Malleable to IPP Revision Post Infection.

[Gatorman97]

Hi guys, I’m looking for some advice/input from others in the bionic brotherhood.

Has anyone done a malleable to IPP revision after a salvage operation? What were your results?

On 11/28/24 I was implanted with a Titan 22cm. Unfortunately, I developed an infection 4 weeks later. This was devastating to me as a newly divorced healthy 51 year old. There was a salvage operation on 12/6/24 and a malleable Rigicon 20 cm was put in.

Due to the infection and conservative sizing I lost between half an inch and 3/4 inch of length and lost girth as well, which took me from average to, well below average. Sucks.

The malleable works pretty well. It is not as rigid as the IPP but I am having sex with it regularly with my new GF. It’s working pretty well and she’s happy.
I have a bit of a soft glans issue but overall, it’s functional. I would just like more rigidity and honestly to get back length and girth, which would likely be possible with an IPP (I’d likely at least get some of the size and girth back).

I’m now considering whether to have a revision surgery done back to an IPP. Honestly, it’s all consuming on my mental state. I would like to have the length, girth, and rigidity back as I am young enough to have some fun prior to settling down, which is my eventual goal. But, damn I do not want to do this again. This would be my third surgery in )6 months. And what happens if something goes wrong?

Anyone ekse been in this situation or know of someone who had a revision to an IPP?? If anyone has any input/advice for me generally, let me know.

Thanks in advance!

[Gatorman97]

Edit: first surgery was 10/28/24, not 11/28/24.

[frank66665]

what are your current measurements with the malleable? if they are acceptable I would leave it alone

[tooyoung]

Revision surgeries have higher risk of infection..not to mention one with a previous history...and with an ipp which has a larger surface area so more prone to an infection...i know losing size sucks so much...but your gf is happy why risk further deterioration? (god forbid)....a working "below average" most of the times is very sufficient...and if I may ask what's below average for you ?

[wolfpacker]

Definitely a very personal decision based on risk vs reward. Personally I think I would go for it, and would accept that if there was another infection or surgical complication post-IPP that I could end up far worse than before with the working malleable.

[LastHope]

tooyoung is making excellent points.

Highly recommend reading the attached paper to solidify your decision.

Here's another section from a different paper.

Penile Prosthesis Infection: Myths and Realities
Kevin J. Hebert and Tobias S. Kohler

6. Revision surgery
Surgical failure can be attributed to device malfunction and/or infection. IPP revision surgery, whether due to either cause, comes with increased risk of postoperative infection. Estimates of infection rates following revision surgery have been as high as 10.0% to 13.3% compared to 0.46% to 2.00% in virgin cases [17, 18, 19, 20, 21]. Interestingly, during IPP revision surgery for device failure, Henry et al [22] found positive bacterial cultures on 70% of clinically uninfected devices suggesting biofilms are a significant source of infection risk with revision surgery. In a small, retrospective series (n=44), Montgomery et al [23] noted a step-wise increase in rate of postoperative infection after stratifying patients by the number of prior IPP surgeries: 1 (6.8%; 3/44), 2 (18.2%; 4/22), 3 (33.3%; 4/12), 4 (50.0%; 4/8), and 5 (100%; 2/2). The increased incidence of postoperative infection following revision surgery is likely multifactorial with scar formation, reduced host resistance, and biofilms each playing a role. Assessment of biofilm formation and organism speciation at time of device explant for clinical infection has shown predominance of gram positive organisms, most commonly coagulase negative Staphylococcus [18, 21, 24, 25]. However, more recent multi-institutional data by Gross et al [26] evaluating culture results at time of clinically infected device explantation or Mulcahy salvage showed no growth in 33% of cases, gram positive isolates in 73% of cases, and gram negative isolates in 39% of cases. Candida (11.1%), anaerobes (10.5%), and MRSA (9.2%) accounted for one third of positive cultures. Furthermore, preoperative antibiotics provided adequate coverage in only 62% to 86% of cases based on culture results at time of explant, suggesting that broadened antibiotic prophylaxis and review of AUA/European Association of Urology guidelines is necessary [26]. There is level 2 evidence of increased risk with revision surgery based on the number of separate studies with concordant findings, their large sample size, and prospective nature.

[wilsonmill]

You say you are healthy, no underlying conditions. I do not know why you got an infection, surgeon? Hospital? Patient? Mfg? I would make sure the surgeon is at the very least listed on the mfg's Center of Excellence. I would explain to the surgeon my concerns and that infection is a High Risk, how are you going to avoid those risks? But the surgeon, hospital and yourself are key to in reducing infection chances.

[Gatorman97]

Hey guys, ty for your responses.

To answer the questions:

I went from about 5.5 inches bone pressed, just over 5 inches from fat pad, at the start of all this. I’m now down to about 5 inches bone pressed which basically means just under 4.5 inches from fat pad. The rods are 12 mm, not sure of girth but it’s less than what it was for certain. I’ve lost quite a bit of girth.

When I had the 22cm Titan before infection it was noticeably harder at inflation than the Rigicon. At 51, even though I have a GF now I do want the ability to be single for a bit before I fully settle down.

My initial surgery was done by Dr. Carrion at USF, a Center of Excellence. He is world renowned…,I think I just got unlucky. My revision to a malleable was done by another USF surgeon and yielded excellent results cosmetically with the tips at mid point of the glans. There have been no complications with the malleable. It’s almost 5 months out and no infection.

If I do the revision it would most likely be with Dr. Parito in Miami via the infrapubic approach.

I don’t have high risk factors: I don’t smoke, am proportionate weight wise, and don’t have diabetes. I do have some high blood pressure.

On infection risk, have been told different things by different surgeons, ranging from 3 to 5 percent to over 10 percent. Dr. Pareto acknowledged the “scary” Mayo Clinic studies, but said the infection risk can be driven in part by the skill of the previous surgeon/length of surgery and the formation of something called biofilm. Given that my previous surgeon was highly skilled he did not think the infection rate would be as significant.

This is a very emotional/gut decision as well as an analytical one (I am analytical by nature). I think about this entirely too much.

Thanks for the input!

[tooyoung]

Hey guys, ty for your responses.

To answer the questions:

I went from about 5.5 inches bone pressed, just over 5 inches from fat pad, at the start of all this. I’m now down to about 5 inches bone pressed which basically means just under 4.5 inches from fat pad. The rods are 12 mm, not sure of girth but it’s less than what it was for certain. I’ve lost quite a bit of girth.

When I had the 22cm Titan before infection it was noticeably harder at inflation than the Rigicon. At 51, even though I have a GF now I do want the ability to be single for a bit before I fully settle down.

My initial surgery was done by Dr. Carrion at USF, a Center of Excellence. He is world renowned…,I think I just got unlucky. My revision to a malleable was done by another USF surgeon and yielded excellent results cosmetically with the tips at mid point of the glans. There have been no complications with the malleable. It’s almost 5 months out and no infection.

If I do the revision it would most likely be with Dr. Parito in Miami via the infrapubic approach.

I don’t have high risk factors: I don’t smoke, am proportionate weight wise, and don’t have diabetes. I do have some high blood pressure.

On infection risk, have been told different things by different surgeons, ranging from 3 to 5 percent to over 10 percent. Dr. Pareto acknowledged the “scary” Mayo Clinic studies, but said the infection risk can be driven in part by the skill of the previous surgeon/length of surgery and the formation of something called biofilm. Given that my previous surgeon was highly skilled he did not think the infection rate would be as significant.

This is a very emotional/gut decision as well as an analytical one (I am analytical by nature). I think about this entirely too much.

Thanks for the input!

Infection might have already taken that half inch in length permenantly due to scarring (not the mpp) and installing an ipp might not retrieve the lost half an inch and believe it or not you might loose further length even with the length expansion bullshit devices..

Man your current length is beyond adequate..it's average in some countries and above average in others (believe it or not)...I don't know about girth as you haven't measured but if it's that bad (i doubt ) you can discuss Urofill atleast with perito....

Your situation is perfect and solid...don't get indulged by the system pushing inflatables and slicing us too many times for a 1 cm (most get a minus instead) our partners won't notice.

If it's not broken don't fix it....I recommend you read mbambo's journal.

[frank66665]

in my opinion you will gain no more than 1 cm, do you think it is worth it? if it is not a pencil in circumference do not do it