My consultation with Dr. Patel — Titan vs. AMS, length, TEP, revisions, and more

[StandUpGuy]

I saw Dr. Patel at UCSD last week to discuss getting a penile implant, and I learned quite a bit that I thought would be worth sharing with everyone here. Some of this has been discussed on the board before, but I figured I’d share what I learned directly from him.

Titan vs. AMS — Girth and Peyronie’s:
Given that I have Peyronie’s disease, Dr. Patel recommended the Coloplast Titan as an option. He explained that the Titan cylinders are much stronger and expand considerably when inflated, and they can even break of the scar tissue ofver time. He said that if you compare a fully inflated Titan with an AMS cylinder, you can see the difference in expansion pretty clearly.

One of my concerns is girth, so this was encouraging to hear.

That said, he did mention a potential downside of the Titan: sometimes the girth can be asymmetric, creating what he described as a sort of “surfboard” appearance, where you're wider in one direction than the other.

His explanation was that the cylinders expand significantly, but they don't expand underneath the urethra. He said that with adequate sexual stimulation, that area can fill out by another centimeter or so, helping even things out. My understanding from the conversation was that he sees this as a potential issue specific to the Titan, rather than something he typically sees with other implants.

He said AMS is the more commonly used implant in his practice, but given my Peyronie’s, he would recommend the Titan for me.

Implant reliability and the pumps:
I asked him about the reliability of the Titan versus AMS. His initial response was that they're roughly comparable in terms of reliability.

However, he did mention that the Titan might sometimes need revision a little sooner, but his anecdotal impression was that guys with Titans tend to use them more frequently than guys with AMS implants. His thought was that this additional use could mean more wear and tear.

He said that, either way, seven to ten years is a reasonable expectation.

We also discussed the pumps. He said he prefers the classic Titan pump over the newer pump design. My understanding is that improving the newer pump is one of the goals of the upcoming Titan Prime, which he expects to become available in the second half of next year.

He ultimately talked me out of waiting for the Prime. Beyond the delay, his point was that with any new product, it takes time to understand its real-world reliability. At this point, I'm pretty convinced I need to move forward with the procedure, and I don't know that I want to wait until next summer for something that hasn't yet established a track record.

Length expectations, traction, and cycling:
This was one of the most interesting parts of the conversation for me.

I told him that my erections are typically around 6.25 inches, although I can stretch to 6.5 inches and sometimes as much as 6⅞ inches. I asked what length I could realistically expect with an implant.

He said probably somewhere between those two measurements.

He explained that I wouldn't necessarily be at that length during the first week and that how quickly I get there depends largely on how much cycling I do and how much time I spend using a VED to help with the process.

I also told him that I regularly use a traction device. He was happy to hear that, and when I asked whether I could continue using it after implantation, he thought that would probably be okay with the Titan, given the strength of its cylinders. He would not recommend doing the same with AMS.

Obviously, I'd want to follow his specific postoperative instructions before resuming any traction.

In his videos, he has said that implant length should be within a few millimeters of your original size. I had wondered whether he meant stretched length or erect length, and this conversation helped clarify his expectations for my particular situation.

One thing I appreciate is that he doesn't seem to automatically set expectations around significant length loss. He seems relatively aggressive about sizing and trying to preserve length, which is encouraging.

Recovery timeline:
He recommended planning for approximately 10 days off work, although he has had patients working from home the next day.

He said cycling typically begins at four weeks, although it might be possible to start earlier if you're feeling up to it.

Obviously, recovery and the timing of cycling will depend on the individual and the surgeon's instructions.

TEP — Tunica Expansion Protocol:
I also asked him about the Tunica Expansion Protocol (TEP), which I've seen discussed in connection with severe Peyronie's disease.

He said it's something they may use in selected cases of severe Peyronie's. He mentioned that length improvements can range from approximately 1 to 4 centimeters, but emphasized that the procedure comes with significant risks and a more involved recovery.

I didn't completely understand his explanation of the surgical approach. My understanding was that during a standard implant procedure, the prosthesis is placed from the inside, whereas TEP involves working from the outside in some way.

What really stood out to me, though, was his discussion of the potential complications, including necrosis (tissue death). Depending on the severity, the consequences can be devastating.

He told me about patients who had undergone surgery in Mexico and subsequently returned with severe complications, including penile tissue that had died and required removal.

That scared the hell out of me.

To be clear, I'm not saying there aren't good surgeons in Mexico. But hearing those stories drove home how serious these procedures are and how important it is to choose an experienced surgeon with the resources to manage complications.

If there's one major takeaway from that part of the conversation, it's this: Please do your homework and don't make your decision based on price alone. I'd strongly encourage anyone considering surgery to investigate their surgeon's experience, case volume, complication rates, and ability to handle difficult revisions. A high-volume surgeon at a major medical center or university hospital is certainly worth considering.

Infection rates, revisions, and upsizing:

I also asked about infection and revision rates.

Dr. Patel quoted an infection rate of approximately 1% and a revision rate of approximately 3%. He indicated that the revision rate was similar whether it was the first revision or a subsequent one, and that the risk of infection doesn't necessarily increase with each revision.

He also mentioned that although revisions are obviously unfortunate, they can sometimes provide an opportunity to receive a larger implant.

I don't know exactly why that might be possible. My speculation is that changes in the surrounding tissue or the capsule of scar tissue might play a role, but he didn't give me an explanation, so that's just my guess. I've also seen a few guys here report getting larger implants during revisions.

The TEP discussion was probably the biggest reality check of the entire appointment. Potential length gains sound appealing, but the risks can be serious, and this isn't something to approach casually.

I hope this is helpful to others who are researching their options.

[Rider1400]

Great post! Sounds like you’ve found a good surgeon! As far as waiting, I’m with the Dr. I wouldn’t wait if your ready for an implant. There will be a time for a revision in the future at some point so by then the new prime won’t be new anymore and likely be the standard. Good luck with your decisions and hope all goes well