Titan IPP (Rev 1) – Cylinder Repositioning

[Flounder]

I was implanted 3.5 years ago at age 68, fully expecting it to be a one-and-done procedure. To be clear, my implant has not failed—it still functions exactly as designed (arguably better now than when new). The issue is fit. It’s not positioned correctly, causing discomfort for my wife and myself.

It took me close to a year to fully break in this implant, so I’m not thrilled about starting that process over again. That said, I know it has to be done. And I know what to expect this time so I feel better prepared going in.

Original surgery background:
My left proximal corpora was significantly fibrotic, likely from about five years of injections. The surgeon addressed this during dilation, but the first inflation test showed curvature and a noticeable lean. The left cylinder was removed, more work was done at the base and it was reinserted with 1 cm trimmed off the proximal end. The second inflation test looked good—straight, stable erection with even tips. Closure was routine, and the procedure was considered successful.

Post-op experience:
I actually felt pretty good leaving recovery and was able to walk out to the car. Unfortunately, the ride home turned into a nightmare. What should have been under three hours stretched into 6.5 hrs. due to a parade traffic in the city and then driving straight into the remnants of Hurricane Nicole—heavy rain, high winds, construction, potholes… the works. My wife and designated driver was totally stressed by the time we got home. But she kept it together and brought us home safely. I was in significant pain. Ice pack, meds, and bed for me—she opted for the wine fridge.

Soon after removing the mummy wrap at home, I developed a scrotal hematoma. My scrotum swelled to about softball size—painful and it delayed cycling for weeks. No way to know if that was bad luck or related to the long, rough trip home, but I’d prefer not to repeat that experience. For this revision, I’ve chosen a highly regarded surgeon closer to home. He is an Coloplast COE surgeon who specializes in implants, implant revisions, and penile reconstruction. Also I will be staying overnight in the hospital to remain sedentary for 24 hrs. Post surgery.

Reason for revision:
The issue now is impending distal erosion on the left side, along with discomfort along the underside of the shaft. From the beginning, the left tip never sat in the glans as well as the right. At this point, the left tip has migrated completely out of the glans and is pushing downward and outward, with very little tissue covering it. The right side is also backing out slightly, but with more tissue coverage.

MRI confirmed the left cylinder is not centered in the corpora. It also showed the implant is undersized, which is consistent with stretch testing done by the doctor during my first consultation.

Surgical plan:
The plan is to remove the existing cylinders and pump, then perform a tunneling procedure to properly reposition the left cylinder. If the distal corpora is compromised, additional reinforcement may be needed. A new Titan (Classic) will be placed, likely longer with final sizing determined intraoperatively. The existing reservoir will remain in place and reused since it’s functioning well and they are considered nearly indestructible. Also it’s in the ideal ectopic position and not worth the discomfort to change it out.

This revision came together in just 3 weeks from my first consultation visit. I was hoping to defer it to after summer but the doctor said this shouldn’t wait and squeezed me into his schedule. It’s kind of surreal thinking that I should be in recovery and starting the healing process over again by this time tomorrow

[edjohn]

What about the one question that’s on everybody’s mind… why did the left cylinder erode if it was undersized?

[Flounder]

What about the one question that’s on everybody’s mind… why did the left cylinder erode if it was undersized?

Well I doubt everybody.....

perhaps a picture better explains my erosion risk is below the glans because the left tip is no longer positioned in the glans,

If Implant were too big, the risk (push) would be into the glans. Erosion is often associated with oversized. But not always.

[edjohn]

What about the one question that’s on everybody’s mind… why did the left cylinder erode if it was undersized?

Well I doubt everybody.....

perhaps a picture better explains my erosion risk is below the glans because the left tip is no longer positioned in the glans,

If Implant were too big, the risk (push) would be into the glans. Erosion is often associated with oversized. But not always.

OK so your CC just happen to be prone to it. There is no biological reason that being undersized caused the damage, it just manifested short of the glans because that's where the end of it fall... or perhaps the end of your CC was full of fibrosis or something and the cylinders "deflect" off that and push down towards the (thinner) lower side? Physiologically, erosion is typically when chronic pressure on tissues causes them to atrophy so you would assume the cylinders had to be pushing down on the bottom even when deflated which thinned that part. Regardless, a reposition should be much better.

[Flounder]

My revision surgery was this morning. The recovery room nurse told me I had a conversation with the surgeon afterward, but I have no memory of it—anesthesia can be funny that way. He did speak briefly with my wife and covered the basics: surgery went well, I did fine, and she’d be able to see me once I was transferred to my room for the night. So at this point, I don’t have many details about the procedure itself.

I did receive a copy of the Titan warranty registration form. It lists a 24XL pre-connected cylinder set with pump, along with an RTE kit. That suggests I was upsized from 22 cm to 24 cm cylinders plus some amount of RTEs, which I’m pleased about.

I have a drain this time around, and it’s already been emptied twice today. The nurse said that’s more than usual. Honestly, I’m grateful that all that blood and fluid isn’t collecting in my scrotum. In hindsight, maybe that rough drive home from NY after my first implant wasn’t the cause of the hematoma—could just be how my body responds. At least I have a better understanding of that now.

I felt around my glans this afternoon, and both distal tips seem to be positioned exactly where they should be. That was my highest priority going into this, and at least preliminarily, it looks like mission accomplished.