My reasons for going Infrapubic and Minimally Invasive

[Quincy]

So I'm now 2 weeks post surgery. I activated at 1 week and my doctor has told me to wait one more before sex. I have minimal swelling and no bruising at all, unlike many of the pictures we've all seen. There's been some pain from pinching the bulb of the pump and some from maximum inflation, but it's not bad. Some have told me that I must be good at handling pain, but I'm really not. Just ask my wife.

I attribute the quick recovery, early activation, and fast clearance for sex to the type of surgery I received and a good doctor. This is NOT an ad for my doctor and I won't refer to him here. If you want to know more about my doctor, send me a PM.

As many of you know, I did a LOT of research before choosing a doctor and a methodology. Initially, I was all for a peno-scrotal surgery. I even turned one doctor down because he did only infrapubic implants. I changed my mind while doing research and after talking with three different doctors.

I am NOT a doctor. None of what follows is advice, just my rambling about the information I've received. Some of this information I had before surgery and some I've come to understand since.

Healing and early activation. The "minimally invasive" infrapubic procedure helps with this tremendously. Many of the guys I've spoken with are activated at 3 or 6 weeks out. Meanwhile, the penis is slowly healing in a certain state, sometimes deflated, others inflated. My doctor believes that it is better to heal with the penis moving between states, not in a single state. With this approach, healing is faster and the pain is lower, especially in the scrotum, where the pump is located. The hardest part of activation is pushing hard on the pump in your scrotum. It hurts for me to do it (think pinching your sac really, really hard), but imagine how much more it would hurt if there was a surgery incision on my sac, making all of the scrotal skin hurt more and having inflamed nerves, as well as lots more swelling and bruising. I have no scrotal bruising at all. The only time my doctor touched my sack was to drop the pump into it. In addition to not having the incision to deal with, the swelling was far less. I was up and walking 2 miles and better just 4 days after surgery. The faster healing is why I was activated at one week and cleared for sex at just 3 weeks.

Tubing difficulty: During a pre-surgery appointment, my doctor showed me the path the tubes take, using a demo implant. Because he goes infrapubic and turns the cylinders sideways, the tubing routes much easier, with no chance of kinking and not needing extra length. The tubing for a peno-scrotal version of the implant is actually longer because the tubes have to be looped almost back on themselves. It's much more complex routing and results in being harder for the surgeon and again impacting healing.

Length: It is true that some doctors have undersized patients doing both types of surgery. There is some belief that it is harder to get the correct length with infrapubic incision. It seems that if your doctor knows what he is doing, either can get the right length, but it appears to be a little harder with infrapubic. The surgeon needs more skill. So if doing infrapubic surgery, you probably want the most skilled surgeon you can find. But that's what I wanted regardless of approach. I need more time to heal and assess, but for now, at least, I'm happy with the implant length I have.

Nerve damage: The biggest reason I originally wanted to have peno-scrotal surgery was that I was afraid of having the dorsal never damaged, resulting in lower or totally lost sensation. At least one of the men here at FT has had this problem. My doctor said that once a doctor is trained there should NEVER be a cause of this happening. The nerve is easy to identify and avoid. So again, choose a surgeon with experience and skill.

Infection: Peno-scrotal surgery leaves an incision in the wrinkly skin of the scrotum. This skin is harder to keep clean and easier to have bacteria due to not being smooth. Being below the dick also can contribute. Infrapubic surgery uses a small incision in the smooth skin above the dick. Easier to clean, easier to keep clean. My doctor double-stiched my incision and then put surgical glue on it, completely sealing it off from the outside and leaving no way for bacteria to get in. The top doctors that do infrapubic, minimally invasive surgery both believe that it minimizes the chance of infection. I now agree with them.

Apparently the infrapubic surgery is more difficult for the surgeon. I asked my doctor about that, specifically. He told me that it is more difficult to learn but he feels it's worth learning, and many lesser-skilled urologists do peno-scrotal surgery because it is easier to learn. Top implant surgeons obviously do it because they think it is best.

I am NOT saying that peno-scrotal surgery is bad. Most of the very best surgeons in the field do it. Of the top 10 or so implant doctors, only two that I know of prefer infrapubic, minimally invasive surgery. That's a strong argument against the approach I chose. There are undoubtedly others and there are probably counter-arguments regarding things I've posted, as well as ideas I've never considered. But I'm personally very glad I went this route. Note that not all infrapubic surgeries are considered "minimally invasive" and many men here have had long recovery times even though their doctors used infrapubic incisions.

FWIW, separately, my doctor also said having the surgeon use a drain is important. The surgery causes a lot of fluids to build up in the surgery area and scrotum. I had a drain overnight and every time they emptied it, there was a lot of fluid. With no drain, the body has to take time to re-absorb those fluids and healing is delayed.

So these are the points favoring this approach. I don't want to offend anyone, and I definitely don't think my choices are for everyone. The surgery you had and your outcome are perfectly fine and I'm not disparaging you or your decision. I don't want to argue with anyone. My reason for posting this is that there seems to be a lot of question regarding why anyone would want to do infrapubic when peno-scrotal is so much better. I thought I'd post a counterpoint.

I'm delighted with the knowledge and support I've received here, and I just want to share thoughts.

Quincy.

[radioradio]

Thanks Quincy. Great post.
Glad you’re doing so well.
Bob

[oldbeek]

I also hadinfrapubic. It healed real quick. I posted many times about pain. My dr pumped me nearly 100% and said do not touch the pump for 4 weeks. You guys know the pain while max pumping. Imagine that for 4 solid weeks. Has nothing to do with infrapubic procedure. Just my idiot doctor. On the west coast, I would recommend Quincys Dr. Nice post Quincy. I sure made a mistake not using Dr Karpman.

[David_Webb]

Quincy,

Extremely well written and excellent information. Thank you!

When researching methods I was swayed to the penoscrotal method after hearing about the dorsal nerve problem and sizing issues I have read here that were associated to infrapubic method. When I located a doctor working less than 1 mile from my home I started googling him and found a paper he published about the benefits of infrapubic method being superior. I still made an appointment to get an impression of his comfort level and experience but intended on going to see a high volume clinic if I wasn’t convinced his was the right surgeon.

During our first appointment he informed me that he does both but almost exclusively does penoscrotal now as he feels it has more positives and laid out some pros and cons that essentially mirrored your explanations above, except he believes that the infrapubic is easier as placing the reservoir can be difficult with a less experience. His main reason for the penoscrotal is the scar can be somewhat hidden when cut in a wrinkle of the sack it is much more likely to never be noticed. The infrapubic method does leave a scar above the penis that would likely raise some concern or suspicion with a new partner. I am pretty much engaged and intend on marrying my GF but I still liked the idea of not having a visible scar on my pubic area. My opinion is that unmarried men this would be a higher level of concern as maybe not every partner will be in the know of your bionic powers.

Bottom line for me wast penoscrotal was the preferred method my local doctor prefers and as discussed in length here you should always go with the doctors preferred method. There are also other contributing factors like previous hernia or other surgeries that may be relevant in the doctors descision to choose a method.

[Happy Toy]

So I'm now 2 weeks post surgery. I activated at 1 week and my doctor has told me to wait one more before sex. I have minimal swelling and no bruising at all, unlike many of the pictures we've all seen. There's been some pain from pinching the bulb of the pump and some from maximum inflation, but it's not bad. Some have told me that I must be good at handling pain, but I'm really not. Just ask my wife.

I attribute the quick recovery, early activation, and fast clearance for sex to the type of surgery I received and a good doctor. This is NOT an ad for my doctor and I won't refer to him here. If you want to know more about my doctor, send me a PM.

As many of you know, I did a LOT of research before choosing a doctor and a methodology. Initially, I was all for a peno-scrotal surgery. I even turned one doctor down because he did only infrapubic implants. I changed my mind while doing research and after talking with three different doctors.

I am NOT a doctor. None of what follows is advice, just my rambling about the information I've received. Some of this information I had before surgery and some I've come to understand since.

Healing and early activation. The "minimally invasive" infrapubic procedure helps with this tremendously. Many of the guys I've spoken with are activated at 3 or 6 weeks out. Meanwhile, the penis is slowly healing in a certain state, sometimes deflated, others inflated. My doctor believes that it is better to heal with the penis moving between states, not in a single state. With this approach, healing is faster and the pain is lower, especially in the scrotum, where the pump is located. The hardest part of activation is pushing hard on the pump in your scrotum. It hurts for me to do it (think pinching your sac really, really hard), but imagine how much more it would hurt if there was a surgery incision on my sac, making all of the scrotal skin hurt more and having inflamed nerves, as well as lots more swelling and bruising. I have no scrotal bruising at all. The only time my doctor touched my sack was to drop the pump into it. In addition to not having the incision to deal with, the swelling was far less. I was up and walking 2 miles and better just 4 days after surgery. The faster healing is why I was activated at one week and cleared for sex at just 3 weeks.

Tubing difficulty: During a pre-surgery appointment, my doctor showed me the path the tubes take, using a demo implant. Because he goes infrapubic and turns the cylinders sideways, the tubing routes much easier, with no chance of kinking and not needing extra length. The tubing for a peno-scrotal version of the implant is actually longer because the tubes have to be looped almost back on themselves. It's much more complex routing and results in being harder for the surgeon and again impacting healing.

Length: It is true that some doctors have undersized patients doing both types of surgery. There is some belief that it is harder to get the correct length with infrapubic incision. It seems that if your doctor knows what he is doing, either can get the right length, but it appears to be a little harder with infrapubic. The surgeon needs more skill. So if doing infrapubic surgery, you probably want the most skilled surgeon you can find. But that's what I wanted regardless of approach. I need more time to heal and assess, but for now, at least, I'm happy with the implant length I have.

Nerve damage: The biggest reason I originally wanted to have peno-scrotal surgery was that I was afraid of having the dorsal never damaged, resulting in lower or totally lost sensation. At least one of the men here at FT has had this problem. My doctor said that once a doctor is trained there should NEVER be a cause of this happening. The nerve is easy to identify and avoid. So again, choose a surgeon with experience and skill.

Infection: Peno-scrotal surgery leaves an incision in the wrinkly skin of the scrotum. This skin is harder to keep clean and easier to have bacteria due to not being smooth. Being below the dick also can contribute. Infrapubic surgery uses a small incision in the smooth skin above the dick. Easier to clean, easier to keep clean. My doctor double-stiched my incision and then put surgical glue on it, completely sealing it off from the outside and leaving no way for bacteria to get in. The top doctors that do infrapubic, minimally invasive surgery both believe that it minimizes the chance of infection. I now agree with them.

Apparently the infrapubic surgery is more difficult for the surgeon. I asked my doctor about that, specifically. He told me that it is more difficult to learn but he feels it's worth learning, and many lesser-skilled urologists do peno-scrotal surgery because it is easier to learn. Top implant surgeons obviously do it because they think it is best.

I am NOT saying that peno-scrotal surgery is bad. Most of the very best surgeons in the field do it. Of the top 10 or so implant doctors, only two that I know of prefer infrapubic, minimally invasive surgery. That's a strong argument against the approach I chose. There are undoubtedly others and there are probably counter-arguments regarding things I've posted, as well as ideas I've never considered. But I'm personally very glad I went this route. Note that not all infrapubic surgeries are considered "minimally invasive" and many men here have had long recovery times even though their doctors used infrapubic incisions.

FWIW, separately, my doctor also said having the surgeon use a drain is important. The surgery causes a lot of fluids to build up in the surgery area and scrotum. I had a drain overnight and every time they emptied it, there was a lot of fluid. With no drain, the body has to take time to re-absorb those fluids and healing is delayed.

So these are the points favoring this approach. I don't want to offend anyone, and I definitely don't think my choices are for everyone. The surgery you had and your outcome are perfectly fine and I'm not disparaging you or your decision. I don't want to argue with anyone. My reason for posting this is that there seems to be a lot of question regarding why anyone would want to do infrapubic when peno-scrotal is so much better. I thought I'd post a counterpoint.

I'm delighted with the knowledge and support I've received here, and I just want to share thoughts.

Quincy.

Thanks Quincy. This past Tuesday I had my pre-op consultation. My Dr. is going to do the surgery the very same way your's was done, and after reading your account, I feel really good he is. The only difference is I'm also having a scrotal-plastie done. The skin of the sack goes about half way up my shaft, this will be removed, so I will have stitches there as well. I too thought the peno-scrotal was a better more direct way but after seeing some pictures and reading posts here on FT I have changed my mind and feel very good about infra-pubic approach. I also went on Coloplast website under "find a Dr." and there he was along with another doc who also is with Kaiser, I'm very happy and looking forward to surgery day next Tuesday at 11am .
Will keep you posted, Andy

[Greg1956]

Hi Quincy,
Great post. I think the key is simply a skilled surgeon. My surgery was done using the Penoscrotal incision and aside from that I could have written your post. I healed quickly, almost no bruising or swelling, no pain and only mild discomfort, activated early and sex at 5 weeks. I think the only reason I had to wait that long was due to having Scrotoplasty surery at the same time so there was another incision to heal. I have been so happy with my results and can't think of a thing I would have changed.

Greg