Tony’s excision, grafting and implant diary.

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TonySa

PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Hawk

Tony, the inflated looks like it narrows or step in on the right near the base.  
Is that a change?  
On the deflated are you saying that in the past you did not have any irregularities from relatively new deflated cylinders?  I could almost believe that looks normal for very deflated new cylinders of a non-LGX

Also, what made you think and self-diagnose as a graft coming loose?  
Did you have pain?  Did you know the instant it happened?  
Did you discover it after the fact?
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

TonySa

The two pics in last post are both deflated.  First now, second from last week. The narrower base is plaque that was not removed and hopefully will expand due to the capacity of the CX.  There is no pain so the theory about the graft coming loose is hopefully incorrect. It's just the increased bulging happened after intercourse abc seems to be in the area where the lower graft was/is?  Hopefully it's all normal and can be managed by slightly inflating the cylinders when not in use—but I wouldn't do that until after 3 months so as to not limit the capacity of the reservoir.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Hawk

I am no doctor but 6 weeks in, I really think as long as you are super deflated during the night a little bit of fluid in the cylinders during the day is not going to be an issue.  You are stretching the reservoir 8 - 10 hours a day.  That is a lot more than you are stretching your penis.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

TonySa

I'm beginning to think since my edema and swelling has gone down I can now see the flattened cylinder, dog ear type effects when fully deflated when the edema was rounding things out before.  
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Hawk

I think you just hit the bullseye and solved the mystery!  I am almost certain that is correct since I had a similar situation as did Floppy only much sooner in the process since less swelling and maybe stiffer cylinders with a Titan.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

TonySa

PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Alibaba

Then the dog ears are in the deflated state?  I must have missed that. Dog ears should smooth out with just a few pumps.  In reality, for a while adding enough to smooth them out when you can helps eliminate them for good at an earlier time. Would it help your graft to heal smoothly and evenly keeping enough fluid in the cylinders to be smooth rather than dog eared? Just a thought. Cheers man.  
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

TonySa

Yes, only prominent in deflated state.  I think this is where the cylinders tend to fold (crease really) when walking around.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Alibaba

Quote from: TonySa on November 06, 2018, 03:05:22 PM
Yes, only prominent in deflated state.  I think this is where the cylinders tend to fold (crease really) when walking around.

Dog ear then.  A couple pumps should smooth it out. Cheers.  
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

TonySa

60 days out and finally managed an orgasm in less than 1/2 hr.  Sensations from degloving returning, but sutures are a hassle—3 of 4 have not dissolved or created scar tissue.  As they say, each week gets better!
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

TonySa

And again today, feeling much better about the excision/grafting w implant.  Guess the excision/grafting impact on the nerves is improving...feeling more pleasure able sensations.  Also, beginning to feel a bit of slight discomfort/stretch when pumped to the max which I hope is a good sign of increasing size w time as I think I'm still less length and girth than originally.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Hawk

Quote from: TonySa on November 17, 2018, 04:36:22 PM
Also, beginning to feel a bit of slight discomfort/stretch when pumped to the max which I hope is a good sign of increasing size w time as I think I'm still less length and girth than originally.

When you say "originally" do you mean immediatly pre-op? If so, when you say "you think" does that mean you did not take precise, objective, pre-op measurements?

Btw, I suspect the feeling will very slow.y improve for a full year at least.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

TonySa

I was thinking the bone pressed flaccid stretch was the measurement needed.  I'll have to find any other measurements I made.  The postop measurements (not bone pressed) matched the preop measurements the doc made.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Alibaba

I always measure between my ears as the perception how I feel about it is most important!  ;D
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

TonySa

PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

TonySa

10 weeks post surgery update:
Sensitivity slowly returning with orgasms very delayed and not always possible
3 (of 4) Internal stitches remain hard.
Thrombosis (see photo link) has grown in size.  Doc didn't seem worried but I will follow up.
See: https://www.peyroniesforum.net/index.php/topic,11123.0.html
Circumcision scar from excision grafting very fifteens from silicone gel wraps.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

TonySa

Most likely due to excision/grafting rather than implant portion of operation.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Pfract

Oh boy... That looks like a vein coming out. Similar to mine on the side. Does it hurt or anything? I've never seen this result as part of IPP placement. Did your doctor gave you any hint on what it might be because of?  

TonySa

He didn't say specifically.  It is not painful, just a distraction (hard knit feel) when having sex.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Pfract

Seems to be so similar... The vein I took picture of, seems to be the same with no improvement. Read that doctors recommend just anti inflammatory and it resolves with time. Do you feel any difference in the bulge on the vein, while lying down? Is it always like that? Are you taking any medication that might  have helped to cause that?  

TonySa

The thrombosis has tripled in size from when I first noticed it after surgery. Bin already on anti-inflammatories.  Will see doc Monday.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Pfract

Oh damn... That sucks and I am sure you are worried. Good luck with this.please report back when you see your doctor.  By the way, what dosage are you taking of anti inflammatory? Is it ibuprofen?

TonySa

200 mg Celebrex a day and 3,000 mg Tylenol a day.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Alibaba

Wow.  Keep us posted how it resolves. Thombosed veins can take a long time in legs. Dicks?  I don't know. Kind of gives an idea what goes on with these boys that want to try the quack cheap schelerotherapy where they cork off veins although deeper veins. Be well soon.  
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

TonySa

3.5 months post surgery:

Thrombosis appears to have completely resolved.
Length (full bone pressed inflated) is up .25" to 6.25"
Intercourse is akward with some buckling where "dog ears" are on shaft.
Sensitivity seems to continue to incrementally improve overbtime-orgasm still difficult.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Hawk

You don't have any dog ears or any trace of where they are when you are inflated do you?
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

TonySa

They're gone when inflated but tends to bend there w the in and out motion.  Going to see NP tomorrow.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Hawk

I am very surprised that a non-LGX model would do that fully inflated.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

Alibaba

Though known for better rigidity than the LGX and seemingly often preferred for syndromes of bent dicks, all AMS models are known to not be as rigid as Coloplast.  
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

Pfract

Hey Tony! very nice to read that your vein thrombosis has resolved itself. As for the implant buckling... that's a bit distressing. But can you describe a bit better what do you mean buy buckling? are you having difficulty inserting the penis for penetration?

TonySa

User error...lol

So I went back to the doc and explained my problem of inserting penis during intercouse (resulting in bending or buckling).  Turns out I have not been fully inflating...apparently slightly pushing deflate valve while pumping.  I seem to have it now and will try again.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Hawk

Man, I don't think you could ever accidentally hit a Coloplast deflate valve.  
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

TonySa

Almost four months and now penis working like a dream.  Sensitivity keeps improving, can now orgasm, stitches slowly dissolving and no longer a distraction when jerking off.  Now successfully fully pumping and therefore useable for intercourse.  
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Pfract

 8) That is so nice to read Tony!!! if it feels good to read another success story, i can only imagine how you must be feeling! enjoy it :D ;D

LWillisjr

Same here Tony, I know you have been a member on the forum for some time and that the decision for surgery was a difficult one.
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

p-diddy

53 y.o, healthy, fit, married. 
Mild to mod ED starting 3 years ago,
Peyronies disease, penile trauma/fracture.
Implanted with Titan 22cm by Dr. Eid on 12/19/2018. 
Started cycling day 4.

curved

I apologize in advance if I am not posting this question for the group in the appropriate section. Long story short is that I have had Peyronies Disease for just under 4 years and have tried all conventional/unconventional treatments (Xiaflex, VED, traction, PRP, stem cells, ESWT, orals, etc.). At one point through Xiaflex I had gotten my downward curve of 40 degrees to almost straight.  Peyronies Disease returned approx 3-4 months later and I currently have upward curve of approx 35 degrees.  I have significant plaque and am now trying to decide if I should go with penoscrotal plication or implant.  I do not have significant ED but recognize that most will get ED at one point. I have lost approx 1 inch because of Peyronies and currently measure at 14 cm on the SPL measurement.  I am using RestoreX at least 1x daily for 30 min. I am afraid to lose any more length but the surgeon recommending plication has indicated that he wouldn't expect me to lose more than 1-2mm. I have a phone call consult with Dr. Eid next week to get his perspective. Anyone have any advice/thoughts?  While plication is less invasive there is potential for loss of length when I don't feel like I have much length to give up.  There is also a chance that Peyronies Disease could come back (assuming I am one of the ones that attribute this to a genetic wound disorder). On the implant side I take care of this once and for all but recovery is a bit more difficult and of course you no longer have a naturally occurring erection.  Thanks in advance for any thoughts.
51 yrs old; diagnosed 3.5 yrs ago; 90 degree upward bend
But I had no ED
tried all pills, VED, traction, Xiaflex PRP, ESWT, H-100 & stem cells; IF diet. implant surgery with Dr. Eid 3/28/19
to correct deformity - 20 CM Titan 2cm RTE / 1 cm RTE

Hawk

With an implant you would have the added advantage of still getting an erect glans and spongiosum which men with total Ed do not get with an implant.

I think the decision is a tough one and very individualized.  I had clear ED so my decion was much easier.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

TonySa

I trust Dr Eid will advise you well and give you some valuable info for your decision.  BTW plication always results in size loss equal to the shorter side.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

TonySa

I returned to my PCP, a female PA for the first time since my surgery and she got to see an implant live for the first time.  I thought she should know how life transforming they can be.
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Alibaba

Quote from: TonySa on January 05, 2019, 11:16:38 AM
Almost four months and now penis working like a dream.

Absolutely fantastic! Thank you for sharing the good news. Made my evening better reading it. Cheers man.  
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

curved

was wondering if anyone had heard of the "Scratch" technique for management of Peyronies in conjunction with penile implant.  Believe this is relatively new and is being done by Drs. Hakki (GA) and Perito (FL).  Essentially they breakup/incise the plaque prior to implant to help with length and curvature reduction (this is done with an infrapubic incision). There is a video out on you tube on it. Then they use the "no touch" technique for the penile implant. There is no degloving involved.  I know Dr. Eid believes the implant alone can straighten the penis quite a bit but was curious if others had any familiarity with either these docs or this technique?  Thanks.
51 yrs old; diagnosed 3.5 yrs ago; 90 degree upward bend
But I had no ED
tried all pills, VED, traction, Xiaflex PRP, ESWT, H-100 & stem cells; IF diet. implant surgery with Dr. Eid 3/28/19
to correct deformity - 20 CM Titan 2cm RTE / 1 cm RTE

curved

Found this summary of surgical decision options when correcting peyronies with implant.  Thought i would pass along.https://surgery.duke.edu/sites/surgery.duke.edu/files/field/attachments/DUA17-Lentz-IPP-for-Peyronies Disease-REVISED.pdf
51 yrs old; diagnosed 3.5 yrs ago; 90 degree upward bend
But I had no ED
tried all pills, VED, traction, Xiaflex PRP, ESWT, H-100 & stem cells; IF diet. implant surgery with Dr. Eid 3/28/19
to correct deformity - 20 CM Titan 2cm RTE / 1 cm RTE

TonySa

In order to scratch the plaque, how would they reach it without degloving?  
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Hawk

Quote from: curved on February 04, 2019, 05:02:46 PM
I know Dr. Eid believes the implant alone can straighten the penis quite a bit but was curious if others had any familiarity with either these docs or this technique?  Thanks.

Correction:  Dr Eid does not believe the implant alone can straighten a curve, he does it on a very regular basis and documents the results.  There is no debate or room for opinion on whether he straightens severe curves.

Many doctors (not all) claim to use the "No touch teqnique" but in fact use a very degraded imitation of that technique and have much higher infection rates.

Also keep in mind that Dr. Eid does routinely use incision and molding.  It is in many surgical notes including mine and my curve was very minor.  He can often do the incisions at the base through the scrotal incision and does not deglove.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

redbullmaster

From watching Dr Eid videos, he breaks up the scar tissue when he opens up the cavities for the implant.
Guessing its the same technique as Drs. Hakki, without degloving would think its the only way to do it.  

curved

Hawk--- just want to make sure I understand your point on this:

"Correction:  Dr Eid does not believe the implant alone can straighten a curve, he does it on a very regular basis and documents the results.  There is no debate or room for opinion on whether he straightens severe curves."

In conjunction with the implant Dr Eid will employ molding and or incisions to straighten the penis to an acceptable curve (e.g. <30 degrees)? I didn't realize he was also using molding/incisions.  My bad for not having that critical clarification and appreciate the additional info.  After I posted yesterday I did reach out to his office to ask about the scratch technique.  As usual he was quick to reply and said he was familiar with it and would utilize it on me if necessary but didn't think it would be.

I did get finalization of scheduling for my surgery for late March and will provide detail in my implant journal as appropriate.
51 yrs old; diagnosed 3.5 yrs ago; 90 degree upward bend
But I had no ED
tried all pills, VED, traction, Xiaflex PRP, ESWT, H-100 & stem cells; IF diet. implant surgery with Dr. Eid 3/28/19
to correct deformity - 20 CM Titan 2cm RTE / 1 cm RTE

Hawk

I think we are walking all over Tony's journal here.  I will post this response to curved but this needs to be split off into its own topic.

Curved, here is an excerpt from Dr. Eid's surgical notes for my surgery:

e)      CORRECTION OF PENILE ANGULATION:

Examination of the penis with the cylinders fully inflated revealed the presence of a mild curvature to the dorsum.  The area of deformity was determined to be proximal near the base of the penis.  Using a combination of superficial incisions and blunt remodeling of the tunica albuginea, the defect is corrected.  Further dissection was done to expose the tunica albuginea on the side of the penile shaft near the base of the penis.  A series of small parallel excisions were made at the level of the corporotomy, and the resulting defect was closed with a running 3-0 PDS suture.  An erection was induced again to test the adequacy of the repair.  Marked improvement of the shape of the penile shaft was noted.  The cylinders were deflated and then reinflated and the patient's penis was reexamined.  The correction of the angulation accomplished, we turned our attention to the next part of the procedure.
 
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
Hawk - Updated 10/27/18 - Peyronies Society Forums

TonySa

Would the individual then have stitches on the shaft where the tunica was exposed?
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.