Evidence to support decision making on choice of surgeon

The final frontier. Deciding when, if and how.
Robert1966
Posts: 39
Joined: Mon Sep 11, 2017 8:26 pm

Evidence to support decision making on choice of surgeon

Postby Robert1966 » Thu Jun 13, 2019 10:00 pm

Hi All,
There is a lot of dialogue in the group on the benefits of selecting an experienced (or in fact highly experienced) implant surgeon. I share below an excerpt from the following paper: http://tau.amegroups.com/article/view/1459/2434

which specifically documents outcomes from surgeons of varying levels of experience. From my own experience with a surgeon that had done over 3500 surgeries, he measured my penis size as 19 cm during the surgery, but specifically chose to add a 20cm implant. He told me in pre-operation consultation that he would 'aggressively size the implant'. 12 months out the sizing and angle etc of the implant is spot on. There is no risk of tip (or base) erosion .. a consequence of an oversized implant.

The choice of surgeon is likely to have an impact on eventual penile length after PPI. A frequent implanter (widely considered as a surgeon who inserts more than 25 PPIs per year) is likely to use a longer PPI cylinder compared to an infrequent implanter. In an outcome analysis study comparing 57 penile prostheses implanted by a multiple surgeon group versus 57 penile prostheses placed by a single surgeon in a center of excellence (COE), Henry et al. found that the median cylinder length of implants placed by the COE surgeon was 2 cm greater than those placed by the multiple surgeon group (P<0.0001). More than 82% of implants placed by the COE surgeon had cylinders that were 17 cm or longer, with 37% having cylinder lengths between 20-22 cm. This was in contrast to the multiple surgeon group, whereby more than 55% of implants had cylinders that were less than 17 cm with only 14.3% having cylinder lengths between 20-22 cm. Median operative time was also considerably shorter for the COE surgeon (34 vs. 94 minutes, P<0.0001) (10).
Born 1958, ED issues following prostatectomy in 2009 for PCa. Used Cialis and prostaglandin but ultimately unworkable. Implanted 2/6/2018, 20cm Titan no RTE

navy6587
Posts: 234
Joined: Mon Apr 23, 2018 8:22 pm
Location: Providence Forge, VA
Contact:

Re: Evidence to support decision making on choice of surgeon

Postby navy6587 » Fri Jun 14, 2019 7:35 am

Damn, Robert, where was this info last year? I guess I should have been more circumspect with my questions of both my Virginia Urology docs AND more insistent that I go to NYC. I would have loved more transparency of data from any organization regarding their assessment of the greater Richmond/ Williamsburg/ Norfolk Virginia area. I couldn't find any nor were there any patient recommendations/ warnings on any site I viewed. My profile info should serve as a warning to any man in my area to NOT select VU or any of their docs as their choice.

Thanks,
Edd
74; ED at 50. Fired by 1st doc (Szobota - VA Uro) too many q's & contact w/ Coloplast rep. New doc: Ellen (VA Uro) implanted 11/8/18. 22cm Titan + 2cm RTEs; moron docs, product rep, intake/ dischg nurses! NEVER again! L- 6.75"; G- 5.5" oval.

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Quincy
Posts: 413
Joined: Tue Mar 27, 2012 6:03 pm
Location: Boise, ID

Re: Evidence to support decision making on choice of surgeon

Postby Quincy » Fri Jun 14, 2019 1:19 pm

I'm happy I found FrankTalk early in my investigation of penile implants. The information here is terrific all by itself, and while I would never make a medical decision based on recommendations from a discussion board, it gave me lots of things to learn about and research. I eventually decided to go to one of the top doctors in the field, a guy who had written papers about maintaining length and decreasing recovery time. Very happy with the decision and would not have done the travel without learning a lot from here and elsewhere. I now think I would have been fine just going to my local guy, but I'm SURE I got great treatment from the doctor I chose.

Everyone should learn as much as they can, and when a doctor says you're asking too many questions, I'd drop the doc instantly. It's my body, I want and deserve to know everything I can.

Quincy
71, Boise area, Married
ED from type 2 diabetes and PCa radiation.
AMS LGX surgery 6/5/18 with Edward Karpman in Silicon Valley, 18cm+3RTE

navy6587
Posts: 234
Joined: Mon Apr 23, 2018 8:22 pm
Location: Providence Forge, VA
Contact:

Re: Evidence to support decision making on choice of surgeon

Postby navy6587 » Fri Jun 14, 2019 9:38 pm

Quincy...how right you are. Fortunately, I won't make the same mistake twice 'cause I don't intend to have a revision...EVER!

Edd
74; ED at 50. Fired by 1st doc (Szobota - VA Uro) too many q's & contact w/ Coloplast rep. New doc: Ellen (VA Uro) implanted 11/8/18. 22cm Titan + 2cm RTEs; moron docs, product rep, intake/ dischg nurses! NEVER again! L- 6.75"; G- 5.5" oval.

Robert1966
Posts: 39
Joined: Mon Sep 11, 2017 8:26 pm

Re: Evidence to support decision making on choice of surgeon

Postby Robert1966 » Fri Jun 14, 2019 10:59 pm

It may be of interest to those outside of the US, that driven by the urologist Stephen K. Wilson, there are 'Centres of Excellence in Penile Implants'
Currently there are three Centres of Excellence in Germany, and one in each of Korea, Spain, UK and Australia

The base criteria for establishing a Centre of Excellence in Penile Implants are:
- 50 surgical procedures yearly for 5 years.
- must serve as a tertiary referral center for less frequent implanters to refer difficult cases.
- The physician must be recognized by his peers as a key opinion leader in prosthetic urology and must teach and publish clinical papers in peer reviewed literature.
- Stephen Wilson must have participated in surgery with the named physician attesting to his surgical skills.

Here is debate on this issue by a US based author:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5715184/
Born 1958, ED issues following prostatectomy in 2009 for PCa. Used Cialis and prostaglandin but ultimately unworkable. Implanted 2/6/2018, 20cm Titan no RTE

jump.ship
Posts: 145
Joined: Fri Apr 26, 2019 2:03 am

Re: Evidence to support decision making on choice of surgeon

Postby jump.ship » Sat Jun 15, 2019 3:57 am

It is quite shocking that surgeons are allowed to toss any oul size in and hope for the best.

I can get the implant on the NHS here for free, but I would never do it! Instead I am living like hermit to save up the money to go private.
Uk Based - 39 Years
ED from day one - VL confirmed with NHS
Implanted Jan 2022 - Dr Eid - 22cm Titan / no RTEs


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