Thinking about an implant

[buddypayne]

What questions should I ask my urologist about getting an implant by him?

[BearsWin]

I think most folks on this board would agree it's critical your urologist has extensive experience with implant surgery.

I would first ascertain that he/she has done hundreds if not thousands of implants and is actively doing a fair number monthly. You'll see various names come up on the board regularly and if you live in proximty to one of those surgeons I'd at least have a consultation.

If your question was more "should I get an implant" versus "should I use my current urologist for an implant" I'm sure any doctor can walk you through the various options - most folks have had either no or vastly diminished response from oral medications and most commonly have tried Trimix or other injectables and either haven't had adequate success or have had a side effect that makes continued use unsafe.

Hope that starts to answer your question.

[newbie443]

What questions should I ask my urologist about getting an implant by him?

The thing is many doctors have had men ask questions and have learned what to reply. Experience has been shown to lower the risk of reoperation for infection and other causes. https://www.garber-online.com/pdf/Highe ... ctions.pdf But that study shows the doctors who do 8-30 a year are really close to the ones that do 31 and more a year. The thing is to stay away from the ones that just do less than 8 a year and most of all 0-2 a year. But how do you know how many the doctor does? He could say anything. The thing is to ask questions that will give you an indication of the doctors experience and interest in the surgery and concern to do the best for you. Reoperations with replacement surgery is more difficult than the first implant surgery and not all doctors do them. So ask if the doctor does repairs or replacement surgery. If he dose not do them ask who they send men to for that and that would be the next place I would go to. Another question would be to ask how long you will be left inflated after the surgery. A study called the " coffin effect" in the general discussion section of this site in the documents worth reading list pined to the top, shows longer waits for activation (when you deflate and start cycling the device by inflating and deflating it) have a relation to size loss during surgery. The 8 week waits for a simple implant is an indication of a lower volume doctor. # weeks or less is a indication of a more experienced doctor. But if you require more work do then you may need a longer wait to start cycling. You can ask about size loss and infection rate but again how can you verify the information. Best to ask to speak to a man the doctor implanted and ask about size loss and if he knows if the doctor really does reoperations or not and wait time for activation. You can put your doctors name in the search box at the upper right of this page and see if there is anything posted.

Good luck

[Jage64]

My first post here on FrankTalk, this is a great resource.

I recently met with a urologist at Kaiser in northern California, and when I visited with him I had numerous questions that were generated by lurking on FT for the past few weeks. I recommend you do that, read as many experiences as you can and write down the questions that come to mind. Also watch YouTube videos, Dr. Clavell has many excellent videos.

I my case, I had probably 20 questions to ask him, and he appreciated that I had done some homework and had good questions to ask. It made the visit much more beneficial for both of us. Since I may use Kaiser, the urologist is 'assigned' to me, I don't get to pick. Although I'm sure I could probably change urologists if I made a case for doing so. When I spoke to my primary care physician about an implant, I was referred to urology and then assigned to this doctor. He's a very nice guy, easygoing and answered all my questions.

Although the questions were answered, I'm not convinced they're to my liking. I asked how many of these he had done, he said about 100. I asked if he used Coloplast or AMS, he said that Kaiser uses AMS (so I don't have a choice). As he warned me about correctly sizing so as to not cause the implant to rupture the skin, I got the sense that he would opt for a smaller implant than I could accommodate just to minimize risks. I asked if he was the type to try to push the envelope a bit or if he would prefer to undersize in the name of safety (this I felt was a rigged question to see what he'd say), he opted for undersizing just to be safe.

At the end of the visit, he had me drop my pants and after a short inspection he held me in a position and said that I could expect the final product to look just about like this... I was shocked. I would not go through all this to have my penis end up so short. Prior to my ED, I was 7" and not particularly girthy, (I'm 6'5"). I realize that I have probably lost length due to the ED, but my guess is he had me extended to about 4.5". I realize that I will not emerge from surgery at 7", but 4.5" to say... 6" is noticeable. Up to that point, I was enthusiastic and nearly ready to make the surgery appointment. I left there extremely disillusioned.

So, here I am. I can pay $25 copay and have this kind doctor give me what looks like a 4.5" dick. Or, I can research other highly rated docs and pay out of pocket ($20,000?) for what I hope would be something closer to 6"+ with the option of choosing the implant and having it performed by someone that has seen everything, knows all the tricks and will allow me to contact them directly (instead of going through phone tree hell).

My inclination right now is that I'll pay out of pocket. The LAST thing I think I want to do is cheap out on this and then wonder what could have been if I had only paid for the best. I think that would give me ED just thinking about what I may have missed. I've reached out to high volume doctors to see what they say.

Read up on FrankTalk, make notes when a question comes to mind.

[newbie443]

My first post here on FrankTalk, this is a great resource.

I recently met with a urologist at Kaiser in northern California, and when I visited with him I had numerous questions that were generated by lurking on FT for the past few weeks. I recommend you do that, read as many experiences as you can and write down the questions that come to mind. Also watch YouTube videos, Dr. Clavell has many excellent videos.

I my case, I had probably 20 questions to ask him, and he appreciated that I had done some homework and had good questions to ask. It made the visit much more beneficial for both of us. Since I may use Kaiser, the urologist is 'assigned' to me, I don't get to pick. Although I'm sure I could probably change urologists if I made a case for doing so. When I spoke to my primary care physician about an implant, I was referred to urology and then assigned to this doctor. He's a very nice guy, easygoing and answered all my questions.

Although the questions were answered, I'm not convinced they're to my liking. I asked how many of these he had done, he said about 100. I asked if he used Coloplast or AMS, he said that Kaiser uses AMS (so I don't have a choice). As he warned me about correctly sizing so as to not cause the implant to rupture the skin, I got the sense that he would opt for a smaller implant than I could accommodate just to minimize risks. I asked if he was the type to try to push the envelope a bit or if he would prefer to undersize in the name of safety (this I felt was a rigged question to see what he'd say), he opted for undersizing just to be safe.

At the end of the visit, he had me drop my pants and after a short inspection he held me in a position and said that I could expect the final product to look just about like this... I was shocked. I would not go through all this to have my penis end up so short. Prior to my ED, I was 7" and not particularly girthy, (I'm 6'5"). I realize that I have probably lost length due to the ED, but my guess is he had me extended to about 4.5". I realize that I will not emerge from surgery at 7", but 4.5" to say... 6" is noticeable. Up to that point, I was enthusiastic and nearly ready to make the surgery appointment. I left there extremely disillusioned.

So, here I am. I can pay $25 copay and have this kind doctor give me what looks like a 4.5" dick. Or, I can research other highly rated docs and pay out of pocket ($20,000?) for what I hope would be something closer to 6"+ with the option of choosing the implant and having it performed by someone that has seen everything, knows all the tricks and will allow me to contact them directly (instead of going through phone tree hell).

My inclination right now is that I'll pay out of pocket. The LAST thing I think I want to do is cheap out on this and then wonder what could have been if I had only paid for the best. I think that would give me ED just thinking about what I may have missed. I've reached out to high volume doctors to see what they say.

Read up on FrankTalk, make notes when a question comes to mind.

Welcome to the site. Go online to your insurance company's site and log in to your policy and look for a doctor search function. Worth a shot to see if there are some other better doctors in network with your policy. There are some really good doctors in CA and you might check with them to see if they are able to file with your insurance.

Good luck.

[Floridaspeedo]

I have a history of kidney stones so I have known 2 urologists very very well during my adult life. Both did veinous tests on me, Cialis, Trimix, etc.

Either could have done my implant (one is a well known surgean highly trained in robotics for testicular cancer) but even they suggested going to a Dr. with more experience with the IPP procedure. Not necessairly high volume, but more experience.

So I researched two Dr's and made a decision who to go with and I am very happy.

I urge you to do research on a Dr who is well trained on the procedure. You don't necessarily need a high volume implanter but that will depend on your case, scrotal versus infrapubic, pyronnies, etc.

[crazyjoe]

Buddy -- where are you located?

[Jage64]

Welcome to the site. Go online to your insurance company's site and log in to your policy and look for a doctor search function. Worth a shot to see if there are some other better doctors in network with your policy. There are some really good doctors in CA and you might check with them to see if they are able to file with your insurance.

Good luck.

With a normal insurance company, this would be good advice. With Kaiser Permanente, you get the doctors that are in their closed system. There are no "out of network" doctor options, and Kaiser will not pay for anything outside of their closed system.

Hence my dilemma, $25 or $25,000.....

[Musson]

Jage, PM’d you. Looking for any info on Kaiser NorCal you might have.

[woodturner]

I did a ton of research before I got my implant 8 years ago. In my opinion a Doctor's implant experience is the most important criteria if you are seriously considering an implant.

I researched many doctors and I chose Dr Aaron Lentz before he became so well known on this board.
He is a high volume surgeon.
I have to have a revision now (fault is the implant not the doctor). I have chosen another high volume surgeon, a Dr Hotaling (live to far away to go back to Dr Lentz).
As Dr Hotaling told me that 5% of the surgeons do 80% of the implants. I remember reading that several years ago.
If they run into a bit of a problem the high volume doctor is going to have a much better chance of dealing with it. In fact, it is not uncommon for some high volume surgeons to do surgeries fixing what other doctors screwed up.

Just a few things you may want to consider.