I would like to know which high volume surgeons currently in the US are performing TEP (Tunica Expansion Procedure). Will anyone talking to Dr. Eid or Dr.Kramer ask about it. I am aware that they probably don't do it themselves but is more because of much higher risk or the fact that this technique is very new and are therefore not trained themselves for it. I think it is the later.
We have one instance of a person, namely Tartao having undergone this procedure in Brazil and he has regained all of his pre peyronies length after the implant in just 4 months it seems. This could be a valuable resource for people who have lost considerable length and wish to have it back, all without the need for grafting !
Talk to Dr.Clavell or Dr. Robert Venezuela. They both perform the sliding technique.
Shrunken Dick, why would anyone undergo the sliding procedure when there is a more advanced and safer procedure like TEP ? Moreover, I'm talking about a US resource for forum members. I personally don't have to undergo this.
Ironically, I just finished 2 visits and testing with Dr. Eid about the implant, and I am booked for Sept. with Dr. Valenzuela for a consultation. I first saw him last year (before my 4 go-rounds of Xiaflex which amounted to very little if at all). The reason is the penile size (not to mention the out of network cost) where Dr. Eid has let me know that I can only expect 5 1/2 inches after implant (loss of at least 1 to 1/12 inches post Peyronies) and with Dr. Valenzuela potentially I would be better off in size. How much remains to be seen. My only concerns were what another implant specialist (Dr. Colon) said about his associate that that procedure is dangerous and you could end up in his words with "dead dick". Not sure how much of that is sour grapes to a competitor or it is really that risky? Last year I was scheduled with Dr. Valenzuela for the procedure but was very unsure and wanted to see if a lesser path could be taken. He said to me you're not ready and I will see you in another year, lol now it's a year and I am back.
I have no idea why you would even consider the sliding technique with a 5.5 inch penis. This procedure is the most invasive procedure in the world. It comes with VERY significant risks. There have been multiple cases of the head of the penis getting Necrosis and then chopped off to save your life. Moreover, it requires a lot of grafting that is a very big risk in itself.
First of all, a 5.5 inch penis with dr Eid will make you very satisfied , more than you could ever ask for. Secondly if you are dead set on regaining length, ONLY consider the new TEP.
@dannys1s1 ; what kind of surgery did Valenzuela offer you? TEP is new, but there is no multicentric study on it. Moreover, Egydio reported and average 3.3 cm penile gain. That means they are adding girth and length gain together. If his procedure is safe and effective, others will adopt TEP in their practice. As of now, the sliding technique is the only technique that guarantees length gain.
I would like to see a copy of that guarantee so we can highlight it. I have never seen a guarantee of increased penis size by a legitimate physician.
Hawk, it seems you are ignorant. There are multicentric studies on sliding techniques. The average length gain is about 3 cm.
Shrunken dick you are mistaken when you say 3.3 cm gain length and girth combined was the result through TEP. By average they meant average length gain among all subjects, not including girth. That would make no sense. Regardless, we are not on this subject to argue about sliding technique or TEP, we are here to find resources that do. TEP with expertise in the US.
@gausRifle; lol, have you read that paper. They mentioned mean penile gain was 3.3 cm. It means they are counting both length and girth gain. By the way if egydio can increase length by 3 cm without risking glan necrosis then others will adopt TEP in their practice in no time.
Quote from: Hawk on August 11, 2021, 09:15:12 AM
I would like to see a copy of that guarantee so we can highlight it. I have never seen a guarantee of increased penis size by a legitimate physician.
shrunken_dick,
I asked for the guarantee that you said exists. If you mistake "mean gain" for an individual guarantee, then you are the ignorant one. Maybe this will help.
Guarantee - An unconditional commitment that something will happen.
Mean - A number or quantity having a value that is intermediate between other numbers or quantities,
With your newfound knowledge, maybe you can now tell the mean in an example with a 50% failure rate if one man loses an inch and the other man gains 4 inches. Hopefully, this helps you understand the difference between a mean gain and a guarantee of a gain.
Quote from: shrunken_dick on August 14, 2021, 05:45:27 AM
@gausRifle; lol, have you read that paper. They mentioned mean penile gain was 3.3 cm. It means they are counting both length and girth gain. By the way if egydio can increase length by 3 cm without risking glan necrosis then others will adopt TEP in their practice in no time.
Egydio is a very, very suspicious professional. He has done some weird things and even got banned for 6 months. He's being investigated for "ideological falsehood" (I don't know if the translation of the term to English is exactly that. In Portuguese, we call "falsidade ideológica".
Ok course, this doesn't mean he just did bad things in his life. He's a pioneer, but to develop certain techniques he screwed some patients.
I advise anyone in this forum against the sliding technique. This is a very dangerous procedure and could leave you without penis. TEP is much safer.
TEP is also developed by Egydio. If it is indeed much safer like the paper, why aren't more surgeons adopting this. I am aware that this technique was only first published in the International Journal of Impotence Research only in 2020. But unless we push the doctors here in the US , they will just try to play it safe and not learn anything new and tell patients to just deal with a shortened penis. We need to push them to do some research, learn a new skill and confer us the benefits.
I don't know the reasons. Probably because it's a new technique and needs more proof.
I think in USA you'll find a few Drs. that do some sliding crap. Just that.
There are just a few Drs. in the world that do TEP. There's a famous Dr. in Serbia (I can't remember his name) that does it too.
I can't agree that we have to push doctors to learn something new. However, if there is a safe, proven method of safely restoring size during implant beyond the gains currently made with an implant, doctors will be competing to be the first and the best known at safely offering it.
Can tartao or anyone else confirm that TEP does not involve dissection of the urethra like the research paper states. If it is indeed true, how is lengthening performed on the ventral side if urethra is not being disected ? If there is scar tissue beneath the urethra , how are relaxing incision being made without lifting the urethra out ? I would assume that you would need to lift both sides to make cuts in order for it to expand.
From the TEP literature.
The patient's expectation must be managed ab initio. The patient must understand that his estimation of size is subjective per se, and maximum enlargement is always limited to the length of the urethra and the dissected neurovascular bundle. Because the full potential length can only be determined intraoperatively when the bundle is dissected, the size of the implant cannot be determined until the maximum penile length has been achieved.
Tissue expansion can occur anywhere on the circumference of the penis to the maximum length of the urethra and neurovascular bundle. As the urethra is made of spongy tissue and is more elastic, in practice the limit of the penile enlargement depends on the length of the dissected neurovascular bundle. Since the urethra does not determine penile length restriction.....When the limiting factor is the urethra, the paraurethral tissue maybe
relaxed by incisions to permit additional lengthening of the penis
It sounds to me a bit ambiguous, but I'm not a doctor.
Quote from: GaussRifle on August 21, 2021, 09:21:07 PMIf it is indeed true, how is lengthening performed on the ventral side if urethra is not being disected ? If there is scar tissue beneath the urethra , how are relaxing incision being made without lifting the urethra out ? I would assume that you would need to lift both sides to make cuts in order for it to expand.
I have exactly the same question in my mind. That is why I said, sliding technique, MUST and circular incision and grafting are the only surgeries which can enlarge a penis. TEP is a fraud invented by egydio.
you may be right although to play devil's advocate, he might be saying under normal circumstances the length is not determined by the urethra but in some instances, the urethra is in fact the restriction, and then some sort of cut happens with TEP.
It is specifically written in the paper that an important principle of TEP is that the urethra is left untouched. This is even published in the Nature and Inernational Journal of Sexual Medicine Journals. These are peer reviewed journals. So there must be some credibility I'm hoping to the claims.
Shrunken_dick I'd like to know more about your status. Are you planning to get an implant or already have one ?
The nuero=vascular bundle almost always sets the maximum potential of lengthening whether by traction or surgery. The urethra can also be limiting especially if you had prostate surgery because it removes a section along with the prostate. Neither of the neurovascular bundle or urethra is shortened by Peyronies Disease so lengthening back to your natural size should not be restricted by those issues. Lengthening beyond your natural size has clear limits.
@Guassrifle; I haven't done my implant yet but I am looking into sliding technique.
So I had my consultation with Dr. Robert Valenzuela today. It was a follow-up from my last year's appointment with him about implant surgery options, but I backed away then, wanting to see if there was a less invasive solution out there before surgery was considered. At that time he discussed a very scary procedure including degloving at the circumcision location. Today he informed me that he went to Brazil and was trained on TEP and showed me exactly the same incisions that were illustrated in the TEP documentation I previously downloaded. I know he is a highly recognized surgeon for Mt. Sinai so my confidence is high as a result. He also stated he performs the surgery from a scrotal incision to avoid any issues with necrosis of the penile gland which he explained was very rare but did happen in the earlier method to a small number of patients in the area of .05 of 1% of those procedures. My out-of-pocket cost would be $4500 over and above his in-network insurance payment for the implant itself, as opposed to what is being charged in Brazil (40K) as he also mentioned. As part of the surgery, he explained he would also be removing some of the plaque. According to him, TEP is not penile lengthening, it is penile restoration to the pre-Peyronies size length with a potential gain of 3.3 cm (1.29 inches). He also explained there is a process I will need to follow afterwards for 6 months in order to restore my full length. I regrettably did not ask him about girth and this procedure, and as well his thoughts about dermal-filler for penile implant patients which I am also interested to hear about. I need to have some tests done pre-surgery by my primary and then schedule the surgery date.
@danny; Did he explained you how the length can be restored without dissecting the urethra?
He did say pretty much what Hawk wrote which is the constraint isn't there and with the incisions of the TEP procedure and the removal of the plaque, the constraints of the tissue stretching would be restored allowing the extending of the penis to its former length. This was my understanding at least...his patience at the bedside isn't his forte hopefully his skill as a surgeon is though.
I beliebe you guys are not fully understanding the question shrunken dick and I are asking. Maybe we did not make it clear.... Apologies.. We get that you can restore penis to its original lemgth hopefully. The real question is , in order to make these incisions will the surgeon have to touch the urethra on the underside and move it sideways (known as dissection) in order to make incision below it to allow for free expansion on the underside? We ask this and are particularly interested of the urethra is touched or not as earlier studies have shown that dissection of urethra can have complications like necrosis.
I am not sure I am following this conversation and I am no expert on TEP but I do not see how a TEP can be performed through a scrotal incision. I doubt that it can be.
The urethra is somewhat protected by the spongiosium but any deep incision would require temporarily moving it out of the way ie: dissection.
Hawk, I'm a bit of a fish out of water with the medical implication of the point that you mentioned. He did say, that he would not be doing a circumcision cut (he also noted this avoids the concerns raised about necrosis of the Gland) he instead would be cutting at the base by the scrotum which is closer to what I remembered hearing and may be different than what I stated earlier though.
Danny, next time you see the doctor can you please clarify these points with him : 1) he'll do a scrotal ncision, no circumcision incision 2) will he need to dissect the urethra to expand the underside of the penis ?
I have an upcoming pre-surgery visit on 10/14/21 with Dr. Valenzuela and surgery to occur on the 19th. I will ask him the questions in the previous post at that visit.
Keep us informed @danny.
Danny,
Are you rushing into this? This is not a race. You have time to become very informed in general. You have time to understand exactly what will transpire with YOUR surgery. You have time to make sure you find the right doctor. You have time to formulate a list of written questions.
Hi Danny! I have a couple of questions for you.
1). Are you diabetic?
2). You said that Dr. Valenzuela told you that the sliding technique has glan necrosis as a possible complication in 0.5 to 1% of patients. Did he ( Valenzuela ) say that glan necrosis happens exclusively in diabetic patients or it can happen to anyone in general?
I am not diabetic and he did not specify that prerequisite when we discussed the potential of glan necrosis. I have the email for his office and I would be willing to forward any questions I receive on a PM to him if you like.
Dear Danny! Thanks for offering help. Can you ask him the following question?
If the glan necrosis happens exclusively in diabetic men, or it can happen to anyone undergoing the sliding technique?
Hawk,
My apologies I just noticed your post from 10/6/21 in this thread. I have a list of questions for the Dr. as my appointment is for later today. If these questions are answered to my satisfaction I am proceeding with my surgery next week. I will post again after my visit today to let everyone hear his responses. Would also like to speak to you if you wouldn't mind. Thanks again.
So I spoke with Dr. Robert Valenzuela and these were the questions (and his answers)
I asked him:
1. How many of these implants do you do per year?
300
2. Will he be doing a scrotal incision, (no circumcision incision)?
yes
3. Do you use a vertical scrotal incision?
yes
4. Does he need to dissect the urethra to expand the underside of the penis?
5. Is this his specialty or does he perform other urological surgeries and
treatments?
No, the Urethra is not mobilized
6. What is HIS infection rate (not national statistics)?
less than 0.2 percent
7. Is he committed to one brand of the implant or does he have a choice for the best
match to your situation?
Yes Coloplast Titan as with this procedure Girth will expand noticeably
8. How many TEP has he performed
100s
9. Does he often use rear tip extenders and has he ever sized up and trimmed the
rear tip of an implant down?
no
10. Will he take measurements prior to surgery and promises you what your minimum
size will be after surgery and initial cycling?
yes
11. Does Glan necrosis happen exclusively in diabetic men, or it can happen to
anyone undergoing the sliding technique?
yes it can
When he does TEP, does he do multiple small incisions all around each Corpus
Cavernousum (i.e. 360 degrees) (Rt. and Lt.)? If Yes, .....
No, it is not 360
What narcotics will I get he said that 95% do not require narcotic pain relievers?
I'm on for Tuesday's surgery and will keep you all up to date.
Ok, thanks Danny for answering questions. When will he give you the minimum length you expect to gain ?
Best of luck for the procedure !!! And please start your implant journal on this board under your own topic !
Thanks Danny for asking my question to your doctor. Please keep us updated.
So I had the Implant surgery today :) (The TEP Procedure) with Dr. Valenquesz. I will be writing a detailed report in the upcoming days as well as follow-ups to show my gratitude to this forum. Not sure if this is premature and I will be eating these words later, but this was a walk in the park for me today. The pain is modest at most and according to the Dr. after the surgery, he told me I gained at least 3 cm with TEP. Currently, at this minute though, it looks short and swollen (a lot shorter than presurgery) this may be as expected though. I have an appointment on Thursday to remove the drain and will know more at that time. If anyone knows about what to expect here please let me know.
@danny ; happy for you. Make your own journal.
Congratulations Danny. Be very careful... you are probably on heavy pain meds and don't feel any pain for now. The name of the game is patience, you will not see the final result until about 6 months atleast to a year. If you have questions from another fellow member underone TEP and have questions about aftercare , reach out to Tartao on this forum
It is time to start your own implant journal under your own topic on this board with a little bit of background as your first post !
Thank you GaussRifle,
I will reach out to Tartao in a PM tomorrow. I went to Dr. V. today and they removed the drain and as well all wrappings but left two pieces of tape that on Friday after I shower I need to remove. There is pain now but not that bad and lots of swelling on my penis which is as wide
Quote from: dannys1s1 on October 21, 2021, 12:13:57 AM
I will reach out to Tartao in a PM tomorrow. ...
Please do your communicating on open forum. If others had communicated by PM you would have learned nothing. This is your chance to start a journal and give back.
Hawk, I wasn't able to find the name Tartao on the member list for the PM so that ends that. Maybe he is there under another name I don't know?
As far as where I am at right now, well I knew going into this the personality of Dr. V was going to be less than a perfect situation for me as he is not very patient and available. The fact that he did TEP and the fact of how he did TEP Vertical Scrotal was very appealing to me so at this point I believe it was the right move for me.
At my initial office visit the day after my Surgery I was deflated by an MA as part of the cleanup which included bandage removal along with removing the blood drain. The Dr. had an emergency and needed to leave. I am not sure if I am entirely deflated now as my penis still feels hard The pubic area is swollen and is extended and the length in this state is like 4 inches while the girth is about 6' wide. A lot of the swelling has gone down which includes my ball sac. I tried to see what would happen if I stimulated my self and no matter what I did I could feel any sensation at the bottom or underside of my penis. This is alarming although very possibly to be expected again the Dr. is an easy-going kind of guy just hard to get a response from which doesn't help to help me to feel more at ease as a result. This is an example of an email exchange from the
other day.
Hi Dr.,
A couple of questions that I would appreciate having answered.
1. Should I be in a deflated mode right now? (after my visit yesterday that was how the implant was left).
2. I have been reading that cycling the pump early on (within the first weeks) is beneficial to regain length and yet my first upcoming appointment isn't until 11/18.?
Other than these concerns everything seems to be great.
Thank you
The prosthesis needs to be in deflated mode as it was left.
this minimizes your discomfort and allows for the formation of an adequate pseudo capsule for the reservoir
So only one question was answered and I don't know if cycling at one month after surgery is following best practice? In any case, the pain seems to be better although it's deflated it looks like a short hard dick, and anywhere I will be going is going to take work to hide it. He told me on the day of the office visit he expects 6 1/2 to 7 1/2 length and as for girth he made a joke "I gave you shoulders".
Thank You,
Danny, you cannot draw ANY conclusions based your current state or appearance. You choose your surgeon. Regardless of what you heard from other surgeons or their patients about early cycling, it has no bearing on you because your surgeon will assure that you follow his protocol.
Relax about what happens when. He will update you at your next visit. If you have medical complications then by all means, seek and demand answers.
Thank you Hawk, for your response, everything you said was very reassuring and much appreciated.
Ironically, what you also mentioned regarding seeing the Dr. prior to next month's appointment "If you have medical complications", is in fact the case now, as I will be seeing him tomorrow for what seems to be a UTI. He responded in an email yesterday to come in after I had let him know that when I urinate it is painful and that I see some blood droplets. He mentioned having my urine and bladder checked.
It is now 8 days post-surgery. I have pain by just standing or walking in the scrotum and penis and so to get relief instead I have been keeping myself in a horizontal position with my legs elevated when doing this magically I am pain-free for a time. Unfortunately, this also means I am immobilized so I am hoping to get some clarity tomorrow with this and all of the other concerns.
I had my follow-up with Dr. V. yesterday as a result of his recommendation to come in after I let him know that I have been seeing what appears to be blood droplets during very painful urination. During the examination, he showed me that there was a cut on the inner side of the tip of the urethra on the glans of my penis which would in theory explain the blood. He also stated that I was still partially inflated hence the hard and short appearance as I mentioned earlier and to relieve some of the discomfort he would deflate me. In the next few minutes, I experienced the most pain I have felt in so many years as he manipulated the pump valve with his hand, and maybe this was because at that point in time it was only 9 days after surgery and I was still very raw and swollen but WOW that was so bad. I told, "If this is what I will be feeling to have sex I will never have sex again". He said to me, "Do you think that I would be doing this (meaning implants) if that was the case". After I cooled down he went on to say that everything looks good and he also prescribed phenazopyridine to help numb the Urethra as he explained that in order to get the length he has to stretch the urethra which makes it sensitive and as well I should avoid coffee and other irritants. After the office visit and the deflate, I felt much better. My penis still looks like a small hard dick but more flexible and far less noticeable in clothes than before. After the visit, last night I have been able to be much more physically active with far less pain and not needing to lay around to avoid pain as before. I guess when I have my next appointment on 11/18 the cycling will begin. The rational side of me knows that working the pump at that later time frame will be a far different experience as Dr. Valenzuela has said, but when I do a mock inflate now it is so sensitive that I am concerned for future usage. Faith and patience that it will all be ok is my guiding light.
There will be NO discomfort when inflating when you are TOTALLy healed. You will literally be able to bend your penis in half and squeeze it with zero pain. That might take a full year to get to that point but I think it will be sooner.
Post-Surgery week 4
Hi all,
I had my 1st months follow-up visit today. It didn't go quite as I expected in this regard as I had some prepared questions that I mentioned to the doctor that I had for him expecting we would have a sit-down conversation afterward, instead as I'm laying there he said shoot so I started to ramble off whatever came to mine compared to the detailed list on my phone. Anyway, and most importantly, he said I looked good and everything is as he would expect to see. I asked him about sensitivity loss on the underside of my penis and he said it's is to be expected based on where all the cutting was done and it would improve in time. I mentioned to him as well that I cannot orgasm (I tried a few times in the past weeks to no avail) he said he would also expect that at this stage. I asked him about my length which when erect is currently short like 4" when measured from the pubic area directly above my penis and he said 2 X a day cycling for 45 minutes each for 6 months will be required to restore maximum length. He also mentioned that I am still swelled up in the pubic area which will come down in time as well adding another inch or so. So I need to be patient and have faith that he is right on all counts. I am home now doing the first cycling session. It's really uncomfortable and painful so I am using a Hothands in a sock and wrapping that around my penis which seems to help blood flow or whatever it's actually doing but the feeling is much better. Just don't like those chemicals in that product so near to that area. Anyone's thoughts about any of this would be very welcome. thanks.
@danny; 4" after TEP is too short. I remember you saying that your doctor expects 7".
Post-Surgery week 4
Hi Shrunken_dick, I totally agree about the size, although I may have undersized my length in the last post as I redid the measurement today while fully erect. One issue I see is that the pelvic area above the penis is protruding significantly (which is all new to my body and is clearly part of the post-surgery) and he did say that the swelling will come down and will change the appearance and give me more length. I remeasured myself bone pressed on the top at the body (where it is extended outward as I mentioned) it's like 5" and yet if I measure on the side of the penis where it begins at the body it measures 7' so it's very hard to say which is an accurate measurement. I have attached a picture to show what I am trying to say. In any case, I have begun cycling about 2 hours 2 to 3 times a day at maximum pumping (the pump is extremely hard to press down) so lets see what many months of this stretching will do.
Danny,
Update your signature line. You are not implant bound.
Include your procedure, the date, your surgeon, the implant model, size, and any RT extenders.
Also, is this your journal or GaussRifle's topic? I want you to have a good journal that people can follow. I will gladly make posts about your implant a separate topic. I also recommend you start every post with
"Post-Surgery week ?"
That way members can follow your progress and you can refer back to your journal when talking to others or when looking at your own progress.