When can I get an implant, amongst other questions

[Lostandsad]

I'm only almost two months into the acute phase of Peyronie's, so naturally I was pretty hesitant even thinking about getting an implant, but this has been taking a huge toll on me mentally. I'm starting to get more pain, more plaques, hinge points, and I'm starting to get ED, even with daily Cialis and all the other supplements I take. I kind of just want to say f it and get an implant so I can be happy and be in a good mental space that I once was in, before Peyronie's, and live my life(I promise I'd still stick around on these forums though)

So my questions are, how long do I have to wait until I can get an implant? Do I have to wait until everything stabilizes?
I would plan to see Dr. Eid because from what I've read, he seems to be the most skilled, and the most compassionate. But, he's nearing retirement age(also another reason why I want to get the implant sooner than later).
If I get the implant done by him and he retires, which surgeon do I see to get a revision?
What do surgeons typically do during these penile implant surgeries for Peyronie's patients? Do they get rid of the scarring/plaque during the surgery? (I assume a surgeon of Dr. Eid's caliber takes pride in his work and tries to do everything in his power to make it look as nice as possible)

Thanks in advance everyone.

[Hawk]

You are early in the process to get an implant, especially at this age.  You have to wonder how much of this ED is related to distraction and stress over your condition.

Your signature line does not mention whether you are in a stable relationship.  You don't give details about your ED.  Can you have intercourse?

In answer to what is done during an implant, that varies by surgeons.  Any high-volume skilled surgeon will manually remodel the penis with the force of the implant and his hands.  With a Titan, that is often all that is needed.  Dr. Eid (and I am sure others) will make relief incisions, especially if the bend is near the base of the shaft since that area is readily accessible through the scrotal incision.

Some doctors will do incision and grafting, but that usually involves degloving the penis with an incision around the shaft right behind the glans (sub coronal incision).  That is a far longer surgery with a significantly longer healing and a greater chance of infection.  Dr. Eid would say grafting is rarely required to straighten a penis if an implant is being installed.

[Lostandsad]

I'm in a long term stable relationship of 3 years. Sex was manageable, up until the last time it was too painful to even last 3 minutes cause the new hinge point made it too painful.
My Erectile Dysfunction was manageable to daily cialis but it's starting to lose some efficacy.
I don't think it's entirely related to distraction and stress due to this condition, since during tough times through other bouts of depression unrelated to Peyronie's, I've used sex as a way to cope.
I'm uncircumcised, does that mean I have to get circumcised before getting an implant too?

[nemo]

I would agree with Hawk that you are probably jumping the gun here. You're just a couple months into the active phase, and there's a decent chance that you will see improvement yet. Especially once the pain subsides, I suspect your erections will be stronger and more resilient, even if the visible signs of the Peyronies Disease are still there. You just have no way of knowing yet, and to eliminate even that chance by going straight to an implant would be unfortunate.

Plus, the longer you go without playing the "final option" card, the less revisions you will need over the course of your life.

I say ride this out - and I understand the mental duress, believe me.  Ride it out and see how you turn out. Only once you're well into the chronic stage should you assess and decide whether or not there's a way forward with your natural erections or not.

Just my two cents,
nemo

[Jimmi85]

Strangely, I was just about to start a New topic asking pretty much the same question.

I'm 36, diabetic, suffer from PE and a 50-60 degree upward curve.

My peyronies Started about 2 years ago and although I can have intercourse, it is sporadic, limited to one position and doesn't last very long 😂 I have been in a relationship for 5 months, the first once since my Peronist started and it's taking its toll.

I can get erections, but often not strong enough for intercourse - will a surgeon still fit an implant?

I have lost almost 2.5 inches and have gone from being able to go for a hour or so to maybe a minute if I'm lucky and it's really taking it's toll on my mental state of mind.

Also, as a diabetic, I am more prone to erectyle dysfunction so if it's going to happen in any case I would like to sort it now while I'm still young.

[Lostandsad]

Jimmi, you seem like a better candidate than me.

It's hard mentally right now, just even getting out of bed and getting through day to day. I know it's early and I shouldn't give up but damn it has not been easy. My gf sees how stressed, depressed and unhappy I've been lately and she supports whatever I'm gonna do. I have the time and money to get it done, so it's been on my mind now...
I just got my PMP and SomaErect VED, but I fear if none of this works after a year, and Dr. Eid retires, that would make me even more depressed. I know he's not the only one, but he is certainly the best in my opinion.  

[GaussRifle]

 How old is Dr..Eid and do we know if he has been training someone equally skilled ?

[Lostandsad]

He's 68 years old. I'm not sure if he's training someone, I sure hope so.  

[Hawk]

A good surgeon is more than training.  It is:
Natural Talent
Experience - several thousand implants. (300 implants a year for decades)
Love for the procedure
Compassion
Bedside manner
accessibility
a trained team - unlike most who get pool-assigned surgical assistants, Dr. Eid takes the same crew into the OR every time. (other than anesthesiologist)

[Jimmi85]

i actually have a video consultation this evening. Being based in the UK i don't have the same options as those in the US but the Dr I'm scheduled to speak with , DR Nenad Djakovic seems like he knows what he's talking about.

I know this might sound like a silly question, but what questions should I be asking him? I think I'm pretty much set on a three piece inflatable so I guess his volume is important among other questions. What are the other must say questions?

[Hawk]

There is certainly NOTHING silly about getting input for questions before consulting a doctor for any condition.  It is silly not to.

Here is a post worth reading (full disclosure - I wrote it     )

https://www.peyroniesforum.net/index.php/topic,10810.msg100840.html#msg100840

[Jimmi85]

Thanks Hawk, that's a great read.

So he seemed like a nice guy and knew what he was talking about......i think.

He recommended incision and graft over the Plication and Implant and i don't know how i feel about that. With my diabetes, lack of NTE without daily Tadalafil and sometimes weak erections even with it along with my PE i am worried even if I don't get a horrible infection or nerve damage ( both greatly increased due to Diabetes ) i will have a straight penis that cant always get hard enough for intercourse...

Interestingly, he said the Peyronies doesn't have any impact on the ability to get an erection, that is, my erections will be the same post surgery than they are now. I was always of the understanding that the scar prevented normal bloodflow and therefore erections tend to be weaker?

In terms of his volume, he does 50 implants a year, and 90 Incision and Grafting. Being based in the UK with a population 5 times less than the US, i assume these arent bad numbers?

He is sending me more information via email today, to include what implant he uses and will then spend the next few weeks deciding which route to go down.

Part of me thinks have the Incision and graft first and then the implant if I'm not happy with the outcome but then why put myself through two operations?

[Lostandsad]

I think you're better off paying more money to see a more experienced, higher volume implant specialist. Peyronie's fibrosis is known to cause erectile dysfunction. For him to be saying that it doesn't cause erectile dysfunction, is a huge red flag to me. Guaranteeing you will have the same erections post surgery is another red flag. Clearly he has more experience with incision and grafting, which is why he's recommending you to do that first.

https://pubmed.ncbi.nlm.nih.gov/21595832/

I would avoid him like the plague.

Hawk and Nemo, I know it's early for me, but man I'm tired of taking a million pills a day, hours of traction/heat, and not even seeing a slither of improvement. I understand it's a marathon, not a sprint, but it's affecting me mentally too much. I can go the implant route if I pay out of pocket right?

[nemo]

I'm not saying you couldn't find some doc willing to implant you, but I would see implanting a guy your age, only 2-months into Peyronies Disease, to be borderline malpractice. There's just too many guys who get better to some degree, not worse, to make an irreversible decision like that.

In the last ten minutes I just read an account on one of these threads about "markdubby" whose two initial plaques have nearly disappeared and his indentation and hinge is steadily improving.

Imagine if he'd been implanted two months in.

Again, I say you have to not get ahead of yourself.

nemo

[Lostandsad]

It's affecting me mentally too much. I even try to write about things I'm grateful for, but I can't snap out of the depression. For every person that shows improvement, there's also a bunch who don't. I'm losing sleep and skipping meals. I struggle to get out of bed. I'm constantly reminded when I look down and see the torsion, the plaques, how my penis looks all messed up. Really messing with me mentally. I can't have sex like I used to, and the pain really sucks. Again, sorry for the rant. I'm probably going to try to contact Dr. Eid soon to see what he says.  

[Ontheroad]

My recommendation from my experience. Get an appointment with Eid ASAP, he will tell you how to proceed. If you need an implant, just get it, it will prevent things going worse.

Get professional advise, they will tell you how to proceed and if you have to wait, they will also tell you that.

Wish you the best!

[Hawk]

Even if you get an implant you need to use traction and/or VED of a couple of months before.  The surgeon will likely NOT tell you that but you are apt to get a larger implant so you just as well get started.

[GaussRifle]

I second Hawk's advice and VERY STROGLY urge what he told you. We all know what you are going through, we all see the indentation,  weak erection , disgust on looking down and all of that but that doesn't mean that you skip steps in order to get the best outcome. Even if you are adamant on getting the implant, you still  needs a bare minimum of 3 to 6 months of traction or/and VED to get the biggest implant in you with both great length and girth.

[nemo]

I feel for you, because I know what a mental spiral this disease can trigger.  Many of us have been there at some point.

There's no one better to talk to than Dr. Eid, it seems. I'd recommend providing him pictures of your erection from various angles so you and he can discuss exactly what's going on and what an implant would do.

I do wish you the best, and I'd bet having a discussion with Dr. Eid will at least give you some peace of mind that you're proactively finding resolution to this.

nemo

[Lostandsad]

Thank you all for the support/advice/responses. I feel so alone in this, so anyone who takes the time to respond, it means a lot to me. My gf says I should see what happens in a year, and we can go from there. I don't know, a year is pretty damn long time considering how much of a struggle it is getting by day to day. Hopefully after all the traction/VED, I'll see improvement to the point where I change my mind about the implant/don't need it anymore. The scary part is if I don't improve and Dr. Eid isn't available anymore.

And question Hawk, for the Titan, it looks like the tips are pretty sharp. Was that at any point uncomfortable for you at all?

[GaussRifle]

Dr.Eid os not the only top specialists. I bet there are others in the cou try too.. What's your age lostAndSad if I may ask ... if you are really just 32 or 33 then you will likely need more revisions down the road... Dr Eid will definitely not be practicing then ... so you'll be forced to go to another top doctor anyway.

[Lostandsad]

I'm around that age yeah, I don't want be too specific cause of privacy reasons. I understand he's not the only one and I'll certainly need a revision down the road. But if I do go down the implant route, I'd feel the most comfortable going to him first, since the location is the most convenient for me, plus his skill/experience/team is top tier.  

[Lostandsad]

Does anyone know if Dr. Eid can clear out the scarring that's pushing against my urethra during the penile implant surgery? My frequent urination issues are getting much worse. I've had a cystoscopy a little over a month ago and there was no stricture. And my urine culture was also negative. I just sent a message to their team and I'm waiting for a response, but would also like to hear your opinions.  

[Hawk]

That is way too specific to your case for us to speculate.  I part it will depend on how close it is to the base.  He will work through a scrotal incision, so he cannot work on the distal end of the shaft.  You will know more when you have your initial apt with him (whether in person or video conference).  Send him photos of your penis erect and flaccid before the first visit and write your questions down and take notes or have someone else take notes while you talk.