. If you take the plunge after trying everything else get a top tier surgeon who is high volume who you can speak with and know they care pre annnd will be there post op understanding the anxiety we all have bordering on neurotic at times lol.

[nuance]

Just had my second revision yesterday with Dr Kramer. My first was an AMS CX with 21 cm with 1cm RTE developed an aneurysm. Loved it. Replaced last April with AMS CX 21 cm again with 2 cm RTEs in part to avoid having to replace my reservoir since coloplast uses a different reservoir with lockout in reservoir. After about year I regained the 1/4-1/2 inch or so of length I noticed I lost with penile implant #1. I wasn’t concerned about length as it already causes some discomfort to my petite wife as it was but measured since many here like me worried with my first that that I would lose inches. I did not. I didn’t lose length I think because Dr Kramer made sure the tips reach out all the way to the tip of my penis.

Skip to since second implant that was now 21 cm using now 2 cm RTEs . I have anatomy with what I think has more of my penis outside my not so deep crura so the tubing came off on the palpable and insertable shaft making deep penetration uncomfortable. I also had what Dr K described as Maserati scrotum lol with lots of palpable tubing. He had warned me postop that the tubing was longer since my initial pump and that might be an issue. I think he was hoping no issue and didn’t have to cut preconnected tubing to create a possible weak point.Because of the discomfort I spoke with Dr K in June and asked him about going with a 24 cm with no RTE implant and since I had also lost girth since implants could we go with a Titan XL 24. Each revision carries an increasing risk of infection and replacing the reservoir has significant risk of bleeding etc. With all that in mind I still decided to go ahead with replacement and had that done yesterday. Reservoirs can be placed under the muscle and be palpable or deeper next to the bladder in the space of Retzius. Dr K said he might have to do submuscular if difficult to remove reservoir. He didn’t have the easy choice of using the right side because I had hernia repair on the right. My original reservoir was on the left deep and fortunately it was able to be removed and replaced. My first two implants were minimally sore post op. The first revision was almost painless and is felt I could drive home the next day though I didn’t to be safe.

Now for this now post op day 1. Yesterday was a very groggy post op days I think related to prepping meds added this time but relatively pain free. I have some scrotal incision discomfort and different this time unlike last I have slight discomfort where the new reservoir is likely due to scar tissue rework to remove old reservoir and the larger reservoir with titan. That said I’ve only had to take Tylenol a few times. I have been icing and taking it easy mainly sleeping and bed rest most of yesterday. This AM I removed dressing and catheter I went home with yesterday. First urination without catheter easy and painless.

The next hurdle will be over the next couple of weeks when the infection risk is most likely. Hoping that doesn’t happen because even in the very capable hands of Dr Kramer it happens. Prayers for me if you are so inclined. Thanks all for being there for me and others as I’ve navigated this 8 year journey since taking the plunge. Best decision I made was to get an implant second only to my choosing Dr Kramer. Great surgeon and great and caring human being. As a physician myself, I’ve worked with many docs and he is in the top tier on all counts. Hope this helps some of you who are wrestling with the decisions I’ve made. If you take the plunge after trying everything else get a top tier surgeon who is high volume who you can speak with and know they care pre annnd will be there post op understanding the anxiety we all have bordering on neurotic at times lol.

Thanks for this post and details provided. Can I ask what cylinder aneurysm is? Also why does replacing the reservoir have significant risk of bleeding? Unless the reservoir gets detached, what might make it difficult to remove it? I'm not sure how many tubes are connected to the reservoir but if there's only one and that gets disconnected, I can see that being problematic. To avoid tubing, mostly like they'll have to splice it as we're all different and it's not easy to find one that fits us exactly. What did the Dr do for the tubing issue in the 2nd revision?

Wishing you a speedy recovery without any infection !!

[Wiggles123]

Reservoir removal can be difficult as your body encapsulates the reservoir just like any other foreign body. That capsule can be enmeshed in other tissues around it and make it very difficult to remove without a large scar.

[nuance]

Reservoir removal can be difficult as your body encapsulates the reservoir just like any other foreign body. That capsule can be enmeshed in other tissues around it and make it very difficult to remove without a large scar.

That should make revisions complicated but those that had revisions said it's not as bad as the first implant. I've watched a few revision videos where the doctor was able to just pull it out with no capsule on it. If a capsule where to be formed, wonder how long that takes.

[Wiggles123]

My revision required extra work to get the reservoir out.

[RelievedofED1]

I was fortunate that my reservoir came out fairly easily. They can cause bleeding but usually not terrible difficult to fix and fortunately very rare. If it is replacing with the same company you can cut the tubing and reuse old one as I did with my first revision. And you can deflate and leave old one and insert new one as an option that has been used without problems per my doc. All of this per Dr Kramer.

[RelievedofED1]

Well I’m now two months out from my second revision and switch to a Titan from AMS CX. At first I was concerned that as many have said that the Titan folds were noticeable and uncomfortable. I don’t really notice them at all anymore unless I palpate looking for them. No pain. Both brands gave me an erection harder than my natural erection. The one advantage for me with the Titan was regaining some of the girth I had lost with the first implant as compared to erections in my thirties. I was 5.5 inches maximum girth with my CX and now 5.75 to 6.25 inches in girth as I get closer to my body. My implants have increased by 1 cm with each implant and I have now gotten all my length back as compared to my thirties.

As I’ve said before, try everything else first and if not working don’t wait years to consider an implant with a high volume surgeon that you feel cares about you as a person not just an implant case. I’m a Dr Kramer fan and would go anywhere to see him if I ever need another implant but there are other docs out there that are also good.

I hope you are all getting the information you need from this site but also talking to prospective surgeons to see if you are a good candidate for an implant and see how they fit your personality. Prayers said for you all.

[wolfpacker]

Well I’m now two months out from my second revision and switch to a Titan from AMS CX. At first I was concerned that as many have said that the Titan folds were noticeable and uncomfortable. I don’t really notice them at all anymore unless I palpate looking for them. No pain. Both brands gave me an erection harder than my natural erection. The one advantage for me with the Titan was regaining some of the girth I had lost with the first implant as compared to erections in my thirties. I was 5.5 inches maximum girth with my CX and now 5.75 to 6.25 inches in girth as I get closer to my body. My implants have increased by 1 cm with each implant and I have now gotten all my length back as compared to my thirties.

As I’ve said before, try everything else first and if not working don’t wait years to consider an implant with a high volume surgeon that you feel cares about you as a person not just an implant case. I’m a Dr Kramer fan and would go anywhere to see him if I ever need another implant but there are other docs out there that are also good.

I hope you are all getting the information you need from this site but also talking to prospective surgeons to see if you are a good candidate for an implant and see how they fit your personality. Prayers said for you all.

Very interesting to read your account of CX vs Titan, not many men on here have had both. I have a Titan now but if I had to get a revision today, I'd consider a CX because I really don't love the titan "flacid"/deflated look. Was it more natural with a CX? Also I saw you said the titan gives better girth at the base, was mid-shaft girth improved with the titan too?

[RelievedofED1]

The CX was a little more natural as to hang than the Titan which at least while Titan cylinders are newish like mine Titan is a bit stiffer though I doubt anyone in a locker room would notice. The entire shaft is girthier than before when I had CX by 1/4 inch or more but even more so at the base. And shaft more round and slightly less oval though like the appearance flaccid versus CX I doubt anyone would notice except me. Having had both if the goal is an erection hard enough for penetration then both work great. Not sure the risk of infection etc would be worth a revision if a working comfortable implant. Please reach out if I didn’t answer all your questions as I can’t seem to copy and quote your post to review while writing.

Thanks for the questions.

[nuance]

Very interesting to read your account of CX vs Titan, not many men on here have had both. I have a Titan now but if I had to get a revision today, I'd consider a CX because I really don't love the titan "flacid"/deflated look. Was it more natural with a CX? Also I saw you said the titan gives better girth at the base, was mid-shaft girth improved with the titan too?

Is it still hard or does it bend to the side? what about it don't you like?