Surgery or an Implant

[SW01]

I have been perusing the comments, and for hours, and would like to see if someone has some current input on whether they had surgery for the plaque removal or went to an implant.

Just so everyone can have a little history about my story, because I do think it is appropriate to lessen the confusion. I have been dealing with LUPUS and arthritis since about age 40 with a lot of issues. I was in the public safety area so could not take a lot of prescription drugs due to mandatory drug tests. I mostly took the minimum dosage of various pills, which was at different times tramadol, gabapentin, and lyrica. I retired at 52 when my wife said I could either retire or divorce. I worked a bit much it seems. I preferred marriage over work after all. We got married at 17 and together ever since. Not all great times, but mostly good. In June 2016, I was working on my pool deck in the summer. One complication of LUPUS is intolerance to heat. I should have been in the house, but nooooooo. Walking across my 2 by 8 deck supports, I got a little foggy and fell about 3 feet straight on the boys. Needless to say I was black and blue from my knees to my lower stomache.  Went to my regular doc the next day, and he said everything looked okay but referred me to a urologist.

As a little history, up until that time I had had no issues with getting or maintaining an erection. I had a pretty solid 7 inches with a girth of about the same. I hate to say it but even if I imbibed a bit much alcohol still had no problem with an erection or keeping one for a while. Pretty much if I wanted a hard on I got one and kept it for as long as I wanted.

After the accident, I started having issues. I was always very active. Would work 10 - 12 hours a day and come home and work on the farm till midnight. After retirement, stayed out working most of the day even with the LUPUS issues. In fall of 2016, I did not want to get off the couch and would move from the bed to the couch. The only positive with this is our dog was in heaven. He never left my side all day or night. Started irritating the urologist. Got my testosterone tested and it was 20. Literally 20. In the past during physicals it would be over 800. Also told him I was having issues getting an erection. He put me on androgel supplements. I already exercise regularly, eat pretty healthy, and take vitamin supplements, but not any of the testosterone supplements. He also gave me a prescription for generic viagra, sildenafil. I started with 40 mg. at first and the erections came back okay. Not like before, but were there. As the next 6 - 8 months went on I had to go up to 100 mg of sildenafil to get an erection. Kept going to urologist and he kept telling my I will be on testosterone treatments for the rest of my life. One negative is I really have to work out hard to keep my pecs toned. Not sure why that is a side effect. As he said hey plastic surgeons can take care of that. I just work out more.

In fall of 2017, on a regular visit to urologist and more tests. My testosterone stays around 500, which is in normal range, but only with the androgel. About October 2017, I noticed a small hourglass issue about an inch from my pelvic bone. No other issues at that time. He said no big deal, just take the sildenafil and keep going on. In December, I noticed a hard nodule in the same area, and a slight bend to the left. Back to urologist. His words, Looks like you got peyronies. You need to take 400 mg of VE two times a day. Nothing else. Started researching along with my wife, who is a medical records coder. I still could get an erection on the drugs so no big issue.

Big surprise the nodule gets bigger. Mind you at this time the urologist has never touched my dick, just looked at it. Started taking VE, ALC, Bromaline, Aloe Vera, Protein, pretty much anything that I read about that might remotely help. Around March when the bend got noticeably worse, about 45 degrees to the left and about the same straight up. Weird looking to say the least. My wife got concerned and said I need to see a specialist to make sure it really was Peyronies and not cancer, which could have been an issue. Made my own appointment with a specialist in KY. Went to the the visit in April and he says it has not been long enough, not much he can do. He did tell me that it was not cancer so no reason to worry. Made an appointment for the second week of August, which I went to. Suggested I get an Andropeyronies traction device and use it. (I just started this a couple weeks ago. Should have done so earlier but just a bit depressed over the summer. Using it now stretching at 6 inches relaxed and about 5 inches girth relaxed still).

Here is where it gets interesting. This appointment was to inject me with trimix and measure. The first person I saw was this really good looking blonde PA, who tells me to get naked from the waste down and cover myself with a sheet. She then comes back in with a needle and trimix. The first shot was 20 mg, and after 20 minutes nothing. She comes back in and feels around and says she wants to inject me with another 20 mg. This time she brings a male PA with her and asks if he can feel the plague since it is pretty pronounced and easy to identify. I said sure, why not we all just enjoy ourselves.  She injects me with 20 mg again, and again, nothing in 20 minutes. Next time the doctor comes in to have a look.

Since he is in the room, I start talking about my options. Surgery, implants, trimix, sildenafil, etc. He told me that nothing is probably going to help me for much longer if 40 mg of trimix will not give me an erection. The pretty PA jumps in and says she has a new bottle of trimix and could give me ANOTHER SHOT of 20 mg. I said what the hell, I am laying here, might as well go for it. Hospital is down the hall if I need to get to the ER fast. I told her I would just hang around and see what happens. This time I get an immediate erection. She comes back in and says it looks pretty good. She says she is going to take a picture of it to show the doctor when he comes in, just in case it goes down before he gets here. I told her no problem, but she really did not need a picture of some 56 year old guys dick on her phone, so she took the pictures with mine. I thought she was gonna die laughing. (You really have to see the humor sometimes in this).

Okay, all this story to get to the point. Sorry if I am a bit long winded. I used to teach a lot of classes, and never did have an issue talking up a topic. Doctor comes back, still have the erection, but he looks as the pictures first then my dick. Tells me that there are some options since the last shot with 60 mg of trimix got me an erection even with an almost upward bend. He feels that I should be implanted with a coloplast implant to permanently take care of the ED and it will also correct the bend issues. If I wanted to though since I could get an erection with trimix he is willing to excise the plague and place a graft. He does not want to do both of them at the same time since there is a possibility due to the complexity of that operation, the head of my dick could turn purple and have to be removed. WWWTTTTTFFFFFFF.

So I can within the next 8 weeks have an excision and graft to remove the plague, use trimix if sildenafil does not work anymore for the next bit of time until it does not work anymore. He figures I can get a year or two using that method. The other option is just to go straight to the coloplast. I am still in a fog with all of this and wondered if anyone had any specific thoughts on the excision and graft. Did it work for them, and how long. I am not going with the nesbit and he did not recommend it for me.

FYI, I plan on finding a different surgeon for sure to do an implant. Excision and graft I might let him do. My regular urologist is pretty good for a prostate exam and getting androgel and sildenafil from, but that is about it.

Footnote, sorry. I did get my GP to get me a prescription for Pentox, and have been on it for about a month. Maybe it is all in my head but I think the plaque might be little softer. At this point I am about crazy so who knows.

So right now, I am still taking all the supplements, using the Andropeyronies device (not as much as I should but oh well). Am going to order a VED just in case it might help some.  

[TonySa]

Wow, you're really maximizing your treatment protocol-esp if you add VED.  Docs can do both excision, grafting and implant but it removes the option of the LGX (also expans lengthwise).  If moving forward with either surgery really work to find the doc who has the highest volume, experience and best reputation.  It's possibke the implant may resolve the curve without the excision and grafting.

[Hawk]

SW01

IF PERFORMED BY A TOP, HIGH-VOLUME SURGEON, I have no doubt that that the implant alone will:
1. Correct all curve, bend, dent, and any other deformity
2. Resolve ED to the point of giving you sexual stamina beyond what you had even in your youth
3. Prevent future loss of size.

In addition, there is some modest chance it could reclaim some size loss.  This depends on your tunica's ability to stretch of the long-term which depends on many factors including whether you are currently using traction, VED etc.

I do not know what you would get in addition to this from the grafting except some potential size increase but my initial thoughts are that size would have to be a huge issue and they would have to promise a significant gain.  If you get the graft and go from a 5 1/2 " penis to a 7" penis and have to haul refrigerated trimix and needles around with you on vacation etc is it worth it?  If the trimix causes future scaring is it worth it?  Is the lack of spontaneity worth it?  Is the risk that the trimix might stop working in a year worth it?

[SW01]

That is actually the way I am leaning myself. If the surgeon says the implant can take care of the peryronies and get me pretty straight, I am not sure I want to put myself or it through two of those. My option is just finding me a good surgeon, and dealing with insurance issues. I am not really keen on injecting myself just to get an erection especially if the end result in a year or so is not going to change. I appreciate the comments. I am not one to hold off once I make a decision. Good or bad, you make it an live with the consequences. I think the implant is looking like the way I would go.

The only issue I have in traveling is the long plane ride or car ride home. I could travel to Baltimore for Kramer, and stay in my motor home with the wife and visit the grandkids for a couple week. How big a deal is the bathtub. I read Hawks posts and he enjoyed his. I guess a hotel room is an option, but is it fairly easy to travel after about two weeks. My wife does not drive the MH. If the hotel option, I have about 10 hours in a car back from Maryland.  

[TonySa]

I heard no driving next day and less painful if lying down.  Maybe uber from the hospital to the motor home?

[Hawk]

The only issue I have in traveling is the long plane ride or car ride home. I could travel to Baltimore for Kramer, and stay in my motorhome with the wife and visit the grandkids for a couple week. How big a deal is the bathtub. I read Hawks posts and he enjoyed his. I guess a hotel room is an option but is it fairly easy to travel after about two weeks. My wife does not drive the MH. If the hotel option, I have about 10 hours in a car back from Maryland.

I would see if you can talk to someone in Kramer's office and have them mail you the post-op info they typically give patients.  He may or may not want you taking hot baths.  Every surgeon is different as far as how long the catheter is in, how long before activating the cycle process etc.  I agree with not putting it off but make sure you have a solid plan before you start.  You MIGHT be able to drive a motorhome after 2 weeks but you will not likely be entertaining kids or grandkids the first 3 or 4 days.