Infrapubic vs Penoscrotal and Informed Consent

[Underd0sed]

Hi everyone,

I am posting because I am trying to understand whether what I am experiencing is common, and whether there are real risks involved or mostly psychological fallout from how the decision was handled.

Before surgery, I clearly and repeatedly stated that preservation of length and function was a top priority for me. I understand that many high volume surgeons prefer the penoscrotal approach for sizing control, patient satisfaction, and revision flexibility, especially when length is a major concern.

The differences between the approaches were not explained to me in plain terms, and I did not understand that the approach itself was a decision point that could relate to my stated goals.

I was therefore not consciously consenting to one approach over the other.

Post op, I learned the procedure was done infrapubically.

To be clear, I am not accusing my surgeon of bad intent, and I understand that both approaches are used successfully. My concern is about alignment with stated goals and informed consent, and whether this choice actually changes outcomes in a meaningful way for someone whose main fear after safety was length loss.

Some specifics for context:

Implant sizing was 15 cm cylinders with 3 cm RTEs, for 18 cm total internal length
No obvious red flags so far in terms of mechanics
Very early post op phase, so I know it is too soon to judge final outcome

What I am hoping to learn from people with lived experience:
1. Has anyone else gone into surgery prioritizing length without understanding that approach choice was a factor, and later found out the implant was done infrapubically?
2. For those with infrapubic implants:
Did you ultimately regain most of your pre op length?
Do you have any long term regrets specifically tied to the approach?
3. For men who have had revisions or upsizing later:
Did infrapubic versus penoscrotal materially affect your options or outcomes?
4. In hindsight, do you feel the approach choice itself made a meaningful difference, or were sizing, healing, and cycling far more important?

I am trying to separate real, evidence based risks from anxiety and second guessing caused by feeling unheard in the process.

If you have been through something similar, whether the outcome was good, bad, or mixed, I would really appreciate hearing how it played out over time, not just in the early weeks.

Thanks to anyone willing to share their experience.

[Irish Lad 34]

Based on my research, if you a use a high volume surgeon with a good track record, there should be no difference in the outcome no matter what method they choose.

According to zone literature they can get slightly longer cylinders into a penoscrotal incision, but it seems the extra length goes into the internal part of the penis, not the external part, so there is no difference to the actual length of your penis.

Some literature suggests that infrapubic can spare more of your natural tissue, so you can end up with more natural blood flow if you go infrapubic, and there are some suggestions online about infrapubic leading to more girth.

The obvious downsides of infrapubic are the visible scar and the way some people say the pump rides high in the scrotum. The upside is most patients can start cycling quicker.

The obvious downsides to penoscrotal are a slightly longer healing journey.

I have seen some sources suggest that the tubing via infrapubic can be felt above the base of the penis, and it can reduce bone pressed depth in that area, but not everybody says it does that.

On the other hand it seems common for penoscrotal tubing to be palpable beneath the base of the penis, and it can reduce penetrative depth in that area.

The long and short of it is with a very high volume surgeon you shouldn't have a shorter penis from going infrapubic. The only obvious differences should be the visibility of the scar. However you might feel tubing above your penis with infrapubic and if it is very thick it might slightly reduce how deep you can push your penis in, although similar things can happen with penoscrotal.

[Irish Lad 34]

My surgeon actually booked me for an infrapubic implant without highlighting the differences between each approach. He did not even tell me that he offers penoscrotal.

I told him I might want penoscrotal instead because I don't want a scar and I was worried about infrapubic complications that people on Franktalk told me about it.

It was only then he told me he does both penoscrotal and infrapubic, and he then advised me I can choose whatever method I want. He said he could do them both to a high standard but he personally advises that infrapubic would suit me better, but mostly only because I would be able to start cycling quicker. He advised me not to worry about what people are saying on these forums, whatever they say here will not impact the results. I initially went with his advise and booked infrapubic, then changed to penoscrotal, then back to infrapubic, then back penoscrotal again.

I have a good result but I can feel the penoscroral tubing beneath the base of my cylinders, although it's not too bad. However I sometimes wonder if I'd have been better taking his advise and going with infrapubic which is what he suggested initially.

I spoke to 2 of his infrapubic patients before surgery and they were both exceptionally happy with the results, they claim they lost no size. I also spoke to 2 of his penoscrotal patients before surgery and they were both happy too, although one of them only had surgery weeks prior so he could not yet see the long-term result.

[LetoMan]

I agree with Irish Lad. There isn’t any evidence I am aware of that penoscrotal vs. infrapubic results in any difference in length.

Informed consent generally only comes into play when the surgeon is deviating from standard practice. For example, there are different methods of sealing a surgical incision; a doctor is not required to go through each and talk about the relative tradeoffs in each as long as they are all established procedures.

The question is whether the decision of infrapubic vs. penoscrotal fits the sort of decision that a surgeon routinely makes vs. something that should be discussed with the patient. The argument for infrapubic is that it results in less infections. I could see an insurance company claiming that as long as that is the doc’s standard approach, it’s justified, absent some reason why he would deviate from that.

Even if you had a valid claim that the doc should have sought your informed consent, the next question is what your damages are. If the choice between one approach or the other only resulted in a difference in the location of the scar, the damages question might make the issue a non sequitur.

All that said, it’s a technical enough question that any advice you get on it here (including from me) is relatively useless. You should consult a medical malpractice attorney in your jurisdiction for a competent answer.

[Underd0sed]

I agree with Irish Lad. There isn’t any evidence I am aware of that penoscrotal vs. infrapubic results in any difference in length.

Informed consent generally only comes into play when the surgeon is deviating from standard practice. For example, there are different methods of sealing a surgical incision; a doctor is not required to go through each and talk about the relative tradeoffs in each as long as they are all established procedures.

The question is whether the decision of infrapubic vs. penoscrotal fits the sort of decision that a surgeon routinely makes vs. something that should be discussed with the patient. The argument for infrapubic is that it results in less infections. I could see an insurance company claiming that as long as that is the doc’s standard approach, it’s justified, absent some reason why he would deviate from that.

Even if you had a valid claim that the doc should have sought your informed consent, the next question is what your damages are. If the choice between one approach or the other only resulted in a difference in the location of the scar, the damages question might make the issue a non sequitur.

All that said, it’s a technical enough question that any advice you get on it here (including from me) is relatively useless. You should consult a medical malpractice attorney in your jurisdiction for a competent answer.

I understand the point you’re making and appreciate your feedback. However, I disagree with the framing. My issue isn’t that infrapubic is an experimental or nonstandard approach, or that it automatically causes worse outcomes. It’s that I clearly and repeatedly stated that preservation of length and function was a top priority for me, and I was never informed that I had a choice of surgical approach at all. The procedure was scheduled infrapubically as a default, not after a discussion of options, risks, or alignment with my stated goals.

Even if both approaches are considered standard, the choice between them is not comparable to minor technical decisions like how an incision is closed. In the implant world, approach selection is widely discussed because it affects access, visualization, pump placement, nerve handling, and revision strategy. Many high-volume surgeons explicitly involve the patient in that decision.

I’m also not arguing damages in a legal sense here. I’m trying to understand whether my outcome risk profile was altered without my input, especially given that I had limited ability to shop surgeons due to insurance and location constraints. That’s why I’m asking for lived experience and nuance, not legal advice.

[LetoMan]

Fair enough. It seemed like you were making the case for why you should have had the choice. From what I understand, most doctors do one or the other, it’s not usually offered as a choice (though some do offer a choice). My doc didn’t offer a choice. I asked him which way he did it, and he told me. It’s not obvious to me he would have clarified beforehand had I not asked, but maybe he would have.

As for whether doctors choose to do penoscrotal because of all of those reasons you listed, it’s not obvious to me that’s true, but maybe some make some of those claims. As I understand it, the infrapubic approach was developed by Dr. Perito, a highly regarded and experienced implanter. The main arguments I have heard for it are what Irish noted: less probability of infection, and an easier recovery. The drawbacks I have heard are a possibility of nerve damage if done by an inexperienced surgeon, and a more visible scar. I simply haven’t heard the other supposed drawbacks, but perhaps they exist.

When I have heard of guy’s docs skipping infrapubic for penoscrotal, what I recall them saying is the doc prefers infrapubic for the reasons given, but since the guy is single, they would rather give them a scar on the scrotum for their “peace of mind” that they might be self-conscious about it. That’s all I’ve heard.

If you are just looking for reassurance, I’d say this: you pretty much have exactly what the rest of us have, just with a different scar location, and a supposedly easier recovery. You can’t change the location of the scar, so I’d put the rest of that out of your head and focus on the positive.

Most guys are a bit shocked at their length immediately post-op, and perhaps that is what your concern is here. But virtually everyone gains size back, often significant amounts, and studies show almost all guys eventually get back to the size they were immediately pre-implant. So I wouldn’t worry about that, you are going to get there, and the reality is that it has nothing to do with which approach was used.

Congrats on the surgery! The hardest part is behind you. Rest up and recover. Eventually you’ll forget all about that and will be fucking like a monster.

Be well, Leto

[Underd0sed]

Fair enough. It seemed like you were making the case for why you should have had the choice. From what I understand, most doctors do one or the other, it’s not usually offered as a choice (though some do offer a choice). My doc didn’t offer a choice. I asked him which way he did it, and he told me. It’s not obvious to me he would have clarified beforehand had I not asked, but maybe he would have.

As for whether doctors choose to do penoscrotal because of all of those reasons you listed, it’s not obvious to me that’s true, but maybe some make some of those claims. As I understand it, the infrapubic approach was developed by Dr. Perito, a highly regarded and experienced implanter. The main arguments I have heard for it are what Irish noted: less probability of infection, and an easier recovery. The drawbacks I have heard are a possibility of nerve damage if done by an inexperienced surgeon, and a more visible scar. I simply haven’t heard the other supposed drawbacks, but perhaps they exist.

When I have heard of guy’s docs skipping infrapubic for penoscrotal, what I recall them saying is the doc prefers infrapubic for the reasons given, but since the guy is single, they would rather give them a scar on the scrotum for their “peace of mind” that they might be self-conscious about it. That’s all I’ve heard.

If you are just looking for reassurance, I’d say this: you pretty much have exactly what the rest of us have, just with a different scar location, and a supposedly easier recovery. You can’t change the location of the scar, so I’d put the rest of that out of your head and focus on the positive.

Most guys are a bit shocked at their length immediately post-op, and perhaps that is what your concern is here. But virtually everyone gains size back, often significant amounts, and studies show almost all guys eventually get back to the size they were immediately pre-implant. So I wouldn’t worry about that, you are going to get there, and the reality is that it has nothing to do with which approach was used.

Congrats on the surgery! The hardest part is behind you. Rest up and recover. Eventually you’ll forget all about that and will be fucking like a monster.

Be well, Leto

Thanks so much for your response. I didn’t realize how much I needed to hear it until I read it. I’m not too concerned about the scar, but I wasn’t fully prepared for the psychological impact of all this. I’m usually very active and pretty laid back, and the combination of pain, uncertainty, and the sense of finality just got to me. That said, I’m already starting to feel better. I haven’t needed any pain meds today and it’s only day five. I’m confident I’ll be okay, and I’ll be sure to follow the doctor’s cycling instructions exactly as prescribed. Thanks again for the support—it really helped.

-B-

[Underd0sed]

Based on my research, if you a use a high volume surgeon with a good track record, there should be no difference in the outcome no matter what method they choose.

According to zone literature they can get slightly longer cylinders into a penoscrotal incision, but it seems the extra length goes into the internal part of the penis, not the external part, so there is no difference to the actual length of your penis.

Some literature suggests that infrapubic can spare more of your natural tissue, so you can end up with more natural blood flow if you go infrapubic, and there are some suggestions online about infrapubic leading to more girth.

The obvious downsides of infrapubic are the visible scar and the way some people say the pump rides high in the scrotum. The upside is most patients can start cycling quicker.

The obvious downsides to penoscrotal are a slightly longer healing journey.

I have seen some sources suggest that the tubing via infrapubic can be felt above the base of the penis, and it can reduce bone pressed depth in that area, but not everybody says it does that.

On the other hand it seems common for penoscrotal tubing to be palpable beneath the base of the penis, and it can reduce penetrative depth in that area.

The long and short of it is with a very high volume surgeon you shouldn't have a shorter penis from going infrapubic. The only obvious differences should be the visibility of the scar. However you might feel tubing above your penis with infrapubic and if it is very thick it might slightly reduce how deep you can push your penis in, although similar things can happen with penoscrotal.

Thanks for the info . Helps a lot .

[edjohn]

From a physiological perspective there is no way one method could mean a shorter device that doesn’t go as far into the crus… every implant has to fill the natural space just the same or the implant wouldn’t be firm or stay in place. Just have to clarify that.

[Oz1958]

It sounds to me like you are suffering from "buyers remorse" with a big dash of "paradox of choice".
That feeling you get when you bought the Toyota and spend the rest of you life wondering if you should have bought the Ford.
Reality is either would serve you well and have been a good choice but there is that nagging something in the back of your mind that you might be missing out on something ("FOMO, fear of missing out.)

Don't let that psychological dilemma drag you down a great big rabbit hole.

Enjoy what you have and celebrate the positives every day. It's got to be better than what you had before by 1000%, even if it's not 1001%