Comprehensive List of Questions for your Surgeon

[LGXDownunder]

One question I asked both surgeons I evaluated: what is your personal infection rate? He will know and if it’s low he’ll tell you instantly.

I also asked that upfront and it was definitely a major deciding factor. My uro is not high volume, but does 2 or 3 implants a month.
Only ever had one infection in his own patients. Although he recently did a revision for a referred patient who was badly infected apparently.
He has been very responsive with the many questions I've asked.

[SWorks17]

Dear all,

I am still in the R&D and surgeon evaluation phase of journey.

I am likely three months away from my "conversion".

I have done a lot of research. A lot of it reflected circumstances that are specific to me and my desired outcomes.

Nonetheless, I have been able to create an extensive list of items to be discussed with the surgeon before making any decisions. If any of you feel that I missed anything, please add your recommendations.

The list:

Here’s a focused, surgeon‑friendly checklist you can take to your pre‑op visit. I’ve grouped the questions so you can tick them off quickly while you’re in the exam room.

⸻

A. Intra‑operative measurements & device choice
1. What was (or what do you expect) my measured corporal length—from pubic bone to distal tip—in centimetres? The doc pulled on my flaccid dick and said that's about what size you'll be , he didn't measure while he had it stretched.
2. Which AMS 700 LGX cylinder length would that translate to? The doc won't know what that length will be until he does his measurements. He will dilate and then he will use a Furlow tool to take your internal measurements, proximal (inside your body) distal (the penis that you can see on the outside)
3. Can you implant the longest cylinder that fits (≤ my corporal length) and keep rear‑tip extenders (RTEs) to 0–1 cm per side? Sometimes it is necessary to use rear tip extenders to place the pump correctly in the scrotum. But I would still ask this question.
4. If more than 1 cm RTE is needed, what factors would make that unavoidable, and how much will it drop the erection angle?
5. Do you ever perform “no‑RTE” builds, and are they realistic for my anatomy?

⸻

B. Expected erect length—day 1 and long‑term
6. Immediately post‑op, what loss (if any) in visible length should I expect compared with my natural 6.75 in (17.1 cm) erection? The doc will try to get the right implant inside you, so that you won't have any loss of length
7. With disciplined cycling, what length range do your patients typically reach at 6 months and 12 months? I reached my original length in six months, but I still continue to cycle every day, even without using it for sex.
8. Have you documented gains of 1 cm or more with the LGX in your own series, and what cycling protocol do you prescribe? I just don't know if the LGX gave me any extra length, I never measured my dick before I had total ED, but it looks close to where I was in my 20's and 30's. Currently I'm at 6.25 inches, but I don't measure anymore, because it is plenty of dick to satisfy my wife

⸻

C. Cycling protocol & follow‑up
9. When will you clear me to begin cycling, and how many minutes/sets per day do you recommend? For me, I had the penoscrotal install and I was given device training at 6 weeks and I was told to cycle twice a day in the shower for 20 minutes each time. So I would take a shower and leave it inflated to the max while I shaved after the shower, until I couldn't stand the pain.
10. Do you provide a written schedule or smartphone reminders to help patients stay consistent? My doc didn't have any reminders, it's up to you to keep up with your cycling.
11. At what post‑op visits will you re‑measure erect length to verify progress? My doc never measured me at any followup appointment, but some docs might.

⸻

D. Erection angle & rigidity
12. Given my anatomy, what erection angle (degrees from horizontal) do you expect once the implant is fully inflated? I had talked to other Boston Scientific patient champions and the ones I talked to said their dick went straight out at the 3 o'clock position, I would say that this depends on you natural anatomy and how your dick looked earlier in your younger years. My dick also had a upward angle when it was hard when I was younger and I would say that mine is close to that angle now after the implant.
13. If angle is sub‑optimal, what surgical or post‑op strategies do you use to improve it (e.g., ventral phalloplasty, RTE reduction in revision)? I don't think there is any thing you can do about the angle, but who knows. Some here on FrankTalk are gonna switch to the malleable implant to have a better upward angle on their dick

⸻

E. Contingencies & revision planning
14. If I do not regain my pre‑op length after 12 months, what options exist (e.g., cylinder upsizing, sliding technique)? There is not guarantee on this, they try to get you as close as they can with the implant sizes and using rear tip extenders. There are guys on FrankTalk that have had revisions to help with undersizing and oversizing. It might be something they would cover, if they made a mistake, but I'm glad I didn't have to worry about that
15. What is your revision rate for malposition, angle issues, or patient dissatisfaction, and how soon can revisions safely be done? Good Luck on this one, I doubt he will answer this one.

⸻

F. Adjuncts & preparation
16. Would a pre‑op vacuum‑therapy or traction regimen improve intra‑op length or ease dilation? Yes, my doc told me to use a VED before my implant operation to keep my dick from losing length. I had a prostrate procedure before my implant and I had total ED for 3 months, just a limp wet noodle. I would use the VED twice a day 30 minutes each time. My doc didn't have a protocol that using the VED, he just wanted me to keep it stretched.
17. Should I continue VED use right up to the night before surgery, or stop earlier? I can't remember if my doc told me to stop the week of my surgery, but I think I used it right up to the day before my surgery.

⸻

G. Device specifics & documentation
18. Will you give me a printed operative report listing cylinder length, RTE length, and reservoir/ pump details? Yes, they do give you documentation with all the notes, but make sure you ask for it. My document shows the implant model and size and the rear tip extenders they used and my proximal and distal measurements internally.
19. Which model and lot number of the AMS 700 LGX will you implant, and are there any recent updates or recalls I should know about? I don't think they have updated the LGX with any new materials, but it is possible. I haven't heard of any updates. Boston Scientific does have a new pump called the tenacio, which is supposed to be able to get your implant pumped up to the max faster than the old MS pump. I have the MS pump which is like a World War II tank, but it is easy to find, pretty easy to inflate and easy to deflate

⸻

H. Lifestyle & long‑term care
20. How soon after surgery may I resume intercourse, sports, and cycling exercises? I was cleared for sex at 6 weeks because I had the penscrotal install, but with the pain I had I waited till week 8 to have sex and it still hurt and I had a throbbing dick for almost two days. I thought I had broken it. I emailed my doc and he said I probably over did it. It just took more time for sex to be great again. On exercise, I'm a cyclist, so I asked when I could get back on my bike and he said do easy miles at 4 weeks, by 6 weeks I was back to my normal weekly mileage of 100 to 150 a week. I don't have an answer about lifiting weights.
21. What precautions (e.g., antibiotic prophylaxis before dental work) will I need for the life of the implant?My doc didn't have any instructions about taking antibiotics to protect the implant from infection when going to the dentist. But when I had both my knee replacements, I was given specific instructions to take antibiotics 1 hour before any type of dental work for the next two years.

⸻

I hope that helps a little bit Headair,
SWorks

[LGXDownunder]

Welcome Headair,
Very well thought out list of questions. During my research phase I also emailed a fairly long list of questions to my own surgeon, but nowhere near as comprehensive. I think any good surgeon will try their best to answer, but some things might be difficult to predict with the precision that you would like. I'm recently implanted with the AMS 700 LGX that you are considering. If it helps I will comment on my own experience to date in a few areas:

F. Adjuncts & preparation
16. Would a pre‑op vacuum‑therapy or traction regimen improve intra‑op length or ease dilation?
17. Should I continue VED use right up to the night before surgery, or stop earlier?

For about 18 months I used a medical grade VED both for post RRP therapy, and sex, quite aggressively right up until the afternoon before my procedure. Anecdotally I think it has helped allow the longest possible cylinders to be implanted, and restore at least some of the lost size due to ED following my prostatectomy. 6 weeks post op and 4 days into cycling I am already seeing some evidence of size restoration, but I expect a long journey.
I have already become a "shower", consistently now over 5 inches flaccid, which is about 1.5 inches longer than I've ever been in that state.
Yet to measure myself erect, as I'm usually too uncomfortable for that while cycling, but looks to be close to 6 inches.

G. Device specifics & documentation
18. Will you give me a printed operative report listing cylinder length, RTE length, and reservoir/ pump details?
19. Which model and lot number of the AMS 700 LGX will you implant, and are there any recent updates or recalls I should know about?

In my recent experience that should happen automatically. It was either after I woke up in recovery and was taken back to my hospital room, or maybe the next morning a package was delivered containing a small bag of goodies from the BS/AMS rep. It included a document with the details you specify, except updates and recalls. At least there are none shown on mine, and it looks to be a standard document that they use worldwide.

H. Lifestyle & long‑term care
20. How soon after surgery may I resume intercourse, sports, and cycling exercises?
21. What precautions (e.g., antibiotic prophylaxis before dental work) will I need for the life of the implant?

These things seem to vary between surgeons. Mine was to take it easy with no strenuous activity, heavy lifting or bending for at least 6 weeks. I have been cleared for sex this week, at 6 weeks post op. I forgot to ask at activation about things like swimming, sports, cycling (bike riding, not pumping), so I have just emailed those questions. At my initial post op check up I specifically asked about prophylactic antibiotics before dental work and was told that they were not needed.

[Headair123]

One question I asked both surgeons I evaluated: what is your personal infection rate? He will know and if it’s low he’ll tell you instantly.

Great suggestion. I will add it to my list.

Thank you,

[Headair123]

I have been cleared for sex this week, at 6 weeks post op. I forgot to ask at activation about things like swimming, sports, cycling (bike riding, not pumping), so I have just emailed those questions. At my initial post op check up I specifically asked about prophylactic antibiotics before dental work and was told that they were not needed.

Thank you LGXdownunder,

Useful feedback.
I am kind of curious about your no-RTE experience. Considering that this type of cylinder expands in all three dimensions, I would expect it to "motivate" the greatest expansion in length when RTEs are absent. Is that that something you discussed with your surgeon?
All I know is that the less RTE the better the erection angle above the horizon (3:00 o'clock).
Separately, I am an avid cyclist (bicycle). So, I would want to get back to it ASAP. I did some research and it seems that the Selle SMP Pro is a really good bike seat.

Oh, one more thing, what was your erect length prior to the surgery?

Thanks,

[Headair123]

Dear all,


F. Adjuncts & preparation
16. Would a pre‑op vacuum‑therapy or traction regimen improve intra‑op length or ease dilation? Yes, my doc told me to use a VED before my implant operation to keep my dick from losing length. I had a prostrate procedure before my implant and I had total ED for 3 months, just a limp wet noodle. I would use the VED twice a day 30 minutes each time. My doc didn't have a protocol that using the VED, he just wanted me to keep it stretched.
17. Should I continue VED use right up to the night before surgery, or stop earlier? I can't remember if my doc told me to stop the week of my surgery, but I think I used it right up to the day before my surgery.

SWorks

Thank you Sworks,

One other idea occurs to me; in my research I came across some contradictory advice regarding VED AFTER the surgery.
I think the Mayo Clinic or the Cleveland clinic suggested that using a VED after the surgery is a good thing to help with rehabilitation and regaining size.

Other corners of the internet suggested that this would be a bad idea as it might damage the scrotal pump, the cylinders, and the tubing.

Did any of you gentlemen receive any advice from your surgeons on this issue?

[Ephi82]

Dear all,


F. Adjuncts & preparation
16. Would a pre‑op vacuum‑therapy or traction regimen improve intra‑op length or ease dilation? Yes, my doc told me to use a VED before my implant operation to keep my dick from losing length. I had a prostrate procedure before my implant and I had total ED for 3 months, just a limp wet noodle. I would use the VED twice a day 30 minutes each time. My doc didn't have a protocol that using the VED, he just wanted me to keep it stretched.
17. Should I continue VED use right up to the night before surgery, or stop earlier? I can't remember if my doc told me to stop the week of my surgery, but I think I used it right up to the day before my surgery.

SWorks

Thank you Sworks,

One other idea occurs to me; in my research I came across some contradictory advice regarding VED AFTER the surgery.
I think the Mayo Clinic or the Cleveland clinic suggested that using a VED after the surgery is a good thing to help with rehabilitation and regaining size.

Other corners of the internet suggested that this would be a bad idea as it might damage the scrotal pump, the cylinders, and the tubing.

Did any of you gentlemen receive any advice from your surgeons on this issue?

My doc said VED post surgery may damage the implant and will not lengthen or make your post surgery penis thicker.

[LGXDownunder]

Thank you LGXdownunder,

Useful feedback.
I am kind of curious about your no-RTE experience. Considering that this type of cylinder expands in all three dimensions, I would expect it to "motivate" the greatest expansion in length when RTEs are absent. Is that that something you discussed with your surgeon?
All I know is that the less RTE the better the erection angle above the horizon (3:00 o'clock).
Separately, I am an avid cyclist (bicycle). So, I would want to get back to it ASAP. I did some research and it seems that the Selle SMP Pro is a really good bike seat.

Oh, one more thing, what was your erect length prior to the surgery?

Thanks,

Yes, I'm hoping that's the case. Length expansion in particular was one of my key concerns. I told my surgeon often that I wanted to regain lost length due to my prostatectomy. We discussed it several times and considered both the Rigicon Infla10 AX and the AMS 700 LGX due to their claimed expansion properties. He has a lot of experience with the LGX but had only fairly recently started implanting the relatively new Rigicon model. He was initially pretty upbeat about them, but at my final pre op discussion he said that a couple of recent patients were not happy with the results. Didn't go into the reasons but he's very conservative and seemed to have lost his previous enthusiasm for the Rigicon. I still think the Rigicon may have been a good option, but both of us then felt more comfortable going with the well proven LGX. I asked about RTEs and from memory I got a urological answer that it depends on the proximal and distal measurements taken on the operating table. He definitely seemed really happy the morning after my procedure that he was able to get the 21 cm LGX in there, and hadn't needed to use RTEs. So I assumed that was a good thing. It's still very early days but my current erection angle looks to be a little above 3 pm, but I've really only looked from above so far. I'll try and get a better assessment when I have a chance.

My pre op erect length is difficult to be accurate about because I could not get a natural erection whatsoever. I know I lost length post prostatectomy but then regained some through regular and aggressive VED use. My pre RRP erect length was around 6 inches give or take, maybe slightly over with a dose of Viagra and the wind blowing in the right direction. Post RRP absolute zero erectile function, profound ED for 3 years. But I could get a bone pressed 7.4 inches inside a VED. Of course it doesn't stay that way and I lost hardness etc fairly quickly during sex. Which is a PITA as I had to keep stopping to pump again with the VED all the time. Had a lot of girth though.

I'm just a recreational cyclist but I own three bikes and I've been using Selle SMP saddles for many years. I researched them a long time ago and they definitely take the pressure off your bits in my experience. No numb nuts. I haven't done much riding since my prostate surgery, for various reasons, but I had started to get back into it again before my implant procedure.

[Kodixx]

Here's a question for a surgeon - if an implant doesn't increase in length (or barely increases in length), and the VED makes the penis longer, how does that not result in an undersized implant ?

- Chuck

My doc said VED post surgery may damage the implant and will not lengthen or make your post surgery penis thicker.