Dr. Kuehhas congenitale curvature

[JN]

hey guys,

Later today I will be flying to Vienna to have a meeting with Dr. Kuehhas about my congenitale curvature. I've read a lot of good things about him so I wanted to go to him immediately but my parents (I'm 17) wanted my to go to a urologist in my own country (The Netherlands). We visited a urologist and she offered me a Nesbitt operation and she gave me a couple of her statistics, I did the math and eventualy there would be a 82,5% chance something could go wrong, so I declined the offer, my father completely understood. From what I've read Dr. Kuehhas is one of the best in the business so I'm going to try to make this work and set up a surgery as soon as possible. The meeting is on Friday, so saturday I'll be posting if the surgery will happen or not, if the surgery is going to happen I'm going to do my very best to update this file to document my day by day experience post-op. Why am I doing this you may ask, well this condition is for sure not fun and I think the sooner you get it handled the sooner you can stop worrying about it and go on with your life. Maybe somewhere there is a boy or man who just doesn't know what to do and reads this and has found his solution to a better life.

I'll keep you guys updated!

[Dros]

Good luck! And keep us posted :-)

[Jonbinspain]

He did my surgery. He's a very accessible guy. You can ask him anything you want, he'll do his best to answer.

Good luck. Keep us posted.

[redbullmaster]

My only concern is at 17, is if your penis has stopped growing yet, I would wait till your 21 at least, to let it stabilize.

The last thing you want to do is have an operation and in then in two years the curve reappears.

Also who knows what other treatment's may be available by then.

Traction may be something to consider too.

By all means go and see Dr. Kuehhas and see what he says.
But if he recommends surgery, I would wait until you have reached your full puberty before you go ahead.

[JN]

Whatsup guys,

I'm on my way home, today I had the meeting with Dr. Kuehhas. Everything was fine, no scare tissue or anything else that isn't supposed to be there. My curvature has been confirmed at 50 degrees. We discussed the surgery, I will be able to keep my foreskin (which was a big deal to me) and I will lose about 3mm in length which isn't a big deal. The surgery will propably (99% certain) happen late July, so this is my last post until then. I hope someone gets some sort of support or motivation from this!

Life isn't about where you start or finish, it's all about the journey.

Keep you guys posted!

[daved2]

JN, Congratulations on taking the first steps. I, too am going to meet with Dr Kuehhas the first week in August for congenital curve/peyronies. Mine is a 40degree left curve. I was offered a Nesbitt, as well, and decided to go with a different technique. Good luck to you, and all who opt for surgery to correct this debilitating condition.

[JN]

hey guys,

Next week I will be having the STAGE surgery performed by Dr. Kuehhas. I thought I would give a little update about what is going through my mind. I feel kind of weird these last couple of days because this is what I have been waiting for for a over year, but I am incredibly nervous something might go wrong. I'm also thinking about how everything will be after the surgery, sexlife, confidence, psychology etc. All in all I am excited to get this handled and go on with my life but I'm also a little nervous which I think is totally normal.

I will definitely keep you guys updated along the way,

JN

[Pfract]

Completely understandable. Best of luck with the surgery, and I hope the Dr is able to give you your life back!  

[JohnWright]

Hey JN -- I had Nesbit plication surgery on June 24, 2016 and leading up to it I had all the same thoughts, and more. Although, I don't remember any concerns about things going wrong. I had selected a urologist whose specialty is male sexual health and Peyronies Disease/curvature -- it's what he does every day.

For the first week that I was back on my feet out and about in public, I was walking a little taller and smiling a little broader. This is because in the first decade of adulthood in particular I felt like less of a man, etc. etc. etc. and etc. and gathered an impressive load of self-narrative that would eventually be parked at the back of mind. After surgery, I felt like I was slaying those thoughts big time. [A man is not a penis, and there are other ways to express love and please your significant other, but being a shallow Westerner the odds weren't in my favor at a young age to have dealt with the psychology crap].

August 5th is the date my wife and I have set for our reunion. Six weeks will have elapsed from the former me to my new state of the union. I have moments of anxiety and excitement. At full erection, my shaft is now straight, so of course my anxiety is about the to-be-seen items: Will I be able to keep an erection for sufficient time? We'll see. How will the difference in length affect the experience for either of us? We'll see. After 29 years of marriage, how will she react to a straight arrow instead of a 50 degree curve? We'll see. My wife is amazing, she's never said a word about the prior curve, and now she's already planning some special details for our reunion, and I've booked a room in Seattle for us for a couple of nights. So, we'll see!!!!

Oh, and there's the part about the general post-surgery sensations for me. Right now, when I have an erection, the surgery sensations still linger only to the faintest degree. In a couple of instances I've had what I would consider a fairly robust morning erection, about a nine on a titanium scale. Those moments were a little scary -- would the new infrastructure hold? Was something going to rip loose? Was there some unannounced pain waiting just on the other side?

I think most of these kinds of thoughts are just me getting acquainted with my "new" member. None of my concerns have had any fruition. Imagine a wooden sailing vessel on the open sea in the midst of a hurricane. This is what's happening with a post-surgery dick. One marvels that it all holds together and comes through to the other side like, "What storm?"

At this point, I'm ready for August 5th. The healing is going fantastically, and I believe I'll be ready.

One final note: I have one question that I feel has validity: Upon entry, the surgeon found no plaque at any level of tissue that comprises the penis. (The pre-surgery investigations into my dick by various urologists are a blight upon that profession). Peyronie's is caused by plaque. If there is no plaque then the curve is considered congenital. But, I'm not so sure it is that straight forward. And here's why. From puberty til I was 40, I listed 10 degrees to the right. But around age 41, a new epoch began and a year later the curve was fully 50 degrees.

That the curve could worsen, and not be Peyronies Disease, seems odd. Even the surgeon wasn't sure that he could wrap his mind around this data point. So the question is: Will my new straight self eventually curve some more?

Even as I type this post I realize the truth: I'm going to be grateful for what I have today. And grateful that we live at this point in medical history. If I'm thrown another curve of dysfunctional proportion down the road, great, we'll deal with it then and there are many options with which to choose from. Therefore, I'm going to let go of that and ENJOY the journey.

Best to you in your surgery!

John

[scorpion22]

Hi JN,

You are in good hands, Dr Kuehhas fixed my congenital curvature of 90 degrees after the first surgery (with another surgeon) failed.

Dr Kuehhas knows what he is doing, he will communicate all the details to you before the surgery and he will be more than accessible after you have the procedure. The staff in Vienna (where I had mine) is super friendly and the treatment that I got is excellent.

Please don't worry, everything will be fine, you will need some time to recover from the surgery physically and psychologically, but believe me: it will be all worth it when you will see your straight penis for the first time.

Send me a private message if you have any specific questions.

All the support

[notmeplease]

Hi guys,

I have also 50° of curvature.

Since I'm living in France, my generalist sent me to a surgeon in Paris and he proposed me Yachia (correction from 50° to 20° or maybe 15° without any loss of length). The total cost of the surgery would be around 1.600€

Now, I've been in touch with Dr. Kuehhas who proposed me STAGE at 8.000€ in Vienna

At this point, I don't know what to do since the surgeon in Paris told me that "probably" STAGE technique is a variation of Yachia and therefore almost the same results are guaranteed ...

My concern is: Does the STAGE technique straightens the penis (Result: O° of curvature) without any loss or not?

Can you please describe your experience please (results) with Kuehhas?

NOTE: I had already a NESBIT with bad results.

They is a real diff between the cost of both procedures  

[redbullmaster]

The thing to remember is that the Stage is shorting's the longer side of your penis like the Nesbit.
Your penis will end up being the length of the shorter side of your penis.

The Stage is suppose to have less complications then the Nesbit, i.e. less chance of ED and better healing of the penis.

If you want to get back your size, you need to be looking at the The EGYDIO Technique, or if you have ED The MOST Technique.

[JohnWright]

Before today, I had not heard of the EDYGIO technique. This article proved interesting:
The Egydio geometrical procedure for managing penile curvature using a single relaxing incision: A single-centre experience with 330 patients

EDYGIO is actually a grafting procedure. And, at this particular clinic they are using a commercial product with a nice commercial name, but as you read on it is small intestine from a pig. Didn't see that coming.

The statistics on customer satisfaction, and curve re-occurrence are interesting as well.

[Jonbinspain]

I had surgery using the Egydio technique. My penis is now straight again from an almost 90 degs curve. I'm now 8 months post surgery and there is no sign of any recurrence of curvature.

Grafting is only used when necessary in the technique. And the material used in my case was bovine pericard, which has been used in heart surgery for some time.

[JohnWright]

a) In that particular study (at the link above) 8.2% of men needed a follow up operation to address curvature that occurred after the surgery.

The surgeon that I went to for Nesbit only sees a 1% occurrence.

Causes:  It could be part medical technique, part man's body at the cellular level and whatever is happening, and usage.

b) According to the study, grafting is the norm in Edygio:  "In 2002, Egydio et al. presented a technique for penile curvature restoration in which a single relaxing incision is made to the tunica albuginea at the point of maximum curvature followed by the closure of the newly created tunical defect with a graft." This study is quoting Dr Edygio and provides the footnoted reference. All 320 men in the study got the graft. Whether this was disclosed to the patient or not -- unknown.

There are a handful of options for the grafting material (including sourcing vein material from your own body in some studies I've read on penile grafting in general).

Congratulations to you on straightness for eight months! Yeehaw! Hoping for the same results myself!

[JN]

Whatsup guys,

I'm back in my hotel room, I had surgery this morning and the doctor said my penis is fullly straight and I still have my foreskin so I am very happy. He already changed te dresssing before I went home and to be honest that hurt a lot, the bandage keeps ketting stuck to my glans wich hurts when taking it off. I'll have follow ups the next couple of days (fly back on friday). I will keep you guys updated!

[Jonbinspain]

John;

Yes, my mistake. What I meant to say is that excision is avoided unless it's absolutely necessary. It's to try and minimize the risk of post-op ED. In my case, partial excision was necessary.

JN;

After my surgery I was told most definitely not to remove the bandages?  They are there to help minimize post-op swelling.

[JN]

Job,

What I meant to say was that when he took of the bandage and put on a new one that it hurt, I am not taking them of myself, but my bandage was pretty wet so he already put on a new one before I left the hospital

[JN]

Hey guys,

Today is the first day after surgery and I actually feel no pain, walking is fine but my foreskin has started to swell up and I'm getting a bit concerned. I'm pretty sure the dr will fix it at the check up tommorow

[Arkibald]

Hello JN,


Thanks for the update. No pain - That sounds great. I'm sure Dr Kühhas will know what to do with the swelling.

[Jack1909]

It looks like I am the only one who has not being fixed by Kuehhas..that's funny.

But I still think he is the best one in Europe..

[JN]

So I am home again, weirdly enough I don't have any pain, when I get an erection it stings a little bit but I can't call it pain. I have minimal bruising, almost nothing. Everything is going great I guess the worst part about al this is not having sex for 6 weeks...

[daved2]

Hello Gents. I am sitting in Dr Kuehhas waiting room, ready for my surgery consultation. Today, I will find out if the Stage technique or the Egydio grafting technique will be used in my case. From what I understand, the grafting is more invasive and takes longer to heal. I will opt for the best result. I appreciate the comradery that I have received from the board in coming to this decision that let me to travel from the US to London, to search for the most capable surgeon to correct the curvature that has plagued me most of my life.

[Jonbinspain]

daved2;

If you have congenital curvature, it will almost certainly be Stage technique. Egydio is more for those of us who have Peyronie's disease.

[daved2]

Agreed, jonbinspain. I forgot to mention that I have always had a congenital curve. It has worsened due to to peyronies disease. As for which method, Edygio or Stage, Franklin Kuehhas recommended the Egydio technigue to reduce penile length loss. He explained it like this: with Stage, you always shorten the longer side. With Egydio, you preserve the length of the longer side, which , in my case: short side is 13 cm vs. The long side, is 16 cm. Since the long side is not being adjusted, and the short side receives the grafting to lengthen the longer side, then the overall length of my penis is preserved. My concern was/is the recovery time, which he claims that I could be having sex in as little as six weeks. Tomorrow am is my surgery. I intend to post over the next weeks and months as I recover.

[Jonbinspain]

Good luck.

Sorry, I wasn't aware that you had Peyronies too. I should have read back over your previous posts. Yes, if Peyronies is involved, it will be the Egydio tech.

Re recovery. It varies from person to person. Yes, it's possible you will be able to have sex in 6-8 weeks. However, it probably won't feel the same. In my experience, full recovery time is in months, not weeks. I am a tad over 8 months post surgery and would estimate that I'm now about 90% back to my old self.

Once again, all the best. I'm sure it will all go well.  

[daved2]

Jobinspain, Thank you for sharing your experience with recovery expectations, and your well wishes

[JN]

Little update,

Today I took the permanent dressing off, everything feels fine I dont have any real pain. The only thing I'm nervous about is that my flaccid is still bent and when I get an erection (no real erection just a little bit of blood rushing in the penis) my penis is still bent. Did other people who had STAGE surgery also experience this?

[JN]

hey guys,

I have a question for people who also had surgery with doctor Kuehhas. I have read a lot on these forums that people experience retraction. Today marks 3 weeks post-op and I do have erections while I am on these anti-testosteron pills but they are a lot shorter then before, but my flaccid penis is still the exact same size. So if I don't have any retraction while I am flaccid does that mean that I won't have any retraction while I have erections when I am off these anti-testpsteron pills.

[Frank55]

Hello JN,

Thanks for your posts. I had surgery with Dr. Kuehhas in the first week of May. I had the Egydio procedure to correct a 60 degree curvature to the left.

I also do not notice a flaccid size difference, but I am definitely down on erect length. I've been using the Phallosan device consistently and hope to regain most/all length eventually.

Not sure what documentation you were given after the procedure, but the Egydio paperwork states the healing is a 6 month process and the optimal result can only be accomplished with active participation of the patient. I've also been doing manual stretching prior to daytime bathroom use and taking 5 mg Cialis daily. Hopefully those will help as well.

JonB is correct that penile sensation is just not the same during the first few weeks/months after the procedure. Yes I have sensation but also a somewhat leaden penile feeling. Despite my workouts/vitamins and high protein diet, my libido has been way down. The idea of an erection has just not been appealing during these initial months.

By the way gents, that was one item that scared the crap out of me right after the procedure. I had zero penile feeling right after I woke up. I was quickly told that was to be expected and not to worry about it (they give the penis separate anesthetic I think) but that was a scare. Sensation gradually returned.

So your full length may take time/effort to restore. I'd check with Franklin about that. I suppose sex within six weeks is possible but it did not feel right at all to me. I'd rather wait until I really feel ready.

Cheers,
Frank

[JN]

hey Frank55,

You said that you take cialis daily to help with the retraction. I have read before that it really helps with the retraction, I imagine this is because the cialis helps with keeping bloodflow to the penis. I would love to take this but I am 17 and I don't know if this is a problem or anything. Did you ask doctor Kuehhas if you could take it, and should I aks him since I am 17 or would you say it is completely safe.

thanks!

[JohnWright]

JN -- You're only 17 so I wouldn't expect you to know, so no stress! This isn't a critique, just something to be mindful of:  When the question is asked, "Is it completely safe?" there is no way anyone can say anything is completely safe. Walking is safe, for example, until you get hit by a stray bullet.

Especially where drugs are concerned, always consult someone who is licensed to dispense that kind of advice. You and your dad have a good communication channel with your provider, use it.

Here on the forum, communication from one member to another, we can answer questions like, "What is your experience with x, y, or z?" Sharing from our individual experiences is 100% legitimate.

Framing the question is a subtle nuance, but it can have huge consequences by keeping folks out of legal trouble by not crossing the line between sharing experience versus giving medical advice.

Glad to hear your situation is going so well!

[Jonbinspain]

JN;

If Franklin Kuehhas did your surgery, then you have his number on whatsapp?  If you have any doubts about anything, send him a message. He will reply even if it takes a day or two.

If he did not prescribe you Cialis after your surgery, I'm guessing he thinks it's unnecessary in your case.  

[Frank55]

JN,

Affirmative on the previous two posts. The forum cannot provide an answer on that sort of question. Check with Dr. Kuehhas on that one.

I can tell you that here in the States Cialis is available only by prescription, and the typical target market for that product is someone older than you. I think the drug was originally engineered to help with ED (similar to Viagra), but apparently Dr. Kuehhas feels it is also useful for the post penile surgery healing process.

As Jon said, don't be shy about contacting Franklin. He is very open and informative on what to do during the various stages of recovery. He does not always respond immediately, but he always responds.

Best,
Frank

[JN]

hey guys,

Tuesday will be the 4 week post-op mark. I am off the anti testosterone tablets and I am having full erections again. My penis is completely straight and I am very happy with the result! As said above I am 17 years old so I don't know if it affects me more because I am so young but before my operation I was around 17 centimeters erect when I pressed the ruler against my pubic bone. I knew there was going to be some retraction but now I am only 12 centimeters when I measure the same way. I also used to be 15 centimeters girth and now I am only 13. I know this is just a process and it takes time but I have a girlfriend (she knows about the surgery) and as you can imagine I am pretty insecure since I lost so much size... Tuesday I will start with wearing the phallosan forte as much as possible but I know I will not have all the size back in a month or even 2 or 3 months. Do you guys maybe know of some things (penis exercises, pills, certain foods, etc.) that will maybe speed up the process of gaining my size back so I can have it back as soon as possible?

thanks a lot guys!

[Pfract]

ouch! have you asked Dr. Franklin about that? Jonbinspain, had surgery too with him and he is pleased with the operation and as far as he is saying has been having size back. Give him a shout!

[DanP]

You better ask dr kuehhas if you have any doubts. He will help with advice. But from my experience I can tell that thi is normal. I had stage surgery with him also. If you do the stretch you will regain what you lost. It is because of retraction I was told.
Dr Franklin was always answering my questions, so I think you better ask him as he is the nr 1 to ask.
My advice to you, follow the recommendations they work for me and many other. You should also read experiences with stage in the section for congenital penile curvature.  

[Jonbinspain]

JN;

It takes time!  Start slowly with the Phallosan. Use gentle manual stretching too. As your penis gradually heals increase the amount of time you wear it.

In my experience, actual recovery time is longer than you first think. Yes, you can have sex after a few weeks, but it won't feel the same. Real recovery is months, not weeks.

Size wise, after 8+'months I'm still slightly down on size - maybe 1-1/2 cm. I hope to get that back with continued use of traction. If however I don't, I'll be happy with a slightly smaller but fully functional penis.  

[JN]

hey guys,

Another update here, today my phallosan forte was delivered. I will start tommorow and WILL make it a prioroty. Now I have summer holiday so I have more time to wear the phallosan. When school starts in 2 weeks it will be a little more difficult but I am going to do my absolute best to wear it as much as possible. I decided to also do manual stretches for 5 to 10 minutes a day for 4/5 days a week. I also think it is a smart idea to get erections as often as possible to get fresh blood in the penis (don't know if it will help but it definitely won't make the retraction or result worse) so I might as well give it a shot. Yesterday I asked Kuehhas if I could use cialis, he said I could use it 6 months after the operation. Right now I am 4 centimeters down on length and 2/2.5 centimeters down on girth. I am very confident that I can get most, if not all, of this back. If I don't have everything back by January 26th (6 months post-op) I will take the cialis to help. Erections do not hurt at this point, but if I kegel when I have an erection it does hurt, my penis also feels sore after masturbating so I will try to do this as less as possible (it's pretty hard not to now I am straight )

I'll update you guys in a couple of days or next week or so

JN

[JN]

Hey guys

A little update here, everything is going fine no pain. On august 19th I posted that I was down 5 centimeters on length and 2.5 centimeters on girth. As of yesterday I am down 2,5 centimeters on length and 1,5 centimeters on girth so I am extremely happy.

[pdrury]

hey JN
great to read that things are improving very fast.
I am about to undergo Peyronie's surgery with Dr Kuehhas this week.
Nervous but ready to go for it... your update put me at ease.
thanks.

[JN]

another update,

this tuesday I am officially allowed to have sex again, I still notice a little bit of pain when I kegel during an erection so I will wait until next weekend to have sex. On August 24th I wrote here that I was 4 centimeters dowm on length and 2/2.5 centimeters down on girth. As of this moring (I like weight training so I measure my whole body every sunday morning and decided to also do my penis every sunday from now on) I am 2 centimeters down on Length and 0,5 centimeters down on girth. I had a downward curve so the top side of my penis was longer, the top side was 19 centimeters and the bottom 17, and the bottom side is the usable in stage surgery, and I was 15 centimeters girth. When I got my first erection I was 12x12 centimeters and today I am 15x14,5 so as you might imagine I am over the moon. I will be doing an update next week about how sex for the first time went, and after that I will keep doing measurement updates,

see ya next week

[Jonbinspain]

JN;

Good to hear it's going well. Yes, size does take time to recover after surgery.

You may also find that sensation is entirely different after only a few weeks since surgery.

Do as Franklin tells you and you should be fine.  

[JN]

Hello guys,

This morning I flew to vienna for my 8 week post op meeting, I flew back the same night. Everything was fine, I was wearing the phallosan wrong and he showed me how to do it.  

[JN]

so,

It has been about a month since I posted my last update. Today marks 3 months post-op and I couldn't be happier! I am back to having sex again and everything is going great. I don't have any pain, only a little discomfort after ejaculating. I contacted the doctor about this and he said it will pass once I am fully recovered. Before my surgery I was about 17 centimeters on the short side of my penis and 15 centimeters in girth. My first post-op erection I was 12 centimeters length and 13 centimeters in girth, that was on august 19th. Today I measured and I am extremely happy to say that I have all my girth back (15 centimeters) and I am 16 centimeters in length (a 4 cm increase since august 19th). I started with the phallosan on august 25th and since it is recommended to wear it for atleast 6 months I will decide on february 25th (my birthday which is pretty funny) if I stop wearing the device or will continue until I reach 1 year post-op. It is funny how this negative thing (congenitale curvature) changed me in such a positive way. It has been over a year since I went to the first doctor and when I went to that a guy I thought it would never get better and here we are. Time flies. I'm only 17 so I still have a long life ahead of me and I think this experience will be in the back of my mind forever. Before I knew something was wrong with my penis I thought it was just a given to be healthy and since then I learned that being healthy is definitely not a given! And I appreciate it a lot more. Also I think this experience has made me mentally stronger. I will give some updates here and there but probably not consistent.

be positive, see ya later.

[JohnWright]

Congratulations! For congenital curve you did the right thing with surgery. Your final outcome is like mine. Woohoo! Happy days are here again. And you are correct, don't take good health for granted.

Best to you and your new life,

John

[daved2]

Going back to London on November 10th for my three month follow up after Egydio procedure for congenital curvature and peyronies. Post -Op residual curve to the left, as originally had, only to a lesser degree. Will evaluate if further surgery is needed. Not looking forward to recovery or any more size loss.  

[daved2]

Hello again, Gents. I am here in London with an update. I met with Franklin yesterday in his new location: Queen Anne Medical Centre. He is renovating a new office for London Andrology to conduct consultations, and will perform operations in the Queen Anne operating facility. The new office will be strictly male, vs Cadogan Clinic, which has women there for boob jobs, tummy tucks and facelifts. Why do i know all of this? Because Franklin spent nearly 2 hours with me going over options, taking photos, and calibrating my residual curve vs my pre-op curve. Yes, i said the dirty words " residual curve" The words none of us want to hear.

He went into great detail about what he believes is the issue. In my case, he believes that the graft where the Tunica was removed, is pinched, and therefore is not stretching properly. He recommended that I use the Phallosan for the next 3 months at a duration of up to 6 hours per day. If the curve is not greatly improved or corrected, he will re-operate at no cost.

He took the time to show me how to properly and easily use the Phallosan. It is amazing how much more effective the Phallosan can be used than the directions contained when you purchase the unit.

I have to admit, I was disheartened at the sight of the congenital curve, which surfaced within 30 days of my surgery. It has now been three months, and I have a new path to ending my congenitale/ Peyronies journey for good.

I feel at peace knowing that in the next 3 months, I will experience a non-surgical result from using the traction, or I will undergo stage surgery to add two to three sutures. He calculated a 20 degree residual, and estimates that each stage excision, will correct approximately 10 degrees curvature. As for length, that is always a concern. I have weighed everything out, and believe that two stage sutures will not mature really affect further length loss. I could be wrong.

Next week, I will be meeting with Dr Joel Gelman at UC Irvine to get his opinion. I will report again after that appointment, which should give me a well rounded perspective of what my residual curve is, and what needs to be done to correct it.

[Lucketts]

good luck w/ the extra traction daved.  sounds like you're in good hands w/ the doc, and have picked a good one for a 2nd opinion.

just out of curiousity, what new instructions did you get regarding using the phallosan that were not in the instruction manual?  thanks.

[daved2]

Lucketts.

Thanks for your question about the Phallosan intructions given. First of all, he had me start in the "lock" position, to create a vacuum seal.

Roll up the sleeve, and strech around the dome, place the head of the penis into the dome, then unroll the sleeve. This creates a vacuum seal as soon as the band of the sleeve hits the penis, there is an instant seal.

Pull from the top of the device, and swich from lock to pump. Pump multiple times while pulling the device upward, until the penis is completely sucked into the dome, then lock again.

For the protective silicone tip, I was stuffing the whole tip into the thimble-shaped tip. The correct way is stretch to cover the tip, then pull the underskin out from below the recepticle until it is shaped around the head. Instead of a cone shape, it will look like more of a bell shape.

He suggested to wear it ideally for 6 hours per day. The more confortable you make it, the longer you can wear it. He suggested sleeping with it on. Immediately after surgery, this would be too painful, but after a couple of months, i see no difficulty in doing this.