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Here is a bit of my history..

I am single, 45 year straight generally healthy male, located in Toronto, Canada. Never smoked, hardly drink, workout regularly.Was always a mildly anxious person..not clinically diagnosed or treated. I do get performance anxiety with new females and also that leads to PE sometimes(5-6 minutes) . Started noticing softer erections after turning 40. I still continue to get morning erections.

1. Family doctor prescribed Cialis in 2015..daily 20mg. Worked initially..now not so much.I also tried Viagra and that also worked well initially.

2. Started 18 sessions of shock wave in May 2018..felt an improvement initially..however not anymore. I am doing again this year..but results are not encouraging.

3.Had several IC trials at men's clinic this Sept, Oct.After several attempts didn't get the right erection and or dosage. Didn't like the vibe there too.

4. Went to my family doctor in October, she referred to Urologist at University Urology.Met Dr.Sidney Radomski. He wasn't interested to even try IC injections. He prescribed MUSE 500 and 1000.
Recently I was with a female and I noticed I could maintain my erection in lying on top(missionary)..however standing positions are definitely trouble. So MUSE might not be the solution.

5. From the sounds of it an implant will give me ..sexual confidence to have as much penetrative sex and for as long as I desire.Since I always use a condom..even if I ejaculate after 5 min..females wont know it unless I lose erection. On a side note I am pretty skilled at oral sex and using fingers..usually can make females orgasm regularly. However strong thrusting in multiple positions for long has a dominance factor that I find satisfying Being single and dating younger females..I find they love the dominant male frame too.

6. I recently had a long phone consultation with Morganstern Urology, Atlanta staff. They suggest I come down for penile ultrasound and their blood flow tests. They suspect venous leakage that's got progressively worse over the years.

In 2016 January I had first penile girth enhancement by dermal filler (PMMA, brand name Metacrill at AvantiDerma, Tijuana). Pretty happy with the results and before I could do second round they needed a circumcised penis. I had circumcisison in April 2019( a week of pain) 6 weeks of sexual abstinence, for second dermal filler procedure(additional penile girth).That was done in July 2019. The filler is injected under penis skin using a blunt canula..nothing was touched in cavernosa. So if I go to implant route the pain and recovery of a scrotum stich and discomfort isn't my challenge. Adult circumcision hurts like hell.

I am confused on the way ahead. Any guidance /advice will be helpful.

Thank you

The test to determine whether you have a Venous Leak should definitely be your next step. If it is confirmed, a Penile Implant is about the only solution. From doctors I talked to and what I have read, any attempt to surgically repair the leak generally doesn’t work at all or is likely to revert in the near future.

If you do not have a VL then you can get advice from them on how to proceed.

Im no expert in the implant field other than reading extensively. I’m not getting my first one for another 22 hours. Lol.

But one thing you said would concern me as far at your options for future implants.

The dermal filler. What did they actually use?

Reason I mention it is we had someone on here a week or two ago, had just had a malleable for implant put in. I believe Dr Kramer did him.

There was some silicone based dermal filler present in the penis so they scrubbed a three piece and went malleable rod.

I realize the filler you have had been inside you and not caused any issues but when it comes to these surgeries doctors don’t do ANYTHING that might contribute to an infection.

The first doc I interviewed flat out said “no way” to me having a belly hernia stitched up either before or after the implant, albeit while still under anesthesia. The hospital itself is usually real good about piggy backing elective surgeries.

The doc I’m using has said no to fixing my peniscrotal webbing unless he has to go get the pump in my nutsack, and only then after the incision above my dick has been secured.

Your doctors may vary. But the presence of any foreign substance in the penis...even though it’s nowehere near your corporal bodies...is likely to set off alarm bells.

Thank you for the response.

I updated my original post to add the filler. Its PMMA brand name Metacrill.
Avantiderma in Tijuana is world leader in this treatment.
After second round I cant wear a regular sized condom..it gets stuck under my glans and doesn't roll any further down. Had to switch to trojan magnum for the girth only. I am close to 5 1/2 inches in length erect and around 5 1/2 inches in girth at the thickest part. Goal is to get round 3 of filler to move closer to 6 inch erect girth.