Malleables: how to tell when it’s time for a revision?

[LastHope]

Guess it’s simple with the hydraulic ones: they just don’t inflate anymore, and you have to get it fixed ASAP.

With the malleable, how do you know it’s time for a revision? I heard something about ‘wobbling’ at the base? Also if the rods are pushing into your glans, is that irreparable damage?

‘Preciate any guidance here.

That's my million dollar question..unfortunately you won't get a clear cut answer...however, there are three conclusions(still vague) I got from extensive digging on forums...1) malleable getting wobbly is inevitable , however it could happen a few months after surgery, few years or sometimes a decade or 2...anyway it's almost always inevitable. 2) wobbliness doesn't necessarily mean it would compromise ability to penetrate and thrust...i remeber a guy had an extensive consultation with eid on this and eid told him after 20 years "it will be all over the place" ...meaning extra wobbly ,however that will not necessariy affect effectivness...it's just you will need to direct your penis with your hand...and again this could happen anytime post surgery...I saw cases after 4 years I've seen others after 7 when the penis had dropped(looking half erect but still rigid enough)..And you can check clavell video on yt where he changed a malleable of 27 years...the patient reported it was wobbly for a long time but during the last 7 years he wasn't able to penetrate at all (i can't tell whether this is due to material fatigue or the implant has turned extra wobbly) 3) inadequate sizing of the implant will expedite this process tremendously...it could be after a year or so....this is why big dicks can't install malleables or it would be unwise to do so ..as the largest malleable is 13mm (which fits most dicks by the way)...not because big dick will loose girth but because it will turn extra wobbly very quick..and this is also why "sparing of cavernosal tissue" is bullshit especially in mpp...biggest implant possible ensures best implant survival rate possible.

In general, average survivability rate of a malleable I believe is a solid 15 years if and only of done correctly and not undersized by 1 mm (it's a physics thing..more than a size perservance matter)..hakky said expect 15 years out of it....I've tried to get clear cut answers from top malleable implantologists and answers were too vague...atleast till now we know its' survival rate is better than ipps significantly...very significantly... but to what extent? This is malleable (pun intended )...

I think this is the biggest problem with the malleable and ipp's biggest problem is mechanical failure.

Now regarding the extrusion/erosion fixes....it's almost always possible...even full erosions are fixable...in prosthetic urology nowadays, problems are fixable but with greater risks with each fix.

tooyoung, any chance you have a link to the video where Clavell talks about the patient who had the malleable for 27 years? No worries if you can’t find it.

I really want a malleable because I want to avoid the IPP risks + I’m younger and would be paying out of pocket + want to reduce the # of potential revisions as much as possible. But the next phase in my research has been trying to understand the long-term implant strategy for us younger guys. I’d ideally like to be having sex for as long as possible after implantation, so have been trying to understand if implanting an MPP young puts us at any disadvantage on account of the wobble / tissue atrophy longer term.

Here’s Dr. Clavell’s video where he does a revision on a 27 year old AMS DuraPhase 2 malleable (1992?). It sounds like he had been unable to penetrate since around the 21st year. Thanks TooYoung for sharing this!

https://youtu.be/52WKqLbmkBg?si=gqtiiT_OmAh7OmQF

[FenderStrat_93]

That's my million dollar question..unfortunately you won't get a clear cut answer...however, there are three conclusions(still vague) I got from extensive digging on forums...1) malleable getting wobbly is inevitable , however it could happen a few months after surgery, few years or sometimes a decade or 2...anyway it's almost always inevitable. 2) wobbliness doesn't necessarily mean it would compromise ability to penetrate and thrust...i remeber a guy had an extensive consultation with eid on this and eid told him after 20 years "it will be all over the place" ...meaning extra wobbly ,however that will not necessariy affect effectivness...it's just you will need to direct your penis with your hand...and again this could happen anytime post surgery...I saw cases after 4 years I've seen others after 7 when the penis had dropped(looking half erect but still rigid enough)..And you can check clavell video on yt where he changed a malleable of 27 years...the patient reported it was wobbly for a long time but during the last 7 years he wasn't able to penetrate at all (i can't tell whether this is due to material fatigue or the implant has turned extra wobbly) 3) inadequate sizing of the implant will expedite this process tremendously...it could be after a year or so....this is why big dicks can't install malleables or it would be unwise to do so ..as the largest malleable is 13mm (which fits most dicks by the way)...not because big dick will loose girth but because it will turn extra wobbly very quick..and this is also why "sparing of cavernosal tissue" is bullshit especially in mpp...biggest implant possible ensures best implant survival rate possible.

In general, average survivability rate of a malleable I believe is a solid 15 years if and only of done correctly and not undersized by 1 mm (it's a physics thing..more than a size perservance matter)..hakky said expect 15 years out of it....I've tried to get clear cut answers from top malleable implantologists and answers were too vague...atleast till now we know its' survival rate is better than ipps significantly...very significantly... but to what extent? This is malleable (pun intended )...

I think this is the biggest problem with the malleable and ipp's biggest problem is mechanical failure.

Now regarding the extrusion/erosion fixes....it's almost always possible...even full erosions are fixable...in prosthetic urology nowadays, problems are fixable but with greater risks with each fix.

tooyoung, any chance you have a link to the video where Clavell talks about the patient who had the malleable for 27 years? No worries if you can’t find it.

I really want a malleable because I want to avoid the IPP risks + I’m younger and would be paying out of pocket + want to reduce the # of potential revisions as much as possible. But the next phase in my research has been trying to understand the long-term implant strategy for us younger guys. I’d ideally like to be having sex for as long as possible after implantation, so have been trying to understand if implanting an MPP young puts us at any disadvantage on account of the wobble / tissue atrophy longer term.

Here’s Dr. Clavell’s video where he does a revision on a 27 year old AMS DuraPhase 2 malleable (1992?). It sounds like he had been unable to penetrate since around the 21st year. Thanks TooYoung for sharing this!

https://youtu.be/52WKqLbmkBg?si=gqtiiT_OmAh7OmQF

Thanks as always LastHope!

[tooyoung]

That's my million dollar question..unfortunately you won't get a clear cut answer...however, there are three conclusions(still vague) I got from extensive digging on forums...1) malleable getting wobbly is inevitable , however it could happen a few months after surgery, few years or sometimes a decade or 2...anyway it's almost always inevitable. 2) wobbliness doesn't necessarily mean it would compromise ability to penetrate and thrust...i remeber a guy had an extensive consultation with eid on this and eid told him after 20 years "it will be all over the place" ...meaning extra wobbly ,however that will not necessariy affect effectivness...it's just you will need to direct your penis with your hand...and again this could happen anytime post surgery...I saw cases after 4 years I've seen others after 7 when the penis had dropped(looking half erect but still rigid enough)..And you can check clavell video on yt where he changed a malleable of 27 years...the patient reported it was wobbly for a long time but during the last 7 years he wasn't able to penetrate at all (i can't tell whether this is due to material fatigue or the implant has turned extra wobbly) 3) inadequate sizing of the implant will expedite this process tremendously...it could be after a year or so....this is why big dicks can't install malleables or it would be unwise to do so ..as the largest malleable is 13mm (which fits most dicks by the way)...not because big dick will loose girth but because it will turn extra wobbly very quick..and this is also why "sparing of cavernosal tissue" is bullshit especially in mpp...biggest implant possible ensures best implant survival rate possible.

In general, average survivability rate of a malleable I believe is a solid 15 years if and only of done correctly and not undersized by 1 mm (it's a physics thing..more than a size perservance matter)..hakky said expect 15 years out of it....I've tried to get clear cut answers from top malleable implantologists and answers were too vague...atleast till now we know its' survival rate is better than ipps significantly...very significantly... but to what extent? This is malleable (pun intended )...

I think this is the biggest problem with the malleable and ipp's biggest problem is mechanical failure.

Now regarding the extrusion/erosion fixes....it's almost always possible...even full erosions are fixable...in prosthetic urology nowadays, problems are fixable but with greater risks with each fix.

Tooyoung you seems to have made lots of research. May i ask what have you gathered about the risks of urethral injuries with a malleable and if even those are usually fixable without urostomy?

Also I haven't understood why it shouldn’t be undersized?

Hi Thisworld...urethral injury occurs during the surgery..usually by incompetency but not always..however,it's very rare though..it's detected also easily within the surgery by a saline flush test.

I've attached an elaboration from the book "Contemporary Challenges and Controversies in penile implant surgery"...this book is directed for junior surgeons though....I hope it answers your question...but if i were you I wouldn't worry much about urethral injury....I've seen cement blocks corporas(too much fibrosis and pyeronies) that they managed to install implants with no urethral injury.

Regarding how undersizing will affect stability , I've attached 2 drawings figure 1 where the rod is undersized and figure 2 where it's sized well...figure 1 shows how you will be left with extra room around the rod ...this room will allow the rod to move 360° making it wobbly..especially after some time has passed where the spongy tissue between the rod and corpora completely atrophies(vanishes)...in figure 2 there's a little room for the rod to move making it more stable...that's why undersizing is a big mistake in mpp and "sparing spongy tissue" is a horrible idea....lengthwise is the same concept too...except they deliberately leave a room of 1 cm or 2(in erosion prone patients) to minimize erosion risk.

[tooyoung]

Guess it’s simple with the hydraulic ones: they just don’t inflate anymore, and you have to get it fixed ASAP.

With the malleable, how do you know it’s time for a revision? I heard something about ‘wobbling’ at the base? Also if the rods are pushing into your glans, is that irreparable damage?

‘Preciate any guidance here.

That's my million dollar question..unfortunately you won't get a clear cut answer...however, there are three conclusions(still vague) I got from extensive digging on forums...1) malleable getting wobbly is inevitable , however it could happen a few months after surgery, few years or sometimes a decade or 2...anyway it's almost always inevitable. 2) wobbliness doesn't necessarily mean it would compromise ability to penetrate and thrust...i remeber a guy had an extensive consultation with eid on this and eid told him after 20 years "it will be all over the place" ...meaning extra wobbly ,however that will not necessariy affect effectivness...it's just you will need to direct your penis with your hand...and again this could happen anytime post surgery...I saw cases after 4 years I've seen others after 7 when the penis had dropped(looking half erect but still rigid enough)..And you can check clavell video on yt where he changed a malleable of 27 years...the patient reported it was wobbly for a long time but during the last 7 years he wasn't able to penetrate at all (i can't tell whether this is due to material fatigue or the implant has turned extra wobbly) 3) inadequate sizing of the implant will expedite this process tremendously...it could be after a year or so....this is why big dicks can't install malleables or it would be unwise to do so ..as the largest malleable is 13mm (which fits most dicks by the way)...not because big dick will loose girth but because it will turn extra wobbly very quick..and this is also why "sparing of cavernosal tissue" is bullshit especially in mpp...biggest implant possible ensures best implant survival rate possible.

In general, average survivability rate of a malleable I believe is a solid 15 years if and only of done correctly and not undersized by 1 mm (it's a physics thing..more than a size perservance matter)..hakky said expect 15 years out of it....I've tried to get clear cut answers from top malleable implantologists and answers were too vague...atleast till now we know its' survival rate is better than ipps significantly...very significantly... but to what extent? This is malleable (pun intended )...

I think this is the biggest problem with the malleable and ipp's biggest problem is mechanical failure.

Now regarding the extrusion/erosion fixes....it's almost always possible...even full erosions are fixable...in prosthetic urology nowadays, problems are fixable but with greater risks with each fix.

tooyoung, any chance you have a link to the video where Clavell talks about the patient who had the malleable for 27 years? No worries if you can’t find it.

I really want a malleable because I want to avoid the IPP risks + I’m younger and would be paying out of pocket + want to reduce the # of potential revisions as much as possible. But the next phase in my research has been trying to understand the long-term implant strategy for us younger guys. I’d ideally like to be having sex for as long as possible after implantation, so have been trying to understand if implanting an MPP young puts us at any disadvantage on account of the wobble / tissue atrophy longer term.

Hi FenderStrat_93....I'm in the same situation and it sucks so much especially we can't get definitive answers...surgeons usually orient their answers towards experience rather than long term plans for many reasons...anyways there are some hints we can't neglect...for example, eid states on his website that average use of an implant is 1 or 2 times per week...and the more you use the ipp the more wear and tear will happen..considering his stated average life of an ipp is 8 to 12 years (I think it's less...and it's less ), this much use gives you 8 to 12 years.
The problem atleast for me is not only the fact that it will break every few years, but also the daily anxiety I will get and asking myself each time I pump it : will it pump or not ?

Mpp will somewhat buy us a peace of mind..and I said "somewhat" because it will eventually fail too...when will it fail will be unknown too but not in the near future as ipps could...your pump or tubes could go wrong a month out of surgery...this doesn't happen with mpp considering you are implanted correctly...it could last easily 15 years...maybe less but not too much less...Osama shaeer a high volume implantologist told me he has witnessed in his career (he started early 2000s I believe) those who had been implanted by Gamal behiri(the first ever to implant intracavernosally in the 60s) doing just fine...I don't know if he was bullshiting anyway...but he's one of the most honest amongst implantologists...I saw small carrions(first ever semi-rigid implants) being explanted after 40 something years recently...those might be the extremes...might be not too extreme..I don't know.

Is it possible when mpp gets too wobbly to change it with another mpp? I don't think so as it will yield the same last result you had just before the revison surgery...especially if you were originally implanted 13mm...so in this case you will switch to ipps.... but then you already had a good chunk of your prime with a peace of mind...another thing we should consider is going from an ipp to mpp is usually disappointing..you don't want to be driving toyota after driving mercedes...though thedriver and JH007 felt better with the malleable after having an ipp and I think there are alot who think the same.

However,If your penis is already massive...noticeably above average by 2 to 3 folds...don't risk mpp from the beggining and not because loss of size but rather you will get to the nonfunctional "extra" wobbly state too soon...If you are, atleast you won't be caught in a dilemma and you got a big dick ...I hope JH007 gives his take on this since he's massive and past 6 years with a malleable.

I know it sucks...and sucks very much more than anything but eventually and hopefully we will become at ease with the reality of having alot of revisions along the way...and uncertainity becomes our friend.

[FenderStrat_93]

That's my million dollar question..unfortunately you won't get a clear cut answer...however, there are three conclusions(still vague) I got from extensive digging on forums...1) malleable getting wobbly is inevitable , however it could happen a few months after surgery, few years or sometimes a decade or 2...anyway it's almost always inevitable. 2) wobbliness doesn't necessarily mean it would compromise ability to penetrate and thrust...i remeber a guy had an extensive consultation with eid on this and eid told him after 20 years "it will be all over the place" ...meaning extra wobbly ,however that will not necessariy affect effectivness...it's just you will need to direct your penis with your hand...and again this could happen anytime post surgery...I saw cases after 4 years I've seen others after 7 when the penis had dropped(looking half erect but still rigid enough)..And you can check clavell video on yt where he changed a malleable of 27 years...the patient reported it was wobbly for a long time but during the last 7 years he wasn't able to penetrate at all (i can't tell whether this is due to material fatigue or the implant has turned extra wobbly) 3) inadequate sizing of the implant will expedite this process tremendously...it could be after a year or so....this is why big dicks can't install malleables or it would be unwise to do so ..as the largest malleable is 13mm (which fits most dicks by the way)...not because big dick will loose girth but because it will turn extra wobbly very quick..and this is also why "sparing of cavernosal tissue" is bullshit especially in mpp...biggest implant possible ensures best implant survival rate possible.

In general, average survivability rate of a malleable I believe is a solid 15 years if and only of done correctly and not undersized by 1 mm (it's a physics thing..more than a size perservance matter)..hakky said expect 15 years out of it....I've tried to get clear cut answers from top malleable implantologists and answers were too vague...atleast till now we know its' survival rate is better than ipps significantly...very significantly... but to what extent? This is malleable (pun intended )...

I think this is the biggest problem with the malleable and ipp's biggest problem is mechanical failure.

Now regarding the extrusion/erosion fixes....it's almost always possible...even full erosions are fixable...in prosthetic urology nowadays, problems are fixable but with greater risks with each fix.

tooyoung, any chance you have a link to the video where Clavell talks about the patient who had the malleable for 27 years? No worries if you can’t find it.

I really want a malleable because I want to avoid the IPP risks + I’m younger and would be paying out of pocket + want to reduce the # of potential revisions as much as possible. But the next phase in my research has been trying to understand the long-term implant strategy for us younger guys. I’d ideally like to be having sex for as long as possible after implantation, so have been trying to understand if implanting an MPP young puts us at any disadvantage on account of the wobble / tissue atrophy longer term.

Hi FenderStrat_93....I'm in the same situation and it sucks so much especially we can't get definitive answers...surgeons usually orient their answers towards experience rather than long term plans for many reasons...anyways there are some hints we can't neglect...for example, eid states on his website that average use of an implant is 1 or 2 times per week...and the more you use the ipp the more wear and tear will happen..considering his stated average life of an ipp is 8 to 12 years (I think it's less...and it's less ), this much use gives you 8 to 12 years.
The problem atleast for me is not only the fact that it will break every few years, but also the daily anxiety I will get and asking myself each time I pump it : will it pump or not ?

Mpp will somewhat buy us a peace of mind..and I said "somewhat" because it will eventually fail too...when will it fail will be unknown too but not in the near future as ipps could...your pump or tubes could go wrong a month out of surgery...this doesn't happen with mpp considering you are implanted correctly...it could last easily 15 years...maybe less but not too much less...Osama shaeer a high volume implantologist told me he has witnessed in his career (he started early 2000s I believe) those who had been implanted by Gamal behiri(the first ever to implant intracavernosally in the 60s) doing just fine...I don't know if he was bullshiting anyway...but he's one of the most honest amongst implantologists...I saw small carrions(first ever semi-rigid implants) being explanted after 40 something years recently...those might be the extremes...might be not too extreme..I don't know.

Is it possible when mpp gets too wobbly to change it with another mpp? I don't think so as it will yield the same last result you had just before the revison surgery...especially if you were originally implanted 13mm...so in this case you will switch to ipps.... but then you already had a good chunk of your prime with a peace of mind...another thing we should consider is going from an ipp to mpp is usually disappointing..you don't want to be driving toyota after driving mercedes...though thedriver and JH007 felt better with the malleable after having an ipp and I think there are alot who think the same.

However,If your penis is already massive...noticeably above average by 2 to 3 folds...don't risk mpp from the beggining and not because loss of size but rather you will get to the nonfunctional "extra" wobbly state too soon...If you are, atleast you won't be caught in a dilemma and you got a big dick ...I hope JH007 gives his take on this since he's massive and past 6 years with a malleable.

I know it sucks...and sucks very much more than anything but eventually and hopefully we will become at ease with the reality of having alot of revisions along the way...and uncertainity becomes our friend.

Thanks tooyoung for the in depth perspective - and what’s especially interesting to me (and a slight relief too if I’m being honest) is the idea that after MPP if wobbling is an issue, that IPP might be a feasible next option. By that logic, I like the idea that HOPEFULLY I could get away with 15-20 years with an MPP and hopefully get another MPP as a revision later on - but if wobbling is too much of an issue could potentially get another 20 with an IPP later in life (with revisions as-needed, of course). This feels like a potentially ideal long-term strategy for some of us younger guys, and I never even considered it actually.