Are there any major benefits to using a local surgeon?

[Asdefxx]

I want to fly out to a rockstar surgeon as much as the next guy, but before I do that I just wanna make sure it's the right call. Like, could a *good* local surgeon 20 minutes from my apartment be better than an *excellent* surgeon on the other side of the country? To be more specific, I'm talking about Dr. Paul Rusilko in Pittsburgh, who's both high-volume and accredited, but never gets talked about in this forum like Dr. Eid, Dr. Hakky, Dr. Clavell, etc.

Would you say that it's simply better to fly out to someone exceptional, or are there serious benefits to staying local?

Saving some money on the hotel seems like one benefit, but it's not that big a deal. How many nights would you say I need to book *after* the surgery, before I can get on a 2-hour flight back home?

Replacing a 2-hour flight with a 20-min uber seems like another benefit, but how big a deal is it really? Like on a scale of 1 to 10, how miserable or awful was it for you to take a 2-hour flight home, as well as having to wait however long at the airport?

Any other benefits to staying local? I don't care about revisions, since I'll only live here another few years at the most. Staying local would be a major benefit though if god forbid something goes with my surgery. What are the odds of that though, gotta be like 3% or something crazy low, right?

[ElbowRoom]

YES. My surgeon is not "local" per se, but about a 1.5hr drive. Since my surgery I have been back to see him twice for issues that have come up. If he was 4hr away by jet neither visit would have been feasible. It could have probably been handled with labs drawn locally and teleconference calls. But sometimes you just want your surgeon to put his hands on you and really see/understand the situation.

I got really lucky in that my #1 choice of surgeon is also the closet option. If he was farther away I'd probably still have used him, but it is kind of working without a net in some regards.

[LetoMan]

It’s going to be a different answer for everyone. But if you are talking about objective medical benefits, there doesn’t appear to be too much of a benefit between solid local options and the extreme high volume implanters. The medical literature shows that doing a reasonable number of implants per year (31 in one study, I think 25 in another) is associated with an improvement in infection and revision rates. But the studies don’t note an improvement when surgeons go waaaaaay beyond that.

Which makes sense. As much as guys think with their dicks, this isn’t brain surgery. You want a good surgeon who has done the procedure repeatedly, sure. But there isn’t necessarily a benefit to only doing implants. The curve is steep but levels off pretty quickly.

Outside of the benefit of the ease of attending to the original implant, god forbid something comes up you would probably rather be close to your doc than far away.

That all said, if you want to travel a well-worn path and feel comfortable with the handful of implant-only docs… great! That’s an individual decision about what that is worth to you compared to seeing someone locally.

Personally, I would avoid inexperienced general uros in rural or remote areas that don’t perform a lot of surgeries, period. But once you are looking at experienced urological surgeons that perform a variety of procedures, typically associated with major system hospitals, whether they do 50 or 500 implants a year is worth zilch, whereas how you feel about the doc, how you feel about their team and the proximity/travel issues matter a whole lot more.

[Valdekio]

I want to fly out to a rockstar surgeon as much as the next guy, but before I do that I just wanna make sure it's the right call. Like, could a *good* local surgeon 20 minutes from my apartment be better than an *excellent* surgeon on the other side of the country? To be more specific, I'm talking about Dr. Paul Rusilko in Pittsburgh, who's both high-volume and accredited, but never gets talked about in this forum like Dr. Eid, Dr. Hakky, Dr. Clavell, etc.

Would you say that it's simply better to fly out to someone exceptional, or are there serious benefits to staying local?

Saving some money on the hotel seems like one benefit, but it's not that big a deal. How many nights would you say I need to book *after* the surgery, before I can get on a 2-hour flight back home?

Replacing a 2-hour flight with a 20-min uber seems like another benefit, but how big a deal is it really? Like on a scale of 1 to 10, how miserable or awful was it for you to take a 2-hour flight home, as well as having to wait however long at the airport?

Any other benefits to staying local? I don't care about revisions, since I'll only live here another few years at the most. Staying local would be a major benefit though if god forbid something goes with my surgery. What are the odds of that though, gotta be like 3% or something crazy low, right?

High volume and accredited sounds like the best of both worlds being close and all. Sometimes insurance is a consideration as well. Mine certainly was. He wasn't high volume in it recommended by both Boston scientific and Coloplast. I actually don't think there are any high volume in Oklahoma but at 20 or so a year I felt comfortable that he knew what he was doing. Especially after meeting him.

[tomas1]

I stayed local and it worked out very well for me.

I didn't know if my guy was high volume, but it took me about 3 months to get my surgery and insurance had no part in that,

While at the hospital for surgery I found that he was doing other or others that day.

It was nice being able to go home the day after surgery to my own home.

[lasthope2.0]

It’s going to be a different answer for everyone. But if you are talking about objective medical benefits, there doesn’t appear to be too much of a benefit between solid local options and the extreme high volume implanters. The medical literature shows that doing a reasonable number of implants per year (31 in one study, I think 25 in another) is associated with an improvement in infection and revision rates. But the studies don’t note an improvement when surgeons go waaaaaay beyond that.

Which makes sense. As much as guys think with their dicks, this isn’t brain surgery. You want a good surgeon who has done the procedure repeatedly, sure. But there isn’t necessarily a benefit to only doing implants. The curve is steep but levels off pretty quickly.

Outside of the benefit of the ease of attending to the original implant, god forbid something comes up you would probably rather be close to your doc than far away.

That all said, if you want to travel a well-worn path and feel comfortable with the handful of implant-only docs… great! That’s an individual decision about what that is worth to you compared to seeing someone locally.

Personally, I would avoid inexperienced general uros in rural or remote areas that don’t perform a lot of surgeries, period. But once you are looking at experienced urological surgeons that perform a variety of procedures, typically associated with major system hospitals, whether they do 50 or 500 implants a year is worth zilch, whereas how you feel about the doc, how you feel about their team and the proximity/travel issues matter a whole lot more.

Great points, Leto. As an enthusiast community, we can get swept up in the high-volume hype. 50 cases a year...about one a week, still seems solid.

I also have Kaiser option through work. Any tips on how you chose your Kaiser implant surgeon? I’m finding it hard to identify Kaiser urologists with “Center of Excellence” status on the AMS/Coloplast sites.

[UpNorth]

What time frame are you looking at?
I drove about 400 miles to Eid, that’s about the same for you.
Cleveland is close to you.
I went to Cleveland to get my stitches out, check them out as well.

Good Luck
You will be saying “I wish I would have done it sooner”.

[Tony=T]

I watched all the videos from the big guys about going to a dedicated center. If I lived within a couple of hours of one I would have but I don't so I didn't. I felt like traveling in a plane or any form of transportation would have been to uncomfortable for me. I went with a local guy that is 15 minutes away and he is on Coloplast website as a center of excellence doctor. He did an excellent job, no size lost, no infections, no problems of any kind. If there would have been he's 15 minutes away. I think it was a good move and if I had to do it again I would go the same route.

[LetoMan]

I also have Kaiser option through work. Any tips on how you chose your Kaiser implant surgeon? I’m finding it hard to identify Kaiser urologists with “Center of Excellence” status on the AMS/Coloplast sites.

I simply searched their doctor directory for docs that had experience with implants. I came across one that seemed good and was nearby. I got a referral from my GP, set up an appointment, and at the end of the appointment he put the surgery in motion.

Kaiser has upsides and downsides. Upside is the docs are no nonsense. They are all salaried, and have zero incentive to sell you anything. It’s the opposite… since they essentially work for the insurer, they have incentives to ration care. But my experience is that they don’t… they are docs first. So for example, all it took was a 10 minute convo with my doc for him to schedule me for surgery three weeks later. That’s it… no preapproval, nothing. His diagnosis is all that matters.

[lasthope2.0]

I also have Kaiser option through work. Any tips on how you chose your Kaiser implant surgeon? I’m finding it hard to identify Kaiser urologists with “Center of Excellence” status on the AMS/Coloplast sites.

I simply searched their doctor directory for docs that had experience with implants. I came across one that seemed good and was nearby. I got a referral from my GP, set up an appointment, and at the end of the appointment he put the surgery in motion.

Kaiser has upsides and downsides. Upside is the docs are no nonsense. They are all salaried, and have zero incentive to sell you anything. It’s the opposite… since they essentially work for the insurer, they have incentives to ration care. But my experience is that they don’t… they are docs first. So for example, all it took was a 10 minute convo with my doc for him to schedule me for surgery three weeks later. That’s it… no preapproval, nothing. His diagnosis is all that matters.

Thank you LetoMan. This is very helpful. Does the GP referral also work for Kaiser Affiliated providers (urologists)?