Infra Pubic? or Peno scrotal approach?

[kbota53]

Still trying to learn all I can about implants, and have a few questions. Since there are two ways of accessing the corpus cavernosa, my impression is that most surgeons use the scrotal approach, but it seems that the infra pubic approach would be less subject to infection. So, I'm looking for additional knowledge.

Anyone have answers to the following Q?

Which of these methods of installing an implant is least subject to infection?
Which have the highest success rate?
Which have the highest longevity?

What other questions should I be thinking of?

Thanks

k

[jackpTenn]

K

I have had both the scrotal and pubic approach.

The local doctor that punctured my urethra used the scrotal approach. That is the way most urologist learn to do the surgery.

Dr. Milam at Vanderbilt used the pubic approach. Less painful. I had corporal damage from both trimix injections and the punctured urethra. Dr. Milam told me he uses the pubic approach 98% of the time. That way if you have corporal damage it is easier to repair. Less truma, and pain for easier recovery. The pump is placed through the canal where your testicles dropped at birth so there is less truma for the testicles.

Dr. Milam's infection rate is less the 1/2 of 1%. He has had only 1 infection in the last 7 years and that gentleman was diabetic.

Less chance of infection with the pubic approach. The scrotum is full of hills and valleys where germs can hide. In comparison the pubic area is smooth and less places for germs to hide. One thing Dr. Milam does, after you are put to sleep, you are preped with an surgical wash from your shourlers to your knees.

Hope this helps.

Jack

[Frank Talk Admin]

Like most things in medicine, I think it depends on the doctor who does it rather the technique used. Dr. Eid early on started his 'no touch' technique where nothing in the entire surgery touched the surface of the skin. He talks about this at his open seminars since all skin harbors bacteria even after the most thorough treatments. The crags and crevices of the scrotal tissue don't matter if nothing touches the skin. Most doctors use a similar technique now - but the success lies in the doctor, not the technique. The good docs have a very low infection rate - the not so accomplished ones don't.

I think aesthetics might be a consideration. If you trim your pubic hair and a scar would bother you, then that might affect your decision. Take a look at the video on the implant page - that is his third implant and his scar is pretty hard to see.

My thoughts would be to go for the surgeon with whom you feel comfortable. Don't worry about his approach if he does a good job. my two cents
Paul

[jackpTenn]

Paul

If you have corporal damage the approach does matter, I've been there.

Most doctors that use the scrotal approach do not follow Dr. Eid's no touch procedure, and have a higher infection rate.

As for the scar with the pubic approach. I keep my pubic hair very short. The closure that Dr. Milam uses is like a Plastic Surgeon would use. Even I can not find the scar on my pubic area.

Jack

[kbota53]

Thanks guys. I do appreciate the frank dialogue. It really helps. I find it interesting that many guys are worried about having a scar. A little scar in either place just isn't going to bother me one way or the other. But I'm happily married to the same woman for 36 years, and we both have a few scars from life experiences. (I would think that an Infra Pubic incision would heal faster, simply because the skin is smoother, and it's easier to keep clean and care for.)

Having said that, I recall visiting with a gentlemen in Dr Hellstroms office the other day in his 70's, not married, and was happily servicing three ladies from 56 to 66 (If I recall correctly). None of them knew the others, and none of them knew he had an implant. Or so he said. From what I understand, it would be hard to not realize something was different the first time they handled his scrotum. Now remember guys....this was in New Orleans....he he There's lots of "different" folks down there....

k

[jwj6872]

I am also a Dr. Milam patient and as Jack had the pubic approach. When I questioned Dr. Milam about this as what I had seen on a few Internet sites the scrotal approach was used he said it was primarily to allow him to be able to place the resevoir easier. As Jack said I can hardly see my scar and can just barely feel it. I also think the recovery is better with the pubic as it is easier to get the ice pack on the incision then if it has been scrotal. The recovery from an implant is slower and more painful then from the radical prostatectomy.

Bill

[franglais]

x

[kbota53]

I wonder if one of the reasons that many docs prefer the scrotal approach is due to the possibility of dorsal vein damage using the pubic approach. The deep dorsal veins are right in the way and would have to be managed carefully.

justa thought

[jackpTenn]

K

I asked about this at Vanderbilt. Dr. Milam said that the dorsal nerves are easy to find and keep out of harms way. He has never had a problem with it.

I asked the local urologist that sent me to Vanderbilt which approach he uses he said scrotal. I ask why. He said that is the way he learned how.

Jack