Dr Clavell or Dr Hakky for initial implant

[ElbowRoom]

dr hakky just did mine agust 12th.no length loss..minimal pain.just started cycling tuesday and i be damned if it aint bigger and girthier than ever....22cm with 1 inch tip extenderz..have full feeling alreadyvand im truthfully blessed by dr hakky..recovery wasnt nothing just bruising and discolored balls..that man is a godsend with implants

infrapubic or penoscrotal surgery? He’s doing mine soon and I’m wondering which I should request.

[sambalamba]

dr hakky just did mine agust 12th.no length loss..minimal pain.just started cycling tuesday and i be damned if it aint bigger and girthier than ever....22cm with 1 inch tip extenderz..have full feeling alreadyvand im truthfully blessed by dr hakky..recovery wasnt nothing just bruising and discolored balls..that man is a godsend with implants

infrapubic or penoscrotal surgery? He’s doing mine soon and I’m wondering which I should request.

Hakky told me that for a thin person like me with very little infra-pubic fat I will probably feel the tubes with an infra-pubic approach. But recovery is faster. He suggested penoscrotal approach for me. Hakky's penoscrotal horizontal cur direct is unique since almost all other surgeons tend to take a vertical cut approach. I have heard of a few cases where people have lost ventral sensation with penoscrotal approach on this board but those are probably rare. And in a infra-pubic approach the whole procedure is very close to the nerve bundle.

Bottom line: There are pros and cons of both approach. I don't know if one is a clear winner over the other.

[LastHope]

dr hakky just did mine agust 12th.no length loss..minimal pain.just started cycling tuesday and i be damned if it aint bigger and girthier than ever....22cm with 1 inch tip extenderz..have full feeling alreadyvand im truthfully blessed by dr hakky..recovery wasnt nothing just bruising and discolored balls..that man is a godsend with implants

infrapubic or penoscrotal surgery? He’s doing mine soon and I’m wondering which I should request.

ElbowRoom, I found this PS vs IP summary interesting incase you haven't read this already.

The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation

https://pubmed.ncbi.nlm.nih.gov/32488210/

The good of the Penoscrotal approach
(1)
Excellent exposure of both proximal and distal corpora cavernosa even for patients with obesity or corporal fibrosis
(2)
Little risk of injury to dorsal neurovascular bundle
(3)
Pump placement is facilitated
(4)
The small scrotal incision leaves negligible scar
(5)
One incision double implant of IPP and artificial urinary sphincter is possible

The bad of the Penoscrotal approach
(1)
Blind placement of the reservoir into the space of Retzius.
(2)
Scrotal swelling can delay device activation
(3)
Risk of injury of scrotal urethra; the urethra is easily seen and can be repaired

The ugly of the Penoscrotal approach
(1)
None. There is no irreversible complication with PS incision

The good of the Infra Pubic approach
(1)
Easier, safer reservoir placement under direct vision
(2)
Diminished scrotal swelling resulting quicker pump activation
(3)
Shorter operative time in skilled hands
(4)
Incision is remote from patients with incontinence and allows abdominoplasty.

The bad of the Infra Pubic approach
(1)
Limited visualization of distal corpora cavernosa
(2)
Pump placement is not optimal with the risk of pump migration
(3)
Severe obesity and fibrotic corpora are challenging
(4)
Revision surgery after the IP approach, if required, is associated with increased difficulty and worse surgical outcomes
(5)
Scar of IP incision is visible

The ugly of the Infra Pubic approach
(1)
Risk of dorsal nerve injury, a complication from which there is no cure. While a paper in 2018 claimed that there were no reports of this complication in the literature, both Drs. Scott and Wilson sustained one in the 1980s. Wilson has also been an expert witness in six additional cases sustained with IP (all successful) that came to litigation in USA. Decreased penile sensation occurs most often following revision cases when the anatomy is not so clear.

Reference:
Otero JR, Manfredi C, Wilson SK.
The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation.
Int J Impot Res. 2022 Mar;34(2):128-137. doi: 10.1038/s41443-020-0319-4.
Epub 2020 Jun 2. PMID: 32488210.[/i]

[tooyoung]

dr hakky just did mine agust 12th.no length loss..minimal pain.just started cycling tuesday and i be damned if it aint bigger and girthier than ever....22cm with 1 inch tip extenderz..have full feeling alreadyvand im truthfully blessed by dr hakky..recovery wasnt nothing just bruising and discolored balls..that man is a godsend with implants

infrapubic or penoscrotal surgery? He’s doing mine soon and I’m wondering which I should request.

ElbowRoom, I found this PS vs IP summary interesting incase you haven't read this already.

The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation

https://pubmed.ncbi.nlm.nih.gov/32488210/

The good of the Penoscrotal approach
(1)
Excellent exposure of both proximal and distal corpora cavernosa even for patients with obesity or corporal fibrosis
(2)
Little risk of injury to dorsal neurovascular bundle
(3)
Pump placement is facilitated
(4)
The small scrotal incision leaves negligible scar
(5)
One incision double implant of IPP and artificial urinary sphincter is possible

The bad of the Penoscrotal approach
(1)
Blind placement of the reservoir into the space of Retzius.
(2)
Scrotal swelling can delay device activation
(3)
Risk of injury of scrotal urethra; the urethra is easily seen and can be repaired

The ugly of the Penoscrotal approach
(1)
None. There is no irreversible complication with PS incision

The good of the Infra Pubic approach
(1)
Easier, safer reservoir placement under direct vision
(2)
Diminished scrotal swelling resulting quicker pump activation
(3)
Shorter operative time in skilled hands
(4)
Incision is remote from patients with incontinence and allows abdominoplasty.

The bad of the Infra Pubic approach
(1)
Limited visualization of distal corpora cavernosa
(2)
Pump placement is not optimal with the risk of pump migration
(3)
Severe obesity and fibrotic corpora are challenging
(4)
Revision surgery after the IP approach, if required, is associated with increased difficulty and worse surgical outcomes
(5)
Scar of IP incision is visible

The ugly of the Infra Pubic approach
(1)
Risk of dorsal nerve injury, a complication from which there is no cure. While a paper in 2018 claimed that there were no reports of this complication in the literature, both Drs. Scott and Wilson sustained one in the 1980s. Wilson has also been an expert witness in six additional cases sustained with IP (all successful) that came to litigation in USA. Decreased penile sensation occurs most often following revision cases when the anatomy is not so clear.

Reference:
Otero JR, Manfredi C, Wilson SK.
The good, the bad, and the ugly about surgical approaches for inflatable penile prosthesis implantation.
Int J Impot Res. 2022 Mar;34(2):128-137. doi: 10.1038/s41443-020-0319-4.
Epub 2020 Jun 2. PMID: 32488210.[/i]

In Antonini and Perito we trust.

[LastHope]

In Antonini and Perito we trust.

[tooyoung]

In Antonini and Perito we trust.

Lol!!!!!

The most brilliant meme on this forum I've ever seen

[Jage64]

(3)
Shorter operative time in skilled hands

I'm personally convinced that this is why Perito and some others tout the infra-pubic installation. In one of Perito's "Meet the Penis" videos he says as much, he can do many more implantations a day which results in more money to his bottom line.

Since I'm going to be interacting with the pump daily, I want that placed *perfectly*, not blindly as stated in that comparison. Plus, I'd prefer nobody is rooting around near my nerve bundle that carries every sensation I'm trying to improve. I dealt with ED for years, waiting 4 more weeks post-op to have a boner is a drop in the bucket.