Questions to ask DR

The final frontier. Deciding when, if and how.
Journeyman
Posts: 463
Joined: Fri May 12, 2023 3:46 pm

Re: Questions to ask DR

Postby Journeyman » Wed Apr 17, 2024 11:55 am

sswinsfba wrote:BigDog provides a great list of Q's to ask your doc. Jage64 & Journeyman also make good points.

FWIW, there has always seemed to be a preferential bias towards AMS & penoscrotal implants on this site. However, I got a Coloplast Titan that was implanted infrapubicly without any problems whatsoever.

You can read about my experience in the "15 Month Update" thread that I just posted and in my post-op diary where you can find a link to that thread.

I'm not here to trash AMS or the penoscrotal method but here's what I know & have to say:

1) My surgeon -- Dr. Karpman in Mt. View, CA -- previously used AMS but switched to Coloplast because his patients were having too many problems w/AMS -- mainly due to leakage at various connections which have been reported by men here who also got AMS implants -- which required revision which he got tired to having to do.

So, I agree w/Jage64 that you should consult w/a doc who has used both AMS & Coloplast to understand the differences pro/con between AMS & Coloplast.

2) I considered but rejected the penoscrotal method mainly because it takes more surgical time to perform (which means you are under anesthesia longer which puts you at greater risk) and also because the recovery time was longer &, based on what I read, possibly more problematic than for infrapubic.

Before I found Dr. Karpman, I consulted w/a surgeon who only did penoscrotal but who had relatively little surgical implant experience which is mainly why I chose to go w/Karpman (who has a lot of experience & only did infrapublic) but I also did a lot of research on the penoscrotal method and it just didn't appeal to me when compared w/infrapubic.

3) Also, based on my research, I felt that there are fewer risks of post-op complications w/the infrapubic than penoscrotal method. You can read up on both methods and decide about that for yourself.

Regarding Jouneyman's concerns in re: infrapublic:

I don't think there is any risk of nerve damage if you have chosen an EXPERIENCED surgeon who does infrapublic implants frequently.

As for the scar, your public hair will regrow to hide it. If you happen to be "smooth" down there (like I am), while the scar is visible, it is hardly noticeable when I look at myself naked in the mirror everyday.

My squeeze ball placement is also fine. Right in the middle of my balls where it's supposed to be. My balls were never low hangers and do ride higher now but I don't find that a problem.

------------------------------------------------

Good luck in making the "right" choice for you but don't rush into it.

Take the time to do the research that you need to do and to find the "right" surgeon to do the job.

Don't choose a surgeon just because he's close by. Men here have flown thousands of miles to get the implant done by experienced surgeons. Jage64 was one of them.

Choosing the "right" surgeon is the most important decision that you have to make. So, make that choice wisely.

You won't regret it if you do but almost certainly will regret it if you don't.

Again, good luck & best wishes to you.

Thanks for the infrapubic point of view. Btw I had penoscrotal with a coloplast titan. Coming up on my 1 year
54 - Coloplast Titan 22cm , Implanted by Dr. Clavell in April 2023

exr001
Posts: 18
Joined: Tue Jan 14, 2020 12:17 pm

Re: Questions to ask DR

Postby exr001 » Wed Apr 17, 2024 3:01 pm

For anyone interested I just found this old thread here.
52 y.o., Type 2 diabetic
Tried Viagara, Cialis, and high dosage of Tri-Mix and Quad-Mix
Pumps and bands help but not as much as before.
Considering options

sswinsfba
Posts: 572
Joined: Sat Jan 07, 2023 3:08 pm

Re: Questions to ask DR

Postby sswinsfba » Wed Apr 17, 2024 3:54 pm

Journeyman wrote:Thanks for the infrapubic point of view.


You're welcome. :)
Age 73. Started taking 5 mg Cialis daily in 2000. Minor ED started in 2021. Major ED problem started in 2022. Coloplast Titan (20 cm w/1cm RTE) implanted infrapublicly on 01/24/2023 by Dr. Edward Karpman (El Camino Urology Medical Group, Mt. View, CA).

Jage64
Posts: 543
Joined: Sat Oct 22, 2022 9:38 pm

Re: Questions to ask DR

Postby Jage64 » Wed Apr 17, 2024 4:09 pm

I don't want to speak for the OP, but this thread was asking for the questions to ask his doctor, NOT opinions on what implant, approach, surgery, recovery, doctor is better..... in your opinion.

Each man should take the time and develop questions and obtain satisfactory answers for themselves, doing otherwise is abdicating your responsibility for the best outcome and transferring your ultimate results into the hands of someone else.

We all know FT is chock full of opinions, some based in fact and some clearly not.
2/22/23 AMS 700 CX 21cm + 1.5cm RTEs. 58 yrs old, wife of 37 yrs. Penoscrotal. 100ml Conceal reservoir. Dr. Clavell. Pills failing and went right to implant, skipped the injections. 12 mos. later: 7 1/2" x 5 3/4"

Journeyman
Posts: 463
Joined: Fri May 12, 2023 3:46 pm

Re: Questions to ask DR

Postby Journeyman » Thu Apr 18, 2024 12:22 pm

Jage64 wrote:I don't want to speak for the OP, but this thread was asking for the questions to ask his doctor, NOT opinions on what implant, approach, surgery, recovery, doctor is better..... in your opinion.

Each man should take the time and develop questions and obtain satisfactory answers for themselves, doing otherwise is abdicating your responsibility for the best outcome and transferring your ultimate results into the hands of someone else.

We all know FT is chock full of opinions, some based in fact and some clearly not.

Infrapubic surgery vs penoscrotal surgery is a pertinent question ! I said it was my opinion AND to research it . I would definitely want to know what method my surgeon was gonna use , why and the pros and cons of it
54 - Coloplast Titan 22cm , Implanted by Dr. Clavell in April 2023

CigareVolant
Posts: 81
Joined: Wed May 25, 2022 6:13 pm

Re: Questions to ask DR

Postby CigareVolant » Thu Apr 18, 2024 2:14 pm

For me, the only real question is to figure out whether you trust your doctor.

I had all sorts of questions. My cock had a curve that I liked. Would it stay curved? My cock was angled up, which I liked, but most of the implant photos I saw were more straight out. And so on. But in the end, I didn't even bother asking because I realized that the answers didn't matter. A cock that gets hard matters more than a cock that curves. A cock that gets hard is more important than a cock that angles up. Plus, I had a pretty good sense of the answers from lots of reading here.

So figure out if you trust your doctor, and then do what they say. I would recommend that you ask questions about the healing process, who long should you take off from work, that sort of thing.
Implanted June, 2022 by Dr. Karpman. 22cm Titan with 1.5cm RTE.

pjt1958
Posts: 6
Joined: Tue Apr 16, 2024 2:28 pm

Re: Questions to ask DR

Postby pjt1958 » Thu Apr 18, 2024 3:20 pm

Bigdog4all wrote:Some Questions…..

1. Insurance Medicare…..Has insurance been approved?
2. Communications – How & When? Texts or Phone communications.
3. How many PT surgeries within the past year?...50 - 60.....
4. 3 Piece Implant…..AMS700
5. Type of Antibiotics…..
6. How to operate unit
7. Does it make a pumping sound…..
8. Sensations / climax – Any changes?.....
9. What is it made of
10. Solution – Does it need to be replaced
11. Location of parts…..Pump…Cylinders…Reservoir
12. Timeline – To start use…..depending on healing.
13. Do you use Nerve Block?.....Pain is based on individual
14. Swelling
15. How long before training use ?....Depends on person and healing
16. What is the average lifetime…..
17. Risks – Infection?.....Mechanical (Take out and Replace)
18. Operation – How long?.....2 hrs. or less
19. Blood test / Screening…..
20. Blood sugar levels…..To promote better healing
21. Nervousness…..
22. Pain meds…..Oxy, Tylenol Extra Strength, Ibuprofen 800, Tramadol
23. Swelling / Ice…..15 minutes ON …..15 minutes OFF
24. Ice on / Ice off…15 minutes intervals
25. Stool softeners…Maalox or Colax
26. Rest / Relaxation….Much rest but walking around dining room table - exercise
27. Recovery…..Ice Pack, etc
28. Follow up visits…..
29. Meds – Oxycodone, Hydrocodone, Ibuprofen 800, Tylenol Extra Strength
30. When to therapy - Pull on pump
31. Bulb positioning…..Right handed position
32. Will Tadafil assist Glans & Implant…..
33. Catheter is needed…..Removed next day
34. Stay overnight in hospital…..I chose YES, for any precautions


Other questions…..

1. Can I go for a ride, as passenger…
2. How long numb?.....Possible 3 – 4 days
3. Ice & anti-biotics
4. Pain meds?



Thank you! this is excellent. I have an upcoming appointment with Dr. Yafi in Irvine next week and I'm going to print this out.
64 with ED for 10 years. Failed pills, not happy with injections. Considering implant

Jage64
Posts: 543
Joined: Sat Oct 22, 2022 9:38 pm

Re: Questions to ask DR

Postby Jage64 » Thu Apr 18, 2024 8:18 pm

Journeyman wrote:Infrapubic surgery vs penoscrotal surgery is a pertinent question ! I said it was my opinion AND to research it . I would definitely want to know what method my surgeon was gonna use , why and the pros and cons of it


@Journeyman, my post was not in response to your post. sswinsfba made claims in his post that are his opinions. Unfortunately even 15 months ago this was a concern, his opinions stated as fact. This is what I was warning against, it's up to each man to do his own research and not rely on 'facts' posted by (likely) unqualified people online.

For example, it's entirely possible that Dr. Karpman stated what he did about AMS products to sswinsfba. If he did, that's an example of a complete and utter falsehood, which can be proven by the fact that AMS products are at least 2:1 more frequently installed worldwide than Coloplast which even includes the Coloplast malleable option. Also, most of the top 10 implant surgeons in the world offer both products to their patients, knowing that both have pros and cons. If AMS was so risky and had such failures, would a high volume doc take that risk? There is at least one published study that states "While there was no statistically significance in device survival between the two devices, the trend favored AMS 700 CX over Titan (5-year Kaplan-Meier estimates of mechanical survival were 91% vs. 87%," So Dr. Karpman is either just flat wrong, hiding the real reason he doesn't/can't use AMS anymore, or was careless with his AMS installations and was the cause of his purported failures.

AMS products are considerably more expensive than Coloplast from the manufacturer, the surgeon pays more for the implant. Might it be that offering Coloplast results in a larger profit for the surgeon? Possibly. Coloplast might honestly be a better option for the particular patient, but it's not the only option out there. More choices are better than just one.

There are studies that show the infrapubic method can result in a shorter measurement during surgery, and ultimately a shorter implant. Infrapubic results in a more difficult (not impossible) placement of the pump and hoses into your scrotum, but a much easier placement of the reservoir. The opposite is true of penoscrotal, the surgeon can very easily orient the hoses and pump in the scrotum, but has more of a challenge placing the reservoir. Be aware of those differences and choose which one is more important to you.

Here's a video by Dr. Eid explaining some differences:
https://www.youtube.com/watch?v=LoeJC_j1d0g

And here's Dr. Perito's direct response to Dr. Eid:
https://www.youtube.com/watch?v=aUDjOqarAhc

*A good question to ask yourself in response to Dr. Perito's video is would you prefer tubing exiting your penis at 12:00 (topside) and rely on your surgeon to hide the tubing in your particular anatomy when it makes the 180 degree turn, or would you prefer the tubing exiting your penis at 6:00 (underside) right into your scrotum? Notice Dr. Perito does not say that tubing visibility is not an issue, he just in essence states that good surgeons can hide them better than not good surgeons.

The nerve bundle risk with infrapubic was already mentioned, that risk does not exist with penoscrotal.

If you shave your pubic hair, there will be a scar, some men don't want a visible scar.

Again, at least 3 very highly regarded high volume surgeons mentioned here on FT will NOT do an infrapubic installation and have been vocal as to their reasons. Dr. Perito prefers infrapubic, and if you watch his videos he admits that the benefit is mostly due to the speed at which he can do them and how quickly the patient can resume sexual activity. Each man decides if surgeon speed or having sex 2-4 weeks sooner is a big deal. With everything, there's tradeoffs and risks associated with both, or else EVERYBODY would be doing it just one way.

Another study, NOT opinion, found:
"....compared Coloplast Titan® with AMS 700TM CX. They assessed 55 patients who received either one of the prostheses using the EDITS questionnaire. The study found that there was no difference in satisfaction between patients with Titan® and patients with AMS 700 CX "

"Overall satisfaction was very high for both prostheses, and both showed reliability for sexual intercourse. Significant differences, however, were found in three questions. More patients were satisfied with the 700 CX. Only 4% with the 700CX were dissatisfied with the deflation compared to 24% with the Titan"


I recommend you look at this table, which summarizes a few articles and their findings:
https://www.ncbi.nlm.nih.gov/pmc/articl ... objectonly

"Conclusions
Inflatable penile prostheses have been used successfully for ED not responsive to less invasive therapy. Both the AMS 700 series and the Coloplast Titan® have three components, infection prevention mechanisms, and valves that make deflation easier for the user as well as prevent auto-inflation. We found little substantial difference between the two types of IPPs, with studies showing inconsistent minor superiority of one over the other. We recommend surgeons use their own clinical judgment and preference when choosing the right IPPs to use. Preoperative expectations may play an important role and further research controlling for this variable is necessary."


So, back to Dr. Karpman and the story he told sswinsfba, I don't buy it.

In terms of choosing a surgeon, that choice can result in a longer or shorter dick, and if general anesthesia is a concern the frequent implanter can do it in 1/3 the time:

"The choice of surgeon is likely to have an impact on eventual penile length after PPI. A frequent implanter (widely considered as a surgeon who inserts more than 25 PPIs per year) is likely to use a longer PPI cylinder compared to an infrequent implanter. In an outcome analysis study comparing 57 penile prostheses implanted by a multiple surgeon group versus 57 penile prostheses placed by a single surgeon in a center of excellence (COE), Henry et al. found that the median cylinder length of implants placed by the COE surgeon was 2 cm greater than those placed by the multiple surgeon group. More than 82% of implants placed by the COE surgeon had cylinders that were 17 cm or longer, with 37% having cylinder lengths between 20-22 cm. This was in contrast to the multiple surgeon group, whereby more than 55% of implants had cylinders that were less than 17 cm with only 14.3% having cylinder lengths between 20-22 cm. Median operative time was also considerably shorter for the COE surgeon (34 vs. 94 minutes).

EACH MAN NEEDS TO DO HIS OWN RESEARCH IF HE WANTS TO BE PROPERLY INFORMED. I have tried not to include any opinions in this post. Do the research yourself.
2/22/23 AMS 700 CX 21cm + 1.5cm RTEs. 58 yrs old, wife of 37 yrs. Penoscrotal. 100ml Conceal reservoir. Dr. Clavell. Pills failing and went right to implant, skipped the injections. 12 mos. later: 7 1/2" x 5 3/4"

Journeyman
Posts: 463
Joined: Fri May 12, 2023 3:46 pm

Re: Questions to ask DR

Postby Journeyman » Thu Apr 18, 2024 9:53 pm

Jage64 wrote:
Journeyman wrote:Infrapubic surgery vs penoscrotal surgery is a pertinent question ! I said it was my opinion AND to research it . I would definitely want to know what method my surgeon was gonna use , why and the pros and cons of it


@Journeyman, my post was not in response to your post. sswinsfba made claims in his post that are his opinions. Unfortunately even 15 months ago this was a concern, his opinions stated as fact. This is what I was warning against, it's up to each man to do his own research and not rely on 'facts' posted by (likely) unqualified people online.

For example, it's entirely possible that Dr. Karpman stated what he did about AMS products to sswinsfba. If he did, that's an example of a complete and utter falsehood, which can be proven by the fact that AMS products are at least 2:1 more frequently installed worldwide than Coloplast which even includes the Coloplast malleable option. Also, most of the top 10 implant surgeons in the world offer both products to their patients, knowing that both have pros and cons. If AMS was so risky and had such failures, would a high volume doc take that risk? There is at least one published study that states "While there was no statistically significance in device survival between the two devices, the trend favored AMS 700 CX over Titan (5-year Kaplan-Meier estimates of mechanical survival were 91% vs. 87%," So Dr. Karpman is either just flat wrong, hiding the real reason he doesn't/can't use AMS anymore, or was careless with his AMS installations and was the cause of his purported failures.

AMS products are considerably more expensive than Coloplast from the manufacturer, the surgeon pays more for the implant. Might it be that offering Coloplast results in a larger profit for the surgeon? Possibly. Coloplast might honestly be a better option for the particular patient, but it's not the only option out there. More choices are better than just one.

There are studies that show the infrapubic method can result in a shorter measurement during surgery, and ultimately a shorter implant. Infrapubic results in a more difficult (not impossible) placement of the pump and hoses into your scrotum, but a much easier placement of the reservoir. The opposite is true of penoscrotal, the surgeon can very easily orient the hoses and pump in the scrotum, but has more of a challenge placing the reservoir. Be aware of those differences and choose which one is more important to you.

Here's a video by Dr. Eid explaining some differences:
https://www.youtube.com/watch?v=LoeJC_j1d0g

And here's Dr. Perito's direct response to Dr. Eid:
https://www.youtube.com/watch?v=aUDjOqarAhc

*A good question to ask yourself in response to Dr. Perito's video is would you prefer tubing exiting your penis at 12:00 (topside) and rely on your surgeon to hide the tubing in your particular anatomy when it makes the 180 degree turn, or would you prefer the tubing exiting your penis at 6:00 (underside) right into your scrotum? Notice Dr. Perito does not say that tubing visibility is not an issue, he just in essence states that good surgeons can hide them better than not good surgeons.

The nerve bundle risk with infrapubic was already mentioned, that risk does not exist with penoscrotal.

If you shave your pubic hair, there will be a scar, some men don't want a visible scar.

Again, at least 3 very highly regarded high volume surgeons mentioned here on FT will NOT do an infrapubic installation and have been vocal as to their reasons. Dr. Perito prefers infrapubic, and if you watch his videos he admits that the benefit is mostly due to the speed at which he can do them and how quickly the patient can resume sexual activity. Each man decides if surgeon speed or having sex 2-4 weeks sooner is a big deal. With everything, there's tradeoffs and risks associated with both, or else EVERYBODY would be doing it just one way.

Another study, NOT opinion, found:
"....compared Coloplast Titan® with AMS 700TM CX. They assessed 55 patients who received either one of the prostheses using the EDITS questionnaire. The study found that there was no difference in satisfaction between patients with Titan® and patients with AMS 700 CX "

"Overall satisfaction was very high for both prostheses, and both showed reliability for sexual intercourse. Significant differences, however, were found in three questions. More patients were satisfied with the 700 CX. Only 4% with the 700CX were dissatisfied with the deflation compared to 24% with the Titan"


I recommend you look at this table, which summarizes a few articles and their findings:
https://www.ncbi.nlm.nih.gov/pmc/articl ... objectonly

"Conclusions
Inflatable penile prostheses have been used successfully for ED not responsive to less invasive therapy. Both the AMS 700 series and the Coloplast Titan® have three components, infection prevention mechanisms, and valves that make deflation easier for the user as well as prevent auto-inflation. We found little substantial difference between the two types of IPPs, with studies showing inconsistent minor superiority of one over the other. We recommend surgeons use their own clinical judgment and preference when choosing the right IPPs to use. Preoperative expectations may play an important role and further research controlling for this variable is necessary."


So, back to Dr. Karpman and the story he told sswinsfba, I don't buy it.

In terms of choosing a surgeon, that choice can result in a longer or shorter dick, and if general anesthesia is a concern the frequent implanter can do it in 1/3 the time:

"The choice of surgeon is likely to have an impact on eventual penile length after PPI. A frequent implanter (widely considered as a surgeon who inserts more than 25 PPIs per year) is likely to use a longer PPI cylinder compared to an infrequent implanter. In an outcome analysis study comparing 57 penile prostheses implanted by a multiple surgeon group versus 57 penile prostheses placed by a single surgeon in a center of excellence (COE), Henry et al. found that the median cylinder length of implants placed by the COE surgeon was 2 cm greater than those placed by the multiple surgeon group. More than 82% of implants placed by the COE surgeon had cylinders that were 17 cm or longer, with 37% having cylinder lengths between 20-22 cm. This was in contrast to the multiple surgeon group, whereby more than 55% of implants had cylinders that were less than 17 cm with only 14.3% having cylinder lengths between 20-22 cm. Median operative time was also considerably shorter for the COE surgeon (34 vs. 94 minutes).

EACH MAN NEEDS TO DO HIS OWN RESEARCH IF HE WANTS TO BE PROPERLY INFORMED. I have tried not to include any opinions in this post. Do the research yourself.

I agree . I always try to drive home that point . I do believe, however, that sometimes a member wants to hear opinions/;experiences from the members that have been through the surgery and have lived with an implant. I did think you were referencing my post ....sorry.. I have a tremendous amount of respect for the information you ( lost sheep and others)provide. It's obvious that you have put in the work and studied the subject exhaustively. Appreciate you
Last edited by Journeyman on Thu Apr 18, 2024 9:58 pm, edited 1 time in total.
54 - Coloplast Titan 22cm , Implanted by Dr. Clavell in April 2023

Journeyman
Posts: 463
Joined: Fri May 12, 2023 3:46 pm

Re: Questions to ask DR

Postby Journeyman » Thu Apr 18, 2024 9:56 pm

( cont. ) ...... after bigdog4alls post there wasn't many questions left to ask :lol:
54 - Coloplast Titan 22cm , Implanted by Dr. Clavell in April 2023


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