Implant or Surgery

[SW0110]

I have Peyronies, and am told I have two options. Excision surgery or a coloplast. The surgeon I went to wants to either excise the plaque and graft, and leave it for as long as either sildenafil(viagra), or trimix works for me, then implant a coloplast. Or if I want to he will just do the implant, but does not want to mess with the plaque because of potential complications from doing both of those surgeries. He feels strongly about the coloplast due to my curvature, and my length and girth are still pretty good.

I wrote a history, not short mind you just to give you an idea of my history. I do think history is important in dealing with these issues. I have not been dealing with it as long as some, but I do feel it is the result from a fall, so see no reason for things to really get better on their own, a feeling agreed with by several different doctors.I have been perusing the comments, and for hours, and would like to see if someone has some current input on whether they had surgery for the plaque removal, and then an implant, or went to an implant.

Just so everyone can have a little history about my story, because I do think it is appropriate to lessen the confusion. I have been dealing with LUPUS and arthritis since about age 40 with a lot of issues. I was in the public safety area so could not take a lot of prescription drugs due to mandatory drug tests. I mostly took the minimum dosage of various pills, which was at different times tramadol, gabapentin, and lyrica. I retired at 52 when my wife said I could either retire or divorce. I worked a bit much it seems. I preferred marriage over work after all. We got married at 17 and together ever since. Not all great times, but mostly good. In June 2016, I was working on my pool deck in the summer. One complication of LUPUS is intolerance to heat. I should have been in the house, but nooooooo. Walking across my 2 by 8 deck supports, I got a little foggy and fell about 3 feet straight on the boys. Needless to say I was black and blue from my knees to my lower stomache. Went to my regular doc the next day, and he said everything looked okay but referred me to a urologist.

As a little history, up until that time I had had no issues with getting or maintaining an erection. I had a pretty solid 7 inches with a girth of about the same. I hate to say it but even if I imbibed a bit much alcohol still had no problem with an erection or keeping one for a while. Pretty much if I wanted a hard on I got one and kept it for as long as I wanted.

After the accident, I started having issues. I was always very active. Would work 10 - 12 hours a day and come home and work on the farm till midnight. After retirement, stayed out working most of the day even with the LUPUS issues. In fall of 2016, I did not want to get off the couch and would move from the bed to the couch. The only positive with this is our dog was in heaven. He never left my side all day or night. Started irritating the urologist. Got my testosterone tested and it was 20. Literally 20. In the past during physicals it would be over 800. Also told him I was having issues getting an erection. He put me on androgel supplements. I already exercise regularly, eat pretty healthy, and take vitamin supplements, but not any of the testosterone supplements. He also gave me a prescription for generic viagra, sildenafil. I started with 40 mg. at first and the erections came back okay. Not like before, but were there. As the next 6 - 8 months went on I had to go up to 100 mg of sildenafil to get an erection. Kept going to urologist and he kept telling my I will be on testosterone treatments for the rest of my life. One negative is I really have to work out hard to keep my pecs toned. Not sure why that is a side effect. As he said hey plastic surgeons can take care of that. I just work out more.

In fall of 2017, on a regular visit to urologist and more tests. My testosterone stays around 500, which is in normal range, but only with the androgel. About October 2017, I noticed a small hourglass issue about an inch from my pelvic bone. No other issues at that time. He said no big deal, just take the sildenafil and keep going on. In December, I noticed a hard nodule in the same area, and a slight bend to the left. Back to urologist. His words, Looks like you got peyronies. You need to take 400 mg of VE two times a day. Nothing else. Started researching along with my wife, who is a medical records coder. I still could get an erection on the drugs so no big issue.

Big surprise the nodule gets bigger. Mind you at this time the urologist has never touched my dick, just looked at it. Started taking VE, ALC, Bromaline, Aloe Vera, Protein, pretty much anything that I read about that might remotely help. Around March when the bend got noticeably worse, about 45 degrees to the left and about the same straight up. Weird looking to say the least. My wife got concerned and said I need to see a specialist to make sure it really was Peyronies and not cancer, which could have been an issue. Made my own appointment with a specialist in KY. Went to the the visit in April and he says it has not been long enough, not much he can do. He did tell me that it was not cancer so no reason to worry. Made an appointment for the second week of August, which I went to. Suggested I get an Andropeyronies traction device and use it. (I just started this a couple weeks ago. Should have done so earlier but just a bit depressed over the summer. Using it now stretching at 6 inches relaxed and about 5 inches girth relaxed still).

Here is where it gets interesting. This appointment was to inject me with trimix and measure. The first person I saw was this really good looking blonde PA, who tells me to get naked from the waste down and cover myself with a sheet. She then comes back in with a needle and trimix. The first shot was 20 mg, and after 20 minutes nothing. She comes back in and feels around and says she wants to inject me with another 20 mg. This time she brings a male PA with her and asks if he can feel the plague since it is pretty pronounced and easy to identify. I said sure, why not we all just enjoy ourselves. She injects me with 20 mg again, and again, nothing in 20 minutes. Next time the doctor comes in to have a look.

Since he is in the room, I start talking about my options. Surgery, implants, trimix, sildenafil, etc. He told me that nothing is probably going to help me for much longer if 40 mg of trimix will not give me an erection. The pretty PA jumps in and says she has a new bottle of trimix and could give me ANOTHER SHOT of 20 mg. I said what the hell, I am laying here, might as well go for it. Hospital is down the hall if I need to get to the ER fast. I told her I would just hang around and see what happens. This time I get an immediate erection. She comes back in and says it looks pretty good. She says she is going to take a picture of it to show the doctor when he comes in, just in case it goes down before he gets here. I told her no problem, but she really did not need a picture of some 56 year old guys dick on her phone, so she took the pictures with mine. I thought she was gonna die laughing. (You really have to see the humor sometimes in this).

Okay, all this story to get to the point. Sorry if I am a bit long winded. I used to teach a lot of classes, and never did have an issue talking up a topic. Doctor comes back, still have the erection, but he looks as the pictures first then my dick. Tells me that there are some options since the last shot with 60 mg of trimix got me an erection even with an almost upward bend. He feels that I should be implanted with a coloplast implant to permanently take care of the ED and it will also correct the bend issues. If I wanted to though since I could get an erection with trimix he is willing to excise the plague and place a graft. He does not want to do both of them at the same time since there is a possibility due to the complexity of that operation, the head of my dick could turn purple and have to be removed. WWWTTTTTFFFFFFF.

So I can within the next 8 weeks have an excision and graft to remove the plague, use trimix if sildenafil does not work anymore for the next bit of time until it does not work anymore. He figures I can get a year or two using that method. The other option is just to go straight to the coloplast. I am still in a fog with all of this and wondered if anyone had any specific thoughts on the excision and graft. Did it work for them, and how long. I am not going with the nesbit and he did not recommend it for me. If so how long until they actually needed an implant.

FYI, I plan on finding a different surgeon for sure to do an implant. Excision and graft I might let him do. My regular urologist is pretty good for a prostate exam and getting androgel and sildenafil from, but that is about it.

Footnote, sorry. I did get my GP to get me a prescription for Pentox, and have been on it for about a month. Maybe it is all in my head but I think the plaque might be little softer. At this point I am about crazy so who knows.

So right now, I am still taking all the supplements, using the Andropeyronies device (not as much as I should but oh well). Am going to order a VED just in case it might help some.

[Ricardo70]

Hello my friend,

Whenever in the life we have two options it looks like to us a problem.
I am going to give you my humble opinion.
We scare the implant and it is normal.
The graft surgery not always is very successful.
In not very big curvatures, being a young man and with very good erection they work, if they are well realized.
If you have an age (more than 40) and not very good erection, perhaps the definitive answer is the implant.
I would not suffer any more, would implant myself.
To occur, to be a recovery time and to see that that one is not solved definitely... I I do not see it.
To occur to take pills a time and that for the logic of the life and the age, the problem goes to worse...

Fortitude.

[Lost Sheep]

Quick answer and a more considered one to follow:

I had back trouble. Two options for treatment. Surgery or time and rest. I researched. Outcomes 10 years in the future for each option were the same. Surgery was always quicker. Time and bed rest had fewer complications.

My surgeon said, "You can always operate, but you can never un-operate."

I took the conservative approach and elected to not operate.

For my E.D. I took the oral medications for as long as they worked. But oral medications almost always decrease in effectiveness. Eventually, I bypassed injections and got an implant.

You have the option of using medications and perhaps a better surgical solution (or even a true cure) will come along. "You can never un-operate." Having an implant guarantees you will be impotent for the rest of your life and totally dependent on the implant for erections. Kind of like having a leg that does not work well. You can walk along with a limp and running is out of the question or you can amputate and get a prosthetic leg on which you can run, jump, climb. But it the prosthetic fails, you are in a wheelchair.

I waited to get my implant until (if the implant failed) I would be no worse off than I was immediately before the implant. If that is the case with you, I would say, "Get the implant now." But you are experiencing some small amount of recovery/improvement with conservative treatment. That puts you in a dilemma.

Another consideration is cost. Is the implant covered by insurance? Is that option likely to continue to be available?

You posted in the "Implants" section. You are likely to get more responses from implanted men than unimplanted men. That will skew your statistics.

More later. Perhaps tomorrow.

[Jato1229]

I had surgery for my 80degree upward curve. Been dealing with it for over a year. Tried all the injections and the traction devise ( pro extender) I think everything I did made it worse. Bout 10 weeks ago I had graph surgery which I believe made it worse or stayed the same. Very hard to have a Orgasm now. Went to a different DR, he said the only thing that will fix it is implant. He also stated I can try the RESTORE X traction device which I bought. I must say it’s a totally different machine then all the others. Being the mild curve you have ( compared to me ) I would give it a try. I’m gonna get implant due to the severe curve and very Dence plaque. Hopefully about November for the implant. If you were going to go for implants they say use the traction device to stretch as much as possible before you get an implant.

[Lost Sheep]

Just how complex is the plaque removal surgery? Simple or very complex and difficult? I ask because the combination surgery (repair your penis and implant your penis together) vs doing them serially is an option to consider. Together means less risk (one surgery vs two) and also more risk (a complex surgery vs two simpler surgeries).

If you fix the plaque and whatever repairs your penis needs, you may have a simpler implant later on. Implanting your penis now, you are going in to a compromised penis. If the plaque removal makes the subsequent implant surgery an easier one, doing them one at a time could be a good option.

If the plaque does not complicate the implantation, skipping the plaque removal might be best. Although the plaque may limit your choice of implant (Coloplast vs AMS). The AMS is easier to live with (in its flaccid state).

A) Do both at the same time

B) Do them serially, Plaque first, then, implant if you still need it.

C) Leave the plaque and take the implant and be done with it.

I wonder that the two 20mg injections of Trimix did nothing and the one additional 20mg injection (from a different batch) produced immediate and lasting results. Is it possible that the first batch was compromised (age, storage, etc)?

[Waynetho]

C) Leave the plaque and take the implant and be done with it.

That's me. Some proximal plaque cleanup in the crus but my distal plaque "PLATE" (~0.75" diameter) on the dorsal right side at about 1.2-1.5" from the corona is still there. It's just detached from the surrounding tunica after the doctor MODELED my penis after pumping it up while I was still on the table.