Choosing your surgeon

[brianroa7]

I'm 58 and have had treatment for prostate cancer. It was HDR Brachytherapy and it completely killed my erections. I've tried everything including high doses of SuperTrimix with basically no response at all. Soooo, I'm left with the option of an IPP. I'm shooting for surgery in April and my doctor and I chose the Titan.

As with anything in life you want to make the best decisions. I'm getting this done at a major university teaching hospital and I made sure that my doctor is going to do the surgery and not a resident, although they may observe the procedure.I really like my doctor but don't know really how to check out his reputation. He has been very open about his volume, which is usually around 3 a month. He definitely knows his stuff and has told me of the good and the bad, but I still want to be sure that he's good at this. I have asked for his failure rate which he will give me. He holds certifications in many areas of men's sexual health including implants. Since he's teaching others to do this, can I go in with real confidence that he is good? The urologist that treated me during my radiation along with my oncologist both told me to switch to this guy for the implant. They all work at the same university health center, which has an excellent reputation. I just want to be comfortable that I'm setting myself up for a good result. Anything else that I should ask about? I had such excellent care with my cancer treatments that I really want to keep going with the same group of people if possible. Is that a bad idea? I always view the "super-star" doctors and some of these implant centers with a bit of skepticism.
My real goal here is to not get infection and return to a fun sex life with my wife.

[crazyjoe]

You have a valid concern about infections -- so you might ask him how many infections he's had, unless that's what you mean by failure rate.
Another question might be what he thinks will happen to your length, if that is a concern -- I had a guy at a very prominent teaching hospital tell me I would lose 20%, which took him right out of my selection of surgeons...

[Elyrev]

They may have given you great cancer care with this being their specialty, however to me with a volume of maybe 3 a month it does not sound like this doctor specializes in implants or has the experience of several others that are well known and do considerably more volume than that. There is a reason they are well known and have such good reviews from so many patients. If you chose to go with your doctor I wish you luck, However if it were me I would choose one of the top 5.

[Old Guy]

You have good concerns. I'm not sure if 3 a month makes the guy an expert, but how many years has he been doing implants. May just be not as many guys in the area go the surgery route. There has to be some info about the doc somewhere if you Google him. Check the state MD list? Are there patient reviews on the website?
As far as infections, I was made to shower with Hibiclens the night before and the morning of. As long as things are kept clean there is very little chance of infection. Also, the Titan has antibiotic impregnated on the cylinders to reduce chances of infection.
Good luck. Keep FT posted.

[newbie443]

Since he's teaching others to do this, can I go in with real confidence that he is good? Anything else that I should ask about? I had such excellent care with my cancer treatments that I really want to keep going with the same group of people if possible. Is that a bad idea? I always view the "super-star" doctors and some of these implant centers with a bit of skepticism.
My real goal here is to not get infection and return to a fun sex life with my wife.

There are many really good doctors around. And yes with the super star there is a bit of marketing. No doctor is perfect. and many have different surgery methods. Some use a drain and that is an extra incision and possible point for infection. Some have written papers on the differences in methods. This is the paper on doctor case volume and reoperations. https://www.garber-online.com/pdf/Highe ... ctions.pdf So if your doctor is truthful then he is in the group with the lowest infection. You can enter your doctor's name in the search box in the upper right of this page and see if anyone has posted on him. You can also go to Health Grades and look up your doctor for any reviews, awards (and what the awards were for), and check experience to see where he falls on number of cases a year. Should have a "Normal" or "High". If you have trouble finding this let me know.

The biggest question left off so far is does he do revision surgeries and repairs? These are more difficult and many doctors do not do them. If he does not you need to ask who does and that is where I would start my doctor search. Another question that is good to ask is how long you will wait post-surgery to be activated (Start cycling). There is a very good paper on this in the general section of this forum under "Documents worth reading" thread about the "Coffin Effect". Long waits up to 8 weeks are still done by some doctors. Dose he use the "No Touch" method or has he trained with one of the worlds top doctor's.

Your skepticism does have a bit of weight to it. And local follow up care is always a plus in my opinion but there are places where the skill of one of the big name doctors outweigh local care. As in my case all my local doctors do 2-3 a year and do not do revisions. Had 8 week waits for activation. The doctors and the patients I talked to all said I would have size loss from the surgery. Now some doctors have learned from being asked questions and they know the correct answers. So it is getting more difficult for us a bit.

Whatever you decide will be right because only you can decide this. Unk doctors have good results sometimes and the well-known ones have bad results sometimes. It is just a numbers game. There is also a bit of cosmetic surgery with this as well as function.

I hope this was of some help. Good luck with this.

[tomas1]

Easy for me to say, but I wouldn't like to be operated on at a teaching hospital.
I know doctors have to learn some time, but Who knows who is doing the work when you're unconscious?

I also don't like the low volume of his operations.
When do his students learn to do it?

Good like though, you really are doing the right thing.

[Gt1956]

I notice that you conveniently left out your state & the name of the doctor. Just how do you expect advice without that basic info? I'd like to hear you answer that.
Now, to your question. What is high volume. We've talked that point before. Nearly all agreed at 150 a year. Quite a few said 100. Even a few felt 50 was enough. But 36! Get real, there is a chance that he has inflated even that.
My highly opinionated advice is to do a ton more reseach. Its hard for me to see how you couldn't do better. Really, that sounds like a bunch of golf buddies passing a patient around. Sounds suspicious to me.
Oh, as for a teaching hospital. That is totally bunk. My apnea turned out to be difficult to treat. My pulmonologist kicked me up to the local teaching hospital where he studied. The lead doctor made all the same bad conclusions. As the treatment was breaking down he finally answered that I was fat. No shit, my scales & mirror could of told me that. Btw, 220 lbs & 5'10". Yes, I ring the obese bell. Also, he was willing to say that my weight wasn't causing my apnea.
My pcp watched for any new pulmonologists in the area. After almost 10 years I got 1 that wasn't trained locally. Lo & behold. My sleep study was horribly misread. Life got a lot better.
Where my point is. There is just some teaching programs that are just shit. Do not let that claim sway you any.

[newbie443]

I neglected to say welcome to the site. I noticed your only other post was in the show and tell thread asking for someone in your area of Roanoke, VA. You are in an area with a lot of choices not really far away. But that does not exclude your doctor just gives you more options. Health grades can help with that and is what I recommend if men are not happy with the current doctor they have. And as I think local care is worth a lot it is good to start close to home and only expand your search if you are unable to locate a really good doctor close to you. As far as the 36 a year number this does put your doctor in the best group of doctors in the study that was done that I posted the link to, That group was the 30 plus a year group and had the lowest percentage of infection. In the study even the second best group at 8-31 a year was close to the over 31 group and had a separation from the lower 2 groups.

The doctor that did my repair was just like yours in that he teaches at KU med in Kansas City and does the same number of implants a year. The thing is as I posted it is difficult now to know if the doctor has caught on with patients asking these questions and just know the right answers. But there are really good doctors out there that do 2 or 3 a month and stay current on new information on penile implants. They have a real interest in helping the men they care for. On the other hand there are doctors in this same experience group that just meet the minimum and just give the man something that works. Or at least most of the time. The numbers in the study back up the infection risk. The cosmetic aspect of this may be different. And might be the reason behind the higher volume numbers listed by some. So you may want to ask about size loss post surgery. And ask to speak to one or more of the doctors patients and ask about size loss. Many doctors aggressively size and there is or was a paper on this in the general section under documents worth reading thread. A lot of thise are gone now so I am not sure it is still there. This is where looking to see if the doctor trained with one of the big name doctors that markets aggressive sizing. My first doctor marketed aggressive sizing and low infection. This was not an issue with the doctor that did my repair.

One last thing. Your doctors should have had you on VED therapy. If they have not you need to start it now. This is another good indication of how good and up to date your medical doctors are.

Again best of luck with this and let us know how things are going.

[oldbeek]

what area are you in? Could be a teaching hospital in Wyoming.

[tomas1]

newbie said it looked like Roanoke, VA.
I believe you said you had a great result at a teaching hospital in SoCal, but I could be wrong.