Frustrated By Doc’s Implant Sizing Information

[ElbowRoom]

Stretch test is a very rough approximation, actual size is determined at surgery by dilating and direct measurement of the corpora.

Is your doctor a high volume implant surgeon? If not I’d suggest finding a top one, there are many around the country and it’s worth traveling for. IMO the surgeon is the biggest factor in having a surgical outcome you are pleased with, as well as fewest complications.

[Tuscan_Order]

Stretch test is a very rough approximation, actual size is determined at surgery by dilating and direct measurement of the corpora.

Is your doctor a high volume implant surgeon? If not I’d suggest finding a top one, there are many around the country and it’s worth traveling for. IMO the surgeon is the biggest factor in having a surgical outcome you are pleased with, as well as fewest complications.

My understanding is that the stretch test was for the doctor to get a rough approximation of what sizes of implants might be needed to have ready in the OR. My stretch measurement was around 3/4" shorter than what I ended up with after the implant.

[Niculus9]

First things first: do you actually need an implant right now? Or have your surgeons told you that you will be impotent as a result of your prostatectomy — that your disease is such that they can't do a nerve-sparing procedure? There's a real risk of impotence after prostatectomy, but it's not guaranteed. Many men retain or recover their erections.

Don't worry about being a "grower" and that somehow throwing off your measurements during implant surgery — a good implant surgeon will size you correctly regardless. Start using a VED now, unless you're already having great erections with no size loss since you were younger. Focus on recovering from your prostatectomy first. Then take your time finding the best implant surgeon you can. A good surgeon will size you appropriately, and after you've healed for a while, you'll likely be at or near your pre-op size.

If traveling to a high-volume implant surgeon is an option, it's worth calling their office to ask about experience with your insurance. Even if you've been told your plan won't cover care out of state, sometimes they can get approval — it's worth the phone call.

Hang in there. One day at a time. One thing at a time.

I do not need an implant now.

I have suffered from erectile dysfunction for 20 years.

I require testosterone cypionate injections, 10mg Tadalafil daily, and a cock ring to be able to have an erection firm
enough for sex.

Almost zero men with pre-existing erectile dysfunction regain the same level of erectile function after prostate surgery.

So in my case, I was considering an implant for this reason.

I have used a penis pump for years to maintain penile health.

[Niculus9]

I'm sorry to hear that Niculus, but many of us have been through the same and been able to restore both size and sexual function eventually.

GoodWood and Danny are spot on with their advice. We can possibly provide more information if you can tell us more about yourself and the background that has gotten you to this point. But I'll try and do that using my own experience.

1. You may well regain erectile function naturally post prostatectomy. It is normal to lose at least some erectile function temporarily due to trauma from the surgery, even if it is 100% nerve sparing. But there are many variables affecting what may happen longer term. If you are relatively younger, fitter, healthier in general, you likely have a better chance of not suffering permanent ED. Unfortunately I was already 68 when I had my prostatectomy and the ED was sudden, total and permanent. After failure with all the conservative ED treatments my implant restored my original size, and I now have very rigid erections on demand for sex. After your prostate surgery definitely start VED therapy as soon as your doc says it's safe to do so. I lost size quickly from the procedure but was able to turn that around with daily VED use.

2. I agree, if you do ultimately need an implant, the only measurement that matters is when the surgeon dilates you in the OR to determine the correct size. In the lead up to my implant surgery I used a VED aggressively at least twice a day to optimize my length. That helped allow the largest cylinders that my anatomy could safely accommodate. Rather than lose length it's more likely that you will eventually get back your 7.5 inches or very close. You will also likely progress from being a "grower" to a "shower". Your current 2.5 inches soft may well turn into 5 or 6 inches. Pre ED I was 6.5 erect and about 3 flaccid. Now I'm slightly over 6.5 erect and just over 5 flaccid.

3. If you ultimately do need an implant find the best surgeon you can even if you have to travel. My knowledge of US insurance is extremely limited but I know that, through persistence, some guys on here have gotten approval for things that were nominally exclusions.

But wait and see what happens after your procedure. It will take time before you know how it's going to impact you, if at all.

My history is this:

Due to being overprescribed opiates, and refused surgery for for herniated discs (at age 28,) my endocrine system shut down. I’ve been on injectable testosterone, Levothyroxine, 10mg daily of Tadalafil, and the use of a cock ring, to be able to maintain an erection firm enough for sex, for 24 years. I’m
52 now.

I’ve also used a penis pump for 4-5 years to maintain penile health.

I’ve spoken to two penile implant surgeons in Nebraska, and both say that NO ONE retains their original erect length. So either they are incompetent or misinformed (since a number of posters said that they DID eventually succeed in restoring their original erect length.)

I have called NUMEROUS hospitals and surgeons in neighboring states— Iowa, Kansas, Missouri— and I haven’t heard from ANY implant doc, ANYTHING OTHER than, “You will lose 1-2 inches after a prostatectomy, and possibly, after the use of a vaccuum device AND an implant, you can regain perhaps an inch.”

My insurance is Medicare Dual Complete, no private insurance, and no savings to pay out of pocket.

Supposedly “cutting edge surgeons” in New York and Florida have the best results with their patients, but they don’t accept Medicare.

[Niculus9]

I never had a stretch test and my surgeon never examined my erect penis prior to the surgery. He saw the pics of my bent penis and felt around where he could feel the scar tissue. He explained that he would size me on the table during surgery and he was fine with stretch tests and induced erections if it made me happy. I told him that I was good with his decision, in 2 days I will be 3 years out. My penis is 1/8” shorter and 1/8 more narrow than prior to surgery, so basically where I was preop.
I think all the pre surgery measuring is for the patients piece of mind. Watch the surgeries on line, you will need a strong stomach but will see the measuring is done during the surgery. Pick a reputable surgeon and youll be as good as you can be.

Thanks for sharing your experience.
I have indeed watched many vids of implant procedures,
and studied all the available implants.

I’m hoping that SOMEHOW I can find a good surgeon who won’t dismiss my concerns.

[Niculus9]

Relax have conversations with the implant team, chosen manufacture, and us of course. Send them pics to 'show' your point.

Thanks for the encouragement.

I’m doing all I can now to find a good surgeon.

[Niculus9]

I had a prostatectomy too. I wouldn't worry about anything ED related until you are through that surgery. Do your kegels, they will help with make sure you can control urine flow.
Post prostate surgery,You also no longer have ejaculation but will still be able to orgasm. That is strange at first too. I would think you are likely 2 years away from having an implant. They will likely want to make sure you have 2 , 0 PSA tests
To verify cancer gone.

Thanks for sharing your thoughts.

I’ve had erectile dysfunction for 24 years (I’m 52 now,) so I don’t imagine it will IMPROVE after a prostatectomy, so that’s why I’m looking into an implant.

[Niculus9]

I had my implant done about five weeks ago. My doctor did the stretch test and said I was gonna be 4 1/2 inches maximum. I thought he was nuts. My opinion is that they lower your expectations so they don’t over promise because they really don’t know until they actually get you into surgery. I have not started cycling yet and my current flaccid state is 4 1/2 inches. Expecting to gain hopefully around a half an inch flaccid when I start cycling and probably max out somewhere around 6 inches to 6.25”.

Thanks very much for sharing your experience.

Yeah, when he told me that with an implant I would have 5” instead of 7.5”, I nearly shit myself.

It isn’t so much about personal vanity, or thinking I NEED a large penis. It’s simply the fact that for my body to undergo such a drastic change, is really upsetting to me.

[Niculus9]

I don’t understand how these surgeons can just “poo-poo” away my comments, when I could provide them with both medical literature AND the names of various surgeons who DO use Trimix to size penile implants.

…

Did anyone here have their surgeon size their implant by using a chemically induced erection INSTEAD OF a stretched flaccid?

Others are giving you great advice here, but let’s be clear on this: no surgeons are using either an injection or a stretch test to measure for your implant. Instead you are measured on the surgical table and an implant is fitted to you. They may use those methods to give you an idea of what they expect your length will be sometime after actual implantation, but that’s it. That doesn’t change the method of surgical measurement at all.

(I think there is some evidence that stretch tests are bad representations of what your eventual length will be. For example, one study measured pre-implant length by both stretch tests and ICI and the the ICI length was on average 3 cm longer. But again, that has nothing to do with how you are getting measured for an implant)

Yes, the current literature says the the stretched flaccid method UNDERESTIMATES the potential implant size by 21%!

I was frustrated that the two surgeons I had consults with were so condescending, and acted like “know it alls”; they even went so far as to demean me and say, “Look, we do implants in guys with 10 inch penises, and THEY are just happy to have a 9 inch penis that STAYS HARD.”

I was like, what the fuck you assholes?!

Yeah, if I had a TEN INCH DICK I wouldn’t give a shit that I was left with “only a 9 inch penis.”

Thanks for sharing your experience with me.

[danny1553]

Consider LGX as your first implant. Yes, you may lose initially but you will get it back with daily pumping for a few months. My full length pre-op was 187mm. Immediately after I started pumping it was noticeably shorter and I did not even dare to measure it. But once fully recovered, my measure was 189mm, but an extra 2mm I consider as a margin of error therefore I can confidently say that I did not lose any length.
The secret sauce though is to deal with discomfort during the recovery. Pump till it feels no more, wait a few minutes, then add a few more squeezes. Repeat. At this stage it is unlikely that you'd enjoy sex but the primary objective is tissue stretching.