To implant or not to implant that is the question.

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jcb

Gentlemen,
I have read and read and read. Have Peyronies Disease developing ED as a result. Don't even have a decent piss hardon in the mornings anymore. BTW will be 60 yo in June. Doc has mentioned all the options from Verapamil injections to implant. Semi erection makes it impossible to urinate as my bend is almost 90 degrees up about 2/3 of the way down and bending it downwards to hit the toilet cuts off the flow.  Soooo, I get to sit down - just as I did as a young man with a full on erection and taking a leak between sessions. ( You guys remember those days.) Anyway, here I am the forever practical guy. Everyone I have spoken with that has had the implant says that their only regret is not having done it sooner. If that is the ultimate fix, then why do I want to go through the pain and expense and so on of screwing around with this other stuff just to eventually need the implant? Having said all that I am scared to death. I have seen the video of this operation being performed and it hurts just to watch it. Guess I am just venting, but would be nice to hear some input, especially from those of you that have had the "inflatable" implant. Thanks for reading and please excuse my rambling. Thanks for this site. I usually just lurk around and read. Hope to see your replies.
Thanks
James
60 years young

restore

Would like to hear mor testimonies also from those who chose that route.  I've read very positive encouraging descriptions of the 3 piece implant.  I do have questions, and may ask a specialist who performs these operations.  A couple questions I have are:  

Since before peyronies, I had a very high quality erection, rock hard, including the glans.  Will the implant give me that again?  What about girth?  I have lost some.  I've heard that implant won't firm up the glans, just the shaft.  Also, since an implant erection does not bring on arousal, does it feel the same?  That is, will the person build up to an orgasm the same way?

james1947

jcb
I am sure you will get replies from people that get implant.
What I want is to answer you for the
QuoteIf that is the ultimate fix, then why do I want to go through the pain and expense and so on of screwing around with this other stuff just to eventually need the implant?
.
Some people gained length pre implant operation taking Pentox or PAV cocktail and doing VED. I have lost 2" to Peyronie's and I would like to get back some before the implant. If you didn't lost nothing, go ahead. It was also very scary for me to see some videos and some pictures regarding the implant especially if combined with removing Peyronie's scars, but the only choice with ED is implant.
James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

jackp

jcb restore James

Scared to death!!! That is quite normal. Some of the videos posted include a radical approach to peyronies with an implant.

You have valid questions and I will try to answer them for you. If I miss anything or you have additional questions just ask. You can ask here, send me a PM or send me an email to jwp104@att.net. It is OK to ramble, I do myself.

For maximum benefit from an implant a proper daily VED exercise is a must. All that is posted on my blog. I used the VED exercise for about 2 years before my implant and Dr. Milam told me it helped my outcome. The next benefit is choice of surgeons. There are only 3 or 4 in the US that can implant a length expanding implant and straighten the penis with modeling at the same time. Dr. Milam has pioneered that surgery.

The AMS 700 LGX is the only implant that expands in both length and girth. That expansion is up to 20% but not beyond your normal size. A good graphic is at www.amslgx.com/ I also lost 2" to peyronies. With the implant and the skills of Dr. Milam I have gained back just over 1 1/4".  The fact of life those of us with peyronies and ED have to deal with is loss of penile length. I did regain my youthful girth or 6.28".

The implant will give you a rock hard shaft and with the LGX into the base of the glans to prevent floppy glans. The glans is not involved in the implant. Most men over time will regain glans erections. Some young men as soon as 4 weeks, some up to 2 years. Mine returned at about 16 months.

You can have an erection with the implant weather you are aroused or not. Arousal starts in the mind. The erection feels very natural. The longer you use it the more natural it feels. It now has been over 39 months since mine and I feel just as natural as when I was a young man. Yes, you build up to orgasm the same as before. The implant has no effect on orgasms.

There are some stories on my blog that may help you. Feel free to contact me if you have more questions.

Jackp
http://jackp-penileimplant.blogspot.com/  

restore

Thanks Jackp!

I've been thinking lately that the injury that caused me to get peyronie's came from continuing to thrust after I had climaxed aleady.  Since my wife often reaches orgasm through intercourse, (but takes longer than me), I continued to keep thrusting after my orgasm, and I began to go soft in the process, injuring myself.  

I like that an implant won't have that issue.

jcb

Well, hell. Looks to me like that I have not found the right Doc! Had an appt yesterday. Dr. XXXXXXX in San Antonio merely asked me if I had made a decision yet. I was a little surprised by how abrupt he seemed to be. When I hesitated and fumbled a little for words he inserted that he did not think I was ready yet. -About now I'm not feeling real great about this.- I did push ahead and asked him about using the AMS 700 LGX (or whatever it is properly called). He informed me that it cannot be used in Peyronies Disease and that he had to use the Coloplast Titan for patients with Peyronies Disease, the LGX was for patients with ED only. Hmm?? I then mentioned that some of the info I had obtained from this forum seemed to indicate a more positive outcome when one used VED therapy prior to the surgery. To this he replied that Peyronies Disease patients are unable to use VED due to their deformity and the deminsions of the VED cylinder. He told me that if that is what I wanted he would suggest traction and gave me a flyer for Andro Penis.
Although this Doc claims to be a Peyronies Disease specialist and does 150+ implants per year, the more I talk with him the more I get the impression that he has found a gold mine in doing the implant surgery for ED patients and has yet to really get fully up to speed on Peyronies Disease.
I initially had his name where the X's are and thought better of it. If you need it or have a name for me please post here of send me a PM. So I am back to Dr. hunting.  
60 years young

voulezvous

jcb,

Run-don't walk-away from this so-called specialist. As you have probably already read from JackP's comments, the AMS LGX is absolutely the ideal choice for Peyronies Disease implant surgery. There are exceptions but they are based on issues other than ED. I have had my LGX implant since August of 2009 and couldn't be more satisfied. At the time, I was 66 & my dr. was specifically a male sexual health urologist. That's who/what you need to connect with to get the proper information. Not always easy because they are few and far between. Mine was in Minneapolis & Jack's is in TN (not sure where). In all likelihood, you'll have to travel to find one. As for the VED use, just read how many folks have been helped by it, with or without accompanying surgery. I don't usually take a strong position opposed to a trained MD but your dr. sounds like he is not up to speed on Peyronies Disease. Send either me or JackP a PM if you would like further details.

Worried Guy

I believe surgeons stick to certain implants for financial gain.  It is in their interest to use a certain product.  Perhaps they get commission or a discount.  This is why there is a breast implant crisis where possible 40,000 women in Europe may have non medical grade silicone implants.  The surgeons were doing the job on the cheap!!!!  Best way to do this would be to contact the maker directly and ask them if the product is suitable for peyronies sufferers.  

jackp

jcb

Who ever the doctor was you went to in Texas is not up to speed on peyronies and especially peyronies with ED or peyronies with hourglassing and ED.

I had both peyronies and ED along with all the side effects. I had a local doctor that is supposed to be the number one urologist in the area do an implant for me in 2007. Well he messed up and punctured my urethra and thankfully aborted the procedure. I went to several local urologist and even to the head urologist at the local medical school. I found out right quickly I knew more about peyronies and implants than he did. I finally found a honest local urologist that referred me to Vanderbilt.

What is the most common complaint from men with peyronies and ED? Loss of penile size. Dr. Milam has been using length expanding implants for years successfully for men with peyronies. His research is well documented in the Sexual Medicine Society. Problem a lot of urologist are not Male Sexual Function / Urodynamic Specialist. They get stuck on a old technology like the Coloplast Titan and refuse to change.

Besides Voulezous many many men have opted for the AMS 700 LGX and had the curve straightened during implant surgery. For men with peyronies, ED and hourglassing he has a special modeling procedure to fix the hourglassing.

I know several men in Texas that have not been able to find a specialist with these skills in Texas. One young man as young as 25. They went to Vanderbilt and Dr. Milam was able to return there sexual function with a normal looking and feeling penis. The one thing I am told about a Coloplast is that it does not feel as normal as the LGX. A good graphic on the LGX is at www.amslgx.com/

I will be happy to chat with you be either PM or email. There is also a lot of information on my blog. My advice is like others with this doctor don't walk away run.

Jackp
http://jackp-penileimplant.blogspot.com/

restore

jackp, with the implant, can you have a natural erection from being sexually stimulated?  At least partially?  That is, take the case where I am horny, sexually excited, and my wife is slowly performing oral on me, etc., and I am aroused.  Won't I begin to get hard, even without pumping the implant?   I mean, doesn't my brain still tell my body to react by filling my penis with blood?  I still have my penis with all it's parts right?

Sorry if this is commonly understood, I just don't see much in the faq's on the implant sites to answer these questions.  

Worried Guy

Jackp will be able to explain, as he has an implant, but I'm pretty sure as the implant fills the area which would normally expand with blood it would be impossible to gain a normal erection.  But if you could gain an erection you would not need an implant!

Old Man

Guys:

To answer your question about getting a natural erection after an implant operation - No, your erectile tissue is removed during the surgery to permit the implant rods to be placed inside the tunica.

One can be orally stimulated with an implant, but to obtain a proper erection for sex the implant must be inflated to permit penetration, etc.

JackP can fill in the rest of the story for you. He has a blog that explains more in detail about his surgery and the outcome up to date.

Old Man
Age 92. Peyronies Disease at age 24, Peyronies Disease after
stage four radical prostatectomy in 1995, Heart surgery 2004 with three bypasses/three stents.
Three more stents in 2016. Hiatal hernia surgery 2017 with 1/3 stomach reduction. Many other surgeries too.

LWillisjr

Quote from: restore on February 10, 2012, 07:13:12 PM
 I still have my penis with all it's parts right?

The answer is NO! The 2 corpora chambers are removed. And it is these chambers that would normally fill with blood. Without them an erection is not possible. For an implant they are removed and replaced with inflatable devices.
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

restore

Ok I understand now.  Thanks.  I can see why this is a huge section to make.  

Noway

I also have really bad ed and peyronies disease but not a bend. The best for this is pentox and cialis. Also if everything fails I would opt for implant if you have bad ed but surgery such as the nebitt wont fix that problem.

voulezvous

restore,

I'm not going to disagree with what others have written in regard to the corpora cavernosa being replaced by inflatable rods that must be activated in order to become hard. But there is another area of the penis (on the underside) called the corpora spongiosum that is not normally removed during implant surgery. While it does not add anywhere near as much firmness to the penis when aroused, it does fill with blood and can continue to assist an erection. It actually is the source of the blood going to the glans.I have found that, over time, since my surgery in 2009, I am sometimes capable of being stimulated to the point of orgasm without inflating. I do not become hard enough for penetration but I do "firm up" with oral & manual "encouragement". Frankly, I don't know if this is always the case but I just wanted to be clear that there are exceptions. Again, a male sexual health specialist who is both knowledgeable about Peyronies Disease as well as the AMS LGX should be able to explain the physiology of this far better than I can.

jackp

A technical point the corpus Cavernosum's (CC) ARE NOT REMOVED during implant surgery. They are simply dilated.

The only thing that may be removed is scar tissue in the CC. For men with CC damage the pubic approach is preferred because it is easier to repair any damage in the CC's that way.

I know it is just a technical point but when you start telling men something is being removed from there penis it causes a lot of unnecessary anxiety with them.

Jackp
http://jackp-penileimplant.blogspot.com/

restore

Quote from: voulezvous on February 11, 2012, 04:53:30 PM
restore,

...called the corpora spongiosum... It actually is the source of the blood going to the glans.


So that explains why my glans is softer now after Peyronie's.  I supposed the plaque lumps are somehow interfering with the corpora spongiosum?

Also, thanks jackp for your answer.  That makes me feel better.  Implant may be in my future.

Old Man

Note to all:

Adding to JackP's post #16 below, only the spongy erectile tissue is removed from ones penis during implant surgery. This is the reason that implant is considered the "last resort" for therapy after all other options have been exhausted. This tissue cannot be replaced under any circumstances.

The penis is basically left intact during implant surgery except for removal of the above mentioned tissue. The corporal chambers (two of them) are not removed only inflated to insert the implant devices. The third or bottom chamber is not affected in any manner during implant surgery.

Old Man
Age 92. Peyronies Disease at age 24, Peyronies Disease after
stage four radical prostatectomy in 1995, Heart surgery 2004 with three bypasses/three stents.
Three more stents in 2016. Hiatal hernia surgery 2017 with 1/3 stomach reduction. Many other surgeries too.

jackp

Just exactly happens to the corpus Cavernosum during penile implant (IPP)surgery. Just to clarify I sent an email to Todd Doran at Vanderbilt and this is his responce. I hope it helps answer that question.

When you read this I think you will understand why the doctor you choose to do an implant is very important. Right now I only know of 3 or 4 doctors in the US that are proficient at this for a man with peyronies.

Jackp
http://jackp-penileimplant.blogspot.com/

Wednesday, February 15, 2012 11:28 PMFrom: "Doran, Todd James" To: "Jack Pinner"
Tunica albuginea is an elastic thick fibrous outer covering of the erectile body and the inside are expansile sinusoids and collectively they are called the corpus cavernosum. We have a right and left one. Peyronie's disease can cause dysfunction, plaque, scarring of either the sinusoids or the tunica albuginea. Placement of IPP cylinders are more complex and tedious to perform in a man with Peyronies Disease. There are tools to dilate the sinusoids thereby causing their destruction through the dilating process. Sometimes we need to use cavertomes (resembles a cylindrical cheesegrater) that are extremely sharp. They are used to dilate/surgically cut open a space within the corpus cavernosum. The destruction of the architecture of the erectile bodies in order to place the inflatable cylinders are why you can't get an erection at all after an IPP. We don't remove any of the corpus cavernosum to place an IPP, we dilate and create a space to place the cylinders.

Feel free to place this on site verbatim.


Todd

Todd J. Doran, MS, PA-C
Associate in Urologic Surgery
Vanderbilt University
Dept of Urologic Surgery
A-1302 MCN
Nashville, TN 37232
615-322-2880

restore


Worried Guy

Jackp,

I've heard you say many times that it is possible that the gland may still become engorged after an implant.  I believe it took you nearly 2 years before this happened.

Your Uro says...........why you can't get an erection at all after an IPP.  I consider the gland being filled as a major part of an erection!!  How is this still possible with the chambers blocked by the implant?  Forgive me for not knowing the anatomy.  I really should read up.

LWillisjr

There are other arteries that carry blood to the glans and is why it can still inflate. Blood flow into the glans doesn't come from the corpora chambers direct.

Jack,
Thanks for the explanation. I didn't realize the CC's were deflated to allow room for the IPP cylinders.  
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

jackp

Worried Guy

It took me about 16 months for glans erection to return. Some younger men as little as 4 weeks some up to 2 years.

What the uro means you can not get an erection in the Corpus Cavernosum, that is where the IPP cylinders are. The implant has nothing to do with the Corpus Sponglosum, which is part of the glans.

Todd and I have discussed this. What happens is after you have an IPP the blood flow that was going to the CC is redirected to the CS/glans over time. This can not be proved medically but is a logical explanation.

The best graphic of penile anatomy is right here on this forum in the Resource Libary. Look it up and that will help you better understand. A good graphic comparing a length expanding implant and a regular implant is at www.amslgx.com/

Jackp
http://jackp-penileimplant.blogspot.com/  

Noway

So if the implant doesnt work and they removed so you will never get erection again what do you do then?  

Old Man

Noway:

This means there is no return to what you had before the implant surgery. Since the tissue in the corporal chambers has been removed, as of now, there is no replacement that I know of.

Most guys who have problems with their implant or it goes entirely bad, they have another one placed into the penis.

Old Man
Age 92. Peyronies Disease at age 24, Peyronies Disease after
stage four radical prostatectomy in 1995, Heart surgery 2004 with three bypasses/three stents.
Three more stents in 2016. Hiatal hernia surgery 2017 with 1/3 stomach reduction. Many other surgeries too.

Worried Guy

From what i've read the chance of a problem is now low.  Infection rates are only 5% I think.  If the implant is going to fail they say it will fail in the first 3 months.  If this happens it is out with the old and in with the new.  The same goes for an infection.  They take the implant out, wash the area and try again.

jackp

According to AMS if an implant fails prematurely one of two things has happend. 1 A surgical error. 2 Use for which the implant was not designed. Don't ask me what that means I was just told I would be supprised at what some men try to do with an implant.

Most of the good implant doctors have an infection rate of 2% or less. Doctors that use the pubic approach have a lower infection rate than doctors that use the scrotal approach. Dr. Milam's infection rate is less than one half of one percent. That us mainly in men that are diabetic.

Today if you do have an infection there is a procedure where the old implant is removed, the area cleaned and a new implant installed.

Satisfaction rate with the implant is over 93%.

Jackp
http://jackp-penileimplant.blogspot.com/  

voulezvous

I have the AMS LGX implant & I was surprised to find out that the rods used to replace the tissue in the CC are actually "registered". AMS keeps a permanent record of the date of the surgery, who did it (ie: surgeon) & the sizes of the rods & extenders. For all I know, there could be a scanable number on the device. If there is ever a need for replacement due to leakage, infection, or whatever, they can trace back to find the necessary details. Pretty impressive. I was also told by my dr. that the average useage span for the LGX is 10-15 years.

LWillisjr

Documenting and registering implants is pretty common in the medical industry. Not just with penile implants but also with pacemakers, nerve stimulators, etc.
Developed peyronies 2007 - 70 degree dorsal curve
Traction/MEDs/Injections/Surgery 2008 16 years Peyronies free now
My History

Luciano

Well I just read a good book
there is a chapter about penile implants
also about penile implants and Peyronies Disease
interesting part, the author writes about modelling when implanting someone with Peyronies Disease and explains how it should be done.

As for the normal implants he speaks of about 10% failures within the first year. (that means 90% satisfaction)
Can be mechanical, infection, or to much strain (i.e. patients going at it not gently enough and making the rods poke trough the skin)
The thing is, that if you replace the device after infection, you can get shortening because of scar tissue due to the infection.

Its very impressive book. its called:
Male Sexual Function,
A Guide to Clinical Management
Second Edition
by John J. Mulcahy, MD

I cant post the link here because there are certainly copyright issues.
but finding it should not be to difficult. Just do a google search for
Male_Sexual_Function_A_Guide_to_Clinical_Management_2nd_ed 1588299694 pdf

i think it was the 4th or 5th link that made it possible to download.

thats all

Luc

Luciano

Still doing my researches.
here is a good article about implants and length.
The author describes plaque incision without grafting (minimal invasive) before implant to the implant can be done on a straight penis...
very interesting
QuoteAim. This work describes trans-corporal incision (TCI), a minimally invasive
endoscopic approach for plaque incision from within the corpora
cavernosa, restoring straightness and length to the penis, before
calibration of the corpora cavernosa, allowing implantation of a longer
prosthesis in a straight penis, with neither mobilizing the neurovascular
bundle nor a secondary incision.


http://dare.uva.nl/document/351106

Luc

james1947

Luciano
Very interesting indeed, taking inconsideration that can get back some of the length lost to the Peyronie's. I hope other penis surgeons will read the article also!!!
Regarding you previous post, I don't succeed to download
QuoteMale_Sexual_Function_A_Guide_to_Clinical_Management_2nd_ed 1588299694 pdf
.
I get many links by google but no success to download. Some sites tried to install me viruses, my Norton blocked them.
James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Luciano

it was the 6th link, the one with the number in the title
sent you a PM

james1947

Thanks Luciano, I downloaded the book and will read today.
James
Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe ED.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum