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Author Topic: So you are beginning to wonder if or when you should consider an Implant  (Read 4741 times)

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Hawk

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This document is a work in progress but is posted for comment on missing information or corrections in content, typos or needed clarification.

If you have erectile dysfunction from any source or cause, you should be reading this even if you have just started looking for solutions.  That includes erectile dysfunction with or without a deformity from Peyronies Disease.  If you have deformity without erectile dysfunction, Implants can totally straighten bends up to 90 degrees without any other surgery.  Bends over 90 degrees have been corrected with only a Titan implant and some relief incision and remolding during surgery.

Certain high-volume doctors in the U.S. will perform implant surgery to straighten deformity that significantly interferes with intercourse even if the patient gets erections.  Such surgeons believe it is a less traumatizing surgery with less chance of infection and scarring and no sacrifice of penile length.
 
In a sentence, if you ask anyone with a functional implant, they will tell you they should have considered it long before they did.  If true, then it means you probably should have been here a bit sooner.  Now that you are here, let's get down to business.

First, in full disclosure, I have a bias for implants.  I can't help it.  I used VED's, traction, Viagra, Levitra, Cialis, trazodone, L-arginine, cock rings, and bimix injections.  There were about 20 other supplements and exercises.  I tried them in every combination for 15 years.  It seemed my life revolved around rehabilitating my penis.  I was living the life of a constantly horny stud trapped in the body of a eunuch.  There were times I wished I was castrated.  It could be maddening as the complexity of planning sex got more and more involved. I had a tool satchel with VED's, lubes, cock rings, and toys to do the job if I couldn't.  My delay in getting an implant cost me tons of money and an unbelievable investment in time.  It caused Peyronies Disease from injections, and it cost me well over an inch in lost length.  It also cost me 15 years of compromised intimacy. Finally, and most importantly, it took a toll on the inner sense of peace and confidence.  Even with being a confident person by nature, having a strong sense of religious faith, being in a committed marriage with a very supportive wife, it still took a toll in the sense that no matter the activity, I lived with a constant awareness of my erectile dysfunction.  It seemed every comedian had jokes about my condition; every movie referred to exhibited examples of men that, by contrast, were viral.  The implant removed all of that.  It frees me from that almost subconscious fixation to focus on other things.

Choose the Best Surgeon
I put this kind of out of order and placed it first because it is without any doubt the most important paragraph in this post.  Just as mechanics, builders, and plumbers vary, all surgeons do not have the same skill, experience, natural talent, the same passion. The same communication skills, the same compassion, and interest in their patients. LINK --->One Patient's View on Choosing a Surgeon - Peyronies Society Forums

COST
In the U.S., the cost of a three-piece inflatable implant is about 24 thousand dollars. That includes doctor appointments, surgery, anesthesia, hospital, and everything except a motel room and travel.  U.S. Medicare covers implants, as does most insurance.  If you have Medicare and supplemental insurance, often there is no cost to you.  If you have no insurance, some save a little at a time.  Some get a part-time job to speed the process.

Should this be reserved as a last resort?
In the sense that it is not reversible, the answer is yes.  Once you have an implant, you will never get a usable erection without an implant or breakthrough in tissue regeneration medicine.  In the sense of, should you try every other means first, the answer is not necessarily.  Some other means, such as injections, are potentially damaging and can trigger scaring size loss and Peyronies Disease. Others may be unacceptable to you due to the lack of spontaneity, cost, or other factors.  It is my opinion that if a Viagra or similar drug gives you very reliable erections every time without unacceptable side-effects, then you might be best served to delay an implant.  The time is likely coming that the same dose of erectile dysfunction drugs will not work for you on a long-term basis.  Here is more on "Is an implant the last resort LINK--->Is a Penile Implant Really a Last Resort - Peyronies Society Forums

Three main types of implants
1) Malleable Implants - These are considered old technology.  They have the advantage of more simple surgery, and they require little dexterity or strength to inflate because they do not inflate. They are two firm, bendable rods that insert in the two cavernoasa chambers of the penis.  Much like a gooseneck lamp, they can be bent to stick up, down, straight ahead.  Your penis is always the same size. It can be uncomfortable in routine daily life.  The constant stretching tension can erode the penile tissue, and the implant can erode the tissue and break through the glands or end of the penis.

2) Two-piece inflatable implant.  These implants have two inflatable cylinders like heavy-duty balloons, one for each -cavernosa chamber(considered one piece) and a pump with a self-contained fluid reservoir placed in the scrotum (the second piece). Because they contain little fluid, they work best for a smaller penis, especially when prior surgeries or conditions prevent a reservoir placement in the abdominal cavity. They are very seldom used.

3) Now, we come to the current gold standard, the three-piece inflatable implant.  It consists of two inflatable cylinders (one piece), very much like the two-piece implant.  A pump is placed in the scrotum (2nd piece) and a separate fluid reservoir placed in the pelvic cavity (the 3rd piece.)  All of the following references in this post will refer to this type of implant.  There are two leading manufacturers of these implants.  They are AMS and Coloplast.   Both companies make several models for varied complications like constricted or scared cavernosa.  The most common and popular models are the AMS LGX 700 and the Coloplast Titan.  Much is written about these on the implant forum, so I will not detail the differences here.

Surgical Procedure
Surgery usually consists of outpatient surgery with about 6 hours from check-in to release from recovery or one over-night stay in the hospital.  The actual surgery from incision to closure is only about 20 to 40 minutes. There are two main types of approaches to placing a three-piece implant.  Regardless of the approach, nothing is removed from the penis.  All tissue, nerves, blood vessels, tunica, and skin are left intact. The spongy or web-like structures in the cavernosa are pushed aside (and no doubt damaged but not removed).

1) Infra Pubic approach - This requires a horizontal incision in the pubic fat pad just above the penis.  The incision is somewhat concealed with the regrowth of pubic hair. Proponents of this approach suggest that it has a quicker recovery. The quickest recovery I know of is Dr. Eids scrotal approach.  I had intercourse three weeks to the day from surgery. Doctors vary greatly in how soon they allow you to have intercourse from 3 weeks to two months. InfraPubic approach usually involves a drainage tube that has to be removed in 1-3 days.  It also is more likely to leave the tubes from the reservoir to the cylinders in a position where they can be easily felt at the base of the penis or even be seen under the skin.  It also carries an increased risk of nerve damage and a loss of some sensation. 

2) Scrotal Approach. - This approach usually involves only a single 1-inch incision in the scrotum.  If this incision is made vertically on the scrotum's seam or raphe, the scar becomes literally invisible within a few weeks.  If a surgeon uses a horizontal incision, there is usually some visible scar. 

Post Surgical Recovery
This area varies radically from surgeon to surgeon.  Some surgeons send patients home inflated for weeks.  Some send them home deflated. Some have patients cycling the implant (inflating/deflating) within three days; some do not do so for six weeks.  Some allow you to have intercourse within 21 days.  Some do not for months.  Some Surgeons waterproof the incision and encourage submersed baths within three days of surgery.
 Others limit you to showers only for many weeks. Patients individually also very radically during recovery.  Some never take a single narcotic pain medication others do and may even be taking some form of OTC pain medication two months after surgery. Generally, however, you will not even be aware you have an implant in three months unless you stop to focus on it.  All pain and discomfort should be gone.

Finished results
A properly performed implant will leave you with your presurgical size and no functional loss of sensation.  There could be some temporary loss of sensation near the incision that does not interfere with natural feeling intercourse. There should be nothing about the inflated penis that suggests it is an implant.  This is true through either a visual or touching examination.  It should be true during oral sex.  Sex to you and your partner should look and feel the same. Differences will be in the need to inflate by depressing the pump in the scrotum from 10 - 40 times depending on penis size and brand of pump.  This usually takes 45 - 60 seconds if you are starting from the point of total deflation.  The one giveaway of an inflatable implant hen inflated is the pump in the scrotum.  A well-placed pump and implant should not be visible, but the pump can easily be felt, probably not by a cupped hand but by lightly squeezing or probing with the fingers.

In theory, an implant allows a man to have intercourse for as long as he can physically hold out from exhaustion.  In practical means, depending on the individual, there may be sensitivity or a crash of desire after orgasm, and it could take a short refractory period before you want to continue.  Your bionic erection will, however, remain until you push the deflation button on your pump.

Life expectancy of the Three-piece Implant
Estimates and statistics report a wide range of answers, and of course, different men use their implants with a whole range of frequency and duration.  Estimates run from 4 to 16 years, with implants known to fail in 6 months or to last over 20 years.  Both extremes are uncommon.  A replacement implant is usually easier on the patient but more complicated and a little more time-consuming for the surgeon.  Many men have had three implants and function, as well as they did with the first.

Possible complications
The most serious complication is an infection that always results in removing the implant for months before a revision is installed.  The rate with a good surgeon is 1% or lower. 


Some Frequently asked questions in no particular order.

Can you father children after an implant?  Yes, an implant does not affect sperm count or ejaculation.

Can you participate in sports or exercise?  Yes, including mixed martial arts, Trail bikes, and heavy weight lifting.

Is there any loss of sensation - An implant removes no tissue of any kind from the penis.  The skin, nerves, veins, arteries, tunica, and the entire corpus spongiosium and the glans are just like they were before surgery.  The implant does not interfere with sensation.  Your sensation will be as it was in the months before surgery.

Can an implant correct my deformity?  The answer is definitely yes.  The degree of deformity correction depends somewhat on the surgeon's skill, but with incision and manual remolding, some skilled high-volume surgeons like Dr. Eid can correct almost any deformity (even over 90 degrees).  Some may take some daily cycling of the implant.  I had a significant dent in the base and a minor 10-degree curve.  Both were made perfect while still on the operating table.  Men on this forum have had 60 degree bends completely corrected on the operating table.
Link --->An Example of a Penile Implant Straightening a Severe Deformity - Peyronies Society Forums

Since only the two side chambers get inflatable cylinders, will my glans enlarge during arousal?  This is a more complex answer. Your glans will respond as it did before the implant.  If you had total erectile dysfunction, then your glans will not enlarge without either oral erectile dysfunction medication, a safe cock ring, or MUSE inserted into the urethra.  If you only had partial erectile dysfunction, both your glans and entire spongiosum will enlarge and sometimes a partial erection from blood flow around the cylinders.

Logged
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

TonySa

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Re: So you are beginning to wonder if or when you should consider an Implant
« Reply #1 on: November 03, 2018, 04:40:56 PM »

Great summary Hawk!
Logged
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.
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