Implant Experience

[jwj6872]

On December 17, 2009 I received an AMS 700 LGX penile implant. After dealing with ED for three years post prostatectomy I elected to have the implant installed. I went through all of the interventions for ED including vacuum pump, all three ED medications and injections. The injections worked but the planning and three to three and a half hour erections took the toll upon my wife and I and our sex lives. I was told that most men using injections usually follow one of two routes. Their frequency of sex gradually drops off until they just do not care anymore or they move on the a penile implant. My stubborness would not allow me to follow the first path so I chose penile implants. Here is my experience to date with my penile implant.

My prostatectomy was done at Vanderbilt University Medical Center and I knew they did a lot of penile implants. My surgeon for the implant was Dr. Doug Milam. He has done lots of implants and on the day of my implant I was the second one. Prep was easy compared to what I had to do for the prostatectomy. Just nothing by mouth after midnight. My surgery was scheduled for 11:00 AM and I arrived at 10:00 AM. The surgery lasted about two and a half hours or at least that is what they charged my insurance company for the procedure room. I was in recovery only about 45 minutes and woke up with no problems. They did not tubed me for the surgery so they were not concerned about my breathing in recovery. They did not place me in a room for the night but in a surgical holding room just down the hall from recovery. This was because I was scheduled to be released early the next morning. I did have a catheter. I was allowed to eat solid food within a few hours of surgery and was starving in the middle of the night and the nurses brought me a turkey sandwich. They removed the IV catheter around 5:00 AM and the Foley catheter about 6:00 AM. As soon as I unrinated they released me.

Here are some observations. First, the prep for the surgery was a total hair removal. I looked like a brand new baby. My incision was done above the penis and is about two inches long. Some surgeons do it under the penis. Dr. Milam told me ahead of the surgery where the incision would be and it was because it allowed him better access to placement of the reservoir in the abdomen. The implant is partially inflated and remains that way for six weeks post op. An ice pack was kept on my genital area constantly the night of the surgery and into the afternoon of the next day. I was told after 24 hours the ice pack would not help much so I stop using it that afternoon. They also put an athletic supporter on you after the surgery. I knew this was going to happen and had purchase one at a sporting goods store. It was a lot more comfortable then the hospital one.

The night of the surgery I did not have much pain and only asked for a pain pill to help me sleep. I got about four hours sleep that night. I took another one before we left the hospital as we had a two hour drive home. The first day post op swelling and bruising sets in and when they do the pain increases significantly. I began taking a pain pill every four hours. When I had my prostatectomy I never took a pain pill so this gives you an idea of the difference between the two surgeries. My post op instructions were to stay on my back with my feet above my heart as much as possible for the next five days. Believe me, that is all you want to do anyway. In that position the pain was not much and the feet above the heart helps with the swelling. Getting up from the reclined position is tough for the first two to three days and my wife had to put my socks on and help with my underwear during that time. I had some catheter irritation which made urinating the first week something I did not look forward to. On the third day post op the pain got better and I began cutting the pain pills in half. The whole pain pills were really making me loopy. On the fourth day post op I begin only taking the pain pills at night and extra strength tylenol during the day. The swelling began to go down on the third day and the bruising diminish. I also was instructed to pull down on the pump frequently. That was difficult with the swelling and tenderness bit I did do it. A week after the surgery I was off pain pills and was able to drive. I went the our church's Christmas Eve service with a little discomfort while sitting. By the way, sitting was the most uncomfortable and painful position for about 10 days. Two weeks post op I had an appointment with the PA. He checked everything and told me the pump was in the perfect place and I could stop pulling down on it. There was no deflating/inflating done at this appointment.

In the last couple of weeks I have returned to normal activity. It is a little difficult doing some bending and squatting with the partial erection and I have learned to not wear some of my jeans right now. The instructions were to wear briefs for the first six weeks and since I wear them anyway that has been no change for me. I can feel the implant tubes on each side and they reach all the way into the head of my penis. Actually the pain in my penis was one of the first areas to go away. The incision and tender scrotum were the last. My first impression once the swelling went away in my scrotum was the pump is a lot larger then I thought it would be.

As I write this I am getting so use to the implant I do not hardly notice it anymore except for the erection which is probably about a 50% erection. I go back on February 10th to have it activated and begin the process of using it. The reason the implant is partially inflated during surgery is to make sure the chambers in the penis are full and stretched during healing. I am naturally anxious to start using it. How do I feel about the implant at this point? The experience has been about what I expected. I had done enough research and watch videos of the surgery I knew the pain would be something I had to deal with. While the pain was there with the pain pills and the diminishing of the pain so quickly it was not a big deal to me. I was glad the prep for surgery was so easy and the immediate recovery after the surgery went very smoothly. The five days on your back is exactly what you have to do. Lucky for me there were a lot of football games on during that time.

As I progress I will keep all informed. Anyone with any specific questions just let me know and I will respond.

Tamu

[Thomas]

Tamu,

Thank you for sharing your experience. One question I do have, especially for those of us who have had their prostate removed, is how the implant changes the orgasm (if at all). For me, the removal of the prostate has significantly changed the feeling of my orgasm to essentially the penis muscles. Having the implant chambers inserted into the penis always gave me concern that it would somehow alter the remaining part of my orgasm. When the time comes, would you share what impact this has on your orgasm?

- Tom

[jwj6872]

Tom,

I will update my posting as I continue the process with my implant. Right now the feelings in my penis are no different then they were without the implant. My orgasms post prostatectomy actually have been as good as before if not better. I know they last longer.

Tamu

[jackpTenn]

Tamu

I can tell you that you and your wife are in for a treat. Dr. Milam did my implant 10/23/08 a year after a local doctor punctured my urethra and aborted.

This is my story of my one year check up. I lost 1 1/2" to peyronies. Today 15 months later I have gained back to 90% of my pre preynoies length of 1995.

The night after I had my implant activated I was laying on my back with an erection sticking straigh up, hard as a rock. No pills, no shots, no VED & constriction ring. I felt NORMAl for the first time in years.

10/09/2009 My one-year post op at Vanderbilt.

The exam and follow up with Todd Doran PA, and Dr. Douglas Milam

I am delighted with my implant and all the care I received at Vanderbilt. During the exam and follow up questions I spent about 45 minutes with Todd and Dr. Milam. I had a few questions and learned a lot.

We started out with Todd and an intern. I pumped up my implant. Todd showed the intern where the tips of the implant extend into my glans. Of course the glans was flaccid and with a slight downward pressure on the tip you could see where the tip of the implants are. Both sides fit to the same size and approximately ½ way into the glans.

We discussed my success with the implant and the impact it had on my life. I am happy to say the impact has been better than I ever expected. During the discussion Todd asked what is the most common complaint with men with pryronies. Loss of size, length and girth. The AMS 700 LGX is the only implant that can help restore length.

I wish I had a recording but I will tell you basically what Todd said. The AMS 700 LGX will straighten out a peyronies curve. Peyronies is not normally in the erection chambers when the implant is activated it will straighten out the penis. I said to Todd that some men go into surgery expecting an LGX and come out with a CX or other implant. I asked if there was a reason for that. He said that when that happens the doctor does not fully understand the anatomy of the penis and the workings of the implant. Dr. Milam was an engineer before becoming a surgeon and fully understands the mechanical function of the implant and penis. He said that all there patients, with peyronies, that have the LGX have a straight erection like mine.

I have a diminished blood flow to the glans. I told Todd that it is more noticeable now that I have been off blood thinners for a year. He said that was what happens is a lot of men. I asked how could I help blood flow to the glans without the blood thinners. I asked if Cialis would help. He said it would and recommended the daily dosage of 5mg. He wrote me a prescription for the 5mg daily dosage. I will take it along with the coupon for a free months supply from http://www.cialis.com to the pharmacy today. My prescription drug plan (Medicare Part D) does not cover it so I need to shop around the cost.

I asked about the Ambicor 2 piece implant for a gentleman in the New England area. He said they only use it if they cannot get a reservoir in. He said it has a much lower satisfaction rate than the other implants.

I asked about pain with peyronies for another gentleman. He has been having pain with erections and other urinary symptoms. They know Dr. Levine and his work. They disagree with not doing any surgery for peyronies if you have pain. They did not get specific as to what they prescribe for pain only different men have different symptoms and they prescribe different things, and they also occasionally recommend surgery for the pain. They also recommended a second opinion on the urinary symptoms and said they would be glad to help him with that.

We talked about penile injection therapy for ED. They do not recommend it and do not prescribe it. Injection therapy caused my condition to get worse with corporal fibrosis.

We talked about the peyronies society web site. Todd said that now he has a face to put with those coming in after visiting the web site. He said that they have been able to help several men after viewing the site. Todd said he has looked at the site and likes the fact that we are straightforward and informative. The information is usually straight and factual.

We talked about the difference in the pubic and scrotal approach. 98% of the implant that Dr. Milam does is the pubic approach. He said that the dorsal nerves are easy to identify and keep out of harms way. He said that if there is a problem with the corporatomy it is much easier to repair with the pubic approach. We discussed my punctured urethra that happened with the local doctor using the scrotal approach. Todd said that the instrument to dilate the corpora is curved and if not done properly with the scrotal approach that a punctured urethra can happen. He said Dr. Milam is very detailed about this and reminds his students all the time of this.

I asked about revisions. Dr. Milam said that they do “a ton” of revisions.

I asked about the life expectancy of the implant. Dr. Milam said 93% were performing normally at five years. Both Dr. Milam and I have some engineering background. I am a retired Boiler Inspector and Mechanical Contractor. We compared it this way; you can buy the best HVAC system on the market and use the worst or cheapest contractor in town. The system will not perform properly because of an improper installation. If you buy the same equipment from a first rate contractor you get a properly performing system that will save you money in the long run. I said it to him like this; I charge an A/C system with a digital thermostat to the manufacturer’s specifications. 90% of the systems I go to the first time are at least ½ to 1 pound of Freon overcharged. This cuts the efficiency of the system by about 20-30%. Moral, to get the best results use the best equipment and an experienced well qualified people.

We discussed additional penile length. I have gained weight and need to loose 20-30 pounds. Yes I am a big guy 6’2’, 255 pounds. I was told that if I loose the weight I would gain 1 to 1 ½ inches. That will put me back at my length before peyronies. Now all I have to do is get off my butt and do it. I have started back walking 2 miles a day, but as my wife says I need to cut back on the sweets, bread and portions. I lost over 20 pounds several years ago on the Atkins Diet and considering going back to it.

Girth: My erect girth is back to where I was as a teen’s or early 20”s. If I remember my algebra correctly 2” diameter x 3.14 = 6.28” or 1” radios x 3.14 squared = 6.28”. Any way the wife and I are very happy with it.

The best part of this whole experience is the renewed confidence I have. I feel NORMAL for the first time in years.

There was the pain of surgery, the 6 weeks waiting to activate the device, the discomfort when the device was first activated, getting used to the pump in the scrotum and the about 3 month learning curve of using the implant. The small amount of discouragement when first activated that I was not as long as in the VED but as Dr. Milam said at my 3
Month check up I regained it as the AMS 700 LGX continues to expand

Dr. Milam, Todd and I talked about the publication on using the AMS 700 LGX. It has just been submitted to The Journal of Urology and will take 6 to 9 months before it is published. There is a meeting next month (11/09) in California of the Sexual Medicine Society. Dr. Milam has a major presentation at that meeting on the AMS 700 LGX. Dr. Milam will send me a copy of the publication when it is printed and I have his permission to publish it on the peyronies society web site a yahoo implant group.

I also have kidney stones 3 on the left side and 2 on the right. I showed Dr. Milam the report from a CT I had the end of May. He said so long as I was not in pain the wait and see that my local doctor recommended is normal.

Dr. Milam and I discussed that when my local urologist did a bladder scope, after the ultra sound for kidney stones, that he said that with an implant I was limited with options if I had prostate problems. I had a couple of TURP’s about 12 years ago. Dr. Milam said that with the implant there was no problem with any prostate procedure with the implant.

Dr. Milam and his team do all kinds of penile surgery from surgical correction of penile curvature, penile implants, and artificial urinary sphincter to control incontinence, circumcision and lots more.

Before anyone asks, No you cannot gain additional length or girth with the implant above what you normally have. Any one that tells you their product or device will is selling “snake oil.”


Dr. Milam told me I did not need to make the trip back to Nashville any more but if I needed him just let him know. I will always be a patient of his and Vanderbilt.

JackP

[jwj6872]

jackpenn,

Thanks for sharing your experience. As I said in my last post I am anxious to be turned loose on February 10th. Dr. Milam is excellent at what he does. I went against the advice on Dr. Smith at Vanderbilt. Dr. Smith did my prostatectomy and wanted me to wait another year before moving on the an implant. Todd Dorn had told me in his experience what ever you had come back after two years post prostatectomy was all you would get. Dr. Smith disagreed but I felt Doran delt with men with the ED issue post prostatectomy a lot and was closer to it then Dr. Smith.

Counting down to activation!!

Tamu

[jackpTenn]

Tamu

I agree with Todd. Men wait to long for an implant and loss of size is difficult to impossible to regain.

I had peyronies not PCa. I would hate to guess which is worse on a man. Peyronies is not life threatning but the disfigurement and loss of penile size is very difficult on the emotions.

I have a friend in the DFW area that is a RN Nurse Practioner. He had his implant 6 months after peyronies started and with the LGX has now gained back all his penile size.

I know you are looking forward to activation, I sure was.

Enjoy

Jackp

[jwj6872]

Implant Cost:

I just got all of the invoices in from my implant surgery and I know the cost is an interest. Here is the breakdown of the cost:

Hospital Costs;
Recovery Room - $2,224
Procedure Room - $9,282
Anesthesia, Materials & Service - $2,035
Pharmacy - $2.987
Central Supplies - $20,774(AMS 700 LGX implant - $20,400 of this amount)
IV Solutions - $626
Total Cost - $37,928
Insurance Adjustment - $18,494
Net cost - $19,434

Surgeon's Cost - $2,779
Insurance Adjustment - $1,175
Net Cost - $1,604

Anesthesiologist's Cost - $1,445
Insurance Adjustement - $361
Net Cost - $1,084

Complete Total Net Cost - $22,122(This is before insurance payment)

Tamu

[jwj6872]

Just got back from Vanderbilt and had my implant activated. The PA pumped it up and deflated it once and then had me do it three times. I am very pleased with the result. He measured my length and it was right at 5 inches. He said this is more then most first time activations. The girth was not measured but it look exactly like what I had before my prostatectomy. Pumping up this afternoon I did not have any soreness or aching in my penis but my scrotum was tender when squeezing the pump. The PA told me that I will gain girth and length over the next six months to a year. He also said I will literally have a callus develop from squeezing the pump. My penis is a little sore now. I am to pump it up two or three times a day and hold it for at least two minutes before deflating. Of course I am released for sexual activity!!

Tamu

[PK Man]

That is so great to see. My Urologist has indicated that I am a candidate. I am definitely considering taking the plunge. I have to prove that the Trimix doesn't give me the results I want or is unworkable for me. Then it looks like a go.

[rockford]

Hello, I had my implant over 2 years ago. I live in London and the operation was a success. However, when I pump up and with the help of cialis achieve a bulked up erection, during intercourse the blood flows out and I lose tumescence, the head of my penis becomes smaller I have no sensation and therefore can't achieve orgasm. Even though I have acceptance about what is happening, it is leaving me very frustrated with low self-esteem. Any advise out there would be gratefully appreciated. Thanks.