Help I could use some guidance on Implant and Doctor

[LknRon]

Hey Guys, i'm a 52 year old male with the beginning stages of ED. 50% of the time I can achieve a full erection without any meds or rings.The problem that I have is when I have sex i slowly go from hard to soft. Meds work great but, I do not like taking the medications or TriMix shots. I spoke with my Urologist and she suggested having a Penile Implant. This would assure a permanent fix for erections and eliminate me taking any meds. The idea sounds great to me. My wife is 21 years younger than myself.This procedures sounds exciting to her as well. I know as I get older this is going to gradually get worse. I would like to do this as much for me as I would for my wife.

Questions I have:

1st: I don't mind traveling to find the best Penile Implant Dr in the United States. Any recommendations would be greatly appreciated. ( My Insurance has approved the surgery )
2nd: Which surgery is the better of the two, incision in the scrotum ( https://youtu.be/z7WwTMTgCws ) or incision in the pubic area ( https://youtu.be/_JBLpvVtCLE )?
3rd: What is the average recovery time finally have sex? I am not a diabetic or have any other health issues. I would hope to heal rather quick, but some of the stories I read are scary.
4th: Do you prefer the Titan OTR 3-Piece Inflatable Penile Implant- Coloplast or the AMS 700 series—LGX, CX and CXR
5th: What are your Pro's and Con's of having this procedure done?
6th: On average how many of you guys can still achieve somewhat of a natural erection after having surgery or are you always limp until you pump?
7th: How did you mentally handle not being able to have sex, have an erection or have your wife leave your penis alone for all of the estimated recovery time. Scares the hell out of me.

Here are the two Doctors I'm thinking about. Any feedback would be great. Dr. Brian Christine in Alabama or Dr Paul Perito in Miami
Happy New Year to everyone.

[b_rad2]

Creighhill,

Every question on your list has been answered time and time again on this forum. There are several high volume surgeons that are mentioned on this website and Peyroniesforum.net > implants. Brand of device varies by surgeon however high volume surgeons carry both brands in all sizes for any situation and body type.

Not to be vague or berate your post but you have a lot of reading to catch up on. Information is power and it’s all available and a matter of opinion.

Good luck on your new quest!

[tomas1]

Yeah, most of your questions are readily available.
However, if I had a 21 year younger wife, An implant would be great.

OK, my wish list would be an AMS 700 LGX, scrotal incision, Dr Kramer (I hope he oversees or operates himself).
Sex around 21 days if you heal like I did.

No mental issues with it, but I'm older lol.

[Lost Sheep]

Welcome to Franktalk.

Read old threads. The knowledge gained will help you form better questions, understand answers and better interact with your medical team.

When I first joined FrankTalk, I took a couple weekends to read through two and a half years of posts/threads with titles that interested me and appeared informative. I recommend this to you. It will give you a better basis for forming questions and understanding the answers. You will also find several threads asking exactly your question. The answers there are more than you will get in just one thread.

Document your current penile size, both length and girth: photos and written records.

I believe pre-op V.E.D. therapy is helpful. Supplements blood flow, maintains elasticity of tissues and may ease installation - easier for surgeon and makes recovery less uncomfortable is your tissues do not have to get dilated more than they are used to.

Hey Guys, i'm a 52 year old male with the beginning stages of ED. 50% of the time I can achieve a full erection without any meds or rings.The problem that I have is when I have sex i slowly go from hard to soft. Meds work great but, I do not like taking the medications or TriMix shots. I spoke with my Urologist and she suggested having a Penile Implant. This would assure a permanent fix for erections and eliminate me taking any meds. The idea sounds great to me. My wife is 21 years younger than myself.This procedures sounds exciting to her as well. I know as I get older this is going to gradually get worse. I would like to do this as much for me as I would for my wife.

*** The conventional wisdom around implants is to use less invasive solutions and get an implanht only after all else fails to permit penetrative sex. The reasons for this are manifold, principally, danger (infection making things worse, death from anesthesia, botched operation making things worse, lack of natural spontaneous erections - ever again in your life and others, including cost)

1st: I don't mind traveling to find the best Penile Implant Dr in the United States. Any recommendations would be greatly appreciated. ( My Insurance has approved the surgery )

*** Dr. Eid advised me "Find a surgeon in love with his craft." Such a surgeon will be personally dedicated to your best possible outcome.

2nd: Which surgery is the better of the two, incision in the scrotum ( https://youtu.be/z7WwTMTgCws ) or incision in the pubic area ( https://youtu.be/_JBLpvVtCLE )?

*** best to let your selected surgeon choose.

3rd: What is the average recovery time finally have sex? I am not a diabetic or have any other health issues. I would hope to heal rather quick, but some of the stories I read are scary.

*** Your selected surgeon is the best source for this answer

4th: Do you prefer the Titan OTR 3-Piece Inflatable Penile Implant- Coloplast or the AMS 700 series—LGX, CX and CXR

*** Your selected surgeon is the best source for this answer. Factors include your size and any complicating factors like Peyronie's, scar tissue, etc.

5th: What are your Pro's and Con's of having this procedure done?

*** These factors are legion and discussed at length, far better than you will find in any single thread.

6th: On average how many of you guys can still achieve somewhat of a natural erection after having surgery or are you always limp until you pump?

*** Count on never again being able to achieve any kind of erection without the help of the implant. Period.

7th: How did you mentally handle not being able to have sex, have an erection or have your wife leave your penis alone for all of the estimated recovery time. Scares the hell out of me.

*** A drop in the bucket when you consider the rest of your life. Have you two ever been apart for a couple weeks? When I was in the military, separations were not uncommon. I have also heard of people giving up sex for Lent. 40 days. Easy once you decide to do it.

This is a decision not to be taken lightly and if you CAN wait, the conventional wisdom is that you should. There are better treatments being worked on and better implants being worked on, also. An implant is like a prosthetic leg to replace a leg that you can still walk on (although perhaps, badly). Once you cut off your leg, the prosthetic works better than your damaged leg, but you are entirely dependent on the prosthetic to have any semblance of walking halfway normally ever again. The leg is gone. The same with your corpus cavernosum. Once it is damaged/removed during the implant operation, it is not coming back. You will be entirely dependent on the prosthetic to have any semblance of having sex halfway normally again.

There is no going back to how you are now. If losing what you have now is no loss, go for it. If pills, suppositories, vacuum device, injections, testosterone supplements, lifestyle changes offer any hope, pursue them vigorously first. Adopting alternative sexual activities is also a potential solution - temporary or permanent. Just my advice.

[LMCatman]

Perito.....!

[oldbeek]

Perito.....!

Perito does mainly infrapubic I think.

[Notgivingup]

OK, my wish list would be an AMS 700 LGX, scrotal incision, Dr Kramer (I hope he oversees or operates himself).

Kramer operates himself.

[stephen54]

Entirely agree with the guys who have already responded. This site is a serious wealth of knowledge but you've definitely got to commit and dig in deep on the subject matter you're most interested in. There are a wealth of answers here.

I was in a 2 year or so spiral where injections were becoming problematic and efficacy waning and when my doc and I started talking about implants at that point, I discovered this site and lurked off to the edges and read everything I possibly could about implantation. Unsurprisingly, patterns in the posts and information developed, the more I read. The guys here have the entire spectrum of backgrounds, frustrations, partners, dynamics, anatomies, physicians, and...above all in my opinion...goals...as relates to sex / ED / interventional support to combat ED. This site forced me to think further and deeper about my goals within my relationship, and in turn it helped me refine specific actionable strategies to deal with my increasingly uncooperative dick. But god almighty, I invested a shit ton of time reading, reading, reading....

Wishing you best of luck. This is a great group here. Keep reading, keep asking..

[TANGERINE]

since your wife is interested in you getting an implant and your urologist is recommending it, I think that you are in a really good position. Also, your wife is younger than you, so you really need to get the implant as soon as possible. You are lucky to have a young wife -- an older guy with an implant who has a young wife that he can use it on is truly a fantastic couple (I am quite envious).

(a) Be sure to look at the thread "the ultimate implant questionnaire", I think it is a good place to start as there are frequently asked questions ; also, many of us regulars put in some work on the answers.

(b) ask your urologist who she would recommend. tell her that you want to be referred to "a super specialized high volume penile implant surgeon" and that you are willing to travel. She will then come up with a couple names hopefully and you should visit them

(c) there seem to be five favorite surgeons here on franktalk, but it would be presumptuous of me to say that you really need to go to one of those five; though, if you visit some of those surgeons web sites, you will see that there can be the opportunity to do a phone consultation. The chance to have a phone conversation for half an hour with a super expert (for a reasonable fee) can be really great for your own education in this matter.

(d) regarding the titan versus AMS debate, it comes down to your baseline size. If you are nearly six inches or longer, then titan, otherwise, probably AMS (though this topic is very much debated here on franktalk). A very good you tube video on this topic can be found at:

https://www.youtube.com/watch?v=8PPId-OVzag

I agree with everything in the video except that they do not really discuss that the titan diameter is 22 mm and the AMS diameter is 18 mm.

(e) In my opinion, the cylinder diameter contributes to a bigger girth, and my wife likes girth. Others have stated that the key that a woman needs from a penis is : "hardness, hardness, hardness, and then girth" (ie, NOT length)

(f) if you really want to get psyched up, there is a nice article by Anka Radakovich in menshealth dec 11, 2015 titled "why penile implants are the new boob job". I will post that article below.

(g) the note which convinced me to get the implant came from a patient who was also a doctor. He was named Ben. I have posted that letter below, for me, it was life changing.

Good luck !


Tangerine

[TANGERINE]

Here is the testimonia from Doctor Ben, this is very helpful, and I used this to convince myself to go bionic, and now that I am bionic, I agree with what he says:

Home » Testimonials » An American doctor's experience
An American doctor's experience

I'm 61, and very happily married, with my 40th anniversary coming up in June. I have been dealing with ED since I was in my mid-40s. By the mid-90s, I could still get a firm erection, but it would go away with lightning speed (I'm sure that was what I eventually learned was called venous leakage going on), so I had to get it in quickly and never stop moving at a good pace (which I hated, we both prefer a style of intercourse with a slow in and out, accompanied by lots of kissing and touching). The refractory period after orgasm was hours, so more than once in the same session was no longer possible.

Being a physician, I was aware of Viagra when it first came out and started using it in 1998. What a miracle that was! Firm erections and a refractory period as short as a few minutes. 2 orgasms became my norm, extending to 3 occasionally, and 4 on one special occasion. I would get mild headaches and slight blueing of my vision from the Viagra, but I hardly cared--I was more capable than I had been even in my 20s.

This continued to work beautifully for 3 years or so, and then the effectiveness began to fall off. Over a 5-6 year period beginning in 2002 I consulted urologists for the first time, and eventually figured out that the average urologist knew less than I did about ED by this time, so I told them whatever I wanted to try and they prescribed it.

I tried Cialis and Levitra and found the Cialis slightly better than the others for me and started using that. I tried the intra-urethral Muse product, which felt awful and didn't produce an erection. My testosterone level was steadily dropping during this period of time, and got below 200, so we added first Andro-gel, then Testim to the mix. That clearly improved my libido (which had really dropped dramatically), but had no effect on the quality of my erections, which was sufficient for "stuffable" intercourse, but not very firm at all.


I tried tri-mix injections into my penis which improved things somewhat for a while, but is the most likely reason I developed Peyronie's disease (in which scar tissue on the inside of the penis bends it in different directions). Prior to my recent implant surgery (which straightens the penis and essentially cures Peyronie's), my penis was curving upward approximately 15-20 degrees, and 10-15 degrees to the right--on those fleeting occasions when I had an erection firm enough to see it, or while under vacuum.

I tried a vacuum erection device combined with a cock ring. I never could get this to work very well and both of us really hated it. Besides, you can't leave the cock ring on very long, and it leaves your penis numb.

In late 2007 I became aware that a Dr. Larry Lipshultz, here in Houston, Texas, was one of the pre-eminent specialists in the treatment of ED. I learned of him from a couple of patients who sang his praises.

With him, I underwent a quite thorough evaluation. He determined from injecting the penis and doing a Doppler ultrasound that blood flow into my penis was relatively normal, but that the mechanism to capture the blood flow to produce an erection was not--the dreaded venous leakage. Venous leakage doesn't respond well to typical ED treatments. He didn't push the idea of an implant and I wasn't yet ready to consider that. He had a regimen of medications which he said had been successful in reversing venous leakage in some individuals--so over an 18 month period I took 25 mg of Viagra every day, Cialis when intending to have sex, and 2 or 3 other supplements he recommended as good for penis health.

By the fall of 2009, it was clear that I had no significant improvement from that, and I asked him about an implant. He thought I was a perfect candidate--I had tried all the other options, I had conditions which an implant is optimal for--venous leakage and Peyronie's disease, and I was otherwise in excellent health. My fall and early winter schedule simply didn't allow time for having the procedure done, so I saw him again in January and scheduled an implant for 3/3/10.

Around 85% of implants are the 3 piece type, and that is what I chose. They are mechanically more complicated than other types, but produce the firmest and most natural looking erection of any of the choices. More than 90% of men and their partners are satisfied with implants when all is said and done, which is far higher than the satisfaction levels with any other ED treatment.

As I type this, I am 4 days post-op. I have essentially been pain-free at rest since the catheter was removed on Thursday morning, 3 days ago. I have had minimal swelling and bruising, no pain at the incision site (3-4 cm horizontal incision high in the scrotum underneath the penis). I have mild to moderate discomfort from the pump in my scrotum, but others who have had this procedure say you eventually will be unaware it is there. I would just like to fast forward through the next 4-6 weeks, and ride my new bicycle.

Hardly anything is written about the psychological side of ED these days, and most ED is now thought to be organic rather than psychogenic in origin. However, whatever the cause, failure to perform certainly results in some degree of performance anxiety in probably everyone, which doesn't help. I think, however, that it would be unlikely that a primarily psychogenic cause of ED would end up in an implant. I would think that the pharmaceutical approaches would typically handle that well. But in the end, it doesn't matter, if nothing else works, then an implant will--barring surgical complications, infection, etc.

I think that my story is a fairly common one, based on what I have read on a variety of sites on the web. If I had it to do over again, I would have found a top specialist in ED much sooner, and probably had my implant 5 years ago. That is also a quite common comment by those who have had implants--that their only regret is that they did not do it sooner.

Your average doctor, or even average urologist, isn't much help past the point of prescribing Viagra, Cialis, or Levitra. Once you educate yourself about ED, you will know more than most of those doctors on the subject. If one of the pills works well, I see no reason to do anything more for as long as it continues to work. If one of those doesn't take care of the issue, then I would find the nearest real specialist I could find. If you have to drive a long way, so be it. From this website, and others similar to it, you should be able to find what top ED doc is nearest you. Don't choose a doctor for implant surgery who isn't doing them every week. It is critical that your surgeon be very knowledgeable and very experienced. This is not a place to cut corners!!

My wife has been 100% supportive of whatever I wanted to do each step of the way in dealing with ED. We have certainly become better lovers, as our focus has been less on penis-in-vagina sex. However, one of the clinching moments for going ahead with the implant was a conversation in which I asked her how long she envisioned us having sex and how important it was to her. She couldn't come up with a specific number but said she was nowhere near ready to do without sex in the foreseeable future, so I should plan on 15 years or more! And, like the majority of women, she has never been able to achieve orgasm from intercourse alone, but loves the feel of it nonetheless. I know younger people don't like to think about their parents or grandparents having sex, but given good health, the majority of people are sexually active into their eighties or even older that that. And let me promise you that you never feel as old as you look, and that for most of us, desire never goes away.

Although I think it is foolish, guys tend to be obsessed with the size of their penis. I think women would tell you that the 5 most important things about a penis are:


Hardness (outstanding with a 3 piece implant)
Hardness
Hardness
Hardness
Girth (which the implant will most likely increase noticeably)


I don't think length is something your partner is likely to be concerned about if you are 3" longer or more. As a physician who has done pelvic exams on women, I can feel their cervixes with my middle finger, which is 3.5" long (I have long fingers). The only spot inside the vagina, which possibly causes pleasurable sensation for the woman is the famous "G spot", but it is only about 2" inside (and on the front wall of the vagina for the geographically impaired). A penis that is too large will typically be a much greater concern for a woman than one that is too small.

You cannot increase your length with an implant, and you risk some nasty complications if am implant that is too large is used. The head of your penis may be softer (thus smaller) than previously, and the biggest implant that isn't too big might be slightly shorter than your natural cavity, but I would think the most you would lose in good hands is 1-2 cm.

The best predictor of your post-op length is your stretched flaccid length. Stretch it out, plant the butt of the ruler firmly against your pubic bone and measure. This is the most you should expect.

I think that men who say they have lost substantial length are thinking of their penis as it once was, before being shortened by disease, disuse, or as a consequence of prostate surgery. Unless of course, they had an incompetent surgeon. I think that those who claim to have increased size have not obtained their natural maximum in so long that doing so seems like an increase in length.

Also remember that the more belly fat you have, the more of your penis is concealed. Reaching a trim weight will maximize the apparent size of your penis. Lots of other good medical reasons to maintain an optimal weight, but perhaps this one will register more than some of those other very good reasons.

My pre-op flaccid length was about 3 inches, post-op partially flaccid length is 4.5 inches and clearly more girth. My implant was kept inflated to around 80% until the day following the surgery. I didn't have my ruler at the hospital (imagine that), but partially inflated it felt stiffer than I have attained in a long time, very straight, and appeared to be 5.5 to 6". My stretched flaccid length pre-op was about 6.25 inches with the base of the ruler pressed firmly against the pubic bone. I'm totally confident that size will be fine. Now comes the really hard part, impatiently waiting while things heal before I can use it.

I hope this information and the pictures which follow are useful. I certainly pored over every account I could find anywhere on the web before making my decision, and greatly appreciate everyone who has shared their story.

My surgery was on 3/3/10. The first week went well, more or less daily improvement. On day 7 post-op (3/10) I had a really good day, did quite a bit of walking and thought maybe I was capable of doing my office-based job as a physician. That night I had more significant aching in the testicles than I had experienced in a while. I put a cold pack over my testicles and penis when I went to bed, which relieved the discomfort nicely, BUT when I woke up in the morning, I had a aching, moderately nauseating pain, as if I had been kicked in the balls 30 seconds before, only it persisted for a couple of hours. I ended up taking hydrocodone for the first time in 3 or 4 days, slept for a couple of hours, and have basically not had a return of that kind of discomfort--but I have also not applied cold to the region again..

Application of cold tightens (and shrinks LOL) everything up in the genital region, as we all know. What I am wondering is if by applying cold for a sustained period, that the ultimate result was to basically pull the pump harder against my testicle, resulting in the discomfort I had on day 8 post-op. Anybody wish to comment on this and the use of heat and cold in general?

Day 9 and day 10 I have ambulated more, and I drove for the first time (my surgeon wanted me to wait at least a week for that) today. I drove about 30 minutes each way, which didn't seem to bother me, shopped for about 30 minutes, and had lunch at a restaurant. By the time I got back home I was having minor discomfort, which is responding well to the use of a heating pad, as that sort of discomfort has the last few days. It seems that being vertical and having gravity dragging on the new junk in the trunk bothers me more than anything else.

Actually the shopping was to find some briefs which work best while my recuperation continues and my body gets used to my larger package. I am not a boxer guy, and I think boxers wouldn't be good during recovery. However my briefs seem to be of 2 types--too large/loose (gravity pulls on me) and too small/tight (initially feels good, but compresses the pump against the testicle too much). I have lost 29 pounds (deliberately) over the last 3-4 months, which explains the briefs which are too loose, and the too tight ones are ones I have left from when I weighed another 15 pounds less than I do now. Any practical words of wisdom from the vets on underwear choices, or the general management of the recovering package? I have seen some comments that it takes weeks to months before you stop noticing the new equipment--anyone wish to comment on that?

And lastly, what about return to work? I will be returning to work on Monday, 12 days post-op. I feel confident that I will be able to manage my office-based work, which doesn't require any prolonged standing (and fortunately I am at a lovely point in my life where I work 4 days, 30 hours), but I suspect by the end of the day I will be eager to get home, put my feet up, and apply my heating pad. My doctor has said that I should not do any significant lifting, vigorous exercise, and the like for 4-6 weeks post-op. So, generally speaking, I would guess that for the average person, return to office work can likely be done in 7-14 days (sooner for working from home--I have been responding to emails and phone calls since the 2nd day post-op). Probably 14-28 days for returning to work requiring a lot of walking or standing or driving, and probably 28-42 days for returning to heavy work (climbing ladders, lifting heavy objects, turning big valves, etc.). This is all a guess on my part, and there is probably significant individual variation. Again I would welcome comments from those who have been through this.

Best wishes to all,
Ben