Surgery for Peyronie's Disease

[mike67]

Charl
I am one of several Toronto area members who have been sharing information. There is a new Peyronies Disease Support Group started. The first Canadian meeting is planned for Wed. August 10 in Hamilton.
I will PM to you the details.
Mike67

[ComeBacKid]

This is exactly the reason I personally wouldn't go under the knife.  I didn't know a doctor could legally do this if you didn't consent to an amputation.  

http://www.foxnews.com/us/2011/08/18/kentucky-jury-selected-in-penis-amputation-lawsuit/?test=latestnews

[BrooksBro]

http://penileimplant.blogspot.com/2010/03/doctors-story-of-his-journey-with.html

[surfbeachnut]

Jackp, I've tried to send you a personal message but can't get by the numbers not matching. Is there anyway that could talk to you?

[jackp]

Sure I will be glad to talk to you. Send me an email to jwp104@att.net with your contact information. You can also find my contact email on my blog http://jackp-penileimplant.blogspot.com/

I will also be willing to talk to you on the phone. You can email me your phone number or I will send you mine. For me cell to cell is free. Just let me know a good time to talk.

Glad to help.

Jackp

[GaryNC]

My peronies started when I was young and over a few months.  I have a bend to the right about 30 degrees.  I was able to marry and have children.  I was very glad of that.  I would not recommend surgery if you are able to have sex with a woman.  Narrow on one side is not a big issue with no curve.  Women don't really know the difference during sex.  As I have gotten older my erections are not so rigid so this is even less of an issue.  

[james1947]

A New, Innovative, Lengthening Surgical Procedure for Peyronie's Disease by Penile Prosthesis Implantation with Double Dorsal-Ventral Patch Graft: The "Sliding Technique" was published on March, 16, 2012.
Interesting article.
It is just the ABSTRACT of the article, I don't have full access to download the full article and publishing it here may also violate publishing rights

James

Peyronie's Disease;Penile Lengthening;Erectile Dysfunction;Penile Prosthesis;Patch Graft Surgery for Peyronie's Disease
ABSTRACT
Introduction.  Peyronie's disease is the result of the formation of fibrous plaques in the tunica albuginea of the penis; typical presentations of the disease are represented by pain during erection, erectile dysfunction, and penile deformities, such as curvature, narrowing, and penile shortening. The most complex treatment is related to penile shortening.

Aim.  To find a safe procedure in penile shortening due to Peyronie's disease providing a satisfactory lengthening, allowing an early stabilization of the penis, and preventing axial tension on the neurovascular bundles during dilation.

Methods.  We describe a new lengthening surgical procedure based on a ventro-dorsal incision of the tunica albuginea, penile prosthesis implantation, and double dorsal-ventral patch grafting with porcine small intestinal submucosa. Three patients, affected by Peyronie's disease with penile shortening and erectile dysfunction, underwent this procedure with approval of our local ethical committee.

We evaluated the penis lengthening, intraoperative and postoperative complications, patient's preoperative and postoperative sexual life satisfaction (International Index of Erectile Function [IIEF] questionnaire).

Results.  The average operative time was 2 hours and 50 minutes. No major intraoperative nor postoperative complications occurred. No significant bleedings were recorded. Patients were discharged after 48–72 hours.

The average increase in length obtained was 3.2 cm. All patients resumed sexual intercourses with satisfaction; no significant loss of sensitivity or any sign of vascular distress of the glans was recorded. The follow-up is 13 months. The average IIEF score is 60.

Conclusions.  The lengthening of the penis by a double dorsal-ventral patch graft is an innovative procedure that is based on current techniques of plaque incision and grafting, and that can easily resolve severe shortening of the penis due to Peyronie's disease. In the cases presented, this procedure resulted easily, effectively, and safely. Nevertheless, the technique proposed in this article shall be validated through prospective studies with larger samples. Rolle L, Ceruti C, Timpano M, Sedigh O, Destefanis P, Galletto E, Falcone M, and Fontana D. A new, innovative, lengthening surgical procedure for Peyronie's disease by penile prosthesis implantation with double dorsal-ventral patch graft: The "sliding technique." J Sex Med **;**:**–**.

[Luciano]

Very interesting james, good find.
Though i am sceptical this will become a widespread thechnique.
IMHO though, the abstract is not well formulated, but that does not mean that the doctors are not competent.
Beacause reading the abstract, makes me think this only applies to patients having an implant.

Methods.  We describe a new lengthening surgical procedure based on a ventro-dorsal incision of the tunica albuginea, penile prosthesis implantation, and double dorsal-ventral patch grafting with porcine small intestinal submucosa.

this is the only reference to implant. (not even a brand name, type etc..)
Question: can this also be done without implant?
Concerning lengthening, there are other techniques, less invasive to regain length at least with lgx implants.
I read an article where doctors proceed to modeling and grafting with implants and then were able to add mechanical length pieces to the implant to gain length.
(the adding mechanical length pieces was once posted by jackp if i recall correctly, and the grafting part i cannot remember where I read it.)
Base line: the thing is good, but we definetely need more information about it.
Luc

[jackp]

James / Luciano

I agree this procedure is very radical!!!! I have chatted with one man that had it done in Europe and is very dissatisfied with it. He said his penis no longer feels normal.

There are much simpler methods to help regain lost penile size. It starts with the VED protocol for at least 60 days before implant surgery. Then the skills of the doctor and the type implant become very important.

The doctor must have many years experience with implants for men with peyronies, use the length expanding implant (LGX) and know how to do a proper modeling. The doctor should be a Male Sexual Function / Urodynamic Specialist not a general practice urologist. Do at least 100 implants a year.

There are doctors out there that prey on men with peyronies and loss of penile size. The most common complaint for men with peyronies is loss of size.

In this article this procedure has only been done on 3 men. How he ever got it published is beyond me.

The only thing I can say is, if it sounds too good to be true then it is. The key here is beware. As far as I know this procedure is not available in the US and not approved by the American Urological Society or FDA.

My 2 cents.

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

[james1947]

I know that I have obsession to try to find something will help, from many points of view.
I know from Luciano posts, he have also this obsession.

Jackp, your point is right, me and I am sure also Luciano will not go under the knife with someone that made 3 penis lengthenings.
Just sometime things frustrating little bit, like gaining 1/2" from VED usage during 6 weeks and then in 33 additional weeks remain in the same length (the one cylinder VED).

Even that I get here in the Far East surgery prices cheaper than with Dr. Millam, I will not do it here because I didn't get answer how many implants the doctor has made, even I will get I will don't really know the truth and I want to do with the best doctor available.

James

[jackp]

James

With the VED I gained about 3/4" over many months. I used the single cylinder protocol for over 2 years to maintain the gain and keep my penis healthy.

I will tell you that 18 months after my implant I had gained an additional 3/4". Thanks to the skills of Dr. Milam and the AMS 700 LGX.

There is a study by Dr. Dinnen and Dr. Wilson on using the VED before implant surgery to help maintain penile size. I have it posted on my blog.

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

[royswales]

Hi

which NHS hospital did you have your surgery in? Mine is only offering the Nesbit and I am concerned about losing length. Did you have to have a circumsision? I am surprised you did not have post op pain - is this normal dod you think?
Roy

[troubledguy]

hi guys

any recommendation for a good urologist in south east asia, for a surgery on peyronie?

thx!

jerry

[james1947]

troubledguy

I have made a comprehensive check of south east Asia as I am living now in Indonesia.
The best specialist you may find them in Singapore if you will make a google search.
I have written to some, but to one of my questions that in may opinion is the most important if you are talking about surgery I didn't get answer even not from one. The question was:
How many surgeries you have done?
In my opinion, a successful and competent doctor will answer this question
The price was very high also. I asked for an AMS 700 LGX  implant surgery cost and the answers where $US 33,000 and up.
A very good surgeon in the US is asking $US 12,000 but also there I get answers up to $US 33,000

James

[Hawk]

There are doctors in Manhattan such as Dr. Eid that charge over $22,000 for an implant but as you say, most are closer to half that price.  I am considering an implant myself but I am hesitating.  I will probably set an appointment with Dr. Eid later in the year. (a Christmas present)  

[Ben]

I have got two questions about the AMS 700 lgx :
- Does it grow in girth then expand in lenght or does the inflation give lenght and girth simulaneously ?
- What is the difference for the surgeon to implant girth only vs girth / lenght model ?
 

[Hawk]

I have got two questions about the AMS 700 lgx :
- Does it grow in girth then expand in lenght or does the inflation give lenght and girth simulaneously ?
- What is the difference for the surgeon to implant girth only vs girth / lenght model ?

Ben I believe it expands in both dimensions at the same time but one of those with the device will hopefully confirm this.  

Keep in mind this is much like car sales or many medical devices.  Everyone has the best.  Manufactures brag up their device.  They work with doctors to install their devices, patients just like car buyer, like to think they got the best after the fact.  No one wants to say "I just went thru all that to get the second best implant"

The most popular girth only model is made by Coloplasst.  Only Coloplasst and AMS make 3piece inflatable implants.  The Coloplasst Titan sells the fact you get more girth and that girth means more that length.  They claim girth is the essential geometry necessary to get a natural rigid erection that supports itself at a normal degree of rigidness.  They claim this is especially critical on a penis with a BPSFL of 7" or more.

Coloplast's other selling points are that their cylinders are more indestructible than even the improved AMS cylinders (the original AMS had some failure issues).  They also brag up that they have a superior antibacterial impregnated material.

AMS would of course have a response to all of this.

PS: if you watch the video at the top of this board you will hear some of this.  There are also shorter clips on YouTube.

[Ben]

Thank you Hawk for responding me. I will see my surgeon to discuss implantation in october, last time he said that with penile fibrosis like mine it's the only satisfying option. I still can be rigid enough for intercourse but my erection goes away faster than an eye could flick. Venous leakage he said.

I personnaly don't really care about the lenght expansion, I could deal with girth only system if the lenght is ok to me. Sounds to me that Lgx is useful to recover lenght due to implantation.  

[Hawk]

Sounds to me that Lgx is useful to recover lenght due to implantation.

You are correct.  

Picking the right surgeon is everything with this surgery.  The really good ones are few and far between.  Also, beyond all question, you can influence the length by using the VED and or traction for at least a few months before surgery especially if you lost some from Peyronies Disease.  You will lose some from surgery.  

[Ben]

I'll discuss with my surgeon about the results he have with implant. I'm quite ocncerned with sensivity too because even if I can sometimes be hard, I feel almost nothing. The dorsal nerve is pretty out of order. We are few here to have this symptom I think.

Good grief...Is there a disease that makes the penis larger ?

[swolf]

Good grief...Is there a disease that makes the penis larger ?

scrotal elephantiasis    I think I would rather have Peyronie's.

[Ben]

Hello there,
My implant surgery is planned for mid november. I'll be implanted an AMS 700 CX. By doing the stretch test on my own I found out that SPL was a bit under 7. WHen I asked the doc will there be changes in lenght he said no.

I am a bit doubtful about it so i wanna your avices, and for guys who have this type of implant are they satisfied ? I'm 32 and have ED due to corporal fibrosis.

[Hawk]

What made you decide on the 700 CX rather than then 700 LGX and who is your surgeon?  Also, did you mean your measurement was bpsfl rather than spl?

[Ben]

Hawk,
My surgeon is a french one. Not the n°1 I think, he does aprox. 10 implant a year. He said to me he implant only AMS 700 CX because he learned the technique with a top rank surgeon in France (which I've seen too) who's only implanting CX models.
The reliability of the device is over the top according to him.

I don't have so much fibrosis and curve so I think I could benefit from LGX but there seems to be no negociations about it. By the way if he do the job well and size it correctly it will be ok for me. I'm not overpounded and picked a tape ruler without pressing at all. I don't want to be disappointed.

He said to me I'll have a very good result, but time will tell.

[Ben]

So surgery is planned for the very begining of december.I just wish I could have been implanted the following year after trauma because the result should have been a lot better. I'm not confortable with  more lenght loss but anyway it's not the unique aspect of the disease which is bothering me.

I hope that penile implant will boost my self esteem and maybe add a little girth to all that ******* mess.

[Hawk]

Good luck and keep us posted on how you do after surgery.

[james1947]

Ben

Wish you good luck with the surgery and pray for you.
Let us know how was the surgery and the progress afterward.

James

[Noway]

My doctor sais that you dont want them messing with you down there when it came too the topic of surgery it is a last resort period.  

[Hawk]

Who is your doctor and what are his credentials when it comes to penile surgery?

I think most doctors including penile surgeons would say surgery is a last resort.  That means first try Pentox, traction, ved and if you are too curved to have mutually satisfying sex, then go with surgery.

Or if the issue is ED, first try ed drugs, l-arginine and a VED.  Same situation. if you cannot have mutually satisfying intercourse then go with an implant.

Thankfully many men here did not misunderstand the term last option to mean it is not an option.  many have had their quality of life restored by all of the various types of surgery.

[MattFoley]

I completely agree with Hawk, except instead of L-Arginine, please consider taking Citrulline Malate which is a per-cursor to L-Arginine and feeds more L-Arginine into the body than does just taking straight L-Arginine.

Sources: http://fitmixer.com/the-arginine-substitute-that-works-even-better/ and http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291275/

[Hawk]

I completely agree with Hawk, except instead of L-Arginine, please consider taking Citrulline Malate which is a per-cursor to L-Arginine...

I do not disagree with this in theory.  I have experimented with several formulas of L-arginine and precursors that included Citruline and L-Norvaline.  In the final analysis however I seem to get better actual response with L-Arginie.  My guess is that the small amount of vaso-dilation you need for sex is more than covered by a few grams of L-arginine.  If you are a body builder and going for a full body pump there may be a difference.

My only point was to explain what is meant by saying surgery should be a last option.  It was not a exhaustive list of prior options (supplements, and procedures)

[MattFoley]

Thanks, Hawk.

Let me ask you this: When you tried Citrulline vs. L-Arginine, did you notice that the Arginine made you drowsy or sleepy? The reason I ask is because the Arginine made my tired whereas the Citrulline gave me energy. Did you notice any such difference?

[james1947]

I didn't try Citrulline, but L-Arginine is giving me energy and don't makes me sleepy. Taking 1000mg morning and evening.
I feel that L-Arginine is a good part of having  "natural" erections again.

James

[MattFoley]

James, that's awesome. I'm glad to hear it. I'm wondering how that positive effect on you would be compounded by Citrulline since it's a precursor to Arginine.

God bless.

[james1947]

Matt

I am a very conservative old man
If something working, I am not trying other things because I have many allergic reactions

James

[MattFoley]

James, no problem, agreed. Keep doing what works, my friend.  

[Hawk]

I have only ever noticed one side effect of L-Arginine and that is stomach upset/acid reflux if taken late at night.  In fact  I had one horrendous episode of esophageal hell in which it hurt to swallow water for a week.  I am not positive but I think I can trace it to hurriedly swallowing an L-arginine capsule without adequate water right before I went to bed. I think it lodged in my esophagus and dissolved and made a chemical burn.  The gastroenterologist I went to thinks that is a plausible explanation.    

I seldom ever take L-Arginine close to bed-time and I am sure to always follow the sound advice with any vaso-dilator to drink plenty of water.

I have never felt the least bit tired or sleepy from L-Arginine and I have taken some pretty large doses.

I am currently finishing up a combination of White Blood by Controlled Labs and NO2 Black but none of it seems to work any better than plain L-Arginie from GNC.  

[MattFoley]

Hawk, good info. Thank you.

It's weird because for some bizarre reason Arginine helps me sleep better. No clue why this is but Citrulline has the opposite effect. Either way, Arginine and Citrulline are good options for NO boosting.

Are you taking capsules vs. mixing powder? The powder should be less expensive. Also, please consider taking a look at www.vitacost.com. They have incredible prices for most every supplement.

[Angus]

   Urosciences, welcome to the forum. I trust you are here to discuss Peyronies Disease with forum members and not just to advertise Dr. Mulhalls angle measuring device. It isn't necessary to cross-post (two or more almost identical posts in different topics with the same link in each pointing to the measuring device web site). Members will read your posts without the bother of cross-posting; please remove one or the other of your posts so only one remains with your subject. Feel free to add to our discussions, and again, welcome.  

[ISAIHAF]

Hi Guys, I went to Dr Eid and to Dr Zargaroff. I felt alot more comfrtable with Dr Zargaroff, his office is located in Mineola and he spends alot of time with you regarding the procedure. He does ALOT of penile prosthesis but also does grafting, which I had and doesnt automatically sway you into a penile prosthesis like Eid. I owe my life to Dr Zargaroff, definately get a second opinion, his number is 516-537-5757. Good Luck.  

[user2643637]

If you had any experiences about the STAGE technique surgery to solve Peyronie's Disease please let me know!
Dr. Franklin E. Kuehhas + Dr. Paulo Egydio
I'll reply to every single mail. Thank you!

[aazmaish]

Hi James good day .
i contacted Andrology institute dubai for appointment regarding my peyronies check up ..
got reply ( attatchment) ... asking 18000$ for surgery ..
pls see  below and comments.. thanks.
aazmaish
The only permanent way to treat Peyronie's disease is surgery.

The surgical technique we employ to effectively treat Induratio Penis Plastica (Peyronie's disease) is "IPP plaque removal (excision) with subsequent covering of the deformity".

Using micro-surgery, we remove the IPP plaque along with its accompanying scar tissue to re-establish the original status quo before the onset of the disease. We subsequently reconstruct the affected corpus Cavernosum using non-artificial materials (usually high-quality collagen fleece).

Based on our extensive experience, this treatment offers the only sensible technique capable of dealing with the vast majority of cases. It results in no visible scars to the penis, while in the case of circumcised men the actual scar is in the same place as the scar from the circumcision – meaning it is hidden. Very importantly this is the only method available that results in NO shortening of the penis after surgery.

Owing to the degree of difficulty involved, this technique can only be successfully implemented by the very few clinics worldwide that possess the requisite experience.
Having been established 20 years ago, this technique is by no means new. Dr. Konstantinidis has been applying, refining and further developing it over the past 15 years to become a genuine specialist. He is generally capable of satisfactorily treating even those cases pronounced irredeemable by other doctors.

The cost of the surgery which includes all hospital expenses, surgeon fees, pre and post operative visits as well as the cost of the graft is 65000 AED.

[james1947]

aazmaish

A real ripoff.
You can get in the US an implant surgery with one of the leading surgeons as low as $12,000.
Surgeon with 100'ts of surgeries per year.
I am proposing you (it takes some time) read carefully the topics on:
Surgery for Peyronie's Disease - PDS - Peyronies Society Forums
the very board you have posted your post right now.

James

[welshwales]

James that is actually not a bad price in UAE dirham for that particular proceedure. It converts to somewhere in the region of $17.7k USD, which for the induratio penis plastica procedure and all combined costs, and surgery by dr Konstantinidis, is about the best surgical option available. Very few surgeons are capable of that procedure, which is why Konstantinidis has clinics in Dubai, Portugal and Munich.

[james1947]

Sorry, I missed that the 65,000 are not $US

James

[aazmaish]

My point is ...
should i go for the surgery ( in the first instance ) .. i-e I ( andrology institue has booked a free appointment on 6th September, i may try to get some reduction once meet with them )
or should i try for other options first .. i-e oral supplements, traction devices Or the new Priapus shot procedure  .
a loss of the most precious 1.5 inch out of 4 inch ( when erected in good old days ) a 60 degree upward curve wd right side bend .. an acute pain while intercourse has made my sexual life to zero within just 4 months    
pls advise .

a depressed Aazmaish

[welshwales]

If the andrology clinic recommend surgery as a viable option for you, I personally would go for it. The procedure retains length, which in my eyes makes a huge difference compared to just about every other option. If you haven't already lost length due to the disease, you likely will do without intervention. Dr Konstantinidis has an excellent reputation, and if surgery with him was an option for me I would be on a plane to his clinic in Germany!
The induratio penis plastica procedure is extremely effective when performed by an experienced surgeon (Konstantinidis was one of the original pioneers of the procedure) and results are excellent if it is done within two or three years after onset of the disease.

[james1947]

aazmaish

Very strange (at least) for me that a doctor, reputed as it may be, will propose surgery right away, just 4 months in the disease, still in the acute stage.
Using VED, Pentox, low dose Cialis I got back 1.5 cm I lost. Of course is your decision what to do, but I was trying other options before surgery. Surgery is the last choice, not first.

James

[LWillisjr]

Often times surgery does end up being the last resort for many. But James is right, in my opinion it should be the last choice. Of course a surgery center is going to recommend surgery. But don't forget that there are risks associated with ANY surgery. The worst of which could be impotence. They may tell you the risk is small, but still it is a risk.

So I believe it is worth trying other things first as in meds, VED, traction, etc. These have little if any risk associated with them and are at least worth a try. But I would also add it depends on your symptoms. For example, if you are only looking for a small degree of improvement then for sure try these other therapies first. If you need more like a  50 or 60 degree correction, then I doubt you would get this much improvement with VED or traction therapy. So then surgery might be the best case.

So bottom line is that it depends on MANY factors. So many people ask "Should I get surgery" and we can't answer that. We can point out the risks, the success rates, and that fact that some here including myself have had successful surgeries. But in my case I did try other options first, and I carefully considered all the risks as they pertained to MY situation and symptoms.

Les

[aazmaish]

thanks to all well wishers .
i will any way go for the appointment  ( may be in mid September ... ) .. chq the possibilities wd them .
let them see the situation and if they recommend , i will still take some time to see if my oral supplications are helping me .
i would also take surgery as last option...
will keep u update for any further progress in this regard .

thanks ..
Aazmaish