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Author Topic: Nesbit procedure FAILED  (Read 11339 times)

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Bennett Nash

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Nesbit procedure FAILED
« on: September 23, 2011, 02:47:40 PM »

Hello Everyone,
I've posted earlier in some of the surgery threads with questions about the Nesbit procedure.

I had the procedure on 09/12/2011, almost two weeks ago. At this point, the stitches, both internal and external, are pretty much all dissolved.

Looks as though it was a crash and burn.  I'm talking to the surgeon's office about it now but don't have any comforting responses yet.

Here's what happened.  Before the surgery, I had the Payeronies deformity described as "left lateral" in the image on this page.  It's below the drawings, about halfway down the page, in the section with photos - second photo from the top.  My case was a little more extreme than the one shown in the photo.

The only thing the surgery accomplished was to move the left-lateral deformity to the bottom of the penis.  So now, I have the same deformity, only hooked down instead of hooked to the left.

I don't know yet what the surgeon proposes to do about this. He seemed surprised when I told him what was going on.  I did ask him if it was too soon to be checking on the surgery's results, but he said no.  He suggested that even at this early stage, with the stitches newly dissolved, no deformity like the one I'm seeing should be present.

So, pending his direct examination of it, I don't know what's going to happen next.  I don't think I've going to be very enthusiastic about a second Nesbit procedure.

Hope this info helps anyone considering the Nesbit procedure.  My surgeon told me that it works in the majority of cases, but unfortunately I didn't ask him what happened in the cases that failed.  You might want to ask your urologist about that detail.

I'll keep this situation updated as I learn more about it.

Ben Nash
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KAC

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Re: Nesbit procedure FAILED
« Reply #1 on: September 23, 2011, 03:50:14 PM »

Sorry to hear about it, and sorry for what you're going through.  We appreciate you keeping us informed. KAC
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Bennett Nash

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Re: Nesbit procedure FAILED
« Reply #2 on: September 25, 2011, 09:13:09 PM »

The situation has gotten more confusing.  Now my surgeon has told me that when he was preparing to operate, he first induced an erection by injecting the penis with saline.

He reported that when he did so, no deformity was present.  However he knew from previous examinations that when I achieve an erection the normal way, i.e. increased blood flow, the deformity does appear.  For this reason he operated anyway.

He told me that after he made the first incision and got the skin out of the way, he did see the plaque normally associated with Peyronies.  This was evidently how he knew where to make repairs.

I didn't know this until a phone call yesterday.  I still haven't seen him in person, but now it looks as though the problem is a little more complicated than I thought it was.

What a stupid mess.  I'm worried now about blood flow problems.  Even though I have the plaque associated with Peyronies, it only seems to cause deformity when I achieve an erection via blood flow.  There's no deformity with injected saline, meaning that the saline can do what the blood can't.  To mean that means a restriction in blood flow.

If the plaque is causing that restriction and the saline somehow gets past it, fine.  If a blood clot is at work here, I could be in major trouble if the thing starts moving around.

Whatever the case, I still have a deformity when achieving an erection via blood flow even after the operation.  The plaque and/or blood clot is still causing problems.

I hope my insurance doesn't balk payment because of any of this.

Ben Nash
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Gap

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Re: Nesbit procedure FAILED
« Reply #3 on: October 04, 2011, 06:21:24 PM »

I have the same bend as you and I am confronted with potential surgery. I am confused as to why you would get the bend with blood and not with saline. Thank you.
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jackp

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Re: Nesbit procedure FAILED
« Reply #4 on: October 04, 2011, 10:15:52 PM »

gap

I have read Ben's post several times trying to make heads or tails of it.

One conclusion is that his blood flow is not adequate for a full erection, therefore he has a bend. Normally when a doctor injects saline you get a very full erection.

Why a doctor would operate any way is beyond me. Sounds like he was guessing and guessed wrong. He should have had a full work up before surgery including a Color Doppler to check his blood flow both in the flaccid and erect state. The erect state should have been done with an injection of PGE1.

I am not a doctor, or medical professional, just my 2 cents worth.

Jackp
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Gap

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Re: Nesbit procedure FAILED
« Reply #5 on: October 06, 2011, 12:15:57 PM »

Thanks Jack. I appreciate your two cents. More than I've got!
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Bennett Nash

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Re: Nesbit procedure FAILED
« Reply #6 on: October 25, 2011, 06:15:55 PM »

gap
I have read Ben's post several times trying to make heads or tails of it.
One conclusion is that his blood flow is not adequate for a full erection, therefore he has a bend. Normally when a doctor injects saline you get a very full erection.
Why a doctor would operate any way is beyond me. Sounds like he was guessing and guessed wrong. He should have had a full work up before surgery including a Color Doppler to check his blood flow both in the flaccid and erect state. The erect state should have been done with an injection of PGE1.
Jackp
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Hey Jackp,
I have an update which answers that question. 

I finally got to a second post-op exam and asked him why he operated when the saline injection caused an erection that was not deformed.  He replied that he could still feel the plaque under the skin where the deformity had been, and that this sometimes happens with the saline injections.  The reason is that the plaque itself restricts the blood flow, and the saline can be injected to bypass the plaque.

He also added that when he peeled the skin down to examine the plaque, he found that there was a lot of fibrosis surrounding the entire shaft down there.  The plaque lump was just a larger section of it.

He suggested that this may be why there is a new deformity now that the old one has been corrected. 

Then he said that the healing process was still occurring.  There would be changes in shape throughout that process, which in my case is expected to last another month.

He may have been right about that.  Two nights later, I had another nocturnal erection and woke up when another of the internal stitches let go.  After a full month, they're still in the process of dissolving down there.

There is at least one more stitch that hasn't dissolved yet.  I can feel it now when I get a nocturnal erection - it wakes me up every time, because it hurts.  Based on how the others let go, this one will break soon.

However I haven't noticed any changes in shape since a few days after the operation.  It's still hooked down.  Now that I've taken photos and compared before/after shots with the urologist, it's obvious that the new deformity is in fact worse than the old in terms of the angle. 

I have an appointment on 11/11/2011 (if I were a numerologist, I'd be freaking about now).  At that time he's going to induce another erection and take stock of the situation.  He said he couldn't do that in this latest checkup because the healing wasn't complete yet.

Thus, I'm now in a "wait and see" mode, though I can't imagine how anything will change.

I'll be back with updates as soon as I know anything.
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Bennett Nash

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Re: Nesbit procedure FAILED
« Reply #7 on: October 25, 2011, 06:23:10 PM »

I have the same bend as you and I am confronted with potential surgery. I am confused as to why you would get the bend with blood and not with saline. Thank you.

Hey gap,
I hope my previous post sheds a little light on the situation.  Now that I know about the extent of the fibrosis, it may be the reason this has gone wrong. 

Maybe if your plaque is more localized than mine, you won't have this problem if you have the surgery.  But I don't know.  Seems like it would be a good question to ask your urologist:  is the plaque localized?  If it's spread around a large area, will the Nesbit correction be able to compensate for all of it?

e.g. those sorts of questions.

Although it looks as though the Nesbit Procedure bombed in my case, that business about the extent of the plaque makes it a little different than most other cases of Peyronie's.

Who knows.  I just hope that anyone reading this knows that this is an individual report, and should not be taken to mean that the Nesbit Procedure will also fail for them.  It's supposed to be successful in the majority of cases.  With my extended fibrosis, I'm stuck in the minority.

Whatever.  Good luck, Gap.
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jackp

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Re: Nesbit procedure FAILED
« Reply #8 on: October 25, 2011, 09:35:42 PM »

When the doctor indused the erection in November ask if he is going to do a Color Doppler. That may help show the problem.

Again just my 2 cents.

Jackp
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Noway

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Re: Nesbit procedure FAILED
« Reply #9 on: February 05, 2012, 02:24:07 AM »

The nesbit procedure is stupid and I wouldnt do it.. it seems this procedure always fails and has too many complications.
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Luciano

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Re: Nesbit procedure FAILED
« Reply #10 on: February 05, 2012, 02:55:51 AM »

The nesbit procedure is stupid and I wouldnt do it.. it seems this procedure always fails and has too many complications.
Actually this is not correct. The nesbit procedure does not always fail. Actually it is the safest procedure there is on the market because it is only minimal invasive and can be corrected. (OK the correction part is not as easy as I have heard. But i read about surgeons that wrote they had to proceed to corrections after nesbit)
But the main thing is, that hardly anyone of us wants a nesbit proceedure. Because it Always involves shortening. But it is recomended in some cases for those that are born with an acceptable size.

@ben
Just a question. by the picture it looks like you have a narrowing near the bottom of the shaft. The surgeons usually recommend plaque incision with grafting in those cases. Was there a particular reason the surgeon wanted nesbit over incision?

Luc
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LWillisjr

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Re: Nesbit procedure FAILED
« Reply #11 on: February 05, 2012, 03:05:24 PM »

I agree that several have had successful Nesbit procedures. I'm not sure what the basis of Noway's data is.
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james1947

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Re: Nesbit procedure FAILED
« Reply #12 on: February 05, 2012, 07:09:25 PM »

I have to agree with Noway.
I read that this is the most simple surgery, but always losing length. The Peyronie's already shortened the length, so where we can get more short?
I am thinking about myself, 13cm down from 18cm, additional shortening with Nesbit let say 2cm, ends up 11cm. Not what I really want!!!
Have some people on the forum that are happy with the Nesbit procedure?
James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Luciano

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Re: Nesbit procedure FAILED
« Reply #13 on: February 05, 2012, 10:32:25 PM »

I was just trying to say that you should not condemn a procedure, just because it does not apply to your case.
Nesbit is still state of the art in some cases of congenital curvature.
It is not for people with Peyronies Disease that have hourglass and/or strong curvature or that have experienced strong penile shortening.

But in a difficult situation like Peyronies Disease, every case is different. Sometimes for some reason some techniques cannot be applied.
Example: Some cannot have plaque excision done, because the plaque is to diffuse or located under the gland etc.. etc..

Luc
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Worried Guy

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Re: Nesbit procedure FAILED
« Reply #14 on: February 06, 2012, 04:27:40 AM »

Guys I think we need to be realistic on options here. We have to accept that there are very few and the nesbit is a valid one.  If your choice was a bent penis, which you were unable to use, or a straight one, which was SLIGHTLY smaller, what would you do?  This is choice which many people with peyronies may face!
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james1947

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Re: Nesbit procedure FAILED
« Reply #15 on: February 06, 2012, 08:15:45 AM »

I understand what both of you are saying and I don't argue with that. What I am saying that I didn't read on the forum about somebody that was happy with Nesbit procedure. Maybe I didn't read all the posts. 
For this reason I am asking if have somebody on the forum that was happy with the Nesbit procedure and to shear with us the results.
James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Noway

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Re: Nesbit procedure FAILED
« Reply #16 on: February 07, 2012, 02:34:12 AM »

I for one would rather not have a working penis thats smaller.. I would rather just not do the nesbitt procedure as long as there is other options out there. My doctor also said maybe the nesbitt procedure which I found odd because I have really bad Erectile Dysfunction. Also with pentox and cialis works the best for me.
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jackp

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Re: Nesbit procedure FAILED
« Reply #17 on: February 07, 2012, 06:58:26 AM »

Noway

So long as the Pentox and Cialis are working for you that is your best option. If the Cialis, or other Erectile Dysfunction pills, stop working then your best option would be a length expanding implant.
Why go through a Nesbit just to turn around and have an implant when an length expanding implant would do the same thing?

Jackp
http://jackp-penileimplant.blogspot.com/ 
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james1947

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Re: Nesbit procedure FAILED
« Reply #18 on: February 08, 2012, 04:12:46 PM »

I have read in the last few days almost every post on the forum regarding Nesbit procedure and plications.
The only cases that people are happy with the outcome are the cases of congenital curvature.
All the other posts are complaining about the results, including known doctors made surgeries.
My conclusion is yes, Nesbit procedure and plications are options, but just for people with congenital curvature and not for people having Peyronie's.
Luciano you are right that for congenital curvature is a viable option.
James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
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Worried Guy

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Re: Nesbit procedure FAILED
« Reply #19 on: February 08, 2012, 06:50:27 PM »

If they are not options for people with Peyronies then what are the options?  Are you saying there are none?  Not every one with Peyronies posts on here.  I believe Xiaflex may take the place of the nesbit procedure but who knows when that will be.
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james1947

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Re: Nesbit procedure FAILED
« Reply #20 on: February 08, 2012, 07:27:09 PM »

No. I am not saying that don't have other surgery option for Peyronie's.
I know the majority of the people with Peyronie's are not posting here, but this is the only not biased data base available for us and I assume that statistically represents the majority.
For Peyronie's, excision, incision both with grafting had given much better results regarding the length. Because of the straitening can gain back some length lost to Peyronie's. Also preparation to surgery, like taking Pentox and doing VED had given better results after surgery.
With congenital curvature, some people don't lose length, some lose little bit with Nesbit procedure.
With Peyronie's, Nesbit is shortening in addition to what you have already lost to Peyronie's.
James
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Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

Worried Guy

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Re: Nesbit procedure FAILED
« Reply #21 on: February 09, 2012, 02:48:58 PM »

I understand what you are saying.  I believe once we have peyronies it will be very difficult to be 100% satisfied regardless of which option you chose.  We have to make the most of what we are left with.  The reason they use the nesbit is because it carries less risks.  It is unlikely to cause Erectile Dysfunction or nerve damage which is more likely in excision and grafting.  I believe they now tend to use incision because it lowers those risks.  Not all guys have lost massive length with peyronies and some men could lose a 1 cm or 2 and not be that bothered  If you have already lost length and have Erectile Dysfunction then the nesbit will not help you I agree.
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LWillisjr

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Re: Nesbit procedure FAILED
« Reply #22 on: February 09, 2012, 06:37:13 PM »

The type of surgery should be based on each individual's symptoms and situation. There are too many factors to simply say one procedure is better over the other. I have always said that surgery should only be a last resort after tyring other therapies, and you have pain or intercourse is not possible. End of disclaimer.

Congenital curvature
If you are able to achieve a good erection, then I only know of plication to be a viable surgical option for congenital curvature. Congenital curves in excess of 50 degrees are VERY difficult to straighten this way.

Peyronies Disease
If you are able to achieve good erections.... plication is likely recommended for curves of 40 degrees or less. It is less invasive and generally successful at straightening. For curves greater than 40 degrees, plication is not as effective. Generally excision/incision and grafting procedure is used for curves greater than 40-50 degrees but this is a more invasive and risky procedure.

If you are not able to achieve an erection or Erectile Dysfunction is a problem.... then by far an implant makes the most sense.

Doctors.....
There are only a few doctors skilled to do any of the above, and you can find most of them listed on this forum by our members. These doctors do all the procedure listed above and recommend the procedure based on the patient's unique case. I WOULD NOT go to a doctor who is only skilled in one type of procedure. Many of the failed procedures you read about were done by doctors who used the wrong procedure, or who do not do enough of these to stay proficient. Ask youself if you want a doctor to perfrom surgery on you who does 10 like operations per year, or one who does 100 of these per year.
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Luciano

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Re: Nesbit procedure FAILED
« Reply #23 on: February 10, 2012, 03:30:39 AM »


Doctors.....
There are only a few doctors skilled to do any of the above, and you can find most of them listed on this forum by our members. These doctors do all the procedure listed above and recommend the procedure based on the patient's unique case. I WOULD NOT go to a doctor who is only skilled in one type of procedure. Many of the failed procedures you read about were done by doctors who used the wrong procedure, or who do not do enough of these to stay proficient. Ask youself if you want a doctor to perfrom surgery on you who does 10 like operations per year, or one who does 100 of these per year.


I agree 100%
But the major problem is, a doctor has to have a first patient someday. otherwise we will never have new experienced doctors on the market.  and my horror is to have a renoun specialist that is so old his hands are trembling.
As to the "one type of procedure".
I found a Peyronies Disease specialist in my area (Austria -  difficult to find a good Peyronies Disease surgeon).
He suggests plaque incision with dermal graft. saying it was the best procedure.
Now i read (posted the paper in ressources) that dermal graft was outdated because of high Erectile Dysfunction outcome. Everybody uses sapheous vein grafts.
He says no.
To make a long story short. I just want to say that it is extremly difficult to find the right procedure.
And we the patients are quite helpless.
Because if I am wrong, and he is right. I will still not have surgery with him (after the stuff I told him - lol - I too much fear he will seek revenge - which is probably not true)

Luc
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james1947

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Re: Nesbit procedure FAILED
« Reply #24 on: February 10, 2012, 07:37:22 AM »

Big dilemma to go under knife, which procedure and with whom.
The first doctor I have seen for my Peyronie's told me that he will deglove my penis and make excision. All this without even checking the plaques. When I asked him what about the empty place that will remain after the excision he told me that it will feel alone with the time!!!
I decided not to make surgery with him, also he stated that up to day he made some 30 surgeries of this kind.
You are right Luciano, we the patients are quite helpless. Especially that I learned that the knowledge of the veterans on this forum are much bigger than the knowledge of most uro's.
James
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Age 71, Peyronies from Jan 2009 following penis fracture during sex. Severe Erectile Dysfunction.
Lost 2" length and a lot of girth. Late start, still VED, Cialis & Pentox helped. Prostate surgery 2014.
Got amazing support on the forum

jackp

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Re: Nesbit procedure FAILED
« Reply #25 on: February 10, 2012, 01:08:39 PM »

Luciano

I have tried several times to respond to your PM about Omega3. Your in box is full so my responce will not go through. 

Lovaza is FDA approved. I take 4 1GM capsules a day. I go to church with the head pharmacist at St. Jude Children's Hospital and according to him that is the equivalent to 48 OTC pills.

Jackp
http://jackp-penileimplant.blogspot.com/

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Luciano

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Re: Nesbit procedure FAILED
« Reply #26 on: February 10, 2012, 01:56:04 PM »

Luciano

I have tried several times to respond to your PM about Omega3. Your in box is full so my responce will not go through. 

Lovaza is FDA approved. I take 4 1GM capsules a day. I go to church with the head pharmacist at St. Jude Children's Hospital and according to him that is the equivalent to 48 OTC pills.

Jackp
http://jackp-penileimplant.blogspot.com/


very strange:
it says:
Capacity
12 messages, 26.7% full.

but i deleted all of them... so now it should be empty...
but also i never sent a pm to you about omega 3..
But go ahead.. it should be empty now..
Luc
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