Making the big decision

The final frontier. Deciding when, if and how.
ejf110
Posts: 6
Joined: Fri Aug 23, 2019 4:48 am

Making the big decision

Postby ejf110 » Mon Dec 09, 2019 4:29 pm

Hi All,

I posted on this forum a few weeks ago as I was pondering the implant. I now have a provisional operation date of 21 Jan with Prof David Ralph in London.

To give some background: I am 34 and have lived with ED for about 15 years. I’ve never had a definitive diagnosis but venous leak has been mentioned as a probability. Apparently it is very difficult to prove either way - but hey, whatever the cause, the damn thing doesn’t function properly. This has caused untold emotional distress over the years as friends pair off, get married etc and I’m stuck, hoping the tablets would work (they don’t). Relationships have failed and it’s been dreadful. At times I’ve lost hope in life. I realised that to have a shot at normality I would need something invasive.

Injections
These are very unattractive because (1) they are limited to 3 times p/w, (2) they are quite impractical for dating, carrying around and having to inject in the bathroom when you don’t know if a given interaction will lead to sex, (3) over the life cycle of an implant (10 years) they would be more expensive than an implant cost if you were using them to the permitted three times p/w. In Britain they cost about £20 ($27) per shot because the NHS doesn’t make them available at the standard prescritpion rate. I have ruled them out for these reasons - would be interested to know if you think this sounds reasonable.

Implant
Professor Ralph’s specialist nurse said that the cylinders do not go into the glans (contrary to some of the posts in this forum). He is recognised as the top guy in Europe and so I’m not inclined to doubt him. The nurse did say there’s always a risk of floppy head but with a young guy who can get decent (if very short-lived) erections I would probably be ok. However, Prof Ralph said that if I do have floppy head then this can be mitigated with cialis (to some extent) or Vitaros (to a greater extent, but £20 per application!). Reading about instances of floppy head on this forum is the one thing making me anxious about the operation, so I was wondering if anyone had a view on (1) the likelihood, (2) how sub-optimal this would be for normal sex, (3) whether measures like cialis help to mitigate it.

Many thanks in advance.

tomas1
Posts: 1406
Joined: Tue Jul 23, 2013 5:12 pm
Location: Tempe, AZ

Re: Making the big decision

Postby tomas1 » Mon Dec 09, 2019 4:53 pm

Who the hell is that nurse?
The damn cylinders must go into the glans unless the surgeon is incompetent/lazy and doesn't use the traction sutures.
You must nail this down before surgery. If the doc backs up the nurse, run from him regardless of his reputation.
82 years
Inject testosterone weekly.
Got implant on 1/22/19 by Dr Avila.
Scrotal, horizontal incision just over 1"
18cm AMS 700 CX, 3.5cm RTE 100cc reservoir
Diagnosed with Gleason 6 prostate cancer. Monitoring it for now.

Agfa13
Posts: 937
Joined: Thu Oct 31, 2019 6:03 pm
Location: Laurel, Maryland

Re: Making the big decision

Postby Agfa13 » Mon Dec 09, 2019 9:02 pm

Ejf,

Yeah, I agree with Thomas1.
Go to youTube and look up Dr. Kramer and watch his vids (if you can stomach it, lol) and others. Inform yourself.
See how he measures the depth of your shaft before implanting cylinders.
When I saw my Dr., he told me the cylinders go into the glans. My initial implant was messed up, 1st Dr. did not put in cylinders in all the way to the glans, so I do have floppy head. By that, I mean if I try to fuck, esp. anal, cylinders will be poking into glans.
Unless you have had your prostate removed, your glans *may* engorge, but your cylinders do go all the way up. This adds to your ability to have ruff sex, lol.
56, Maryland, revised with Titan on 3/2/20
Document your current penile size: photos and written records
AMS cx at 24cm, now have Titan Classic 20 cm
Show and tell presenter

David_R
Posts: 2145
Joined: Mon Nov 02, 2015 1:03 pm

Re: Making the big decision

Postby David_R » Mon Dec 09, 2019 10:11 pm

+1

merrix
Posts: 987
Joined: Tue Oct 27, 2015 1:08 am

Re: Making the big decision

Postby merrix » Tue Dec 10, 2019 12:39 am

ejf110 wrote:Hi All,

I posted on this forum a few weeks ago as I was pondering the implant. I now have a provisional operation date of 21 Jan with Prof David Ralph in London.
...
Implant
Professor Ralph’s specialist nurse said that the cylinders do not go into the glans (contrary to some of the posts in this forum). He is recognised as the top guy in Europe and so I’m not inclined to doubt him. The nurse did say there’s always a risk of floppy head but with a young guy who can get decent (if very short-lived) erections I would probably be ok. However, Prof Ralph said that if I do have floppy head then this can be mitigated with cialis (to some extent) or Vitaros (to a greater extent, but £20 per application!). Reading about instances of floppy head on this forum is the one thing making me anxious about the operation, so I was wondering if anyone had a view on (1) the likelihood, (2) how sub-optimal this would be for normal sex, (3) whether measures like cialis help to mitigate it.

Many thanks in advance.



Of course, I am not saying I know more about implants than Dr. Ralph...
What I am saying is that something is wrong here.
I just simply don't believe it is Dr. Ralph's opinion that an implant should not reach into the glans.
Either there is something with your anatomy that makes this the right way in your case.
Or you simply misunderstood him (or his nurse).
I think everybody on this site with some knowledge and who has discussed with (competent) doctors can tell you that an implante definitely should go far in to the glans.
Otherwise it simply won't work well. It will fold and you will get 2/3 hard dick and 1/3 soft dick.
That is sort of the definition of a floppy head.

So get this sorted out. Talk to them again. Simply tell them any authority in the field will say that the cylinders should go in to the glans. Show him webpages from Dr. Eid's site, scientific papers or whatever. And ask him why this does not apply to you.
Don't just accept that statement without going to the bottom with why they say so.
And if you don't get a good explanation, I would stay away from them until I do.
43 yo, ED forever from VL
Fit and active
Implanted 151215
Titan XL 24 cm, no RTEs
Dr. Eid
Activated day 13
Sex after 3 weeks
Gained length and girth
So far It works perfectly
Only one advice: Find a world class surgeon

oneperson
Posts: 238
Joined: Tue Oct 22, 2019 10:54 am

Re: Making the big decision

Postby oneperson » Tue Dec 10, 2019 2:46 am

Agree with everybody. Cylinders MUST go into the glans. I cannot imagine any reason why they shouldn't.
Implanted September 12nd 2019. Coloplast Titan OTR 20 cm + 1 cm RTE. Dr Cruz (Spain). Liver transplanted. Born in 1967. ED since 24 in different degrees. Pills stopped working in March 2019. Injections caused much pain.

Lost Sheep
Posts: 3698
Joined: Mon Jul 04, 2016 11:16 pm

Re: Making the big decision

Postby Lost Sheep » Tue Dec 10, 2019 2:11 pm

ejf110 wrote:Professor Ralph’s specialist nurse said that the cylinders do not go into the glans (contrary to some of the posts in this forum). He is recognised as the top guy in Europe and so I’m not inclined to doubt him. The nurse did say there’s always a risk of floppy head but with a young guy who can get decent (if very short-lived) erections I would probably be ok. However, Prof Ralph said that if I do have floppy head then this can be mitigated with cialis (to some extent) or Vitaros (to a greater extent, but £20 per application!). Reading about instances of floppy head on this forum is the one thing making me anxious about the operation, so I was wondering if anyone had a view on (1) the likelihood, (2) how sub-optimal this would be for normal sex, (3) whether measures like cialis help to mitigate it.

Many thanks in advance.

Is it possible the nurse has a different concept of "go into the glans" than the rest of us?

Is it possible to make more pointed inquiries of Mr. Ralph or the nurse, or, better still, interview former patients?

I believe proper placement of the distal tips of the implant put them about 2/3 of the way into the glans (Measure from the coronal ridge to the tip of the meatus - the very end of the penis). At least, that is about where mine is and how I read most descriptions I have read (mostly here). If the tips go more than 3/4 of the way into the glans, I suspect risk of erosion would be problematic. If less than10% of the way, "foldover" of the penis head might be a problem (also known as "SST Syndrome" or "floppy head").

I believe you should ask pointedly for a clarification. What you want from Mr. Ralph (during the surgery) is commonly called "aggressive sizing". But short of anything that would risk the implant eroding through the tip of your penis, of course.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017 Dr Shaw.
READ OLD THREADS to ask better questions and better understand answers.
Make yourself part of your medical team.
Document your current penile size: photos and written records.
Pre-op V.E.D. therapy helps.

Evinrude
Posts: 210
Joined: Sun May 05, 2019 4:02 pm
Location: SC

Re: Making the big decision

Postby Evinrude » Tue Dec 10, 2019 7:13 pm

Lost Sheep wrote:
Is it possible the nurse has a different concept of "go into the glans" than the rest of us?



Just a comment that is funny... I suspected without even noticing at first the poster it had to be Lost Sheep and some "precision" was about to be nailed down in this matter ;)
Age 66, widower in 2017, remarried 2019. ED symptoms just 3 years ago, Viagra worked at first but less and less so as time went on. Never tried injections. AMS 700 LGX 15cm (2cm RTE) Implant 6/19/19 Broderick @ Mayo C. JAX.

ejf110
Posts: 6
Joined: Fri Aug 23, 2019 4:48 am

Re: Making the big decision

Postby ejf110 » Fri Dec 27, 2019 5:29 am

Thanks so much for the feedback all. I spoke further to David Ralph’s team who re-iterated that the cylinders will not go into the glans. They said “Your glans will engorge if it does at the moment”, to which I said if everything engorged properly I wouldn’t need the op in the first place.

Despite the travel cost and the dreadful sterling/dollar exchange rate I am seriously considering Andrew Kramer in Baltimore. A brief email back-and -forth confirms that his procedure “goes into the distal part of the glans” to stabilise it and minimise the prospect of soft glans.

Reviews of Dr Kramer on this site seem to be very positive and I am grateful to have FT. Before reading FT I was simply horrified at the prospect of an implant and was steadily losing hope, but it seems that many patients have had positive experiences.

oneperson
Posts: 238
Joined: Tue Oct 22, 2019 10:54 am

Re: Making the big decision

Postby oneperson » Fri Dec 27, 2019 6:11 am

I cannot believe Dr. Ralph keep the argument that cylinders doesn't go into the glans. My doctor is one of the best in Spain, but he doesn't appear in the best of the world list, and my cylinders are firmly inserted into my glans.

If you search the internet, every doctor says that if the cylinders don't penetrate the glans, the penis will look as a concorde. It has no sense. Ralph is supossed to be one of the best in the world.

It is a common sense question. If the cylinders don't enter the glans, when they are pumped, their hardness will end just before the begining of glans. Even if the glans is full of blood, having nothing to which make firm base, it will hang freely. It is a nonsense.
Implanted September 12nd 2019. Coloplast Titan OTR 20 cm + 1 cm RTE. Dr Cruz (Spain). Liver transplanted. Born in 1967. ED since 24 in different degrees. Pills stopped working in March 2019. Injections caused much pain.


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