24CX or 22+2 Titan?

[principles]

Hello all,

Surgeon estimates that I'd need a 24-26cm penile prosthesis. In my country, Titan XL sizes aren't available (only goes up to 22cm pre-connected), so I have the option to go with a Titan 22cm + 2-4cm of tips or an AMS CX 24cm + 0-2cm of tips. Surgeon also pointed out that I have a loose suspensory ligament and short proximal penis, which correlates to the fact that my erection even at 100% points below 0300, and as we know, RTE's decreases the rigidity factor, which coupled with my anatomy, could increase the potential for the hinge effect. It is known that Titan cylinders are stronger and provide greater axial rigidity due to their proprietary Bioflex material and increased diameter (21mm vs 18mm for the CX), but increased use of RTE's decreases that same rigidity.

What is the better option given my anatomy and the considerations above?

Thank you all in advance!

[merrix]

That is really a question which I think nobody here is fully qualified to answer.
What you say is my belief as well, that a Titan will have higher axial rigidity than a CX, and less RTEs will have higher axial rigidity than more RTEs.
So you are trying to estimate what will have the most negative impact, CX instead of Titan, or 3cm RTEs vs no RTEs.
If that was the case, I would say go for the CX.
It is my 100% belief that RTEs should be avoided if possible. In my head, that is a fact.
The Titan vs CX is another story. Both have pros and cons. Yes, the Titan has better axial rigidity, but that is not the only parameter. There are plenty of research showing no real difference in satisfaction between the different brands and models.
So my take on this is that the RTEs is an objective thing. Less RTEs is better. Period. CX vs Titan is more subjective.

But - and this is a big but - what I say above builds on the assumption that you doc, if he uses the CX, will actually use no RTEs. That is not a given. CX comes in 3 cm increments. That means 33% chance you need no RTEs. 33% chance you need 1 cm. 33% chance you need 2 cm. And even that is not true.
Sometimes you see people with 3 cm RTEs and more with AMS implants. Which in theory should never be needed.
So if your doc gives you a 21 cm CX with 4 cm RTEs, you might as well have gotten a 22 cm Titan with 3 cm RTEs...

If I was you, I would discuss this with your surgeon. Ask him what he thinks about this. What is is his stance on RTEs. Tell him about your concerns, see what his response is.

Good Luck.

[Waynetho]

Hello all,

Surgeon estimates that I'd need a 24-26cm penile prosthesis. In my country, Titan XL sizes aren't available (only goes up to 22cm pre-connected), so I have the option to go with a Titan 22cm + 2-4cm of tips or an AMS CX 24cm + 0-2cm of tips. Surgeon also pointed out that I have a loose suspensory ligament and short proximal penis, which correlates to the fact that my erection even at 100% points below 0300, and as we know, RTE's decreases the rigidity factor, which coupled with my anatomy, could increase the potential for the hinge effect. It is known that Titan cylinders are stronger and provide greater axial rigidity due to their proprietary Bioflex material and increased diameter (21mm vs 18mm for the CX), but increased use of RTE's decreases that same rigidity.

I can speak from experience since I have probably the **SHORTEST** proximal penis of anyone (approximately 1", just under the pubic bone) and also a bit of looseness in my suspensory ligament as well.

I can tell you if your proximal penis is insanely short as mine is, only going to the pubic bone and no further, you will not be able to get any REAR TIPS unless the corporotomies are placed "mid-shaft" (and that's not going to happen). With my CX and no rear-tip extenders, the hard plastic of the rear of the cylinders comes right up to the base of my penis and I can feel them when I squeeze out the fluid. My tubing exits to the sides of my proximal penis, under the skin on the sides of my scrotum, arcs up distally a little and then back down into the scrotum.

With my short crus (proximal penis) and loose suspensory ligament, I hang when inflated, to about 4:00 to 4:30 or about 30-45 degrees lower than horizontal (or straight out). When deflated I hang between 5:00-5:30 or about 60-75 degrees lower than horizontal or straight out, or 15-30 degrees from straight down.

I do have hinging because there is no proximal cylinder beyond my pubic bone to keep everything rigidly in place. That doesn't mean it's not usable though - I'm still able to get full depth penetration, it just requires a little stabilizing with a hand when inserting. I tested the implant for insertion pressure early on and found that when inflated, I can push inward on my penis quite hard without any issue and it stays where it should. It just wobbles a bit as it's bouncing on the ligament without anything behind it to stabilize it.

My thoughts on your situation is that you'll be fine. It's not an optimal situation but it is your anatomy and that you cannot change. You were born with it. I'm pretty sure you won't be getting any rear tips though, if your crus is as short as mine is. Hopefully you have at least 2-3cm of proximal depth, that way the 2 cm Titan tip will probably work.