Repair information

[newbie443]

I have had trouble with my first implant from the surgery until just under 2 weeks ago. The last year I stopped having sex with a partner due to pain and the fear I was going to puncture something and make things even worse. Thought I would share the surgeons notes for my operation to maybe give a clearer picture of what goes on. I was awake for most of this and had a spinal block so that last part is an error in stating I was extubated as I was never intubated. It also indicates I had a catheter for the surgery but I did not see this even tough I was awake. So I might have thought no catheter was used had I not obtained these records. After 3 years trying to get this fixed I am anxious to see what I hope is a properly functioning device is like. I had pump problems also so we will see.

The
patient was prepped with a no-touch technique and sterile drapes were applied. We performed
an incision over the previous scar of the penoscrotal junction using a 15 blade knife. There was
a fluid pocket encountered in the dartos, which was swabbed and cultured. This appeared to be
consistent with pseudocapsule, but there was no signs of any gross infection. The
pseudocapsule sites were identified, the tubing to the left cylinder, this was mobilized. We again
encountered a secondary fluid pocket, which was clear straw-colored fluid did not appear to be
consistent with infection around the pump as well as the 2 cylinder tubings. We identified the
left cylinder, dissected this down to the corporotomy. We then incised the corporotomy with
Bovie electrocautery and we were able to remove the implant using the accessory kits closing
device to atraumatically extract it. We then performed a washout of both the corpora and the
pocket containing the pump. Four 2-0 Vicryl stay sutures were placed in the apices of the
incision. We then performed a dilation and it became apparent that there was a proximal
perforation in the previous corpora. The depth of this was quite extensive. We then decided to
do posterior pseudo-capsulotomy with Metzenbaum scissors. We then secured this with an
interrupted 3-0 Prolene. We sequentially dilated up to number 12 Hegar dilator. Once we were
able to identify the proper placement, a 7/8 dilator was then placed in through the perforation
tract and confirmed that we were in a separate tract. The separate tract was then measured
with the Furlow device and the total corporal length was 22 cm consistent with the patient's
previous device. As a result of this, we felt we were in the correct positioning. We then placed a
3-0 Prolene sling through the tunica albuginea and through the rear-tip extender and this was
then reassembled. The washout was continued with a solution of Ancef and tobramycin, and a
solution of vancomycin and gentamicin. Once this was adequately irrigated, we placed the new
Furlow device by using a 2-0 Vicryl suture through the glans and fired this. Care was taken to
avoid injury to the opposite cylinder, which was still intact and it was pushed down proximally
into the penile shaft. The implant was then properly deployed and appeared to have good
positioning.
We turned our attention to closure. The corporotomy was closed with a running 2-0 Vicryl and
the closing device. We then test inflated and we saw it properly functioning. The penile implant
pump was placed back into the scrotum and we performed a closure using a running 4-0 Vicryl
to close the dartos in 2 layers. The skin was then closed with a running 4-0 chromic suture. The patient was then extubated. His Foley catheter was removed. He was taken off the
operating room table and transferred to the PACU in stable condition.

[cbinspok]

Really interesting, Im trying to find my notes, im getting a bit depressed, why couldn’t mine gone better and now I can’t cycle for 6 weeks maybe more So do I loose more length because of revision? I just want to be done and move on

Cheers

[newbie443]

Really interesting, Im trying to find my notes, im getting a bit depressed, why couldn’t mine gone better and now I can’t cycle for 6 weeks maybe more So do I loose more length because of revision? I just want to be done and move on

Cheers

Doctors vary on wait time and also on other things. Most times you need to wait up to and most commonly 6 months for a reoperation except for infection. And it depends on what they do. I just guess my doctor wants the sling to heal enough to hold and not reopen. From reading a post by you that it is your reservoir and pump placement. If you just did the reservoir I would think wait time to cycle and have sex would be short. Pump adjustment could make a longer wait but you need to talk to your doctor about that. Every doctor has reoperations. Even the best are not perfect. Just a fact of life. But even with a less than perfect outcome it sure feels great to kick ED out of our life. Take care and best of luck going forward with this.

[thedriver]

Really interesting, Im trying to find my notes, im getting a bit depressed, why couldn’t mine gone better and now I can’t cycle for 6 weeks maybe more So do I loose more length because of revision? I just want to be done and move on

Cheers

Doctors vary on wait time and also on other things. Most times you need to wait up to and most commonly 6 months for a reoperation except for infection. And it depends on what they do. I just guess my doctor wants the sling to heal enough to hold and not reopen. From reading a post by you that it is your reservoir and pump placement. If you just did the reservoir I would think wait time to cycle and have sex would be short. Pump adjustment could make a longer wait but you need to talk to your doctor about that. Every doctor has reoperations. Even the best are not perfect. Just a fact of life. But even with a less than perfect outcome it sure feels great to kick ED out of our life. Take care and best of luck going forward with this.

newbie.
When you say they are hopeful the sling heals enough not to re-open the incision,,, are you talking about where they actually inserted the implant cylinder it self ? meaning the internal sutures ?

[newbie443]

I had my 6 week visit Monday and ask the doctor about where the perforation was as the Nurse-Practioner had no information on it when I was at my 2 week wound check up. He said as the notes state that he did a sling in which he placed a permanent suture in the RTE and ran it up to the corporotomy. He made a stirrup and placed the end of the RTE back in the corporal body. I thought he closed the perforation but last Monday he said he did not. That is where I was hoping held and kept my cylinder where it should be but was not the case. So the perforation was not sutured closed and he said if it does come out again the sling will keep it from going as deep as it was before. So I guess the biofilm will surround the cylinder and maybe some healing will happen with the perforation to prevent this and infection but all the tests for infection in the biofilm came back negative. A percentage of us have sealed infection in our biofilm that can cause infection and is the reason infection rates are higher for reoperations. I was lucky for a change and the areas of biofilm checked were all negative. But the perforation was not closed in surgery. So that is a bit of worry and what I was concerned about having the cylinder come out through again. Keeping my fingers crossed. I am released from doctors care and cleared for cycling and sex though. Had to have some modeling done Monday so that is back to a little unlucky and am a bit sore. And I still have this quirky pump and old cylinders. Seems with the new work and support of the left cylinder now I may be a bit longer but lost some girth. To early to tell as I have just had 2 days of cycling after 6 weeks of not.

[thedriver]

I had my 6 week visit Monday and ask the doctor about where the perforation was as the Nurse-Practioner had no information on it when I was at my 2 week wound check up. He said as the notes state that he did a sling in which he placed a permanent suture in the RTE and ran it up to the corporotomy. He made a stirrup and placed the end of the RTE back in the corporal body. I thought he closed the perforation but last Monday he said he did not. That is where I was hoping held and kept my cylinder where it should be but was not the case. So the perforation was not sutured closed and he said if it does come out again the sling will keep it from going as deep as it was before. So I guess the biofilm will surround the cylinder and maybe some healing will happen with the perforation to prevent this and infection but all the tests for infection in the biofilm came back negative. A percentage of us have sealed infection in our biofilm that can cause infection and is the reason infection rates are higher for reoperations. I was lucky for a change and the areas of biofilm checked were all negative. But the perforation was not closed in surgery. So that is a bit of worry and what I was concerned about having the cylinder come out through again. Keeping my fingers crossed. I am released from doctors care and cleared for cycling and sex though. Had to have some modeling done Monday so that is back to a little unlucky and am a bit sore. And I still have this quirky pump and old cylinders. Seems with the new work and support of the left cylinder now I may be a bit longer but lost some girth. To early to tell as I have just had 2 days of cycling after 6 weeks of not.

That sounds scary,,, are you inflating to what you feel is max inflation at this point ?
I would be afraid to inflate if there is a possibility of it coming out again.
Wouldn't they use a graph along with the sling ?

[cbinspok]

Newbie. Sounds like it’s going to come together for you, it all gets so complicated science and emotions merge and then interpretitation of it all.
My brain hurts lol,
My reservore move was successful although there is a lot of “ puffy “ area now where the old lump was so from my view straight down I’m still uneven looking but that beats the tennis ball sticking out my abdomen. Still very sore at incision site, was supposed to be a small cut but I see a “T” cut about the size of a dollar bill folded in half now that I have removed the last of the bandages. It low enough shouldn’t be a problem- no one looks at old guy’s, The pump was relocated sideways its looking good and more importantly no longer is a constantly sore, just hope pumping will not be an issue.
One week to post op opt. Maybe Dr will let me start cycling again
Cheers Gentlemen

[rjdoan]

edited below--I forgot the quote

[rjdoan]

My reservore move was successful although there is a lot of “ puffy “ area now where the old lump was so from my view straight down I’m still uneven looking but that beats the tennis ball sticking out my abdomen. Still very sore at incision site, was supposed to be a small cut but I see a “T” cut about the size of a dollar bill folded in half now that I have removed the last of the bandages. It low enough shouldn’t be a problem- no one looks at old guy’s, The pump was relocated sideways its looking good and more importantly no longer is a constantly sore, just hope pumping will not be an issue.
One week to post op opt. Maybe Dr will let me start cycling again
Cheers Gentlemen

I am glad things are finally moving in the right direction for you! My hope is that you will finally be able to enjoy the new equipment to its fullest!

[cbinspok]

Thanks Rj. This abdomen soreness took me by surprise I used to shaking things off pretty easily, so since March I’ve been definitely knocked down a peg. Staying positive, you think theses delays in cycling will negatively impact my progress towards regaining my length? Hope not ugh.
Tx cb