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Author Topic: Vein ligation in presence of tunica albuginea's scarring  (Read 3713 times)

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Werther

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Vein ligation in presence of tunica albuginea's scarring
« on: January 20, 2018, 08:41:05 PM »

Hey guys,

I'd like to ask abybody here for information about the possibility of getting vein ligation's surgery in order to get rid of venous leak that's caused by plaques in the tunica albuginea.

I already know that the outcomes, in the majority of the cases, have been unsuccesfull (especially in the long term), but it looks like that for someone the results were good and Erectile Dysfunction was resolved this way.

The only problem is that I've only read studies and stories about people who had venous leak, whose cause wasn't scarring; so I don't know if this surgery could be performed when venous leak's culprit is a plaque (or multiple plaques). Does anybody know if Peyronies Disease - when it represents the cause of the leakage - mandatorily prevents the possibility of accessing this kind of surgery? If it's not a contraindication, I guess it could be worth a shot; afterall, in the unfortunate hypothesis that this won't work, there's still the possibility of getting an implant.

If someone's willing to share studies or personal experiences (direct or indirect) with regards to this specific topic, I would be very glad to hear them.

Thanks.
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Werther

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #1 on: April 05, 2018, 12:47:50 PM »

Thank you all for your contributes.

By the way, I was curious to know why these kinds of surgeries don't seem to work (even when there's no scarring in the tunica albuginea), because venogenic Erectile Dysfunction shares the same mechanism of varicocele and for this last disease veins ligation and sclerotherapy work and in fact they're used daily to treat it. After asking several urologists, this is the response I got: "Vein surgery likely does not seem to work because the vein occlusion happens in very very small vessels and ligating larger veins does not seem to help the penis contain the blood to maintain the erection.  It would be great if vein ligation surgery was an effective treatment, but I am not a believer in it".
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Paolo

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #2 on: April 05, 2018, 03:07:53 PM »

I have had varicoceles in my scrotum (veins enlarged like worms) mostly by my left testicle which caused pain, and a strange 'heavy' feeling.

Had it when peyronie's struck but I cleared it up doing body weight squats and other pelvic exercises, in my opinion it was caused by chronic circulation problems in my groin area, no one knows why they develop for certain, my theory is we are not meant to sit for long periods of time, hence pelvic congestion occurs.
Strange though as I exercise 2-3 times a week.

Wouldn't a color doppler confirm your venogenic Erectile Dysfunction?
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Werther

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #3 on: April 05, 2018, 04:44:15 PM »

I had varicoceles too when I was very young (I know what you're referring to when you talk about veins that feel like enlarged worms) and I underwent surgery (sclerotherapy), that worked for me. At my follow up appointment, after the surgery was done, the urologist confirmed me that my varicocele had gone.

The fact I had succesfull sclerotherapy for varicoceles was also one of the reason why I wondered if it could work or not for venogenic Erectile Dysfunction.

By the way, I'm already diagnosed (I got this diagnosis via color doppler, as you said) and I'm just trying to know if there's something else (except for the implant) to cure this problem.
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #4 on: April 05, 2018, 08:34:02 PM »

I am of the opinion that embolisation of the veins done by an interventional radiologist is the superior treatment. There is far less risk of adding damage to a penis that has already shown it does not always heal well after damage, and smaller veins can be dealt with efficiently.
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pey ron

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #5 on: April 06, 2018, 01:58:42 AM »

I've had varicocele for at least 20 years now. Doctors recommended a surgery but I never went for that. Should I revisit that possibility?
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #6 on: April 06, 2018, 02:57:54 AM »

Well if you have had them 20 years then I presume you have managed any pain, all surgery should be thought through, and considered, even if you had a consultation aren't you afraid they would just recommend surgery and take your money, hmmn  :-\
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Werther

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #7 on: April 06, 2018, 07:36:51 AM »

@skunkworks: I'd like to share your opinion too, but apparently today there's no way to embolize smaller vessels inside the penis (which should be very very small) with current techniques and this should explain why these surgeries fail or their effect last just temporarily (take a look at people's reports). I hoped to believe in sclerotherapy's efficacy for the management of venogenic Erectile Dysfunction, but unfortunately I have to say that I agree more with the docs who don't trust it and don't use it, than with the ones who do otherwise. In fact, I even wrote to Herwig (a Kuehhas' colleague who performs sclerotherapy for venous leak's patients) once and he replied to me, telling me how he would have confirmed my diagnosis and how he would have performed the surgery, but when I asked him about the cases and causes of failures he didn't take the time to answer again (even after I urged him twice to do so); this behaviour got me very suspicious, hence it's one more reason to trust more who tell you that these things don't work and explain why.

Maybe in the future, with higher resolution scans (able to find every single incontinent vein in the penis, no matter how small), these surgeries will work well. But not today, unfortunately.
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #9 on: April 10, 2018, 08:40:06 PM »

Thank you for the link, but I still remain suspicious. The study that you quoted is from Dr. Hsu and this name, along with Dr. Herwig's one, are the ones I've been reading about the most on the web (especially on FT) when it comes to veins surgery and most of these reports are not enthusiastic like these doctors' claims.

The lack of general consensus is what worries me the most.

And I personally think it's a shame that there aren't more studies related to surgical intervention for venogenic Erectile Dysfunction, because if there were, some sort of really working techinque would be sorted out, like it happened for varicocele.

It looks like that, once implants were "discovered", urologists found useless investing their time in searching for other cause-related solutions, since implants are suitable for any kind of organic Erectile Dysfunction.
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kusher

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #10 on: April 10, 2018, 09:10:49 PM »

There is no point in starting this thread.. surgery to regain erection is a big lie and all world class surgeons don't recommend it due to low success rate. Even if it was successful, it will be temporary.
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Werther

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #11 on: April 10, 2018, 09:27:37 PM »

My point in starting this thread - as stated above - was to understand the reasons why these surgeries don't work (and when they do, it looks like results are just temporary), because "all world class surgeons", as you call them, just say that these things are useless but mostly they don't even bother to tell you what's the scientific reason behind these failures (even if you ask them about it).

These things were nonetheless interesting to me, because these techniques work for other conditions carachterized by incontinent veins: I had a varicocele when I was younger, I got sclerotherapy and it worked. That's why I kept asking myself why veins surgeries (wheter they're ligation or sclerotherapy) wouldn't work if the disease's mechanism is the same.

By the way, you can find my abovementioned statements in my previous posts made on this thread.
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kusher

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #12 on: April 10, 2018, 09:54:15 PM »

Hsu`s Andrology  this guy has done alot of this surgery and he also optimized it. He is devoted in this kind of surgery and learned all the aspects. U can contact him and let us know what he says
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Werther

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #13 on: April 11, 2018, 11:51:50 AM »

Yeah, I could certainly give it a shot and try to hear his opinion, even if I'm not that trustful.

I'll let you know what the response is (if I'll get one), if you're interested.
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Alibaba

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #14 on: October 12, 2018, 09:29:56 PM »

Let me explain it this way just from treating animals and my family for 40 years. Scar tissue is dense because it has poor blood flow. I've had 22 surgeries and have spent a lot of time asking about scar tissue adhesions and such and studying it. Researchers found one of the reasons the blood flow is reduced in scar tissue is if it grew at a rapid rate your body would recognize it as a threat like cancer. Having had 4 kinds of cancer and studied that too I understand that also because that is how the immune therapy I am on now is supposed to work.  ANYTHING that reduces blood flow will cause scaring and plaque.  My thought is if you already have issues, your temp fix to ligate or chemo fry some veins is only going to reduce blood flow and O2 level and cause you more scaring in the future. I may be wrong, may be right, but what I am certain of, is reading many peoples failed results over sometimes short periods of time from this cheap patch of a fix. For those of you who do not know, scar tissue does not stretch. I learned this when a child was adopted into the family after the birth family had set the child on fire because they did not want the child. That poor kid lived through 15 years of surgeries to add on to skin because scar tissue did not stretch or grow as that poor kid grew.
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Werther

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #15 on: October 13, 2018, 12:22:04 PM »

I don't think that getting veins in the penis ligated or closed in any way would cause it to receive less oxygen and would inevitably lead to more fibrosis (and more Erectile Dysfunction). Oxygen is brought in through the arteries and what you mentioned could possibly happen in my opinion if you're suffering from conditions which cause less bloodflow income (such as with arteriosclerosis for example), but even in these cases I don't know how many men develop scar in their tunicas (I've read a lot of reports of men complaining about Erectile Dysfunction because of reduced bloodflow as confirmed from a dinamic doppler - peak systolic velocitiy less than 70 cm/s - but who said nothing about having scars in the tunica and/or in the corpora).

To make things clear, by the way, I'm not endorsing vascular surgery for Erectile Dysfunction with these words. It's pretty sure that if these things work, they're just temporary (at least as of today). Based on what I've come to understand by the words of some urologists, it happens so because eventually the blood will find a way to leak out from other veins when some have been ligated, leading to venous leak manifesting itself again; otherwise - as already stated in this thread - it happens so because the leakage happens in very small vessels that are impossible to be ligated or embolized.

That doesn't mean that surgeons shouldn't get more effort in order to sort out this puzzle and offer a reliable and stable intervention on veins that actually works. It has been done for varicocele and I can't understand why it can't be done for Erectile Dysfunction. And I'm talking this way because I agree with you on the fact that fibrosis (or scar tissue), which is the cause of the problem, is unmodifiable. If it could be replaced with healthy tissue (wheter with drugs or surgery), things would be a lot easier and we wouldn't be discussing this topic.
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Hawk

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #16 on: October 13, 2018, 12:47:35 PM »

Well, I am theorizing, like all of us, about something I know little about.  However, as a general principle, veins and arteries make up a circulatory system.  If the outflow of that system is significantly decreased then inflow to that system is likewise decreased.  That is why a prolonged erection can lead to serious tissue damage.  Not because the arteries are pinched off, but because the veins are pinched off.  The arteries supply blood that cannot exit therefor the supply stops and there is a serious O2 emergency.  I realize after ligation you do not have a constant erection so it is not an acute situation but I would be concerned there is a chronic reduction in blood flow that to some degree reduces O2 supply and uptake.

I might be completely wrong.
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Werther

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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #17 on: October 13, 2018, 01:30:57 PM »

I disagree with what you said. I'm no doctor neither, but it looks like surgeons who perform this kind of surgeries are well aware of the risk of depriving the organ from total outflow. That's why only some veins are ligated or emobolized with these interventions: this way, the blood will continue to leave the penis after its detumescence even if some veins are closed.
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #18 on: October 13, 2018, 03:10:54 PM »

I agree with Werther on this point. I am 100% sure that through venous surgery Erectile Dysfunction is totally solvable, and it wont cause lack of oxygen for sure. Why there is not much research on this kind of surgery then? On my opinion, there are 3 causes:
1. PDE5 industry moves a huge amount of money. A oneday surgery which solves Erectile Dysfunction, may cause huge losses to these companies.
2. Doctors have much more interest in implanting us than solving the issue forever with a one day surgery, which would be much more cost effective and would be a "one time" surgery. So they probably focus on techniques to
Insert implant with less risks, instead of investigating vascular surgeries.
3. Probably we still don't have a proper technological level to "map" all the small and medium size vessels down there, so the surgery can't really help in many cases.

I'm really depressed about this; we went to the moon but we cant ligate some veins properly.Erectile Dysfunction looks like a curse instead of a medical condition.

I heard about some surgeons which claim to solve Erectile Dysfunction; one is Dr. HERWIG but i didnt really hear good things about him (Gollam's story on FT....) and Dr. GL Hsu which invented a "revolutionary" vein stripping technique which works in 90% of the cases, according to him, and it's long term effective. Well, i don't know if he is a liar but i was really interested in this matter. Unfortunately, i found little informations about the real results of the technique. If someone knows something, please share.
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #19 on: October 13, 2018, 03:40:47 PM »

Well, you know what they say about opinions.  Everybody has one.  If we were in another forum I would simply say "Hey, I am the administrator and I said blah blah blah stop bickering.  :)  lol

I understand that they don't deprive it of "total" outflow. or you would have a perpetual erection.  Perpetual in the sense of for two days until it fell off.  I said if they restrict it partially then they restrict the inflow of oxygen-rich arterial blood the same amount.  Any restriction of oxygen in a plaque prone penis would make me nervous since lack of oxygen is a factor in fibrosis.  That is why fibrosis often follow Erectile Dysfunction because there is some restriction of blood flow.

Next to Hopes point.  I give doctors a little more credit than most conspiracy theories of every doctor is trying to suck every dime out of you he can.  There are problems with closing off blood vessels.  The bodies defense is to make more.  That is true in heart attacks and in the legs if they harvest blood vessels for a by-pass. It is true of anyplace in the body.  It replaces large vessels with bundles of small vessels.If you read the "Definitive Implant Journal by - Merrix at the top of this board you will see that he had a such a surgery and he got great erections for the first time in his life.  It lasted all of a couple months.  Feel free to reply and you or someone else can have the last word.
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #20 on: October 13, 2018, 04:10:03 PM »

Unfortunately, i found little informations about the real results of the technique. If someone knows something, please share.
there was a forum (Erectile Dysfunction-forum) about dr hsu and patients who got his surgery. They were about 10 -15 people. Some had the operation more than once

It only worked in one. In others, something improved but they still having problems and in others it does not work, many went to an implant after that surgery.
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #21 on: October 13, 2018, 11:51:27 PM »

This has always been a heated discussion in any forum. The answer is simple. Occluding a vein helps hold blood in. In other words, keeps it from draining out.  Put on a cock ring and leave it. Your dick turns purple and hurts. Why?  1 simple reason. It is running out of oxygen.
.  It turns purple because of lack of oxygen and it hurts as a signal for the same. Put a rubber band around your finger and it does the same thing.  Impede the flow of blood circulation and you reduce the oxygen.  Your dick consumes oxygen at a constant rate regardless of whether your veins flow like the Mississippi or trickle. If flow is slowed to a trickle less oxygen is available to consume.  In a natural erection, there is still a continuous flow of blood but it is somewhat controlled. Your dick does not turn purple and hurt. It is pretty and pink. You ligate or fry a vein, that flow is stopped forever. Read the early part of Merrix's thread what Dr. Eid told him soon after his surgery which if I remember was around the 15th of December in 2015.  Dr. Eid, a long recognized urological surgeon, not just an implanter, told him there was a 'chance' his glans could die because of the reduced blood flow from the schlerotherapy. Thankfully it hasn't. Merrix is a fine and bright young man with a beautiful cock to boot. Now take that scenerio and add the stories of those who went back to doctor frankenstein who spent 3-4 more hours frying some more veins.  How long is your automobile going to run if you stop the oil filter up? On a side note, I am a person who has many questions and often long doctors visits at university hospitals if the doctor is an amiable guy. Blood flow question were the first I had after my prostatectomy. Of interest was every mans map of veins and arteries to the penis are different. No two men have veins and arteries routed the same. A perfect example is the veins in my left arm look like chain link fence wire. Zigzag back and forth and interconnect like a chain link fence. My right arm are just 1 large vein top and bottom running near a straight line.  Bottom line, is spend your $ on proven treatments only. If you are going to try something controversial, not proven to be at least 90% effective, make sure it is reversible. You can start or stop viagra and levitra. You kill off a vein it is a gonner. Viagra, Levitra, Sildenifil, trimix components all work by opening up your arteries for more blood flow as well as your natural erections. They do not work by jamming a cork in a vein. Pinch off your garden hose and it increases the pressure but it reduces the flow. Fold it over completely and you stop the flow. The concept is simple in theory but not all theoretic concepts work. Add to that, sometimes the body just makes a new outflow route. Dam up a creek and it just cuts a new route around.
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #22 on: October 14, 2018, 01:01:55 PM »

I don't think that closing one or few single veins is like wearing a cock ring: in this last case, you're "closing" all of the veins in the penis and that's why it turns out purple after some time has passed. It's like when people hang themselves: their faces turn purple because both jugulars are restrained and this is what in the end cause the brain to lack of oxygen (and subsequently its death).

Based on your thinking my left testicle should have blown up by now, considering that I got sclerotherapy for varicocele. Truth being told, it hasn't.

Again, I'm not promoting this surgery and I'm not going to try it myself. But the only reason why I think this way is because it's sadly clear to anybody that these interventions don't work for Erectile Dysfunction, not because I think that my penis would risk necrosis. Period.

On the other end, I agree with what was said from hope794. The fact that "penile veins' map" might by different from man to man shouldn't stop researchers from investigating on developing and/or perfectioning instruments and procedures capable of individuating every single vessel in the penis and the ones that are actually "leaking". If this happened, in my opinion these surgeries would really work. Besides, I don't know if we really currently don't know how to do such things, considered that some penile transplants have been performed in the past few years and it was reported full sexual functionality from the recipients (meaning that all vessels - even the smallest - had to be connected from the recipient's stump to the transplanted penis).
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #23 on: October 14, 2018, 04:52:33 PM »

I don't think that closing one or few single veins is like wearing a cock ring: in this last case, you're "closing" all of the veins in the penis and that's why it turns out purple after some time has passed. It's like when people hang themselves: their faces turn purple because both jugulars are restrained and this is what in the end cause the brain to lack of oxygen (and subsequently its death).

Based on your thinking my left testicle should have blown up by now, considering that I got sclerotherapy for varicocele. Truth being told, it hasn't and I had this surgery something like ten years ago.


Werther, Don't overstate Alibaba's position and then defeat your overstatement and act like you defeated the original point.  Of course, it is not just like wearing a cock ring.  If it were, your dick would fall off by the end of the day, so if your dick was attached to your body 3 days after ligation you could say " See Alibaba is wrong".  :)  The cock ring was making a point of oxygen starvation.  Alibaba was clearly making an illustration that you somehow missed.  He was basically saying what I said, if you reduce the outflow -> you reduce the inflow.  -> reduce the inflow -> you reduce oxygen. -> reduce oxygen and you increase the chance for plaque.   Often times, all it takes to trigger plaque is a loss of NTE's.  It does not take a cock ring.  Your penis looks normal, feels normal, but over the oxygen level drop can be enough to trigger a cascade of ugly events.  The clinical record of vein ligation of the penis shows 1) a poor success record,  2) that it is very risky.  Those two points cannot even be argued.  All you can argue is that while risky, it does not always end badly and on rare occasion works for a significant period of time.  No one would argue with that last statement.  Some of us just demand a much lower exposure to risk when it comes to our penis.
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Re: Vein ligation in presence of tunica albuginea's scarring
« Reply #24 on: October 14, 2018, 10:35:32 PM »

O2 levels are not that high in the penis anyway. I often experiment.  When I had the hydrocele in my ball sack, I asked Dr. Kramer if I could stick a needle in it, withdraw the fluid, and I filled 3 vacuum test tubes with it. Set it in tube holder in the fridge for 3 weeks total and watch as it settled into it's individual component, sat a tube in a warm environment and watched for sea monkeys(bacterial, viral, fungal growth) and such.  Likewise, when my wife purchased me a pulse oxygen meter, I tried it on everything. That includes my dick boys.  It was very hard to manage to get some dick in there so it would read, I assure you. The hard tips on the end of the implant bulk it up and the thing is made for a finger, not dicks. With 4.004 billion men with dicks in the world, they need to make a pulse ox meter for dicks!  ;D  Fortunately my left cylinder withdraws when I deflate and I can squeegie it down to about 1/2 shaft level. That let me do my trials. I've had levels of 65, 77, and 85%.  Of course that is the glans and it does not seem the spongiform part would be the highest flow anyway.  Fingers and toes vary from 95% mostly lately to 98% when things were better off and the level you want to look for.  I again postulate that peronies pain is often due to poor blood flow like when your leg or arm go to sleep or you wrap a rubber band around your finger and leave it till it hurts. Cheers boys.
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Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders
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