Very confused right now!

[Jimmi85]

 Hi Everyone,

I saw a specialist yesterday, and to be honest I'm feeling very confused right now and quite frustrated.

The Doppler/Ultrasound showed weakish erections and in his opinion they were just about adequate for intercourse but far from ideal.

He has recommended Shockwave therapy along with the continued use of traction and VED ( which i haven't been doing )  and if in three months time there isn't a significant improvement he has suggested plication.

i have two plaques and he measured the angle of curvature at 55 degrees dorsal.

I am very sceptical about SWT but I can see that it can help with Erectile Function but is very unlikely to alter the curvature which tbh i would accept for the relatively low cost compared to surgery.

I see Plication as a pointless exercise as effectively all that is happening is I am shortening myself even further but the plaque and therefore weak erections will still still be present - What's the point in a much shorter, straight penis if it still doesn't get fully erect consistently? Please correct me if this is wrong?!

I really want to push for the implant but it appears i am in the horrible middle ground of not being able to get properly hard for sex all the time but not bad enough to warrant an implant. I will be self funding any surgery so is the final decision ultimately up to me or the consultant?

Thanks

[Hawk]

Jimmy, anyone that can't get erect enough for intercourse is a legitimate candidate for an implant.  The function of a penis is intercourse.  If you can't have intercourse then why would worse Erectile Dysfunction change the picture?

Just because you are a legitimate candidate for an implant does not mean that is necessarily the best choice for you.  For Erectile Dysfunction you get to consider:
1. Oral Erectile Dysfunction medications
2. Injections
3. VED's
4. Implant

For straightening, you get to consider
1. Traction, Xiaflex
2. Traction and VED alone
3. Nesbit Plication
4. Excision and Grafting
5. An implant

You have a right to assess these for the pros and cons and make an informed decision.

Considerations are:
1. Your age
2. The degree that Erectile Dysfunction reduces satisfaction to you and your partner
3. The degree your bend reduces satisfaction to you and your partner
4. Likelihood of success for bend and Erectile Dysfunction
5. Risk involved (current and future)
6. Your accessibility to a very successful physician for your chooses procedure

An implant by a great high-volume surgeon is the only solution likely to resolve both issues with one out-patient procedure.  It will also likely restore some length and prevent future loss.  At your age, it does however almost guarantee future revisions.

In regard to shockwave therapy, Dr. Trost for one recommends against that in all situations https://malefertilityandpeyroniesclinic.com/peyronies/treatments/

PS: I deleted the duplicate post you made in the Genera; ED discussion board.  Double posting is a violation of forum rules.

[Kobegianna]

In my personal experience I would highly recommended not doing shockwave therapy. Not only is it a waste of money but may make your Peyronie's worse. The idea behind it is that it actually induced little inflammation to cause angiogenesis. Which is the formation of new blood vessels thus in theory making erections stronger. But Peyronie's is mostly thought of as an inflammatory disease causing over growth of scar tissues.

If you already have curvature of over 50 degrees and erectile dysfunction. I truly believe you are wasting money and possibly making your Peyronie's worse with shockwave therapy. I talked to doctor Trost also about shockwave therapy and he does not approve. But just do your due diligence and get different opinions from other urologists.  

[Jimmi85]

sorry Hawk, i didn't realise it was a violation double posting and i didn't know what category it fitted into.

I wasn't expecting miracles with the ESWT but i am surprised to hear that it might make the Peyronies worse. At best i hoped it might make my erections stronger, at worst i would see no difference at all.

I can have sex, but in very limiting positions and my partner tells me i am rarely ' properly hard' .

If the Uro is suggesting two procedures which i don't believe are right for me, then I'm thinking he isn't the right man to implant me. :-(  

[Hawk]

The very fact that your "specialist" is recommending Shockwave therapy (Ineffective and potentially dangerous) and a Plication (totally inadequate for your situation) has to lead anyone to question his value to you as a physician.  

Even more important than picking the right procedure for you is choosing a top-notch specialist. Unfortunately, the one you have seems to fall very short of that standard.

[Pfract]

Adding to this post, i have to say that your reside in the UK, so choose your surgeon very very carefully, as there were very unpleasant results from time to time on members from there, judging by what i see online. Both from David Ralph and Mike fraser. ED destroys you mentally, but don't let that taint your judgment shall you take that route.

[Jimmi85]

Thanks everyone for the advice so far.

Pfract - i think my location is my biggest issue, there seems to be very few Peyronie specialists in UK who come highly recommended. I saw Dr Amr Raheem who seemed knowledgably but i don't agree on the advice he gave me unfortunately. He was very hot on Xiaflex, and said this is the best possible route but it is mega expensive unfortunately.

This is so draining!  

[FlatteningTheCurve]

Hi Jimmy,

I agree, your situation sounds really draining, the uncertainty regarding the best approach forward is indeed stealing a lot of energy.

In terms of specialists in the UK, I have seen Dr Suks Minhas at London Andrology who is really good. He has over 20 years of experience and is on the board of Uroweb's assessment of treatments for Peyronies. What I like about him is that he is not trying to sell a lot of expensive treatments to the patients or pushing for plication as a 'solution' to Peyronies Disease, more trying to give honest and sometimes blunt advice about what I could do next, given my age and situation. For example, he told me that plication would only be a very last resort for someone in their 30's, which sounds very different from what your doctor said (I have also seen plenty of doctors in Sweden who were very keen to have me undergo plication surgery as that is what they had to offer). I first saw Dr Minhas through a private appointment but he has now helped me arrange so that I can see him through the NHS instead.

All that said, I do agree that traction and VED is probably a good next step to take although it is time consuming and the results might come only gradually over a long period of time. Still, that is definitely what I would try in your situation as it helped me a lot with my curvature. 3 months also does not sound like enough to assess the effects of that combo, I would be more inclined to try it for 6 months with monthly measurements to track any changes.

A far as shockwave therapy goes there does not seem to be any conclusive evidence that it actually improves Peyronies Disease.

[Jimmi85]

it really is tough, as I can get erections, especially morning ones ( with daily Cialis ) but my other half says they are not particularly hard so I am very much in the middle for being offered an implant.

Flatteningthecurve - I saw Dr Amr Raheem at London Andrology and having done a bit more research i might book in to see Dr Majed Shabbir in london - He seems to fit the bill, on paper at least. How did you go about seeing your doctor through the NHS? I have private medical insurance but the two Uro's they have offered me are not specialists in Peyronies so at the moment i am self funding...

i realised ESWT would be unlikely to help but i didn't realise it could have adverse effects so that's on the backburner now.

[Hawk]

If the Uro is suggesting two procedures which i don't believe are right for me, then I'm thinking he isn't the right man to implant me. :-(

You do not want just an implant.  You want a very skilled implant surgery.  Keep in mind that most implants on this forum were done by well-known implant surgeons doing well over 100 implants a year with glowing patient reviews. However, we did have one member who required at least three surgeries by the same surgeon before he got a workable implant ( if he ever did, because he never posted an update).

You want an implant aggressively sized with no more than 1 set of RTE's. This is because RTE's do not inflate and therefore do not fit as snugly in the crus (results in a lower angle when inflated).  They also move the tubing from the reservoir to the cylinders further forward.  This often means they can be felt or even visible under the skin at the base of the penis, especially in a person with low body fat.

[FlatteningTheCurve]

Sorry I got them mixed up - I did research London Andrology but ended up going to Imperial College Urology which is where I saw Dr Minhas.

Basically, I booked a private consultation and during that session he said he would send me a referral letter. I then gave that letter to my GP, who in turn could refer me to Dr Minhas through the NHS. That way, I do not need to pay for a consultation every time and he can prescribe me any meds through the NHS instead.

[Bud luck]

I'm on the same position as you, but be aware that diabetes increase the risk of infection, just like me having an autoimmune disease

[Stepone]

Bad luck
I understand your concerns.
I had years of drugs, injections to my penis, and a surgery, but ultimately my saving grace was the implant.
I was very scared, very reluctant, but when my sex life became so miserable, that I had no joy anymore, I made the choice and "just did it".
I found a great high volume surgery and love my sex life and so does my spouse.
I have the thickest and strongest penis I ever had.
StepOne