Using other than a world renowned surgeon

[Gt1956]

I too am in your same position. If I could I would love to see Dr. Kramer. But, i simply cannot travel hours for a consult then travel hours back home. Then turn around travel hours again for surgery and spend three nights in a hotel. Then travel hours back home. I am within 45 minutes of the University of Tennessee Medical Center. I talked with a guy yesterday that told me if a surgeon does 10 of the implant surgeries per month he is considered more than qualified. Not everyone can be a high volume implant surgeon. I can’t believe a reputable surgeon would even think about performing this surgery on anyone and risk law suits if he was not confident to do the surgery. I am just not physically able to travel a great distance to have this done when I have a major medical center in my door. To me seems stupid to do anything other than what your closet too. If I have a problem I am 45 minutes away from my doctor not hours! Thank you for posting your info. It’s long overdue on Franktalk.

Something to think about. In my opinion, a short penis or a floppy head isn't grounds for a malpractice suit. Afterall, as pointed out on many occasions here. It is a penis stiffening procedure. As long as the results can get you into a vagina. I think the doctor is covered.
Any lawyer that would take that case would expect you to pay him up front. That alone would steer me to a better surgeon. YMMV

[Snoozdoc]

Unless you have a time sensitive reversible complication that is made worse due to lack of Timely follow-up. Breach of Duty.

[merrix]

I think there is evidence enough for anybody to accept the fact that the more implants a surgeon does, the better the chances of a good outcome.
Just spend some time searching for published articles on this theme. There is plenty of them. Infection risk is also is highly influenced by surgeon volume.
One study I read states that 25% of all implants are done by surgeons doing no more than 2 implants per year. And 50% of all implants are done by surgeons doing less than 7 per year. I don't understand how anybody can believe that someone doing 1 implant surgery every few months could be as good as someone doing 10 per week. That does not apply to anything else in life, so why should it apply to surgery?
Then of course, just because you choose to go to a low volume doc does not mean you are doomed to fail. But I am sure it means you are doomed to have a higher risk of a less than perfect outcome. Higher risk of infection. Higher risk of high sitting pump. Higher risk of improper sizing. Higher risk of visible/palpable tubing. Etc, etc.
That's just how it is. Experience matters.

I chose to go to one of the most highly rated surgeons on the planet. I travelled 10,000 miles for 35 hours and spent 3 weeks in a hotel to have him do the surgery. I have personally no understanding for those of you who say they don't want to travel to New York, Baltimore or wherever the good surgeons are, because you will need to spend 3 hours in the car or 2 hours on a flight and spend a few days at a hotel. This is exactly the sort of attitude which will put you at risk for imperfect results, and maybe the attitude that has put you where you are in other areas of life and health as well. Some people do whatever to get the best and once doing something, doing it the best way possible. Some settle for mediocracy because it is too much work travelling for a few hours.
If all goes well with the low implant surgeon, then fine, you saved some hassle. But if things don't go well, you will regret for the rest of your life that you were to indolent to spend a few hours travelling.
Of course, if there are medical issues making it impossible for someone to travel, there is a difference and not much can be done.

It is also worth pointing out that as I said above, 50% of all implant patients choose a surgeon who does less than 7 implants per year. So if you are part of that group, you are not alone.

Regarding infection, the infection rate for the two lower volume quartiles, i.e. the infection rate of the 50% of all implants being done by the surgeons with the least experience, is around 3%.
Compare those 3% with the rates of Kramer and Eid, which I believe is around 0.5% (if I remember correctly).That would mean that 50% of all people who do implant surgery choose to expose themselves to a 6 times higher infetion risk than they would have to if they just got their asses in their car or on a flight, a train, or whatever it took to get to a surgeon who would minimize their risks.
Then think about what happens over time. Let us say you will need 3 revisions in life. Totally 4 surgeries.
Let us compare the infection statistics of the top two with the average of the bottom 50% experienced.
Risk of infection with the top two: 1- (1-0,5%)^4 = 2%
The lower 50% volume: 1-(1-3%)^4 = 11.5%
So while it might not seem like a big deal of having a 0.5% or 3% risk of infection at your first surgery (which I think it is though), as you add up your surgeries over time with your replacements, you will easily get to over 10% infection risk accumulated with your local low volume doc. While as with the top guys you can keep racking up your revisions without ever really hitting frightening accumulated infection risk.

Yes, money is also an issue. Insurance coverage is as well.
I am just saying that most things in life can be done if we really think it is important. And when it cannot, then we have to settle for what we can get.

[Gt1956]

Oh come on merrix. Please tell us how you really feel.
I can't agree more with you. Looking back on my past & the experiences I saw co-workers go through. Without a doubt those that choose an option based solely on price more frequently regretted it. Not to say that expensive is always the best. But the best cars are seldom sold at a steep discount.
I honestly understand being in a position where cost & travel might steer you in a certain direction. But think for a minute. Wouldn't that logically mean that you should double down on your research? You need something to level the playing field to where you have a fair chance.
One of the old sayings is "never give a sucker an even break". Do everything in your power to not be the sucker at the card game.

[oldbeek]

I’ve finally gotten to the point where I think an implant is the best course of action

I read posts on here where guys have used these surgeons who are implant experts and yes, having a guy who installs a gazillion of them a week and is widely recognized for his expertise would be best.

I’m not in a position, however, to haul off and pay for the entire thing myself and truthfully, would rather be close to the doc who does the work in case there are issues.

My insurance carrier has no problem paying for me to go to the university affiliated medical school hospital and have this done. I’ve had great results with this hospital for other surgeries and they have a great reputation. Then again, my other surgeries didn’t involve my junk.

I understand not wanting some hack whose name you got from the phone book to do an implant. Yes, it would be great to fly off and see a Dr Kramer or similar. But is there any reason to reject the idea of using a recommended urological surgeon at a reputable med school hospital?

Thus far I’ve had just a single half hour consult to discuss the feasibility of surgery. My regular urologist referred me. This guy is board certified, does all the implants at this med school (dammit I neglected to ask how many per year), made no ridiculous promises, and said based on my physical condition and health I’d be a good candidate.
where are you located? Maybe someone has a reference.

So I guess my question, after all this, is just how critical is a brand name surgeon ? Or can I go forward with some confidence using clinic my insurance will pay for with no real problem that is only an hour away?

Where are you located? Maybe someone here has experience with a doc nearby.

[Txagq8]

Thanks so far. This is the kind of responses I’d hoped for, stuff to make me think.

It’s like the old saying...”you don’t know what you don’t know.”

I’m curious if there’s a thread or location on this site that is like the ultimate repository for questions a guy ought to ask the surgeon. Obviously I missed one obvious one (how many of these surgeries do you do a year?) but I did ask how long he had been doing implants (20 years).

I’m not in the market for cheapest or most convenient. So I’m not saying no to the idea of travel. There probably is an element of wanting to continue using the clinic (Baylor Scott & White) where I have had excellent care historically for other issues.

I will share a few things the doc told me. PLEASE let me know if something sounds flaky.

First of all, he said he installs both AMS and Coloplast. Based on my anatomy after examining me he said he would lean towards the Coloplast but asked if I had a preference based on my research.

He told me I’d have two incisions, one scrotal and one about 1.5 inches above penis. General but not spinal anesthesia. Same day surgery but go home with a drain (1-3 Days?). Partially inflated at discharge and fully cycle on day 14. He mentioned that I would not want to walk around fully inflated all the time but many of his Titan recipients left a bit of fluid in the cylinders — maybe 1/4—- which gave the penis a better shape and appearance without looking constantly erect.

I’m sure I’ll think of the other issues we discussed. He didn’t say why he thought the Coloplast Titan was a better choice, I’m guessing size (I’m not huge but a bit longer than average and quite a bit girthier).

So does any of that sound like he knows what he’s tallking about? I’ll be honest-he had an excellent attitude, told me based on his review of my medical records he wouldn’t need much in the way of additional testing and that we would be talking a lot more if I elected to have it done. I’ve got his e mail. So what else should I ask?

One last thing. I’ve got a small epigastric (above the navel) hernia and I asked if while they had me knocked out, I could get General surgery in to sew it up. One of my friends had a gall bladder removed and they did a hernia the same time. He said not only no but NO! that he understood wanting to avoid two anesthetic events but he didn’t want anything else going on or anybody else involved in order to minimize possibility of infection.

[newbie443]

Thanks so far. This is the kind of responses I’d hoped for, stuff to make me think.

It’s like the old saying...”you don’t know what you don’t know.”

I’m curious if there’s a thread or location on this site that is like the ultimate repository for questions a guy ought to ask the surgeon. Obviously I missed one obvious one (how many of these surgeries do you do a year?) but I did ask how long he had been doing implants (20 years).

I’m not in the market for cheapest or most convenient. So I’m not saying no to the idea of travel. There probably is an element of wanting to continue using the clinic (Baylor Scott & White) where I have had excellent care historically for other issues.

I will share a few things the doc told me. PLEASE let me know if something sounds flaky.

First of all, he said he installs both AMS and Coloplast. Based on my anatomy after examining me he said he would lean towards the Coloplast but asked if I had a preference based on my research.

He told me I’d have two incisions, one scrotal and one about 1.5 inches above penis. General but not spinal anesthesia. Same day surgery but go home with a drain (1-3 Days?). Partially inflated at discharge and fully cycle on day 14. He mentioned that I would not want to walk around fully inflated all the time but many of his Titan recipients left a bit of fluid in the cylinders — maybe 1/4—- which gave the penis a better shape and appearance without looking constantly erect.

I’m sure I’ll think of the other issues we discussed. He didn’t say why he thought the Coloplast Titan was a better choice, I’m guessing size (I’m not huge but a bit longer than average and quite a bit girthier).

So does any of that sound like he knows what he’s tallking about? I’ll be honest-he had an excellent attitude, told me based on his review of my medical records he wouldn’t need much in the way of additional testing and that we would be talking a lot more if I elected to have it done. I’ve got his e mail. So what else should I ask?

One last thing. I’ve got a small epigastric (above the navel) hernia and I asked if while they had me knocked out, I could get General surgery in to sew it up. One of my friends had a gall bladder removed and they did a hernia the same time. He said not only no but NO! that he understood wanting to avoid two anesthetic events but he didn’t want anything else going on or anybody else involved in order to minimize possibility of infection.

Your doc sounds ok to me. One thing to think about, and not meaning to sound negative, all docs have revision rates. So even if you go to the best you are just reducing your chances but not eliminating them. So factor in the chance if you pay out of pocket and get unlucky. Can you pay for the second one if you need it. Your chances of this is very small but it is still a possibility.

I would go on Health Grades and do a search for Penile Implant doctors in your area. Your doctor should pop up and there is a section where you can check and see how many implant surgeries your doc does compared to others. If you need help with that send me a PM and I will help you through it. I have the report on my other computer that shows Doctors who do more than 30 implants a year have the lower infection revision rates. Of course the big name docs work hard to have the lowest.

Another good question to ask your doc is how many revision operations he does or has done. Good to know in case there is a problem.

All the doc's in my insurance covered area do 2-3 a year. The best and most experienced of these doctors told me he does not do revisions because the first implant surgery is really difficult and the revision is more so. Enough more difficult that they don't do them.

If I had a very good doctor in my insurance coverage area I would have gone to him/her. Your doc seems to be concerned about infection rate. I would ask him what that infection rate is.

As far as I am concerned the important thing is that you find a doctor you trust to do this operation. One that has a low risk of infection. One who works to properly size the implant. Or more importantly to avoid those doc's that tend to undersize and just give you "something" to have sex with. There are a lot of really great doctors out there. But also a lot of not really great doctors.

I think that follow up care is very important. So if you find a local doc that is really good I would say go with that doc. If you can't find one local then I'd say travel to one. Just my point of view. Good luck with this.

[notaes]

I disagree with your post but we all are entitled to our opinion. I have been on several juries in my life and I could easily relate to a man that had been maimed! We all are responsible for our actions.

[Greg1956]

I do understand why many of you believe you have to go to one if the top few implant surgeons, but I had the best results I could ever have hoped for going to my local surgeon. This doesn’t mean I took some leap of faith. Rather, I did my due diligence and talked a lot of people. When I heard that a couple top surgeons think my surgeon was a great implant doctor, it was reassuring, but honestly I had already made my decision. To this day I do not know how many implant surgeries he has done. He also did my Prostatectomy and it was a textbook perfect surgery without many of the side effects many men experience following that surgery. I asked him if he was as skilled at implant surgery and he said yes. If you have a great relationship with a doctor you trust, I see no reason not to use him.

There are many occasions in life where quantity doesn’t equal quality. I am not saying the top implant surgeons aten’t good at their craft, but there are plenty of examples here on FT where men who use them have needed revisions. I am two years out and everything has been perfect. It is like some home building companies that can develop a huge neighborhood in a year while a small custom home builder does a few homes a year that are extremely well constructed. I prefer that to the company that just tries to get as many built as possible. When I have seen comments about how quickly some of these surgeons perform an implant surgery, I do not find it reassuring. I prefer that my surgeon took longer to do everything as perfectly as he did.

It is really irritating to hear men who went to a high volume surgeon act like those of us who did not do the same act like we are not as smart or took some huge risk. If you do the research like I did, it is fully possible to find as good a surgeon as those well known doctors.

[Namirrah]

Well stated