Congenital curvature returned after modifed Nesbit - what now?

Previous topic - Next topic

0 Members and 1 Guest are viewing this topic.

Urethra Franklin

Hello everyone,

If someone could offer me some advice I would just be really, really grateful. I have pondered this for so long and feel completely stuck about which decision to make.

My situation:

I am 49 y.o., born with congenital lateral curvature (now at 70%), partial erectile dysfunction and what feels like a loose base at the penis- all which have worsened over the years.

I had a modified Nesbit four years ago that corrected the curvature, and also cured my painful ejaculations. I lost about a cm in length, but it really improved the sexual experience and also had a positive effect on erection quality. But from the start, I suspected that the looseness of the base would not be able to uphold the erection over time - and this is exactly what happened; already after half a year, the curvature began to return. As of now, the curvature has come back 100%, and even points more downwards than before, though with less torsion than before the surgery, and no return of painful ejaculations.

One year after the surgery (three yearsm ago), my doctor had a visit from Dr. Ralph (if you do not know him, he is an extremely well-renowned urologist from London), and since I had already myself investigated a type of surgery to correct loose ligaments at the base of the penis, it was agreed upon that I could get this done. But this had no effect whatsoever on either the instability or the erectile dysfunction. He had also previously stated that the sense of looseness could be because of the erection not being hard enough (I am not sure!?).

I have now had an offer for another modified Nesbit, but I am worried that this will just be the same story all over again, where the curvature returns soon after – and minus another cm in length! The doctor does not have an explanation for why the curvature returned last time and only says that this happens sometimes and needs to get redone.

I have also thought about getting an implant, as this would probably mean that I would not have to worry about ED anymore and at the same time make sure that the curvature does not return. My current doctor is reluctant about this and says that this should really be the last option. I am able to get erections from both PDE-5 inhibitors or injections, but the side effects of both are often quite horrible, giving me a nighttime itch that can last 3-5 days.

I have consulted with Dr. Ralph online, and he thinks that I should have the surgery redone, and that he would also at the same time check for instability at the base and see if this needs to be redone in the same session. In terms of the recurrence, he suggested that one possible cause could be that the absorbable sutures used last time were not wound tightly enough. He is similarly reluctant about the implant and agrees that this should be the very last option.

I have also consulted Dr. Osama Shaeer in Egypt (also at the top of his field), who also recommends modified Nesbit but when asked about recurrence of curvature, he suggests that he could do something in addition called a double 8 technique with sutures. He also talks about a new kind of sutures that last longer than the ones used before.

Regarding an implant, he was not as reluctant as the other two doctors but of course emphasized the risks of infection, shortening etc. If he would do the implant, he would do it with a so-called slitting technique the short side instead of shortening the long side.

He also seems to be really thorough in his examination and asked me to send results of e.g. penile duplex (can't be done professionally in my country), testosterone levels, and more.

So I have really consulted some of the best doctors in the field, but I still don't know what the hell I should do at this point.

To sum up, my options are:

1. simple modified Nesbit (covered by free health care)
2. Dr. Ralphs modified Nesbit with additional check of ligaments at the base
3. Shaeer's modified Nesbit with sutures
4. Shaeer's implant with the slitting technique

I have read about many who have had the implant and are very happy about it, but since all three doctors are hesitant about it to some degree, I am not as keen on this as I was before. Even though the thought of always being able to have an erection is tempting, I am worried by the risk of infection, shortening, lack of sensitivity and the whole prospect of a definite point of no return (plus a large expense).

I have been examined for Ehlers-Danlos since I generally have the feeling that my ligaments seem weak in the whole of my body, but the conclusion was that I don't have it.

ANY advice or experiences would be much, much appreciated!
 

If you want answers, Please help us by filling in your signature block

Click here for Directions

TonySa

You may want to google Dr. Trost's newer technique of Xiaflex injections + RestoreX traction device.  However, that process or surgery will only address the curve...is the ligaments/unstable base a problem as well along with ED (with severe side effects of treatment)?  If so, perhaps you could do a video consult with Dr. Eid--many think the best implant surgeon who is very careful to preserve as much length as possible.  I had no loss of length with my implant, so I think the possible side effects are mostly dependent on who does your surgery.  You will read on here that it is recommended that you utilize a high volume doc who does at least 100 implants a year.  I'm sure others will weigh in, good luck to you-you've found a very supportive forum!
PxD 2 yrs 9/16.  Failed all treatment. 9/11/18: excision, grafting & implant Dr Karpman MtnView Ca, AMS CX 18cm + 3-1cm RTEs.
Pump failed.  2/11/20 Dr Karpman installed Titan 22cm +1cm RTE.

tek

Did you visit a pelvic floor specialist for the loose  ligaments problem?
If you want answers, Please help us by filling in your signature block

Click here for Directions

Sonic

When you had your surgery done for the ligaments what exactly was the issue? Was the ligaments loose or damaged/torn?

I am interested in this in particular because I also suffer from this phenomenon of loose penis at base

You mentioned this in the post

''he had also previously stated that the sense of looseness could be because of the erection not being hard enough''

This is definitely true. I have noticed at absolute maximum erection it's much less loose the problem is that reaching maximum erection capacity has lowered drastically since being diagnosed. I also suspected ligament damage for years now, but I know that if you tear/badly damage the ligaments you will definitely feel it, it's a very painful injury, I do not remember such injury.

Do you have an indentation? I feel like I am quite sure that this is what is causing the looseness/wobblyness at the base. The part of the shaft does not fill with blood like it used to and the whole area is indented/pinched and so the penis kinda has a bunch of lost tissue and thus simply can't remain as stable as when it was symetrically even.

Interesting topic.

You have to take a long time to figure out what you want to do as it's a very important decision, however I will add, if I were you, and had decided on a surgery, I would opt for an implant, because of the ED + instability issues you have, standard surgeries will probably only cause more harm than good.
30 years. Sudden rightwards curve detected in June 2020
Narrowing on right side and about a 20° curve to the right.
ED + instability due to narrowing.

tek

Ι have an indentation at the base at  right side.
It is not visible when i dont have erection and is total visible when i am full erected.
Its like a piece is missing of the penis like  semi hourglass.
Because its in the part that exiting the body at the base  when i am erected i see it only then.
I always remember to have it but last 2 years i think that it got worst so it caused 20 degree curve from base to the right.Total penis is straight but looking right caused by the missing base part.
Based on my history i hope and suspect that its a pelvic floor muscle problem caused by too many hours sitting in office and home, plus constipation that makes me to pull hard at toilet.
I also sit croslegged at office for many hours, with the right foot upon to the left but i dont know if this is critical.
I will go to a pelvic floor specialist for an evaluation cause i dont know if the muscles are loose or tight.
I suspect though that the muscle at the side that a have problem is a lot stronger than the opposite one.
Of course all these may be excuses to myself to avoid excepting peyronies
Flaccid ultrasound show a very small scar near this area without something else.

Sorry for my bad English.
If you want answers, Please help us by filling in your signature block

Click here for Directions