Which surgery is best for me? Penoscrotal or infrapubic?

[macoza]

I'm scheduled for surgery in a few weeks. But I'd like to find out the best approach to surgery. There are 2 approaches which are the penoscrotal and infrapubic approach. I'd like to know which is safer and better in general and which is best to avoid cutting of nerves? I want to avoid damage to nerves responsible for libido.

[Irish Lad 34]

I had the same conundrum myself. Could not decide what approach to take. My surgeon does both and initially reccomended infrapubic, but loads of people on Franktalk reccomended penoscrotal.

I questioned him on things like penoscrotal, cutting nerves with infrapubic, palpable tubing etc.

He then advised me that he does both infrapubic and penoscrotal and the choice is mine, he would not choose for me. He initially reccomended infrapubic mostly for the smoother healing journey and ability to cycle quicker.

I initially agreed infrapubic, then switched to penoscrtoal, then switched back to infrapubic, then switched back to penoscrotal and now I can't change any more because my implant is scheduled for Wednesday 12th November and the hospital has to order the implant about 1 week in advance and prepare for the surgical approach that they will take.

So I'm going penoscrotal on Wednesday. I still don't know if I should have gone infrapubic! I've seen excellent results with both.

For me the only things that made me question infrapubic were the concept of palpable tubing above the base of the penis, and maybe the visible scar because I shave. On the flipside potential tubing issues beneath the base made me hesitate about penoscrotal.

I think if your surgeon tells you he is better at one approach over another then go with that approach. In my case my surgeon sort of suggested that he is equally as good at both so it was extremely difficult to decide.

[Irish Lad 34]

**forgot to say - regarding cutting the nerves - my surgeon told me that there is practically a 0% risk of it happening with an infrapubic approach.

There are a lot of guys on Franktalk and Reddit saying that it is a risk, but based on what my surgeon told me, in reality it is not really a risk. It would only be a risk if you went to an unqualified low implant surgeon that does 1 implant a year, and even then the risk would be low. Apparently it is very easy to identify and avoid the nerve bundle. There is a Perito video on YouTube where he says a study was published recently where they observed 4,000 infrapubic procedures and 0 of them had cut the nerves.

[macoza]

**forgot to say - regarding cutting the nerves - my surgeon told me that there is practically a 0% risk of it happening with an infrapubic approach.

There are a lot of guys on Franktalk and Reddit saying that it is a risk, but based on what my surgeon told me, in reality it is not really a risk. It would only be a risk if you went to an unqualified low implant surgeon that does 1 implant a year, and even then the risk would be low. Apparently it is very easy to identify and avoid the nerve bundle. There is a Perito video on YouTube where he says a study was published recently where they observed 4,000 infrapubic procedures and 0 of them had cut the nerves.

But if theres a 0% risk of nerves being cut with infrapubic why are there guys on this forum complaining about it?

Would you please post the link to that yt video/

[ElbowRoom]

I just had a PS surgery, I think you’re fine. The big advantage of IP is the reduced healing time. Almost every other advantage goes to PS. That’s of course just my opinion.

I will say the recovery from PS is no joke. My first week was easy, my second and third have been challenging. I get significant pain in various areas, and will probably continue to have that for another couple of weeks at least.

But the device is almost entirely hidden. No palpable or visible tubing or other clues that I have an implant. With IP you are likely to have some tubing at the base of the penis on the sides, and some guys have no problem with it but others are bothered by it.

My surgeon (who does both types) said it’s also harder because of the approach angle to get good dilation of the corpora. This can cause a very slight loss of length with the IP procedure compared to PS.

The incision site on PS is more prone to bacterial contamination by sweat, etc, so you have to keep it clean and use Neosporin on it. The IP incision being higher up stays cleaner.

I chose PS because I think overall the advantages outweigh the IP approach..FOR ME. If you are diabetic, married and don’t care about a little visible tubing, have a low pain tolerance, or just want to recover as fast as possible, go IP. Otherwise I think PS has some big plusses.

[CigareVolant]

I was going to say, "Do whatever your doctor tells you to." I'm surprised that he has no preference.

In any case, it seems like most people have great results either way, so I wouldn't worry about it.

[ElbowRoom]

I was going to say, "Do whatever your doctor tells you to."

I have to say I mostly disagree with this advice. Part of the problem with our medical system is an over-reliance on the opinions of providers. Every case is unique, and one might have completely different considerations and concerns than another.

Sure, ask your surgeon for advice, but don't just "do whatever they say." Do your research, and be your own advocate. That includes surgical approach, type/brand of implant, and any specific concerns you want the surgeon to take into account.

If you feel strongly about any aspect of your surgery and don't feel like your surgeon is listening or addressing it, start looking for other surgeons. Yes, they are the "expert", but you are the customer here...the surgeon works for you.

[tomas1]

I had the same conundrum myself. Could not decide what approach to take. My surgeon does both and initially reccomended infrapubic, but loads of people on Franktalk reccomended penoscrotal.

I questioned him on things like penoscrotal, cutting nerves with infrapubic, palpable tubing etc.

He then advised me that he does both infrapubic and penoscrotal and the choice is mine, he would not choose for me. He initially reccomended infrapubic mostly for the smoother healing journey and ability to cycle quicker.

I initially agreed infrapubic, then switched to penoscrtoal, then switched back to infrapubic, then switched back to penoscrotal and now I can't change any more because my implant is scheduled for Wednesday 12th November and the hospital has to order the implant about 1 week in advance and prepare for the surgical approach that they will take.

So I'm going penoscrotal on Wednesday. I still don't know if I should have gone infrapubic! I've seen excellent results with both.

For me the only things that made me question infrapubic were the concept of palpable tubing above the base of the penis, and maybe the visible scar because I shave. On the flipside potential tubing issues beneath the base made me hesitate about penoscrotal.

I think if your surgeon tells you he is better at one approach over another then go with that approach. In my case my surgeon sort of suggested that he is equally as good at both so it was extremely difficult to decide.

I think you made the right choice. IP is probably easier for the doc, but PS is more difficult, but less intrusive. The hard part for the doc is getting the reservoir placed. Now everyone will say I'm full of shit, but that's a given.

[Jage64]

I had this same question and decided that PS was best for me, even before I chose a surgeon.

The ONLY thing that I am going to interact with in terms of this implant is the pump, and I'm going to use it often. I wanted that pump placed exactly where it should be and not worry about tugging on it during healing or having it end up too high because it being more difficult to place going IP. I don't give a crap where the reservoir is, as long as I can't see or feel it, but I DO care where the pump is in my scrotum.

Dr. Clavell asked me pre-op if I was left or right handed. I asked him why that mattered? He said since I am right handed he would rotate the pump slightly so that my right thumb would fall naturally on the deflate button without having to contort my wrist. It does. My pump placement is great, it is not noticeable at all (and I don't have a particularly big scrotum to start with). I never had to tug on it to pull it down or otherwise fuss with it during healing. I can't see any tubes and can only feel them if I dig down alongside my shaft with my fingers looking for them. My wife can't feel them even when she tries.

I too shave and we sometimes frequent nudist resorts, I did not want a visible scar ratting me out.

Also, in terms of IP, there is a Perito video where he explicitly states that the IP approach can be done in 15 minutes, which means he can perform many more implantations in a day than spending 45 on a PS. Sounds to me like a financial decision for him, and probably many other docs, if you can triple the amount of implants or cut your surgery center time by 2/3, that's some real $$ at the end of the year.

Good luck, I think you made the right choice.