Dr. Andrew Kramer & Titan

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pichou

I went to see Dr. Kramer in his Cape Cod office yesterday for an evaluation for an implant. I went to him because I saw his name on this forum. I've also seen Dr. Munariz from Boston University Medical Center. Which Coloplast Titan calls a Center of Excellence. Dr. Kramer recommended I get the Titan implant. My question is what do know about him? His outcomes, How he treats his patients post-op etc? All you ever hear about on this forums are Dr. Eid and Dr. Milam.
The biggest downside I hear the most about the Titan is the " dog ears " when it is deflated and how uncomfortable it is when deflated. Do you mind telling if that what your experience has been with the Titan?
Btw I'm 75 in very good physical shape. I've had Peyronie's for over 20 years.
20 years Peyronies Disease, tried VED, pills, Trimix & more
ED 15 years.
Hour Glass at base 30 bend left at glans
Penile Implant 7/19/21 Dr. Andrew Kramer
Penoscrotal approach
AMS CX 18cm 2CM RTE

Hawk

Congratulations on taking a bold step.  I am amazed how you have been a member, and I am just now getting to know you.

I will start with a short answer and then give a more detailed answer that you should read.

Short Answer - Dr. Andrew Kramer is beyond a doubt one of the few GREATS.  He is as good as any doctor on Earth.  It is almost a coin flip between him and Doctor Eid.  You can be assured that he will aggressively size your implant, and he has experience with every type of complication that could arise. He is one of two doctors I would go to without any further opinions or thought.

Titan dogears are non-existent within 18 months.  Early on, most men notice their existence, but I know of no one who has been bothered by them.

Long answer - Dr. Kramer has dozens if not hundreds of YouTube videos.  His patients report that he is very responsive.  Probably more than almost any surgeon you will find, with the exception of the extreme accessibility of Dr. Eid.  When I got my implant, it was a flip of the coin since they were equal distances from me.  Dr. Kramer is a world-recognized high-volume surgeon.  He will NOT stack rear-tip extenders that do not inflate to get the right size.  He will give you a larger inflatable implant. The fact that you think Dr. Milam is spoken of on this forum tells me you have not studied the Implant Board for a LONG time.  The only patient and fan of Dr. Milam was the first implantee on the forum (JackP, who died several years ago).  I know men who are strongly outspoken against him, mostly due to his manner.  He would not be a consideration for me, even though he is probably a good surgeon.

If you have any of the following, Titan is what you want
1. Any Penile deformity such as bend, dents, or hourglass deformity
2. If you are more than 5 1/4" in girth or have lost considerable girth
3. If having a smaller, less obtrusive pump means a lot to you.
4. If you are 6" or longer ( it will give you a more rigid "erection" that won't bend

If you have none of those and your penis is under 5 1/2" (Bone-pressed stretched flaccid length BPSFL ), Then you might consider a Boston Scientific LGX.  It gives you a smaller flaccid penis and will likely be a great implant.

I can assure you that you will have to fight the disgust after you get an implant.  You will be disgusted that you did not do it years ago.  That is the case with all of us.  You will eventually get so lost in having an unstoppable penis that you will get over the disgust pretty soon.

I cannot recommend strongly enough that you read some of these journals.  It is an education.  Also if you want to talk by phone, just send me a private message with your phone number and a good time to call.

Anon's Implant Journal - 34 yrs old, 50-degree curve, no Erectile Dysfunction Titan, Dr Haaky, Atlanta
Cold Brews Implant Journal - 22cm Titan, Dr. Lentz, Duke University
Curved's Implant Journal - Titan, Dr. Eid
FloppyNoMore's Implant Journal -Titan,  Dr. Eid
Hawk's Implant Journal - Live Now in Penile Implant Surgery - Titan, Dr Eid, awake during surgery
JackP's implant Journal - The first and oldest implant journal on the forum, AMS-LGX, Dr. Milam

Merrix's Implant Journal - The Ultimate Complete Word on Implant Journals- A Must Read - 42 yrs old, Titan, Dr Eid
P-Diddy - Another Implant Journey- Titan, Dr. Eid Experience with several women where the implant was both revealed and kept secret.
Roddy's Implant Journal - From 90 Degree bend to straight - Deformity only, no erectile Dysfunction, Titan, Dr. Mike Fraser - Glasgow
Stepone's Implant Journal - Titan, Dr. Lentz, Duke University
SteveW's Implant Journal, Gay man - 20 Years of Peyronies - AMS with RTE's, Dr. Etai Goldberg, Saint Louis, MO
SW01 Implant Journal - Titan, Dr. Campbell, Cincinnati
TDix's Implant Journal - 46 yrs old,Titan, Dr Faysal Yafi, Orange, CA,
Tomas' implant journal - AMS CX, 80 yrs old, Dr Avila

FINALLY, I would like to know more about you to put in your signature line:
Are you married or in a steady relationship?
Do you have deformity?  If so describe
What degree of Erectile Dysfunction do you have?

Best Wishes
Hawk


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

SteveW

Hawk,
One thing that may come into play when considering Titan or AMS, as it was explained to me, is the size of any plaque Pichou  may have as a result of the Peyronie's he mentions. I wasn't a candidate for either the Titan or the LGX because of the size of the plaque mass in my penis. The Titan is often preferred for overcoming Peyronies Disease curvature and bending, but can't, it seems, be deployed in all Peyronies Disease cases. It's what I wanted, but this CX is amazing, for me. This is a conversation and evaluation to be done with his surgeon.
Steve
20 years of Peyronie's / ED
Tried pills, VED, Verapamil injections, traction, Trimix & more.
Implanted 2/18/21. AMS cx 18cm + 3 RTE. Gay, 67.
Dr Etai Goldenberg, St Lous, MO
Now having lots and lots of wonderful sex!

Hawk

That a great point, Steve.  I think all manufactures of 3 piece inflatable implants make narrow cylinder models for such situations.  However, Dr. Kramer a least thinks he is good for a Titan as of his preop evaluation.
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

Stepone

I have had my Titan implant for over two years.
I can still feel my dog ears when totally deflated.
They are not as prominent as they were when first installed, but they are still there.

I don't care about the deflated penis appearance at all, to me, it's all about the rigidity, the girth, and the length.
We are both very happy.
StepOne
Nesbit surgery 2015, 66 years young, Titan Implant 4/25/19, 22cm, Dr. Lentz, Duke University NC

Hawk

That is interesting.  I have had my implant for almost three years.  In the early months, the deflated cylinders felt similar to an empty water bottle (somewhat stiff and crinkly).  Now they feel like rubber or silicone.  They feel similar to thin surgical tubing or even a large vein.
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

Pfract

Pichou... You would be in amazing hands with Dr kramer. He started practicing there after leaving chesapeake urology. I followed many journals online of patients that went to him. 90% or more had a very good outcome and he was always there for his patients to sort out issues that sometimes arose.

What was your impression of his office and staff?  

pichou

Thank you all for your replies. They have been very helpful to me. As I get closer to my implant date I'm getting a little nervous. Hearing from other members helps. Pfrat I liked him and his office staff. It was good to hear what you said about his outcome. My only concern was that he only stretched out my penis and said I had good length and girth and would recommend a Titan. He didn't do any measurements. I'mscheduled for surgery on 7/19.
20 years Peyronies Disease, tried VED, pills, Trimix & more
ED 15 years.
Hour Glass at base 30 bend left at glans
Penile Implant 7/19/21 Dr. Andrew Kramer
Penoscrotal approach
AMS CX 18cm 2CM RTE

SteveW

Pichou,
This is really just my personal opinion, from reading here and my own experience, so take it for what it's worth. I don't think pre-op measurements actually mean a lot, and aren't necessary in the hands of a good surgeon. During my last pre-op exam with the doctor, he grabbed my penis, aggressively pulled hard on it and said I would probably need a 18-20cm size implant. The precise measurements are done in the operating room, and my doctor was right. I received an 18cm AMS cx, and it seems to be a really good fit. Your surgeon is one of the best, he knows how to fit an implant.
Steve
20 years of Peyronie's / ED
Tried pills, VED, Verapamil injections, traction, Trimix & more.
Implanted 2/18/21. AMS cx 18cm + 3 RTE. Gay, 67.
Dr Etai Goldenberg, St Lous, MO
Now having lots and lots of wonderful sex!

Hawk

I totally agree with Steve's comment with one small addition.  Doctors don't measure penises pre-op, so they will know what size implant you will need.  The benefit of measurement and documentation is so you have assurance your pre-op size is on record in case there is an issue.

There are only two surgeons in the world I would personally trust doing an implant without pre-op measurement and documentation and you are scheduled with one of them.
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

pichou

Thanks everyone. everything you said makes sense and makes me feel more confident. I'll trust that I have a great surgeon. A working penis is all I'm hoping for.
20 years Peyronies Disease, tried VED, pills, Trimix & more
ED 15 years.
Hour Glass at base 30 bend left at glans
Penile Implant 7/19/21 Dr. Andrew Kramer
Penoscrotal approach
AMS CX 18cm 2CM RTE

tshug

I haven't visited this site for a little while, but I'm glad I did today and seeing pichou's post. From what I've read here pichou you're in good hands with Dr Kramer and I wish you the best of luck on your surgery.

As I've mentioned in earlier posts I'm looking to have my implant replaced and consulted with Dr Eid earlier this year. He advised replacing my CX with a Titan and I was going to schedule it with him for later this year. I had thought about seeing Dr Kramer as well, but with his office in MD it was to far for me.

Being from the Boston area I was also looking for a high volume surgeon in this area and had planned on seeing Dr Munnariz later this month for a consultation.

I was thrilled today to see that Dr Kramer is now practicing on Cape Cod. I plan to call his office  tomorrow and schedule a consultation with him and get his  opinion on replacing my CX.
71 Yrs old
Radical prostatectomy in 2017.
That surgery left me incontinent
2018  implanted AUS 800 artificial Urinary Sphincter
ED & Peyronies
AMS CX Penile Implant Surgery 12/16/2020
Revision- CX replaced with a Titan 20cm + 1 rte 10/26/21 Dr Eid

Hawk

I don't want to take this topic off course but I want to make a critical point.  Pichai started by Private Messaging me.  I told him I have a policy of not answering Peyronies Disease questions by private message. I asked him to post his question on the open forum and I would answer so others could benefit from the exchange.  In addition, he would have the advantage of opinions every bit as valuable as my own. Private messaging deprives others of critical information.  He felt his questions were not important or unique but he agreed to post.

Within days, the contribution of his post made a huge difference in Tshug's decision-making process.  That is how a forum is supposed to work.  Private messaging robs support from those we most want to help.
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

pichou

Hawk is right. I didn't think my questions were important enough to post. Tshug I'ts great you are going to see Dr. Kramer. I would be interested in hearing what you thought of Dr.Munnariz. Good luck
20 years Peyronies Disease, tried VED, pills, Trimix & more
ED 15 years.
Hour Glass at base 30 bend left at glans
Penile Implant 7/19/21 Dr. Andrew Kramer
Penoscrotal approach
AMS CX 18cm 2CM RTE

tshug

Pichou, I was able to make an appointment to see Dr Kramer next Friday 7/9. My appointment with Dr Munarriz is not until 7/15 and after meeting with Dr Kramer I will probably cancel that appointment.

I don't have a lot of info on Dr Munarriz and haven't seen or heard of anyone who has had implant surgery done by him. Dr Eid mentioned him as a Boston area implant surgeon when I met with Dr Eid. I think even if I met with Dr Munarriz I still would have had Dr Eid do the surgery.

After having my implant sized wrong by my previous surgeon I want the best penile implant surgeon doing my next implant surgery. From what I've read here on this forum I'll feel a lot more confident having it done by either Dr Eid or Dr Kramer. I'll decide on which doctor after talking with Dr Kramer.
71 Yrs old
Radical prostatectomy in 2017.
That surgery left me incontinent
2018  implanted AUS 800 artificial Urinary Sphincter
ED & Peyronies
AMS CX Penile Implant Surgery 12/16/2020
Revision- CX replaced with a Titan 20cm + 1 rte 10/26/21 Dr Eid

pichou

Tsug, That's great. You got in to see Dr. Kramer really fast. Let me know what you think of him after your appointment.
20 years Peyronies Disease, tried VED, pills, Trimix & more
ED 15 years.
Hour Glass at base 30 bend left at glans
Penile Implant 7/19/21 Dr. Andrew Kramer
Penoscrotal approach
AMS CX 18cm 2CM RTE

Stepone

Tshug,
Curious here.
Where is Dr Kramer practicing urology now?
Did he leave Maryland completely?
StepOne  
Nesbit surgery 2015, 66 years young, Titan Implant 4/25/19, 22cm, Dr. Lentz, Duke University NC

Hawk

Dr, Kramer is "permanently" located at:

UAACC ( Urology Associates Of Cape Cod)
Andrew C. Kramer MD
110 Main Street
Hyannis MA 02601
Office: 508-771-9550
Fax: 508-862-6358
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

tshug

Stepone, I don't know why Dr Kramer changed locations, but I was lucky to find out that he did thanks to pichou's post. His new location is only 1.5 hrs from where I live.  
71 Yrs old
Radical prostatectomy in 2017.
That surgery left me incontinent
2018  implanted AUS 800 artificial Urinary Sphincter
ED & Peyronies
AMS CX Penile Implant Surgery 12/16/2020
Revision- CX replaced with a Titan 20cm + 1 rte 10/26/21 Dr Eid

Hawk

He changed locations because he fell into disfavor with his prior hospital because he gave politically-incorrect testimony as an expert witness in a rape case.

I could write a chapter on the absurdity of it but I will leave it with that.

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

tshug

Pichou, I had my meeting with Dr Kramer today. I found him to be very friendly and knowledgeable. I will be scheduling surgery by him later this year.

I don't want to confuse your posts with mine since everyone's cases are different so I will create a new post with more details on my visit today.

Good luck with your surgery later this month and keep us updated on your progress.
71 Yrs old
Radical prostatectomy in 2017.
That surgery left me incontinent
2018  implanted AUS 800 artificial Urinary Sphincter
ED & Peyronies
AMS CX Penile Implant Surgery 12/16/2020
Revision- CX replaced with a Titan 20cm + 1 rte 10/26/21 Dr Eid

SW01

As everyone says. Find the best doc you can. Then trust them. If you have peyronies, get the titan. Period. My first implant was a titan. Straightened me out and was really close to pre ed size when it mysteriously quit working after hernia surgery.

Special circumstances had me use my local uro for a replacement. Ams 700 was installed. Very good experience and doc ended up doing a great job. I got lucky on that one.

Ams 700 has been in for about 16 months. Still hate the damn pump. Big and blocky. Cylinders though are softer. So much so that my natural curve showed back up. No curve with titan at all. Still no plaque or any peyronies issues. Just a slight banana type curve. My wife ended up happy it showed back up. On the in and out, curve causes glans to pressures that spot she likes. So cannot complain. Much.

Oh loved my titan pump a lot. Small and a lot easier on my boys in the scrotum.

Good luck.

Dealt with ED, 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.

pichou

I had my implant done on 7/19/21 by Dr. Andrew C. Kramer. To say I was super anxious is an understatement. I've had other surgeries and never have I been so nervous.  ;D It's a good thing I was the first surgery of the day. I was on my way home by 10:30 am. I only had a 1 hour drive home so it wasn't bad

I was expecting a Titan but I ended up getting am AMS 700 CX. 18 cm with 2 2cm RTE. Dr. Kramer later told me he is almost exclusively putting in AMS implants.

My first night was uneventful. In the morning around 7:30am it was time to take out the foley catheter and take off the dressing. When I took off the disposal underwear that he put over the dressing I understood why he called it a " mummy dressing " My scrotum and penis were completely covered and rapped in the dressing only the very tip of my glans with the catheter stuck out. I decided to take out the catheter first and it came out with no problem or pain. I then started to unwrap the dressing. When I finished unwrapping it. I was in total shock. I thought " What the hell did I do ". I was Black & Blue ( more black than blue ) from my pubic bone down to rectum. I was also swollen from my pubic bone down to my rectum. Because of the swelling my penis looked about 1 1/2inches long. My balls were as big as a softball. I was also oozing blood from the incision on my scrotum. I put a pressure dressing on my balls and called Dr. Kramer's office. No one got back to me on Tuesday. I called back again Wednesday morning. Dr. Kramer called me back and said he never got the message. I also began to put ice on all the swelling about 6-8 times a day. He said if it wasn't improving by Monday I could go in to the office to see him.
Over the course of the week the swelling gradually went down and the bruising and bleeding got a lot better.

I saw Dr. Kramer on Tuesday. That was a 2 week follow-up. I still have a little swelling and a little bruising on my glans, penis and scrotum. My penis is a little sore and my balls are still very sensitive. He said all this was normal and he's happy with the results.

I thought the pump sits high in the scrotum but he said he thinks it's good. He did say I could pull down on the pump 2-3 times/day to try and lower it some more if I wanted to. I'm not sure how to go about doing that.

I asked about keeping my penis pointed up towards my belly button. He doesn't think that's necessary but if I wanted to do it he has no objection.

He said I could start taking baths if I wanted to. I was inflated to about 20% after the implant ( It didn't know that ) He deflated me to 0%. It didn't hurt.

I have another appointment with him in 2 weeks. He said I can try cycling in another week and get familiar with the pump before my 4 week visit. He's going to cycle the implant then and have me do it.
I asked him about a cycling protocol and he said he doesn't really have a strict protocol. He said you can cycle anywhere from 15 minutes 1-3 times a day.

I still have a hard time figuring out the pump. I can feel the bulb but not the deflation valve. I guess I'll just always walk around with a hard on  :)  
20 years Peyronies Disease, tried VED, pills, Trimix & more
ED 15 years.
Hour Glass at base 30 bend left at glans
Penile Implant 7/19/21 Dr. Andrew Kramer
Penoscrotal approach
AMS CX 18cm 2CM RTE

Hawk

Quote from: pichou on August 05, 2021, 07:02:25 PM
I still have a hard time figuring out the pump. I can feel the bulb but not the deflation valve. I guess I'll just always walk around with a hard-on  :)

Well, that might be annoying but still a lot better than never walking around with a hard-on.  :)

I think you actually have one 2cm RTE.  (one on each cylinder but that is referred to as one).


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

nemo

Great report, Pichou!  Will be following closely your progress.  Stories like these are like "implant school" for those of us considering the future.

Best of luck,
Nemo
51 yrs. old, multiple auto-immune conditions. First episode of Peyronies Disease in 2002. Recurred a couple times since. Over the years I have tried Topical Verapamil, Iontophoresis, all the supps and Cialis + Pentoxifylline. Still functional, always worried.

tshug

Pichou, it took until most of the swelling was gone after 4 weeks before I was able to comfortably find the deflate button on my CX. It sounds like you're  progressing well and hopefully that will continue. As for pulling down on the pump once you can feel the small bar at the top of the pump where the deflate button is located you should be able to gently grab the bar with two fingers and gently pull down the pump down. I was able to this during my recovery and it helped in positioning the pump especially while sitting. Please keep us updated as you continue to recover.

From your post it seems strange to me that Dr Kramer is mostly implanting AMS now where from what I've read here he's successfully used both AMS and Titan in the past. I haven't found anything negative or seen any recalls lately on the Titan. I have another consult scheduled with Dr Eid at the end of August and with Dr Kramer in September to discuss my implant replacement and will ask both of them again about which implant they would use and why.
71 Yrs old
Radical prostatectomy in 2017.
That surgery left me incontinent
2018  implanted AUS 800 artificial Urinary Sphincter
ED & Peyronies
AMS CX Penile Implant Surgery 12/16/2020
Revision- CX replaced with a Titan 20cm + 1 rte 10/26/21 Dr Eid

Hawk

Surgeons tend to lean toward one implant or the other.  I suspect there are incentives offered by companies and since doctors consider the implants are of similar quality they have no problem promoting one.   That is total guessing on my part.

There are no recalls.  Both implants have been on the market for many years.
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

pichou

Thank You Everyone the replies. Another week has gone by and my post op days are getting better. I'm in my 3rd week and all the bruising is gone. My boys ( balls & scrotum ) are still sore but better. I still can't feel the deflate button but will work on that.
I have been working on the pump placement. I've been gently pulling on it once a day but it doesn't seem to be moving. I still get these twinge's in my scrotum for no reason. I've read other guy's have experienced the same thing.
I understand a lot of doctors may prefer one implant over another. I just think they should say that right up front. The other thing Dr. Kramer told is that he see's less infection rates in " HIS " practice with AMS implants.
20 years Peyronies Disease, tried VED, pills, Trimix & more
ED 15 years.
Hour Glass at base 30 bend left at glans
Penile Implant 7/19/21 Dr. Andrew Kramer
Penoscrotal approach
AMS CX 18cm 2CM RTE

pichou

I should have also added I think I'll be very happy with the AMS CX. I just wish it was my choice. Also I haven't loss any size at least in the deflated state and I can feel the tips of the implant in my glans.
I have also started exercising without any problems. :)
20 years Peyronies Disease, tried VED, pills, Trimix & more
ED 15 years.
Hour Glass at base 30 bend left at glans
Penile Implant 7/19/21 Dr. Andrew Kramer
Penoscrotal approach
AMS CX 18cm 2CM RTE