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Welcome to J Francois Eid, MD - Directly answering member questions in the "Medical Professionals" section below the Treatment boards.
https://www.peyroniesforum.net/index.php/topic,17819.0.html

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Author Topic: One Patient's View on Choosing a Surgeon  (Read 3076 times)

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Hawk

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One Patient's View on Choosing a Surgeon
« on: October 11, 2018, 10:43:20 AM »

What is to follow is nothing but one patient's opinion.  It is not the forum's official stance.  There are no such attitudes here.  If you are familiar with this forum, you will be amazed to know that what I am about to post was attacked by a moderator on another forum.  It left me wondering, what is the point of having a forum.

All surgeons, like all mechanics, artists, and carpenters, are not the same.  Some have much more experience with every imaginable complication that can arise.  Some have a natural gift or talent.  Some are more dedicated.  Some are more honest.  Some absolutely love what they do.  Some specialize in a few procedures.  Less important but still important, some are more pleasant, available, and approachable. A perfect surgeon would rank at the very top on all of these.  There might not be a perfect surgeon.  It is also probably not possible for a patient to accurately measure all of these, especially before surgery.  There are, however, things we can look for.

Many people disagree with several of these. You will have to decide your standards and the degree of risk you are willing to take.
My advice is to pick a surgeon:

1. Who documents your penis length before surgery and promises you a minimum length after surgery.
2. Get a surgeon who does not need or want a company rep (for the product he is installing) in the operating room with him.
3. does over 100 implants a year.
4. implants both AMS and Coloplast Titan (and recommends Titan for correction of significant deformity)
5. takes several implants in the OR with him (to assure he fits an implant to you and not try to fit you to an implant).
6. Has actually removed an implant from a patient during surgery because he thought he could get better results with another implant.
7. Tries to avoid the use of Rear Tip Extenders (and does NOT STACK RTE's) This means rather than making an implant fit by adding more than one set of uninflatable RTE.s he uses a longer implant.
8. Can tell you HIS infection rates (not industry average)
9. Is very accessible to you for questions as you are healing
10. Inquire if he uses a scrotal or retropubic approach
11. I prefer a scrotal to a retro-pubic approach.  It hides the tubes from the reservoir to the cylinders better, hides the scar, and greatly reduces the chance of nerve damage.
12. if scrotal, is it a vertical incision on the raphe that hides the scar? (this is only a slight cosmetic issue)

It is essential to know at least what others say that have had the same surgery with this surgeon.

Make no mistake.  I think you can pick a less experienced, less talented, rude surgeon that is less than honest, and by some combination of events, you could come out with a good result.  Even a great surgeon will have a patient who gets an infection out of every 100 - 200 patients.  We are not talking about a guaranteed perfect outcome vs certain doom.  We are talking about the likelihood of your outcome. Your job is to go with the odds.  Studies show that high-volume surgeons give you better odds of a great outcome.

Others may think of things I missed.  If so, jump in and let us hear from you.
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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

SW01

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Re: One Patient's View on Choosing a Surgeon
« Reply #1 on: October 21, 2018, 07:53:36 PM »

I just want to say that what is posted here is so important. I am on my 4th urologist surgeon and it has been an experience. My history does not go back to far. A little over 2 years ago I fell straight down on a 2 by 8 while working on my deck. Immediately saw my regular dr. Who forwarded me to s urologist. Looked at me but did not do any tests on me. Said I was bruised and should be fine. Yea right. A couple months later had no energy and would wake up and move to the couch. Back to urologist. Testosterone tests showed a level 20. I think low normal is 300. So started on androgel. Started feeling better but no erections. Back to urologist. Still no tests mind you. Said oh you have Erectile Dysfunction. Put me on sildenafil. Got soft erections. Said to take more pills. About year after fall I noticed a hard deposit on my shaft about one inch from my belly and my dick stared curving up. 1st urologist said looks like peyronies, never touched me mind you. Said to take vitamin e. So thought I would go Off to new urologist. Still no tests on my dick even after falling three feet straight down and being black and blue from my knees to my stomache for about 2 months. This one ticked me off after one appt.

 Off to 3rd urologist. This one actually has a PA inject me with trimix. After 3 injections I get an erection pointing straight up at the ceiling when I am standing. Tells me yep you have peyronies. Two options, excise and grafting along with trimix after to get an erection. Or get a titan implanted. Either way I probably will need the implant in a year or so anyway. When do I want to schedule surgery. I said I would let them know.

For personal reasons I have delineated elsewhere I would love a local surgeon. Went to coloplast website and found a center of excellence site. Not sure what that is  but it was a 2.5 hour drive there. Made appt to see 4th urologist surgeon. This one listened to me. Told me no way he was doing anything to me until he checks me for damage from fall. At the very least he is doing ultrasound and blood flow tests. He will not discuss an implant till then. At least he is doing due diligence. I will be honest if the tests show I need an implant I plan on traveling to one of the top implant surgeons to have it done. It may go to s### but the odds are on my side using one of them versus someone who does a few a month.

Just my opinion mind you but most of the local docs I saw left me with a bad feeling so I moved on. This is my body and I am feeling comfortable with my surgeon.
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Dealt with Erectile Dysfunction, Peyronies, & venous leak for 3 yrs.
implant on March 7, 2019 w/ a Titan 18 cm plus 1cm RTE
Revision after hernia surgery. Dr. Andrew Todd, Richmond KY
Removed Titan and put in LGX 18 cm plus 2 RTE's, 20 cm total.

Hawk

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Re: One Patient's View on Choosing a Surgeon
« Reply #2 on: October 21, 2018, 08:11:33 PM »

SW, I cannot imagine your new doctor is not going to recommend an implant.  There really is little else that resolves Erectile Dysfunction with or without Peyronies.  Hopefully, you will transfer any records of the test to whoever ends up doing the surgery.  I suspect these "Centers of Excellence" are Coloplast's marketing ploy to promote surgeons that use their product.  It probably does represent some level of volume and success but probably not the level you or I would necessarily demand.

In case you missed it, these two reports/studies clearly indicate that high-volume penile implant surgeons have a significantly lower incidence of infection. Infection is the most feared outcome of implant surgery.

The first study is a NY state-only study, so the rates are probably lower since some men would go out of state for a salvage operation.  I add here that Dr. Eid has significantly less than a 1% infection rate and uses the "No-Touch" system he developed for IPP surgery.  Always insist on a surgeon giving their own documented infection rates and not letting them quote averages or industry-wide probability.

1.  https://www.issm.info/news/sex-health-headlines/surgeon-experience-associated-with-penile-implant-infection-rates/

2.  https://www.garber-online.com/pdf/Higher%20volume-lower%20infections.pdf
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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

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Re: One Patient's View on Choosing a Surgeon
« Reply #3 on: October 21, 2018, 10:03:17 PM »

SW01, I agree 100% with you firing your doctors. Unless a doctor does due diligence examinations, discusses things in a manner you feel confident and comfortable with, fire his ass. There are compassionate and reasonable urologists despite (this may piss somebody off) urologists as a whole being an odd lot. For those who disagree, I had a conversation a few years ago with a hospital administrator about a urologist who I thought was an ass. He also say urologists were his most numerous complaints and biggest headache.  I went through 15 myself. Keep trying, don't give up.  There are good ones. Give a general location where you are and maybe someone knows a good or great one in your area if this doc does not help. Cheers man
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Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders
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