The more revisions you have on your implant, the greater the infection risk?

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Pfract

One of the thoughts i always had, ever since i started researching more about penile implants, was the effect it would have with each subsequent revision as each implant wore out. I was unsure if the risk of infection remained the same, or if it would slightly increase with each revision as years go by and you need another IPP.

Searching pubmed, i found this which has the participation of Dr. Landon W Trost. Not only he is the inventor of Restorex, he works at Mayo Clinic, and is part of the ISSM. "International Society for Sexual Medicine". To say it seems reputable enough. And.... it concerns me, deeply.

https://www.ncbi.nlm.nih.gov/pubmed/29795529

Infection risk of undergoing multiple penile prostheses: an analysis of referred patient surgical histories.
Quote
Inflatable penile prosthesis (IPP) is the gold standard for medically refractory erectile dysfunction. Infectious complications remain a significant concern in IPP revision surgery. We sought to evaluate the impact of number of IPP surgeries on subsequent infection rates. A retrospective analysis was performed on all new patients (self or outside provider referred) presenting for consideration of IPP revision or salvage surgery between 2013 and 2015. Histories were reviewed including number of prior IPPs, reason for evaluation, and rate, number, and timing of prior IPP infections. No patients were operated on by the primary investigator prior to data acquisition. We identified 44 patients with at least one prior IPP presenting for consultation regarding IPP revision/salvage. There were 88 IPPs placed by 28 different surgeons. In patients with two or more devices, 55% had at least two different surgeons. The most common reason for presentation was malfunction (52%). The risk of specific device infection was strongly correlated and increased based on number of prior IPPs: 1st (6.8%; 3/44), 2nd (18.2%; 4/22), 3rd (33.3%; 4/12), 4th (50%; 4/8), and 5th (100%; 2/2) (R2 = 0.90, p = 0.01). Similarly, overall rates of infection positively correlated with number of prior IPP-related surgeries performed (R2 = 0.97, p < 0.01). The median time to development of infection after most recent IPP surgery was 2 months (IQR 1-3.3 months). Infection rates of revision/salvage IPP surgery increase with each subsequent IPP placement or following IPP-related surgeries. The majority of patients referred for penile implant surgery can expect to have experienced at least one infection by their 4th device. These data represent a change in paradigm on revision prosthetic surgery.

I wonder what the top doctors have to say about this? Is it because of the same reason you *might* get infections on the first implant? skin bacteria? or the changes inside your penis/scrotum?  :-\ I am so worried now because being young still... 32 i would have a couple of revisions down the line... assuming each titan lasts 5 years with very good usage..... that would be 4/5 implants?
Penile fracture during sex, Portugal 2014 - [url=http://www.peyroniesforum.net/index.php/topic,11131.0.html]Penile Implant Forum -Tech info compilation and Index - Peyronies Society Forums[/url]

Hawk

I too have stumbled across data that suggest the infection rate climbs with subsequent revisions but the numbers were lower.  It also failed to explain any reason this would be true.  I am going to put this on a list of things I will ask Dr. Eid next time we talk.  I have just not gotten around to calling but will likely call next week and ask his staff if he can call when he has some time to talk.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Werther

The point is that youngsters aren't suitable at all for implants. Unless they'll make these devices last something like 30 years, I don't see how can you deal with an implant while aging when you got it at a very young age...

Hawk

Quote from: Werther on October 26, 2018, 08:48:11 AM
The point is that youngsters aren't suitable at all for implants.

I disagree.  If I could only have a working penis for 8 years, would I rather have it from 25 to 33 or from 65 to 73?  The answer is clear.  I would rather have it when younger.  I have only had an implant for less than 3 months.  During the first 3 weeks I could not imagine getting a revision.  Now I know that if this thing only lasted a year I would be back for my next one as soon as it failed.  A month of no sex for a year of spontaneous sex on demand is an easy choice for me. 

My wife told me yesterday "I really appreciate you and all you do" and then before she walked away, she added with a smile, "I also appreciate your new dick." 

The infection stats need to be clarified, but anyone with significant erectile dysfunction is fooling themselves and losing size and years of intimacy if they put off an implant.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

TonySa

I agree w Hawk, if it's not useable...why wait?
Other considerations are:
What were the final outcomes after infection? Hopefully good.
Which doctors did the revisions, high or low volume as we know they have different infection rates.
What is the average lifespan of an implant done today?  (I believe greater than 5 years.)
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

Hawk

The study raises questions deserving an answer but the sample is so small (about 40 patients) that any slight variable could skew the data dramatically.  For instance, the group having 4 revisions had 100% infection rate.  That was a whopping group of TWO men.  Most of the groups were less than 10 men. 

Strangely only 52% of these men were getting revisions for device failure.  Does that mean 48% were because of botched procedures?  If so these must have been at the hands of less competent surgeons.

I am also not clear on whether Dr. Landon is evaluating the infection rate of patients before they got to him, or if he is saying 2 out of 2 men got an infection when I installed the 4th revision implant in them.

All questions that need answers.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

skunkworks

n= is way way too small for this to be significant. Plus as Hawk pointed out, half of them were possibly there because of an incompetent surgeon in the first place. Good surgeons are anal about everything to do with the procedure.

But this does serve to highlight how important it is to get individual post op infection numbers (not industry averages) from a surgeon before going under the knife with them.
This is an emotionally destructive condition, we all have it, let's be nice to each other.

[url=http://goo.gl/IOBhJr]Review of current treatment options by Levine and Sherer]

suicidecomingsoon

Quote from: TonySa on October 26, 2018, 10:35:50 AM
I
What is the average lifespan of an implant done today?  (I believe greater than 5 years.)
Dr.Eid says that the average would be 10 years with many lasting up to 15 years and a few at 20. But the biggest factor that would influence this would be the frequency of implant use. He said (if I remember correctly) something as if used 1 or 2 times a week it would last 8-10 years, once a week 15 years and once a month 15 or more years. Something like that said in a video

Werther

Is an implant always feasible and effective in the same way even after you had lots and lots of revisions such as when you got implanted at a very young age? I ask this because it appears to me that the more revisions you get, the less the device lasts based on the study posted in this thread, so that it looks like it's possible that you come to a point where you can't even get implanted anymore... Something like teeth implants: after you changed one, it's not sure that you can get another new one in the same spot, because you'll have to see if you still have enough bone: it could very well happen that you don't and you can't get a new implant if this is the case.

That's why I wrote that I think that an implant isn't suitable for youngsters. Maybe I'm totally mistakened, but I personally think that mine is a legitimate doubt.

Hawk

I question if the longevity of an implant is really that long.  It would be nice to see hard stats on longevity associated with frequency of cycling.  A failure after by 24 months may be uncommon but I don't think it is rare.  Also, many individuals cycle their implant 2 times a day.

Some failures may be unrelated to frequency of cycling, for instance, Titan tubing failures.  For those unaware, tubing is the connecting tubings, not the cylinders that inflate.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

suicidecomingsoon

It is possible that the fact that the implants fail is due to the use while having a sexual act (due to movement, the greater stress on the device) rather than cycling, since having sex you are more aggressive or more energetic and due to this  will it increase the risk or stress on certain elements such as tubing?

Is it possible that the use refers to that more than if you cycle it or if you masturbate? (Because this does not put so much stress on the implant?

Pfract

Hey hawk.. Do you remember that post somewhat recent from a guy who lives in NYC and is a male nurse? He had his 4 years ago and it failed. Dr Eid did his initial one...
Penile fracture during sex, Portugal 2014 - [url=http://www.peyroniesforum.net/index.php/topic,11131.0.html]Penile Implant Forum -Tech info compilation and Index - Peyronies Society Forums[/url]

Hawk

I am not sure but I do recall someone telling me 2nd hand information of two that failed within 24 months.  I have the advantage of an implant not costing me anything.  I know that is a huge advantage to be able to get a great surgeon at no out of pocket cost (other than travel and a room).  If mine fails and my wife is still healthy, I will get another one immediately.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Pfract

I will search for it if I remember lately. Assuming one knows it is going to fail probably in X amount of years, then one should start saving money right away for a revision, as soon as you do your first surgery. Kind of like one does for retirement? But in this case is so your penis doesn't retire early? 😕 please let us know what Dr Eid has to say about this if you guys do talk about it
Penile fracture during sex, Portugal 2014 - [url=http://www.peyroniesforum.net/index.php/topic,11131.0.html]Penile Implant Forum -Tech info compilation and Index - Peyronies Society Forums[/url]

Frank55

Here is Dr. Kramer's page on it Pfract. He states a revision procedure is actually easier than the original implant. That does not mean it is something to look forward to though.  ;)

https://kramerurology.com/patient-resources/lifespan-of-penile-implant
Single and 58 yrs. old - first peyronies symptoms Fall 2015
Had grafting surgery by Franklin Kuehhas in June 2016 - complete failure
Borderline Erectile Dysfunction possible but not taking drugs, shots or using VED
Now evaluating options for next step

Hawk

I think Dr. Kramer is tops however some of his expressions and statements can be misinterpreted.  For instance, he will finish a procedure that makes you a little light-headed to watch and as he finishes he will say, "and there it is, nothing but a little scratch on the scrotum"  EXCUSE ME !!!!  :)

The page you put a link to says 85% of men will have the same implant in 15 years.  While I wish that were true, I just do not believe that.  I think there is something closer to 5% (of the original number) failure rate per year.  I have never heard as good a longevity as he claims on that page.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Frank55

Right. It is important to remember that to a degree these surgeons are selling implants. Part of that sales process may be to (tactfully, and with an escape hatch) overstate a common concern - device longevity. The replacement of a failed implant may be easier than the original procedure (as Dr. Kramer claims on that page), but again that does not mean it too will not be an ordeal. Perhaps just to a lesser degree.

I also think they understate the impact and recovery from having such a prosthesis originally placed. Quite a difference between the "no big deal" that is sometimes insinuated and the realities that are described on this forum. Again Hawk - that is where you, Alibaba, Tony and Merrix have been and continue to be invaluable. Yours is the real "FT" as opposed to the agenda talk.  :)
Single and 58 yrs. old - first peyronies symptoms Fall 2015
Had grafting surgery by Franklin Kuehhas in June 2016 - complete failure
Borderline Erectile Dysfunction possible but not taking drugs, shots or using VED
Now evaluating options for next step

Hawk

Don't forget FloppyNOMore.  He has valuable, fresh, day to day real-life input.  He is currently on day two.  :)
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Pfract

frank55: I don't think they lie. It's just that the majority of the population that installs an implant is 50+ yo, and from what i've seen on the board both here and on FT, (i don't want to offend anyone) but the level of usage on the device is not the same as somebody younger. Either their wife doesn't want it, or they lost length due to peyronies and now their penis is much shorter, rendering the implant almost "useless", or they lost interest in sex for whatever reason, so the implant on that scenario might last indeed much longer.... 10+ years? compared to somebody in their 30s... having sex 3/4 times a week, for at least 30 min straight... I think thats why the longevity stats are like that.

realisticaly, 95% or more of the guys from 18 to 40/45yo have no problems with their erections...
Penile fracture during sex, Portugal 2014 - [url=http://www.peyroniesforum.net/index.php/topic,11131.0.html]Penile Implant Forum -Tech info compilation and Index - Peyronies Society Forums[/url]

Frank55

Pfact - I'd agree that they don't necessarily lie. But remember there is a difference between an outright lie and sales copy that minimizes or trivializes some potentially unpleasant truths about the purchase of a given product or service. Again, it is important to remember these surgeons are also salespeople. Nothing wrong with that - we all have to make a living - but buyer beware.

You may have read this already - Dr. Eid's page on implant device life expectancy. I think this page has a higher degree of honesty than Dr. Kramer's page. Note he assumes the device will be used 1 - 2 times per week. That is probably a more realistic activity level for a 50+ patient than someone in the 18 - 45 yr. old range.

https://www.urologicalcare.com/penile-implants-prosthesis/life-expectancy-of-penile-implants/
Single and 58 yrs. old - first peyronies symptoms Fall 2015
Had grafting surgery by Franklin Kuehhas in June 2016 - complete failure
Borderline Erectile Dysfunction possible but not taking drugs, shots or using VED
Now evaluating options for next step

Tortão Pra Direita

2021, does anybody have an answer to this question?

I understand the small group that was studied, but it is still a bit scary.
Almost always the problem is not with the cylinders, but with the tubings. Maybe this is a dumb question, but why Coloplast or Boston haven't invented yet a mechanism of replacement that doesn't require removing the entire implant? The implant could have more tubing connections, so it would be easier to just remove the damaged part without removing everything. Does this sound reasonable?
1993 born. Brazil.
Peyronies since Sep 2019.
Penis developed curvature, lots of plaque, loss of size and axial rigidity. Severe peyronie.
Mar/21 TEP + Titan Touch 20 cm + 1.5 RTE.

Surgery done by Dr. Marco Tulio Cavalcanti, in São Paulo.

Hawk

I am not sure which question you mean unless it is the original question of whether infection rate creeps up with a revision as opposed to an initial implant.  The answer to that is known.  It is Yeas it does because the surgery is somewhat longer which by itself increases risk.

I asked Dr. Eid if they ever replace just defective parts if an implant fails early such as in one or two years.  He does not and most others do not.  He asked, how would the patient feel if a year later another part failed.  He would feel I did him a disservice and he would be correct.

Titan's vulnerability is known to be the tubing while AMS is the pump.  The failure rate and longevity of both systems are about the same. 
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Tortão Pra Direita

Thanks for your answer, Hawk.
Yes, my question was regarding the original question of this thread.
A longer surgery makes sense, but is each new revision more difficult/longer than the previous revisions?
The problem is the study posted shows a growing number of infections and not a steady infection rate for all revisions.
1993 born. Brazil.
Peyronies since Sep 2019.
Penis developed curvature, lots of plaque, loss of size and axial rigidity. Severe peyronie.
Mar/21 TEP + Titan Touch 20 cm + 1.5 RTE.

Surgery done by Dr. Marco Tulio Cavalcanti, in São Paulo.

GaussRifle

I have done extensive research on this topic and the answer as to why the infection rate is not steady across revisions and goes up is that each time a device is explanted for replacement and a new device is put in, it induces very slight fibrosis in the nearby tissue. So the fibrosis along the implant kind of builds up which makes antibiotics reach less and less of, since more fibrosis causes more regions of the penile tissue to be inaccessible by antibiotics, bacteria microfilm develops.
26 year old
45-50 degree downward curve with an indentation on one side when erect.
Using RestoreX and Xiaflex injections
Taking coq10 with daily Cialis 5mg.

Hawk

Here is a direct question to Dr. Eid with his reply.  His answer seems to be a little unclear but I give it to you the way he gave it to me.

I will pose the same question to Dr. Kramer.

______________________________________________________________________________________________________________________________
4) Dr. Eid, We have seen studies that infection rates continue to climb. with every subsequent implant, This is a huge concern for young men with Erectile Dysfunction.  To what degree is this true.

Yes, removal replacements are more complicated procedures, requiring a more experienced surgeon and take longer to perform. My infection rate with the "No-Touch" technique since 2006 for more than 3700 consecutive patients is 0.6% including removal replacement implants. Over 50% of the patients that became infected however involved cases with increased surgical time (greater than 2 hours), excessive manipulation of the device and penile tissue, excessive dissection and prior history of surgery( prostate, bladder, and previous implant). In experienced hands, I believe that the infection rate for an R/R is the same as for virgin implants.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Tortão Pra Direita

Interesting, gaussrifle. Thanks for your reply.


Thank you for your reply too, Hawk. It's more comforting to know the infection numbers (including the revisions)of Dr. Eid are quite low. My doctor does the "No-Touch" technique too. At the end of the day, what we can best do (and advise people to do) is to seek experienced and high-volume doctors.
1993 born. Brazil.
Peyronies since Sep 2019.
Penis developed curvature, lots of plaque, loss of size and axial rigidity. Severe peyronie.
Mar/21 TEP + Titan Touch 20 cm + 1.5 RTE.

Surgery done by Dr. Marco Tulio Cavalcanti, in São Paulo.

GaussRifle

Dr Eid, mentions that the overall rate of infections is 0.6 percent including revisions. I am guessing the majority of the procedure he does are first time virgin implants, so considering he does only 10 percent revision cases, this would mean the rate of infection with revisions is closer to 6 percent.
Moreover tartao I have already linked and sent you the rate of erosion for penile implants. The rate is close to. 2.56 percent on average per year for inflatable. So for younger patients , it might be an issue in long run
26 year old
45-50 degree downward curve with an indentation on one side when erect.
Using RestoreX and Xiaflex injections
Taking coq10 with daily Cialis 5mg.

Hawk

Gaussrifle,

I aggressively confront assumptions and unsupported opinions. It is not personal.  I wish all members did the same. If we don't do that, then we just as well shut the forum down because we will spread as much misinformation as facts, and you cannot educate people doing that.

Please explain your basis for concluding his revisions are 10% of his procedures.  Are you just assuming?  He does a number of revisions for patients who had unsatisfactory results with other surgeons, one currently on this forum.  You can not just assume an arbitrary number to plug into a math formula.

1. Speaking of your math formula, I am very interested in seeing that and the numbers you plugged into your formula and where you got these numbers.

2. Why don't we assume since he fixes other doctors' mistakes and since he has been doing implants for decades that half of his implants are revisions? Assuming 10%-20%-30%-40% 50%- or 60% and then declaring an infection rate based on that to thousands of readers is irresponsible.

3. How do you reconcile your 6% infection rate number for R/R's with Dr. Eid's own statement "In experienced hands, I believe that the infection rate for an R/R is the same as for virgin implants."

It gets very frustrating when people make assumptions and post them as facts without ever supplying the data their conclusions are based on.  It undercuts what this forum is about, the education of men and their partners with accurate information they can use to make serious decisions.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Tortão Pra Direita

Gauss,
Maybe I'm not understanding you correctly, but that study you sent me just shows a rate of glans erosion of 2.5%. It's not "per year".
https://www.nature.com/articles/s41443-020-00376-6
"The rate of erosion with IPP and MPP has also been studied. The AUA Erectile Dysfunction Guidelines reviewed the rate of erosion for MPP and IPP in 7 and 20 studies, respectively [2]. The rate of erosion for IPP was on average 2.5% (range 0–6.5%) and for a MPP was on average 4.1% (range 0–17.5%). With chronic compression on the corpora cavernosum and the urethra, it is not surprising that the MPP is more likely to have an erosion. Slightly downsizing the malleable cylinders during implantation can help mitigate the risk of erosion."

Also, I think this number is considering lots of doctors that do this kind of surgery (experienced, inexperienced, who knows). We can reduce the chances of glans erosion if we seek an experienced doctor.


Now, back to infection rates... I was watching some videos of Dr. Eid on Youtube (a very informative channel). Here, a guy asks:

Hello doctor!!
Medical papers say the infection rate of revision surgery is 5-10%.
It seems too high... virgin surgery's infetion rate is only 1%(or less than)
Why is it dramatically high when revision surgery is done?
Does a revision surgery done by skilled doctor(more than 100 case per year) also have a 5-10% infection rate?


Response by Dr. Eid:

Hello - In my experience, there is no difference between revision and virgin surgery. What puts the patient at risk for infection is:
1. Extended surgical time
2. Excessive manipulation of the device (Removing and repositioning it over and over during surgery, allowing contact with the patient's skin )
3. Extent of bleeding/hematoma formation in the scrotum.

Operating time is reduced if the surgeon determines what device to use pre-operatively based on the patient's medical history. Typically, the more experienced the physician, the less risk of infection.
My overall infection risk is 0.6%, and I do not see a higher risk of infection in revision cases. In my opinion, the ones with the most risk of infection are those that are over 2 hours long, if it's difficult removing/replacing the device, and when there is hematoma formation.

Link: https://www.youtube.com/watch?v=roIRJdh-zIw&lc=UgzHzyDbmcA3JYjWYTV4AaABAg

It's similar to the answer by Eid that Hawk showed above, tbh. Well, I think this brings some relief.
1993 born. Brazil.
Peyronies since Sep 2019.
Penis developed curvature, lots of plaque, loss of size and axial rigidity. Severe peyronie.
Mar/21 TEP + Titan Touch 20 cm + 1.5 RTE.

Surgery done by Dr. Marco Tulio Cavalcanti, in São Paulo.