Dr. Eid Replies: Answers to some Critical Questions from Forum Members

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Hawk

I contacted Dr. Eid and Dr. Kramer's offices by phone.  With Dr. Kramer, I had to leave a voicemail.  In fairness, I only made one call to each and I am Dr. Eid's patient.  I was given Dr. Eid's email address and followed up with an email.  In the email, I explained our forum, the reason we expanded our Erectile Dysfunction section of the forum and asked specific questions that have come up here.  I also provided a link to the forum in case he wanted to see what we are all about.  I have no knowledge on whether he took a look at the forum or not.  The questions I asked him are questions that as an implant patient and long-time administrator I did not feel confident answering.  I try to make it a practice never to carelessly spout off if I am not well informed.  Graciously, Dr. Eid replied to my email in writing so we do not have to speculate on these important questions.

He began by congratulating us on the work we do here to help men maintain and improve their quality of life. Below is a direct cut and paste of part of his response.
________________________________________________________________________________________________________________________________________
Please see below answers to your questions:

1) Do you ever do excision and grafting to correct deformity?
This is very rarely needed. Grafting May cause excessive scarring and areas of numbness of the penile skin decreasing sensitivity and ability to reach orgasm. In 99% of cases, the penile implant will shape the shaft of the penis over time with daily cycling of the device. Grafting will also significantly increase the risk of infection. When it comes to surgical manipulation and dissection of the penis my philosophy is that "less" is better. Less means less pain, smaller incision, less bleeding, less swelling, less infections, faster recovery and faster use of the device.

2) I just learned from my surgical notes that you do incision and remolding.  Typically, how severe of a bend can you straighten with an implant and remolding?
Significant curvatures as much as 180 degrees can be corrected in this fashion. Will send you pictures of immediate post-operative pictures. (Dr. Eid indicates in later consultation that some deformities near the glans are more difficult to correct with an implant.) https://photos.google.com/share/AF1QipPCiwuLEx05gi7oN8A3veJ-TY06NRfzhBshJXLRZMVDUDH7-T4vEl6iD-ohHEufXw?key=cWJ5RDhvYTY4NnRKQ1JTeTNhT0xTWnhIWWN2NWV3. (More straightening will occur with daily cycling.)


3) Is a man with good erectile function ever a candidate for an implant just to straighten his penis?  It seems a less invasive procedure than grafting. Some have tried Xiaflex with less than satisfactory results.
Yes, the way I manage patients with Peyronies Disease is based on the ability and quality of sexual intercourse. If a patient and his partner are happy with and able to have intercourse then observation or Xiaflex is the best option. On the other hand, if intercourse is not possible a penile implant may be a better option than plication or Nesbit procedure even in a potent patient. Significant shortening occurs with correction of curvatures such that thrusting during intercourse is no longer possible. That individual is much better served with a penile implant that straightens the shaft of the penis without losing length regardless of whether or not Erectile Dysfunction is present.

4) We have seen studies that infection rates continue to climb. with every subsequent implant, This is a huge concern for young men with Erectile Dysfunction.  To what degree is this true.

Yes, removal replacements are more complicated procedures, requiring a more experienced surgeon and take longer to perform. My infection rate with the "No-Touch" technique since 2006 for more than 3700 consecutive patients is 0.6% including removal replacement implants. Over 50% of the patients that became infected however involved cases with increased surgical time (greater than 2 hours), excessive manipulation of the device and penile tissue, excessive dissection and prior history of surgery( prostate, bladder, and previous implant). In experienced hands, I believe that the infection rate for an R/R is the same as for virgin implants.

Great questions by the way. They reflect a high level of knowledge and sophistication.


Sincerely,

J. François Eid, M.D.
Director
Advanced Urological Care, PC
Penile Implant Specialist - Dr. J. F. Eid, top New York Urologist
435 East 63rd Street,
New York, NY 10065
Phone: (212) 535-6690; Fax: (212) 535-7025
Patient Portal: www.UrologicalCare.com/patientportal
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

curved

Thanks Hawk.  This addresses my question about implant possibility with Peyronies but not Erectile Dysfunction.  Really appreciated!
51 yrs old; diagnosed 3.5 yrs ago; 90 degree upward bend
But I had no Erectile Dysfunction
tried all pills, VED, traction, Xiaflex PRP, ESWT, H-100 & stem cells; IF diet. implant surgery with Dr. Eid 3/28/19
to correct deformity - 20 CM Titan 2cm RTE / 1 cm RTE

Bubba dawg

5 Rounds of Xiaflex. Good results.

I am known to give out false information and post nonsense with little to no evidence to back up my claims.
I have ignored several warnings. Further reports to the moderators or Administrators and I will be banned.

TonySa

Wow, thanks Hawk.  This is the premiere surgeon in my book.  I hope he's training other surgeons across the country!
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.

tomas1

I wish he would take his talent on the road; like to Phoenix?
84 years old.
Implanted 01/22/19 by Dr Avila.
18cm AMS 700 CX, 3.5cm RTE 100cc reservoir
Diagnosed with Gleason  6 prostate cancer.
Monitoring it for now.

Hawk

That thought was not fresh on my mind until after I submitted the questions.  I'll probably slip that in the next round.  He said he would be glad to respond to me as we have questions come up.  He is not just a great surgeon.  He is a great guy in my book.  I don't want to abuse him though.  Sometimes I wonder how he has a life with panicked new implantees calling his private phone during off hours and weekends, but when it is you on the other end of the line, you are certainly glad he does.  The amazing thing is not just that he does it but that he does it with such a caring attitude.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Pfract

This is amazing! and that last question you asked... so important! HUGE THANKS Hawk! going to add this to the index right now

edit: and by the way, did Kramer ever got back to you? or are you still waiting for an answer? What do you make of that?
Penile fracture during sex, Portugal 2014 - [url=http://www.peyroniesforum.net/index.php/topic,11131.0.html]Penile Implant Forum -Tech info compilation and Index - Peyronies Society Forums[/url]

Alibaba

The few times I contacted Dr. Eid since 2009, his answers all were proven to be spot on over time. Much credit to the man for his input and professionalism. It would be nice if some of the arrogant "bully" urologists learned how to do quality work and respect their patient like this man.
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

TonySa

Hawk, next time can you ask him which implants are recommended for best correcting peyronies and under which circumstances?
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.

TonySa

Great questions, it will be interesting to hear if if he even thinks an ongoing acute peyronies condition even exists—or is it something else with or without an accompanying peyronies?
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.

Roddy

This is fantastic work, Hawk. Thanks for putting in the hours on behalf of all the members. Much appreciated.
Aged 50 congenital curvature and then Peyronies onset, excision and grafting not successful,
Coloplast Titan implant on June 3rd, 2019 (aged 47) to correct a 90 degree bend
Dr. Mike Fraser - Glasgow, Scotland.

TDix

I did get an answer from Dr Yafi concerning why surgery doesn't cause more scar tissue.  He basically said any healing of a "tear" or micro tear will heal much differently than a precise incision.  He likened it to splitting your chin open.  If you just let it heal, it will produce a large scar compared to going to the doctor and having it stitched up
47 yrs old, 3 yrs diagnosed
Xiaflex w/original uro resulted in a fracture
Excision/grafting by Dr Faysal Yafi 3/26/19
Implanted by Dr Yafi 8/11/20, Titan 20cm + 1cm RTE

2Oldfords

   Thank you Hawk for taking your time and energy to get answers to a lot of unresolved questions on this board.
    I appreciate Dr. Eid taking the time to answer as I'm sure he is a busy man.
    I am anxiously waiting for the answers to the questions regarding surgery with or without "active"
Peyronies Disease. I had surgery on my hand for DD and it has been stable/nonrecurring. My excision grafting for Peyronies Disease went badly as my Peyronies Disease is actually worse now than it was. So his answers may shed some light on that subject.
Age - 65
Peyronies of unknown length of time
70 Deg curve 10-11 o'clock
first 2 uro's offer for xiaflex and referral
incision/grafting 12/18/18, Implant 9/11/20

Hawk

Below is the letter with questions I recently submitted to Dr. Eid.  In it he humbly suggested I also get other input to be exposed to different opinions. I will follow through on that.  I have communicated with Dr. Levine in the past.  I also wrote a review of his book on Peyronies Disease when approached by him and his publisher. It is good to see the confidence Dr. Eid has in these two specific physicians.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Dr. Eid,

I appreciate the responses to the questions our support form asked several months back.  I hope you can begin to appreciate our gratitude for your support.  I am sure I speak not only for our thousands of members but the thousands of guests that read the forum but never join. 

I am accepting your invitation to contact you as needed so we can have authoritative answers  to the following questions:
______________________________________________________________________________________________________________________________________________

Very nice hearing from you again.
The questions are great and very thoughtful. I have tried to answer them in the best possible way.  I am sure that there are many good and different answers that would be obtained from my colleagues. You may want to ask the same question to other doctors and see how they would respond. Larry Levine in Chicago and Ricardo Munariz in Boston are two Physicians that I recommend.

Sincerely,

J. François Eid, M.D.
Director
Advanced Urological Care, PC
Penile Implant Specialist - Dr. J. F. Eid, top New York Urologist
435 East 63rd Street,
New York, NY 10065
Phone: (212) 535-6690; Fax: (212) 535-7025
Patient Portal: www.UrologicalCare.com/patientportal

1. Since trauma and even micro-trauma is reported to trigger active phase (acute phase) of Peyronies Disease why doesn't the significant trauma of surgery trigger another active phase in those that already have Peyronies Disease?  Very good question. In reality, we have a very poor understanding of what triggers Peyronie's disease. I suspect that micro-trauma is only one of the causes of Peyronie's disease. Peyronie's disease is best viewed as a deterioration of human flesh that occurs more often in patients that are at risk of endothelial dysfunction; diabetes, hyperlipidemia, hypertension, are the conditions often present in men who present with Peyronie's disease. Nerve injury which occurs after prostatectomy and radiation therapy can cause penile scarring. Surgery does not injure tissue in the same way as those aforementioned conditions. 

2. Some surgeons and studies suggest only patients in the stable phase of Peyronies Disease are candidates for surgery.  Some patients seem to stay in the acute phase.  Do you agree that only Peyronies Disease patients in the stable phase without flare-ups of pain are candidates for an implant?  if you disagree why?  Historically the only surgical treatment for Peyronie's disease was to correct the curvature with different techniques. It was felt that further changes in angulation could occur in the active phase that would then compromise the result of the surgical procedure. This is not the case for an individual with Peyronie's disease with an implant. The result of an implant surgery would not be affected by the acute phase.

3. What brand and models of cylinders do you recommend for correction of penile deformity and why?  (AMS CX  Titan, Etc)  Coloplast Titan. These cylinders are tunica dependent and will expand to greater girth. In addition, they can be inflated to very high pressure which helps to model the tunica of the penis over time.

4. It has been reported that you told a patient that pumping too hard (say using two hands for the final pumps) shortens pump life.  To what degree is this known to be accurate?  Is it enough of a consideration that you recommend against maximum inflation?   The component that is most likely to fail of the penile implant is the tubing connection at the level of the pump. Repetitive stress causes fracture of the tubing and leakage of saline. The tubing sustains tremendous pressure as well. The more one pumps the more likely the device will fail. The life expectancy of the device also depends on how the pump is positioned in the scrotum. Acute angulation of the tubing at the point of connection to the pump and tubing crossing over each other will foreshorten the life expectancy of the device.


5. Debate erupts on our forum that young men (we have a surprising number) should delay an implant because of the number of revisions likely to be needed.  Beyond just infection which you addressed, Is there any other damage that limits the number of revisions a man can have?  What do you consider a maximum number?  In what way if any will a penis suffer or degrade with a maximum number of revisions (aesthetics, sensation, size, etc.)  A tough question to answer. Pressure atrophy of the flesh of the penis and glans will occur over time if the implant is maintained partially inflated. This also can occur if the cylinders are oversized. This, of course, is more likely to occur with the malleable implants. What's great about an inflatable implant is that it can be deflated and maintained deflate in order to spare the remaining erectile tissue and penile glans. This is a more important issue for the younger patient than the number of surgeries that one has. Revision surgery is more challenging for the doctor to do and the risk of infection and urethral injury are also greater. I would say that it is preferable to limit the replacements to 3 to 4 surgeries in one's lifetime, not always possible. However, it is also unreasonable to expect a man to perform penile self-injection forever; quality of life matters. An implant gives one a permanent reprieve from the constant thought of having Erectile Dysfunction! There is nothing like it.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Roddy

Thanks, Hawk. Appreciate your effort in contacting Dr Eid. When he says "Pressure atrophy of the flesh of the penis and glans will occur over time if the implant is maintained partially inflated", what does he mean by "if the implant is maintained partially inflated"? Pardon my ignorance but given that the Titan is always maintained partially inflated as it is always in a 'semi' state when deflated I'm a tad worried that my deflated implant may endanger and cause long term erosion of penile tissue and therefore reducing the chance of subsequent renewal. Am I misunderstanding what he is saying?
Aged 50 congenital curvature and then Peyronies onset, excision and grafting not successful,
Coloplast Titan implant on June 3rd, 2019 (aged 47) to correct a 90 degree bend
Dr. Mike Fraser - Glasgow, Scotland.

Hawk

Partially inflated means that all the fluid is not in the reservoir.  Some of it has been pumped into the cylinders so the cylinders are partially inflated.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Roddy

Yeah, that's what I thought. Good to know so as to always try and empty the implant of all liquid back to the reservoir. Do any of you feel that the 'semi' feeling of your penis after deflation is as a result of the hard plastic cylinders inside your shaft, solution left within your cylinders from not deflating 100% or a measure of both? I'm only 6 weeks in so feel I'm too early in the whole process to know.
Aged 50 congenital curvature and then Peyronies onset, excision and grafting not successful,
Coloplast Titan implant on June 3rd, 2019 (aged 47) to correct a 90 degree bend
Dr. Mike Fraser - Glasgow, Scotland.

Hawk

The cylinders are stiff when new and although they soften with time they remain more rigid and give more length to your flaccid penis then you normally had when totally flaccid.

Keep in mind that semi-rigid implants are still used and put much more constant compression on penile tissue.  The semi-rigid implants do sometimes cause erosion.  I think the concern Dr. Eid has is with men that constantly semi-inflate whether to make a larger package or to make it quicker to inflate.  It is not likely that doing so on occasion would be an issue.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Pfract

Amazing that he wrote back with answers to these questions! Interesting the number of revisions he ''recommendeds'' having in one's lifetime... Some food for thought!
Penile fracture during sex, Portugal 2014 - [url=http://www.peyroniesforum.net/index.php/topic,11131.0.html]Penile Implant Forum -Tech info compilation and Index - Peyronies Society Forums[/url]

Werther

Is there a reason why he said that "it is preferable to limit the replacements to 3 to 4 surgeries in one's lifetime"?

Could this be motivated by the fact that "Pressure atrophy of the flesh of the penis and glans will occur over time"?

Pfract

Did you read the entire post? The answer for that is right there in the list
Penile fracture during sex, Portugal 2014 - [url=http://www.peyroniesforum.net/index.php/topic,11131.0.html]Penile Implant Forum -Tech info compilation and Index - Peyronies Society Forums[/url]

Hawk

My read of it is not that it will occur over time but that there is some risk and that risk is heightened if the man keeps his penis partially inflated.  For now, I don't think we are getting a more clear explanation without a back and forth conversation with a high volume surgeon such as you would get during a consultation.

Dr. Eid has made himself available as we need clarification and I am up for discussing it with him by phone but I do not want to take advantage of his generosity where it is not necessary. 

I will direct the same question to a few other surgeons and see if they respond.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Werther

Quote from: Hawk on July 20, 2019, 11:21:23 AM
My read of it is not that it will occur over time but that there is some risk and that risk is heightened if the man keeps his penis partially inflated.

My read is that "extraneous bodies" in the penis will cause it to rot as time goes by. Correct me if I've misundertood the post.

QuoteI will direct the same question to a few other surgeons and see if they respond.

That was what I asked other surgeons/physicians. I hope others will chime in. Apparently - as it could be imaginable - Eid is not the only expert on peyronie's disease and Erectile Dysfunction.

SW01

Interesting. I read it that if you keep it pumped up all the time it can cause issues. Like the one piece malleable implant CAN do, not always does. I think your body chemistry and your own health issues could also impact it.

Deflate it when not in use and you should be as good as you can be. There is always someone with an anomaly of course.

Personally. Deflated this titan is big enough for me. I do not need to pump it up a little. Walking around with it deflated still bulges the Jean's out a bit. Have no problem with that.

Happy, happy. My other option was no bulge, at all period anymore. Just soft tissue down south.

Dead dick, soft dick, no dick, not much difference to me. I would rather attempt the fix and deal with any of those consequences than never getting hard again. Quality of life issue for me.

For me, not even close decision. Implant.
Dealt with Erectile Dysfunction, Peyronies, & venous leak for 3 yrs.
implant on March 7, 2019 w/ a Titan 18 cm plus 1cm RTE
Revision after hernia surgery. Dr. Andrew Todd, Richmond KY
Removed Titan and put in LGX 18 cm plus 2 RTE's, 20 cm total.

Hawk

Quote from: Werther on July 20, 2019, 01:39:27 PM
My read is that "extraneous bodies" in the penis will cause it to rot as time goes by.

Your interpretation of "it will rot over time" made me laugh but it is fine for you to embrace that interpretation if you like.  That is the beauty of having his words directly from him so everyone who can read English can draw their own conclusion and form their own opinions. It is pointless for 16,000 members to post their interpretation of what he said when we can all read exactly what he said. :) That is why I did not offer my take on it until you asked.  Those that can read, can read his plain English sentence. 

Since you have drawn your conclusion that you will rot if you get an implant I would assume that closes the door on an implant in your mind and it is time for you to move on to other options such as
Quote from: Hawk on July 16, 2019, 12:22:43 PM
Plan B
Others apparently think it is a better plan to try to preserve their flaccid penises with VED's, traction etc until closer to age 50 and forgo sexually satisfying sex until you near retirement and then have an implant until 62 - 80 years of age if you live that long.  (since a fully functional implant on a corpse generally does not result in sex)  ;)   If you are single I think it would be awkward to take a VED on a date unless you have an extremely close relationship with an understanding girlfriend.

Plan C
Still, others would not get an implant at all and instead would try to preserve their flaccid penises until something better comes along hopefully in their lifetime.  We can be certain nothing is coming to the actual consumer in less than 10 years so under the luckiest scenario they would forgo satisfying sex until sometime after age 32.  Under bad circumstances, significantly better improvements might not emerge in their lifetime.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

DELETED

Thanks, Hawk. It would be nice to address all of these questions directly to Dr.Kramer, Dr.Karpman and maybe to some of the other very experienced implant surgeon as Dr.Wilson or Dr.Perito

Hawk

Yes AlexSamo,

I will be reaching out to the ones Dr. Eid recommended plus Dr. Kramer.  I do not know anything about Dr. Wilson and I will not contact the last one on your list. There has been far too much controversy surrounding him.

Not only do I want their opinions for the forum, but I am also interested to see how many are concerned enough about our community to take the time and respond.

Hawk
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Alibaba

Doctor Eid was very clear: " Pressure atrophy of the flesh of the penis and glans will occur over time if the implant is maintained partially inflated. This also can occur if the cylinders are oversized. This, of course, is more likely to occur with the malleable implants. What's great about an inflatable implant is that it can be deflated and maintained deflate in order to spare the remaining erectile tissue and penile glans."

for those who have trouble understanding:  Hard all the time puts pressure on tissue and it dies (due to blood flow being constricted).  The deflated implant no-longer puts this pressure on the tissues so they remain healthy thus reducing the chance of erosion. Statistically, I think I read where the inflatable implant, because it can be deflated, reduced the chance of erosion by over 90+%.
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

tomas1

Ali, you mention in your profile that you hated the infra-pubic installation.
Could you elaborate on why since there's an ongoing discussion on another forum about that subject.
I'd also be interested. I like my scrotal installation.
84 years old.
Implanted 01/22/19 by Dr Avila.
18cm AMS 700 CX, 3.5cm RTE 100cc reservoir
Diagnosed with Gleason  6 prostate cancer.
Monitoring it for now.

Hawk

Tomas,

I hope Alibaba will respond because hearing from someone that had both techniques is rare and valuable.  I have heard the best argument for the infra-pubic approach from two well-known surgeons that perform only that technique and it revolved around less tenderness in the scrotum, therefore, the conclusion a patient can activate his pump sooner and have sex sooner, "often within 21 days"  The problem with that argument is that I had the penoscrotal approach and had sex in 21 days as do many of Dr. Eid's patients so that can hardly be considered a legitimate advantage. Doctor Eid says the infra-pubic approach might facilitate reservoir placement if a patient had prior abdominal surgery.  Again, however, I had an appendectomy for a ruptured appendix and a laparoscopic prostatectomy. It is a little known secret that a laparoscopic prostatectomy rearranges your abdominal organs more than an open prostatectomy does because they do not repair the tissue that holds them in place and they are just allowed to settle in a new position.  In spite of these two abdominal surgeries, I required no infra-pubic incision to place my reservoir so that advantage of infra-pubic is at least overstated even by Dr. Eid.

Here is a chart comparing the infra-pubic approach to the No-Touch penoscrotal approach.  The addition of the No-touch technique developed by Dr. Eid for implant surgery might alter the comparison to some degree. https://www.urologicalcare.com/penile-implants-prosthesis/no-touch-vs-infra-pubic-technique/
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

tomas1

I think my incision was pretty much out of the way of the pump and I never had a problem with pain when cycling. I suppose if the incision is near the pump, it could be a problem.
I used Neosporin on my incision and my snake eyes and all healed quickly.

I'll read the chart later.

I just read the chart and found it interesting.
My surgeon used no drain in my scrotum and I never had any swelling or bruising. I don't quite understand why that didn't happen.

From the chart:

Infra-pubic & Trans Scrotal patients have a drain placed through skin because the openings in the penis are not closed completely and bleeding occurs. This results in more post-operative swelling and the need for pressure dressing. The drain must be removed the day after penile implant surgery. The drain sticks out through the skin can cause post-operative soreness, is painful to remove and requires the patient to spend the night in the hospital. Some believe that this also provides an additional route for bacterial contamination. 

Part of the procedure is completed in 30 minutes or more. The openings in the base of the penis are not closed requiring placement of a drain to remove blood, which continues to drain from the penile shaft. Pre-operative skin preparation, closure of the incision, and placement of the drain requires additional surgical time.


I really have to commend my surgeon for his skill of sizing my cylinders. As I've mentioned, I was at lifelong length right after first inflate.
I am a bit disappointed in him for his lack of instructions and seemingly not caring how I did after surgery. I guess he wanted me to call him, but I wish he'd (or even a member of his staff) had contacted me to see how I was doing.
I also vehemently disagree about his telling me that an LGX at 18cm or larger would be floppy. Wonder where he got that idea?
I've never heard of it and know people with 24cm LGX with no complaints

Thank goodness for online forums for answers to any questions I might have had.
84 years old.
Implanted 01/22/19 by Dr Avila.
18cm AMS 700 CX, 3.5cm RTE 100cc reservoir
Diagnosed with Gleason  6 prostate cancer.
Monitoring it for now.

Stepone

Ugh!
I try to read everyone's comments. I find them helpful. But now!
I am confused.
I read the comments about erosion, and then read backwards until I saw Dr. Eids responses regarding inflating partially. It really scared me about erosion. Does my penis have too much fluid in it? It's not hanging limp, do I need to squeeze it, until it hangs limp?
My penis always seems to be partially inflated, so I have been squeezing it to get all the fluid out, to the point, that I feel the two cylinders inside and they sort of move around easily within my penis. They feel sort of crinkly and shift easily within the penis.
So I noticed today my penis is black and blue on the one side. So did i squeeze it too much? or what?
Any ideas?
I was ok before reading what Dr Eid wrote and I thought maybe I need to try to squeeze more out. I don't understand and I am really confused.
How much do I squeeze? How do I determine this? When do I know to stop squeezing?
As I said I thought I was doing ok until I interpreted Dr. Eids warning?
Help....
Nesbit surgery 2015, 66 years young, Titan Implant 4/25/19, 22cm, Dr. Lentz, Duke University NC

tomas1

It's hard to say how much fluid you have to evacuate, but it sounds like you squeezed too hard.
When I deflate my CS, I just give it a small squeeze and it does hang pretty normally.
My flaccid length is only 1/2" less than erect.

I wonder if erosion was going on if you'd notice discomfort from the tips in the glans?
If not, I don't think I'd worry about erosion, but what do I know?
84 years old.
Implanted 01/22/19 by Dr Avila.
18cm AMS 700 CX, 3.5cm RTE 100cc reservoir
Diagnosed with Gleason  6 prostate cancer.
Monitoring it for now.

Stepone

Thanks, I have no discomfort in the glans.
I have an appointment with my surgeon in 10 days. I will ask him and report back about this erosion issue and ask how to tell when all the fluid is drained.
Nesbit surgery 2015, 66 years young, Titan Implant 4/25/19, 22cm, Dr. Lentz, Duke University NC

Hawk

Guys,

Let's not get obsessive worrying about deflation and erosion.  erosion is very uncommon with inflatable implants and much more common with malleable implants that do not deflate at all.  even with malleable implants, it is not like it is a very common problem.

With inflatable implants, the biggest danger is with someone who will have an implant for many decades AND does not deflate it fully.

Many men put 4 - 6 pumps into the implant on a regular bases without issue.  That is however what I would be concerned about.  If you can find the deflate valve there is nothing complicated about deflating an implant.  With anything other than an AMS LGX you will feel somewhat flat cylinders that likely have a crinkle or dogear bend or fold in them.  It does not take a steam roller to deflate them, merely a gently steady squeeze. With a Titan, your penis will, of course, be longer when deflated than pre-implant flaccid length.  That does not mean you are not deflated.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

TDix

You can add Dr Yafi into this as I emailed him and he's more than happy to answer any or our questions
47 yrs old, 3 yrs diagnosed
Xiaflex w/original uro resulted in a fracture
Excision/grafting by Dr Faysal Yafi 3/26/19
Implanted by Dr Yafi 8/11/20, Titan 20cm + 1cm RTE

Hawk

Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Alibaba

Just wanted to let you friends (and maybe a few foes) know that I will answer in a day or two. I'm running a bit on the worn out side, here it is a few minutes till midnight and I'm checking on y'all; and want to try to give you men aspiring to be boys again my best thought out answer plus, if I can find them, links from the NCBI why infrapubic and be a hazard for revisions. Cheers buddies.
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

Werther

Quotefor those who have trouble understanding:  Hard all the time puts pressure on tissue and it dies (due to blood flow being constricted).  The deflated implant no-longer puts this pressure on the tissues so they remain healthy thus reducing the chance of erosion. Statistically, I think I read where the inflatable implant, because it can be deflated, reduced the chance of erosion by over 90+%.

This was what I made out of Eid's words (yes, I used the verb "to rot" but I thought it was clear that I was obviously exaggerating the meaning of "pressure athrophy").

I bet that "soft cylinders" (for want of a better word) will cause less problems than others (i.e. semirigid or rigid implants) but nonetheless they should exert pressure on the contiguous erectile bodies, shouldn't they?

Based on your response (@Alibaba), if I didn't misunderstand your post, it looks like we interpreted Eid's answer the same way. I'd just like to ask you if you could post a reference of the papers where's stated that chances of erosion with inflatable implants are reduced by over 90+%.

DISCLAIMER: I'm not trying to flame over this very subject and I'm sorry if I got out of hand with my previous posts.

Cheers to everybody

Hawk

Quote from: Werther on July 27, 2019, 12:24:09 PM
This was what I made out of Eid's words (yes, I used the verb "to rot" but I thought it was clear that I was obviously exaggerating the meaning of "pressure athrophy").
Cheers to everybody

Werther, In all due respect which I have tried to show. repeatedly acknowledging that you used exaggerated terms does nothing to advance an accurate, clear discussion and encourages others to respond in kind.  Before long it destroys the forum discussion to the point that we help no one.

I will try to find the incidence of erosion with malleable implants (which is not real high) compared to inflatable implants.  I do know I have been on Erectile Dysfunction forums for over a decade and I have only ever encountered one case of erosion of an inflatable implant out of hundreds that have had implants for over a decade.  That case was associated with infection and a failure to promptly remove the implant. That rate is amazing in view of some of the non-skilled surgeons that shove 3 or 4 implants in a patient per year and you midsize and who don't even keep a selection of sizes on hand. 

Dr. Eid has done thousands of implants as has Dr. Kramer and a few others.  I have ready access to ask Dr. Eid.  Everyone has to make up their mind based on the best information they can find but I trust Dr. Eid to tell it like it is.  I never had a sense that he tried to downplay risks or problems with implants.

Others might be aware of studies or statistics that I am not aware of.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

Werther

Quote from: Hawk on July 27, 2019, 01:55:45 PM
I will try to find the incidence of erosion with malleable implants (which is not real high) compared to inflatable implants.

This is the point in my opinion.

If we aren't able to provide members with such information, then we are not really superior to other forums that deal with this very subject.

That's whay I asked Alibaba to kindly post his reference since he said that 90%+ of men with inflatable implants don't get through the risk of erosion.

If this is acutally a neutral informative board, then this is what it should be kept in my opinion: asking for evidence.

P.S. I'm not implying that inflatable implants will cause erosion as much as semirigid implants do; I'm looking for evidence and that's why I asked this questions. I sincerely hope that I will bw proven wrong.

Alibaba

Well, boys, I am slow to respond here but that is not to say I have not worked on the reply about the infrapubic v.s. scrotal implant issue. I know somewhere on the competing forum, I had posted a national health service report comparing the approaches and another dealing with infrapubic revisions. I have not been able to find it again. On the other forum with over 2000 posts and few "missing" posts, I again, was not able to sort it out. The gist of the matter was that both were comparable in surgical outcomes and revisions needed but infrapubic had a much higher incidence of nerve damage upon revisions because of scar tissue growing around the nerves which travel on the top of the penis, the same place all the tubing comes out of the cavernosa in an infrapubic implant.  There was also the increased stated risk in the initial implant though much lower with careful excision and a doctor not blind as a bat. That issue is totally avoided with the scrotal approach.  I found an article mentioning the same information but they wanted $39 for me to copy the url or the article itself. There was no link for me to request a discounted or free use for educational purposes which I consider this forum to be.

I had miserable issues of pain from ALL 3 tubes (reservoir and L & R cylinder) wrapped around my dick from the top side and traveling around the right side of my dick to the pump. I also attribute that to an extent of my dick leaning to the left now rather than hanging center. There were also protrusions of tubing jutting out as it wrapped around my penis.  All these issues are common if you do searches. 3 doctors told me that infrapubic is preferable only to people with a lot of fat.  With a little thought, that is understandable. High pumps, which I had, are a common known with infrapubic.  The tubing is just too damn short for the pump to hang down in your sack and it tends to hang on which ever side the tubing comes around your penis. Keep in mind, it is coming from BESIDE your penis so straight down from there is where is can expect to be. My right nut was in constant pain from the antagonization of that huge square block fighting for the same space.  I have argued and drawn out anatomical diagrams to show how it is more difficult if not impossible to properly measure for an implant with the infrapubic approach.  Add some gut to it and it is much harder still. In the past, I've argued that unless they use a curved tool to measure the penis or position a person in the heal to heal knees wide apart (I do not remember the name for this position) verses flat like most doctors do, full-length measurement is not possible at any level of accuracy nor is opening up the cavernosal space.  Note and I have point-blank asked the method of install many times over the past 4 years, many floppy heads or shortened penis' like I had with my infrapubic are just that. Infrapubic implants. The advantage is the space above your penis is less sensitive than your penis and below. It has less veins so less chance of bleeding, and the place for your reservoir is "right there".   If I had known the issues I was going to have with an infrapubic were going to be as severe as they were, I would not have had an implant, period. There were times I was so uncomfortable I had to sit down on the floor where ever I was till the pain resolved enough to go home for more Advil. Sitting down in the floor in the middle of Target makes you look like a nut case till they see the tears run down your cheek. I had made many attempts to get an implant. I have HIV and many phobic doctors would not touch me for it. Some admitted it, some did not but their nurses did. No, I never sued them for disability act issues though it is covered. When I was sold the first implant doctor that would do it on another forum, I asked about scrotal. He said he will not do it that way. I had wanted a working penis so bad, I was willing to accept any way to get it done at that point. Having had both ways now, I see there is a MAJOR difference in the way it feels in my body. The ONLY advantage I see of infrapubic is the tubing is not where your hand hits it if you are giving yourself a hand job. Let's be honest here folks. Your dick it there, your hand is there. It is going to happen.  If the exit from the cavernosa was a little further back in the scrotal approach, that would not be an issue either. Easier than asking for littler hands.  Cheers gentlemen.
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

Hawk

Quote from: Alibaba on August 08, 2019, 11:31:48 PM
When you give yourself a hand job. Let's be honest here folks. Your dick it there, your hand is there. It is going to happen.  If the exit from the cavernosa was a little further back in the scrotal approach, that would not be an issue either. Easier than asking for littler hands.  Cheers gentlemen.

Alibaba, I am not sure I followed that part.  I can feel no tubing unless I press my finger in just above my scrotum on the left underside.  I have to press in almost to my first knuckle and I am not overweight at all.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

tomas1

I'm a natural skeptic and I think some docs use pre-connected implants meant for scrotal approach (shorter tubes to the pump from the cylinders) than the longer tubes meant for infra-pubic.

I'm just glad my pump hangs free. My doc said it is better when I have shrunken testicles due to using testosterone for years.
84 years old.
Implanted 01/22/19 by Dr Avila.
18cm AMS 700 CX, 3.5cm RTE 100cc reservoir
Diagnosed with Gleason  6 prostate cancer.
Monitoring it for now.

Alibaba

Looks like plenty of late night spelling errors Hawk and not a good explanation. My tubing exits the bottom side of the cavernosa.  Imagine an erect penis. Palm to the underside of the penis. Thumb and forefinger circling shaft. Jacking off. The back of my hand hits the tubing on every stroke. If it had exited my cavernosa closer to the perineum, my hand would not hit it. Possibly it is an issue specific to me but from factory diagrams, it looks as if my installation is normal.  This may be part where doctor Eid wraps with tissue he saves.  Cheers.
Milam 1/13/16-LGX 21cm - BAD service & surgical outcome Hated infrapubic.
Kramer revision 3/1/17 Titan 22cm + 1.5 cm extenders

samsung

#2 here is an outright lie. And I'm not calling Hawk a liar. Dr. Eid must have said this. But he must have been speaking about human beings, of which I most assuredly am not a part of. Otherwise an implant would help me.

But as far as my case is concerned, I spoke to him yesterday and he said an implant would not straighten me out. Because my curve is more toward the head of my penis. He said this. I heard him with my ears. I did not imagine it.
45 y.o. Single. Onset of symptoms (pain-stinging like a wasp) @ 6/2018. No sudden injury. Curve developed slowly. 40 deg. dorsal. Hourglassing. Torsion to left flaccid. 4 rounds xiaflex. Restorex, DMSO+, heat, arginine, cialis, lipoic acid, vit. K2

Hawk

Samsung, did Dr. Eid flatly say that an implant would not straighten your penis or did he say that because of the location he could not guarantee that it would totally straighten your 30-degree curve?  Those are VERY different statements.

Dr. Eid is not a BS'er.  He does not build expectations he is not almost certain that he can deliver.  He told me I would likely need a second incision for the reservoir because of prior surgeries.  He told me he would promise me a 6 1/2" penis.  He made no second incision and I have 7" penis.  He promised me no additional girth and I got 1/4".

I have no doubt Dr. Eid would be cautious of telling a man that insists on near perfection for a penis you state no one is likely to ever see erect except you.  That is an unrealistic obsession that I would never touch if I were a surgeon.  I would accept that there was no way I was ever going to make this man pleased with the final outcome because much of the displeasure is coming from your thought process and not from your penis.   I feel for what you battle.  I wish I could recommend something that you were motivated to try for the mental battles that you fight.  Throwing Peyronies Disease on top of that can't be easy.  Hopefully, treatment for that and your penis will reach the public in the days ahead.  Until then I hope you can focus on helping others even less fortunate than you.  You have a lot to offer.  If you can obsess on that you will make a huge difference to many.

Best wishes to you.
PS: I modified the answer to #2 based on your input.  Thank you!
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]

samsung

I do see the difference in what he said and my thinking.

He said that because the location of the curvature was so distal he could not guarantee the penis would be made perfectly straight.

I agree with you and I hear what you are saying. But from my point of view I am screwed either way.

It is really 2 things I am hung up on the most.

1. The concept of calcification. It all ends here for me and chases me toward an implant because I see no point in doing anything if the plaque is calcified. If 2 people (NEO, Tony, maybe a couple others) say traction, etc. can soften plaque, but hundreds of others say once calcified all treatment lacks a point, then of course my mind drifts toward giving up.

2. Now that he has said it can't be perfectly straight then I don't see the point of an implant.

Maybe that doesn't make sense. But there is where I'm at. I wish there was a better way of explaining this. My thinking is that if I am willing to cut my penis apart in getting an implant and do something virtually no other man on earth would ever consider, then I should be rewarded with something better than I already have. It works right now. But it is deformed. I don't want to watch it wither away. But if I get an implant, why go through all that only to have the curve reduced x percent?
45 y.o. Single. Onset of symptoms (pain-stinging like a wasp) @ 6/2018. No sudden injury. Curve developed slowly. 40 deg. dorsal. Hourglassing. Torsion to left flaccid. 4 rounds xiaflex. Restorex, DMSO+, heat, arginine, cialis, lipoic acid, vit. K2

Hawk

I understand your point to some degree.  I do not face what you face so I won't pretend to know.  I cannot advise you because I am not in your situation.  If I had those issues in my current situation I would try mechanical traction as long as the plaque was not under the area where the traction strap cinches.  This would be my logic.  Traction preceded by mild to moderate heat might not soften plaque but it is going to place tension on the shortest run of fibers.  Whether it stretches the plaque or stretches the fibers connected to the plaque, the shortest run that is causing the bend might be lengthened and correct the bend.

This is not a statement of what will happen but a statement of what I would hope for based on sound logic.

PS:  I might move some of these posts to their own topic or another existing topic.  If I do I will notify you.
Prostatectomy 2004, radiation 2009, currently 70 yrs old
After pills, injections, VED - Dr Eid, Titan 22cm implant 8/7/18
[url=http://www.peyroniesforum.net/index.php/topic,872.0.html]Hawk - Updated 10/27/18 - Peyronies Society Forums[/url]