Purpose of RTEs

The final frontier. Deciding when, if and how.
Horizon
Posts: 10
Joined: Tue Sep 18, 2018 7:47 am

Purpose of RTEs

Postby Horizon » Fri Sep 28, 2018 1:58 pm

Hi everybody

Would you please explain the purposes or rear tip extenders and why surgeons use them?

I’m implanted with titan 16+3 rte.
I asked my surgeon why did he choose this option and not 18+1 or 20+0?
Unfortunately I didn’t get clear answer.

Thanks in advance.
45 years. Titan touch 16+3 RTE’s.
Diagnosed with peyronies 2 years ago. Dr. Adham Zazza

Hawkman
Posts: 556
Joined: Sat Aug 25, 2012 3:09 pm
Location: PA
Contact:

Re: Purpose of RTEs

Postby Hawkman » Fri Sep 28, 2018 3:02 pm

Most if not all high volume surgeons make it a point to do all they can to either eliminate or reduce the number of RTE's used. At times they will even go to a larger implant and trim down the uninflatable rear portion to avoid RTE's. One reason they are successful at avoiding or minimizing RTE's is that they maintain a large inventory of expensive implants and take several into the OR with them with every surgery.

There are at least 2 reasons, they do what they can to avoid RTE's.

#1 RTE's obviously do not inflate. They are fixed. scar tissue encapsulates the portion of the implant within the body (the crus). the inflated penis is supported much like a small porch flag with a flagpole in a holder, or a fence post in the ground. The penis is supported by the portion of the penis that is internal. In time the scar tissue around the internal base is stretched just slightly. This allows the fixed part to wobble or become less stable. Again, it is much like a fence post in a hole that is just slightly too big. Even a slight enlargement of a post hole causes considerable wobble and movement of the far end of the post. The longer the pole or post the more movement of the far end. ----- If there are no RTE's then this process is greatly minimized. The scar tissue is far less likely to stretch because the inflated part of the implant goes well into the body. When it deflates it takes pressure off of the scar capsule. Next, even if the capsule did slightly enlarge, when you inflate the internal part of the implant it will still fit snugly within the capsule preventing wobble. IE: If the internal part of the implant is inflatable it will snuggly fill the internal scar capsule. If the internal part of the implant is fixed RTE's it will more loosely fill the scar capsule.

#2 The tubes from the reservoir enter the implant at a junction near the rear of the implant. The more RTE's you put on the end of the implant the further forward you move that junction and the tubes that connect to it. This can make hiding the tubes more difficult. In worst case scenarios the tubes can be both visible and palpable in the scrotum or the shaft and can even sometimes be felt by your partner during sex.

Here is an excellent video that shows the contrast of the same man with and without RTE's
https://youtu.be/oGBMccEQERw

RTE's are just one of the factors that determine whether you have an optimal implant. The best surgeons do use them on occasion. They just avoid them and minimize them when they can. Instability or wobble does not prevent intercourse if you are firmly inflated. It can be a functional issue but is largely cosmetic with your erection pointing down rather than up.
Prostatectomy 2004-Bimix caused Peyronies-Viagra had little effect. Active sex life with wife of 50 yrs- been dependent on a VED for 10 yrs. 22cm Titan w/Dr. Eid Aug 7th See my Implant Journal -> http://www.peyroniesforum.net/index.php/board,56.0.html

Horizon
Posts: 10
Joined: Tue Sep 18, 2018 7:47 am

Re: Purpose of RTEs

Postby Horizon » Sat Sep 29, 2018 3:13 am

Thank you Kawkman for the clear explanation.

Is there any medical reasons why surgons use RTE? Why are they still produced?
45 years. Titan touch 16+3 RTE’s.
Diagnosed with peyronies 2 years ago. Dr. Adham Zazza

Hawkman
Posts: 556
Joined: Sat Aug 25, 2012 3:09 pm
Location: PA
Contact:

Re: Purpose of RTEs

Postby Hawkman » Sat Sep 29, 2018 8:31 am

Horizon wrote:Thank you Hawkman for the clear explanation. Is there any medical reasons why surgeons use RTE? Why are they still produced?


The short answer is for patients that fall between standard cylinder lengths. In reality, it can mean for patients that fall between the cylinder lengths the surgeon has in inventory.

The long rambling answer :
Ideally, a surgeon fills the available space in your corpora cavernosa so that your post-surgical size is optimal. Too little implant and you end up with size loss and even issues like a floppy glans that make penetration difficult. Oversizing results in bends and deformity because the implant cannot straighten out. It can also result in erosion. Erosion is just what it sounds like. The implant exerts constant pressure on the penile tissue and the tissue thins and erodes. An implant can actually wear completely through to the outside world. Erosion can be a problem with malleable implants that cannot be deflated.

Since Coloplast Titan implants come in 2 cm increments and AMS come in 4 cm increments the RTE's are used to aggressively fill the cavernosa that falls between sizes. As I mentioned, some surgeons such as Dr. Eid for one, will go up a size and trim the fixed part of the cylinder to avoid RTE's. I think he trims up to 1/2 cm. This is not a standard practice recommended by Coloplast but he is skilled and experienced enough in this practice that he knows it is safe and reliable. At times he is forced to add one RTE depending on where the patient's measurements fall. Without RTE's (or a willingness to trim the fixed rear portion) a surgeon using a Titan in a patient with a 23 cm cavernosum would be forced to drop back 1 cm (about 3/8") to safely avoid oversizing. In fact, a minimally skilled surgeon might drop back even if you were 22.5 cm or exactly 22cm. Undersizing means a grumbling unhappy patient but oversizing means a potential medical problem that must be surgically corrected. So, an inexperienced surgeon often ops for the safe approach. Remember that RTE's are a fixed diameter and cannot expand to fill a capsule that stretches or erodes. Titan RTE's are larger diameter than AMS RTE's but still fixed.
Prostatectomy 2004-Bimix caused Peyronies-Viagra had little effect. Active sex life with wife of 50 yrs- been dependent on a VED for 10 yrs. 22cm Titan w/Dr. Eid Aug 7th See my Implant Journal -> http://www.peyroniesforum.net/index.php/board,56.0.html

Limpbizcit
Posts: 80
Joined: Tue Nov 21, 2017 6:39 am

Re: Purpose of RTEs

Postby Limpbizcit » Sat Sep 29, 2018 9:26 am

Very clear answer Hawkman. Its responses like that, that I log in for.
Age 47. ED for over 20 years. Diagnosed with Hypogonadism. Pills and trimix do not work consistently. Implanted with 24cm AMS CX 12/12/17. Infected implant removed and replaced with AMS Spectra 2/18/18. Implanted with 26CM Titan 10/02/18. So far so good.

Horizon
Posts: 10
Joined: Tue Sep 18, 2018 7:47 am

Re: Purpose of RTEs

Postby Horizon » Sat Sep 29, 2018 1:54 pm

Thank you very much Hawkman.
45 years. Titan touch 16+3 RTE’s.
Diagnosed with peyronies 2 years ago. Dr. Adham Zazza

TomW46
Posts: 180
Joined: Mon Sep 18, 2017 5:52 pm

Re: Purpose of RTEs

Postby TomW46 » Sun Sep 30, 2018 11:18 pm

Watching Dr. Kramer's videos (he didn't video my surgery) you can see how exactly he measures the crus side and the dick side to determine what is required to make the tubes come out where they should and avoid any floppy heads, dog ears or wobble.
Age 72, wife is 52. 20+1 cm Titan Touch implanted by Dr. Kramer on 18 October 2017. Revision to AMS LGX 21+2 cm on 11 June 2018 by Dr. Carrion at Tampa General. Age-related ED + slight Peyronies bend (left) and slight hourglass in the center.

oldbeek
Posts: 1479
Joined: Sun Sep 10, 2017 1:46 pm
Location: Los Angeles area

Re: Purpose of RTEs

Postby oldbeek » Mon Oct 01, 2018 12:32 am

Horizon, Did you have infrapubic? I had a very deep cruse and with infrapubic, the RTEs were needed to get the tubes that enter the implant out beyond my pubic bone. The tubes enter on top of my dick not on the under side as they do with scrotal approach. I did not know the tubes went in on top till feeling around the last few days. Wish I knew this major difference before.
78, good health, RP 7-2017, all nerves taken , PSA 0.05, 4-18,, .08 11/18,.07 1/19,.05 4/19, .06 2/20 Pain with trimix, implant 4-18, Infra-pubic, AMS lgx 15 cm with 5cm rte. Implant at USC Keck. Dr Boyd and Dr Loh Doyle 6 x 4.5, 800 AUS 7-21-20

Horizon
Posts: 10
Joined: Tue Sep 18, 2018 7:47 am

Re: Purpose of RTEs

Postby Horizon » Mon Oct 01, 2018 6:05 am

oldbeek wrote:Horizon, Did you have infrapubic? I had a very deep cruse and with infrapubic, the RTEs were needed to get the tubes that enter the implant out beyond my pubic bone. The tubes enter on top of my dick not on the under side as they do with scrotal approach. I did not know the tubes went in on top till feeling around the last few days. Wish I knew this major difference before.


oldbeek, No, I had scrotal approach. Implant is fine, except that I can feel the beginning of the solid parts of cylinders under the pubic bone. It is also very rigid inside the crus which makes it uncomfortable (as the penis is erected all the time).
45 years. Titan touch 16+3 RTE’s.
Diagnosed with peyronies 2 years ago. Dr. Adham Zazza

Jamesbond
Posts: 205
Joined: Wed Jun 03, 2015 5:56 pm
Location: NYC, sometimes NJ

Re: Purpose of RTEs

Postby Jamesbond » Mon Oct 01, 2018 7:22 am

Ok
How does the implant get anchored?
Is it attached with screws into the bone?
Does it just sit on top of the pubic bone?
Thank you
Bond
Thinking of getting implant. Have not done it because of the length I
have lost.
50, Straight, I miss women


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