Should a patient have a choice what implant or how its put in?

[2Oldfords]

    I called my Dr.'s office to get some questions answered about this upcoming surgical procedure.
I asked would he install a titan instead of AMS. answer he has installed them but he normally uses AMS. I just wanted to know would he be objective as to what might be best for me as titan might be better for men with peyronies. I asked what method he used to install, infrapubic or penoscrotal. answer infrapubic. I know this takes less operating time but I would prefer the penoscrotal route. Is this something a patient should have a choice on? I really didn't have a pre-surgical appointment I was told this is your only option when he saw my erection during office exam. I was given a sample ams valve and then to admin to get pre-surgical approval which I found out today has been approved. I asked should I have an appointment to go over the details? or am I just supposed to show up the day of surgery? answer just show up day of surgery, by the way I'll call you and tell you the surgical day and time. I said wait I have a day picked out that is 2 months off. That shouldn't be a problem right? there is plenty of time to get everything scheduled for that day right? answer ok that day is on Thursday at 1 pm if the Dr. is ok with that and operating room is available.

  Am I just being difficult or am I wrong or just a concerned man that doesn't want to be rushed into something I don't agree with?

[TDix]

I would definitely want to choose what and how when it comes to the finality of an implant.  You shouldn't put yourself in a situation you are not comfortable with.  I would voice my concerns directly with the doctor.  If he is not accommodating to your needs, maybe get a second opinion?  Seeing as your last surgery did not satisfy you I would not proceed into anything you are not completely comfortable with.  That's how I would approach it.  I would hate to hear you had another failed surgery and weren't completely happy with such a big surgical decision.  I wish you nothing but success after all you have been through

[TDix]

Granted I never really had a choice of what type of graft was used on me either.  I put complete trust in Dr Yafi.  If your dr is dead set on using an AMS and going intrapubic, I would ask why.  Is it easier for him?  Just would want clear answers to why.  If he is knowledgeable and proposes convincing evidence to you it may ease your fears

[2Oldfords]

   Thanks Tdix for your reply. Like you, if My Dr. gives compelling reason for using a certain product or performing a procedure in a specific way I would feel more comfortable. That is the reason I called his care team for answers was to help with anxiety. This has to work for me the first time...

[Pfract]

2Oldfords:

You definitely deserve a choice. I was reading through your story, and reminded me of your other post. I start to see a lot of red flags here.

-infrapubic
-ams implant
-doctor not too concerned about explaining options
-too much rush

... IF i where you, i would be booking a video consultation with Dr. Eid. It costs you around 300 bucks and you can do it on the confort of your own home. Alternatively, you can also just arrange a phone call which sits at around 175$ US. You can also choose how much time to book.

My opinion? steer clear from your doctor, and at the bare minimum seek two or three second opinions. You already have some feedback here, and seen the result of patients that went either to Dr. Eid or had a titan put in. Why risk it?

There are also bend tests you can see for both implants. I can find you the link on Pubmed. Titan is clearly stiffer.

[Hawk]

I personally would not have an infrapubic procedure.  That was a consideration on the doctor I choose.  I am not suggesting it is no good, just that it is not my choice for a couple reasons.  Only a very high volume surgeon is likely to have substantial experience with multiple approaches and devices.  That gives you options that you deserve real input on in consultation with your surgeon.  A high volume surgeon has a stock of every device size and does not make up the difference by adding multiple Rear Tip Extenders to the device he has at hand.

You cannot however and should not ask a doctor to try some other doctor's procedure or to install a device he does not install at least weekly.  If he complied, you would likely get substandard skill and experience with that device or procedure.  If you pick a surgeon with a high volume in both, than you can safely express preferences.  Unless he has a satisfactory reason for recommending against your wishes the surgeon will give a lot of weight to your informed preference.

I would have pause with a surgeon that did not seem to be prepared to give you options or at least provide very specific reasons why an option should not be considered in your specific case. If you think his lack of responsiveness is an issue now, just wait until you have an implant and have a ton of questions or a problem.

[Roddy]

I agree with what the others have said. From this side of the Atlantic I, rightly or wrongly, presumed that you guys all had more choice and 'consumer power', so to speak, than us over here in the UK who really just have to go with whichever surgeon we are assigned. From the research I did prior to my implant, and on the back of my close friend's opinion (a Pancreatic surgeon), the most likely route to a successful outcome is a surgeon with high volume. You've heard that before and it's nothing new but when he told me that performing an operation that you're not too experienced in can lead to mistakes/complications, you need to listen. That is what caused me to stop what I was doing, re-evaluate my choice of surgeon, and go with a high volume surgeon.

Something that really impressed me about my own surgeon, Michael Fraser, was when he told me that if there are ever complications he is unsure about, he will not press on regardless into the unknown. Instead, he takes stock, contacts other expert surgeons - David Ralph in London and his colleagues in the States, and together they will review cases together to find the best outcome. He told me those surgeons do likewise with him. When I told me surgeon friend this he said that was the mark of a surgeon at the top of their game - one who realises their limitations and seeks advice from colleagues. Only years of experience can create that. My poor outcome first time around was, I think, because my original surgeon made wrong decisions (major one was excision of the plaque) based upon lack of experience.

So the reason I share all that with you is that your experiences shout out to me that you should be going elsewhere. Like I did. From what I understand for you it's a buyers market to a large extent. Look upon what you are about to do as a final solution to your problems. A one time operation. Make your operation by Dr Eid, or whatever leading surgeon you choose, be a successful one rather than an attempt to try and undo the poor work of a sub-standard surgeon.

[Frank55]

I don't like the sound of this 2OldFords. I'm particularly uncomfortable with the "just show up on the day of surgery" comment. That strongly insinuates a "just take what we recommend without asking questions" attitude. That is the exact opposite of what you want at this point. It also insinuates a production line approach of "one size (and surgical approach) fits all." It doesn't - not by a mile.

I really don't like the sound of this.

[curved]

2oldfords.... agree with what others have said... no way would I compromise on this at all.  Unfortunately it is not uncommon for a surgeon to recommend AMS vs Titan and vice versa depending on whether or not they receive some level of compensation from either company.  I remember seeing a post a few months back listing out which doctors received compensation from either AMS or Coloplast for speaking at conferences, etc.  All that being said there are advantages of AMS vs Titan and vice versa depending upon what your goals are.... however I do believe there is a general consensus to go with the Titan for those with Peyronies Disease because the the implant tends to be more rigid and will help straighten curvature.  However there may be specific case by case reasons where AMS may be better even for those with Peyronies Disease.... I believe AMS may have a bit more narrow cylinders (please don't quote me on that) and may need to be used if there is lots of plaque narrowing the shaft.  I agree with Pfract and would invest the $300 to consult with Dr Eid or perhaps Dr Kramer (don't know the cost for his consult) and get all questions answered on implant and process.  Most importantly, in my opinion, find a high volume implant surgeon that can and will implant either the Titan or AMS depending on what is best for your situation.

[curved]

2 oldfords----https://projects.propublica.org/docdollars.... here is a link to a website that gives some info on whether or not your doc gets $$ from coloplast or AMS.... may be worth taking a quick look.

[SW01]

I saw 3 urologists and passed on them until I found the 4th who did my surgery. One thing all of them did agree on is with my 30 or so degree peyronies curve and the dents and plaque I needed the stiffer cylinders of the titan.

Implanted with a titan an still had a very slight curve right after surgery. After about 3.5 months even that is about gone. No dents and I cannot even find the plaque.

I would at least get one more opinion. Not about getting the implant. Just about selection and incision type. Also how many they do. I eventually went with one who did 1 to 3 a week but averaged about 75 a year. But he answered all my questions. Saw me when I wanted. Called me back when I had questions. His staff was great. Put me in touch with other patients. Had a great surgical team. Great experience but took a chance on a non high volume implanter. He did make it a focal point of his urology practice which was important to me along with being a peyronies specialist.

All in all scared to death not about getting implant. Would have done that years ago. But in choosing doc. I did best I could researching and went for it. But took me 4 to find one I took a risk on.

[tomas1]

It sounds like I agree with what others have advised you.
I didn't realize you had Peyronies or curvature.
To me, that limits you to Titan or AMS CX. Probably Titan.
I also recommend Peno-scrotal, and feel lucky my doctors used it.
He went against my wishes as to model (CX instead of LGX),
and too long RTEs.
I personally would run from that doc and wish I'd gone elsewhere.

[TDix]

 https://youtu.be/zmmEs9craEQ
I know I am biased towards Dr Yafi, but his approach towards a patients happiness should be what you seek in a qualified doctor

[TonySa]

I want to propose something a bit different.
I believe many (if not most docs) have both a preferred brand of implant and surgical approach.  I recommend folks consult w docs to find out their recommendations.  If they offer options, all the better.  But,  I wouldn't ask them to do something different than what they normally do.  I believe a doc doing what they do day in and day out will give the best outcome.
I would not even ask a doc to minimize the RTE's (although I prefer this).  If they're not willing to swap out an implant size they chose initially (and how many will if they must absorb the cost)...I suspect they'd skip the RTE's rather than adding them to maximize length.
Do your research , and if their protocol doesn't match up with your preferences...keep consulting.
Hope this makes sense...

[TDix]

I agree Tony.  I looked at Dr Yafi's website and he promotes both implants, which means he offers both.  If I go that route in the future I would want the option

[Hawk]

A $300 phone consultation or better yet, the same price for a video conference will answer all your questions in a very friendly conversational manner.  You can ask anything and say anything.  I think you would consider it an education worth the price.

[Frank55]

Thanks for that link TDix. Always good to know what options are out there and was not aware of Dr. Yafi until you began posting your experience. It is appreciated.

[Pfract]

I just want to take a moment to thank you all that posted in the thread. Amazing support and plenty of good information right there. Hopefully we will hear from the original poster soon.  

[2Oldfords]

    First off, Thanks all of you for your support, concern and great advice. I truly appreciate each and every one of you for taking the time to help me make decisions.
   I'm sorry I haven't posted back in a little while. I have read each post but have not replied back until now as I have other things going on in my life that I'm dealing with also I was waiting for response from my Dr's office. I missed a phone call from my Dr. so he left a voice mail explaining his reasons for his choices. I wasn't ok with his answers until he called me again and we were able to have a real conversation. I will try to keep this short but he likes the antibiotic coated AMS, I expressed my concern about scar tissue from recent surgery and peyronies deformity and that the titan is supposed to be stiffer so less affected by all the above. He said I hear you, I know your dick has been been pretty beat up with the reconstructive surgery and peyronies. I'll install the CX version and it will take care of all that. I asked how are you going to deal with the hourglassing I have going on now? Will you make incisions to let it expand? He said no he will dialate until the implant can be installed and he is happy with the looks of it. More to come

[2Oldfords]

   Ok, I'm back. We talked about the infrapubic vs scrotal installation of IPP. I expressed that I would be more comfortable with the scrotal approach. He said he had done it both ways, He liked the infrapubic method as the routing of the tubes cannot be felt as easily if at all. He also said that he has used this method many many times in his 30 years and he feels this gives the best results. In his voice mail he mentioned installing the pump laterally. I asked what is that? His answer was the pump is installed to one side of the testicles instead of in between the boys. He said this makes it more accessible and easier to operate. First I have heard of this method. As far as the just show up for surgery he expressed that he knows I live hours from his office so he was happy to answer any and all questions that I might have by phone. I also asked him if this is another night in the hospital and he said yes, I would have a small catheter until morning and yes I would have a drain.
   I will admit I like Dr. Knoll, I think he is a good surgeon and he has always been very personable with me. No I have not talked to any other Doctors yet about doing this procedure. I have had surgery done before with other Doctors and I'm not scared to change. I did find a different orthopedic doctor to work on me when I wasn't happy with the bedside manner of one that had worked on my hand/arm several times.
   Yesterday I received a letter from BCBS. They denied my IPP. Denied as non-covered service per members medical contract which states as an exclusion for treatment of sexual dysfunction regardless of cause. What? They approved the excision/grafting. Another call to his office, spoke to admin person who told me it was approved. She said she didn't read it right and had made a mistake. She is going to talk to the Dr. and re-file. So if they can't get this worked out I will have to wait until I can get on Medicare.

[Roddy]

Hi. I read your reply with interest. You seem confident in your surgeon now and that's good. I wanted to give you a brief insight into my choice of device.

I'm on day 17 post op. I had over 90 degrees of curvature in a downward shape caused by firstly a congenital curve then when that became damaged, the onset of peyronies. With peyronies came hourglassing and a bend to the left also. In short, my penis was in one hell of a mess and completely unusable for sex. I was told by my first surgeon that after his attempt at excision and grafting went wrong that there was little hope of correcting the mess. This led me to a much, much more experienced surgeon who has, so far, not only corrected the mess, but has given me the straightest penis of my life so far. He did this with a Coloplast Titan since the extra strength of this device. My worry pre-op was that an implant once fitted would inflate but merely inflate to the natural shape of my deformed penis. Mr Fraser was very confident that the pressure delivered by the Titan would far exceed any pressure from a natural erection and would, as a consequence straighten me out. This is proving to be the case. The Titan, and the skills of this surgeon, have taken me from 90 degrees to almost straight and he assures me over time it will get even better. So from a choice of device point of view, I'm living proof of the strength of the Titan. Hope that doesn't add to your confusion?

[2Oldfords]

   Hi Roddy and thanks for your insight. I know the Titan has stronger cylinders. I have seen the comparisons of Titan vs AMS. That is why I was convinced I needed one. Dr. Knoll advised that the AMS CX version was up to the task. I don't have any bend that needs to be straightened anymore. I do however have a constricting band from peyronies about midshaft. I was told that after the dilation process during surgery it would be ok. He said the LGX might not take care of this deformity as well and that it might leave a ripple or wavey  appearance that is why he would use the CX instead.
  At some point you have to believe and have faith in a Dr. This would be true for a second, third or forth opinion from other Dr.'s. I hear a lot of people on this forum sing the praise of Dr. Karpmen and Dr. Eid others as well. I ask this, If Dr. Knoll has been doing this for 30 years and was screwing up surgeries on that many people would you not read of any complaints online? You sure can find horror stories from That Dr. in Florida (Perito)? And people on this forum outright say to avoid this guy at all cost. I value everyone's input greatly this is exactly why this forum is so important to people like me.

[Roddy]

Yes, well said. It's very important to have faith in your surgeon and to feel a bond of sorts between you. It's stressful enough without a surgeon with a poor bedside manner who doesn't reassure you. Sounds to me like your doctor has given you the reassurance that you're seeking. I have an extremely limited knowledge of all of this unlike a number of regular posters on this forum. It has been a Godsend to me and supports me on a daily basis when members reply with advice. Good luck with the whole ordeal, sir. I hope you get the outcome you desperately desire. There's so much proof on this forum that the implant process can be life-changing.

[TonySa]

The CX is absolutely an option for peyronies.  My doc prefers the antibiotic coating as well and did an infrapubic approach.  If you're going w him, id seriously consider going w his recommendations on what he does day in and day out as this is what really improves outcomes in my opinion.

[tomas1]

Not to add more confusion, but, I would still opt for the scrotal approach.
It seems to me with the infra-pubic approach you will have 2 tubes having to go possibly 180 degrees from where they egress your penis.
It is possibly a little more difficult to route the reservoir and its tube, but it's just one tube.

As far as the pump position, I've never heard of installing it sideways but I'd like to hear of any benefits to that.

Sorry that I can only really give my own observation from a one time installation.

I've heard many satisfied customers of Perito (sp?). Maybe it's due to the thousands of installations he's performed?

[Hawk]

I am not attempting to dissuade anyone from a chosen procedure or surgeon they seem clear they are gravitating toward.  I do however want readers to know that there is ZERO difference in infection between Titan and AMS and that both provide for an antibiotic coating.  The Titan has a hydrophilic coating on ALL components of the implant.  This coating rapidly absorbs and binds any antibacterial solution of choice prior to implantation and provides increased surface lubricity to decrease bacterial adherence.  Unlike the competitor that puts a coating on cylinders and pumps only, the Titan coats all connectors and RTE's.

The Titan pump is smaller requiring a little more of a learning curve to deflate
The AMS pump is larger and easier to deflate but can be deflated accidentally.

Interestingly enough, the highest volume doctor on the planet says that tube routing is superior with a scrotal approach not to mention that you are left with zero sign of a scar and less chance of nerve damage although nerve damage is not a high risk with a skilled surgeon.

[2Oldfords]

   Ok, I have heard everyone loud and clear, amazing amount of information and advice. I am a little overwhelmed. In the end I will be getting an implant period. Maybe its a good thing my insurance has denied coverage for now. This will give me some time to sort it all out. Hawk I knew both brands have an antibiotic coating of sorts and both have about the same infection rate. I didn't think about the tubes and clamps etc being coated. Thank you for sharing. I still think I would prefer the titan installed penoscrotal  by a great and well respected surgeon. Can I get there anytime soon? No. Right now If my insurance decides to cover this I will have to accept what is available to me if it is reasonable to assume it will be ok. My other option would be to wait until I'm 65 on medicare and retired so I don't have to worry about work and then my options will improve.
   Thank you all for sharing your thoughts with me. I have a lot to think about so don't think If I don't post for a little while I've given up or had my feelings hurt or whatever. I just need time to work it out. Thanks again everybody.

[Hawk]

OldFords, If you decide to wait.  I would use a VED or Traction (preferably both) as you wait to maintain or increase size.  Waiting without stretching and frequent erections means a smaller implant.  Good luck with your journey.

[Pfract]

Understood 2Oldfords. The support you had was amazing. Really nice to see everybody come together to give you really good advice. Remember, don't rush this.

Best of luck

[SW01]

Definitely use traction and ved. My initial curve was around 60 degrees or worse. Got it to about 30 degrees by surgery after 8 months of traction and ved. Also took pentox if you can get it.

Titan implant 3.5 months no realcurve at all now.

Happy to throw the andropeyronies traction device out. Like a torture device.

[Pfract]

Titan vs AMS - lab rigidity test - pubmed article - Peyronies Society Forums

Something that should be added to this thread.