Interesting presentations

[Cnidium]

Lost Sheep,

The chart at the bottom of the AMS vs TItan comparison presentation confirms what you say.

But doesn't this mean that everyone with an AMS or everyone with a Titan will have nearly the same girth? Say presurgery you have 1 guy with a 18mm diameter and another with 23mm diameter, both with same length, and they both get a non-narrow titan. Wouldnt they then be brought to close girths as a result? Or am I missing something.

I guess a more general question is: Do guys with a lot of girth lose girth from an implant, since according to the chart the titan is maxing at 18-22cm? I dont think this is the case because I saw Kramer do a video of a guy with 'extreme girth' and Kramer was confident he retained the man's dimensions.

Lastly, that chart shows the 18cm titan achieving a greater diameter than the 22mm titan. So does this mean the longer titan cannot expand in girth as much as the shorter titan? Does this mean there is a benefit for a shorter titan for girthier guys?

Thanks

[Lost Sheep]

Lost Sheep,
Lastly, that chart shows the 18cm titan achieving a greater diameter than the 22mm titan. So does this mean the longer titan cannot expand in girth as much as the shorter titan? Does this mean there is a benefit for a shorter titan for girthier guys?

Thanks

That the longer Titan does not increase in girth with the same increases in pressure as the shorter Titan is a mystery to me, too

Have you read the Dr Garber article comparing the AMS units and the Coloplast?

http://garber-online.com/pdf/PenileImpl ... ew2005.pdf

Therein, he describes the construction of the devices and other salient points

[treifsnyder]

I guess my thought is simply, as a surgeon as well, I've directly compared, so I'd challenge Cnidium a bit on what does it matter between Eid/Kramer- it looked like Kramer this week did 3 straight guys who were 24cm, and used a 24 device with no tips- so he seems to not use them, though perhaps he's changing? Also side by side, Kramer's hands are 20 years younger and boy, they look 20 times more clean and efficient in movement and technique. But take it with a grain of salt- wherever someone feels confident, that's where they should go. Both Kramer and Eid seem to be doing great work

[PFracture]

I tend to agree with you Mr. Reifsnyder- Dr Kramer's hands are just on another level. Effortless, efficient, and purposeful. Nothing like him that I've ever seen in watching anyone do any surgery. it's unique for sure.

I don't know how you guys can notice those differences, without having no medicine expertise whatsoever. Just my 2 cents, even though I won't say it wouldn't be entirely possible.

[Cnidium]

So I agree it may appear Kramer is more skilled by his hand movements. But what about the end result? Does good looking efficiency really mean something if either technique produces the same end result?

And as far as end results go, we dont have 3rd party researched proof to say whether Eid or Kramer has a higher patient satisfaction rate. However, in another post Merrix pointed out that there have been a few Kramer patients recently who have been displeased with the pump placement with AMS devices. Now this could be solely because of the AMS device in combination with the patients anatomy. I also realized the error in assuming anything from these observations: I could have not noticed recent Eid complaints, Eid complaints could be happening but simply not posted here, there could have been an equal number of Eid complaints in the past, ect.

But the fact is that myself and Merrix have noticed the complains by Kramer patients lately, and that at least is a small factor in my decision making.

Its really not that important though and isn't swaying my decision, just like their apparent intra-surgery handskill doesnt affect me.
Im trying to think of a good analogy... I don't know, maybe like the difference between two swordsman? They both have the objective of disarming their enemy. One swordsman does so in fancy swift motions, and the other can do it a more subtle or slower fashion. I know this anology doesnt fit perfectly to the Kramer/Eid debate, but Im sure you can see at least some comparison.

To me what really will sell me on one or the other is whether or not one will let me do this surgery without general anesthesia. I will probably get the surgery done anyways, but I will prefer the surgeon who will do it without general.
Also, I will give preference to the surgeon if his office staff can make my crappy insurance cover even a small amount of the surgery.
Less important, but still something on my mind a lot, is rate of use of RTE's, or lack there of.

So ya, in summary, the real selling points to me are 1. surgery without anesthesia, and 2. insurance coverage, and 3, less likely to use RTE's,. IF all of these are equal, then I will have to judge which is more skilled than the other, about which I am still deciding.

[ThePlumber1964]

A couple of points here:

1. I think that the intra-surgery handskill is of paramount importance! Skillful surgery techniques affect patients and outcomes, and leave the patients with either an incredible scrotal swelling and/or pain and a 6+ weeks of recovery, vs a one week of discomfort taken care by ibuprofen and no oxy and a 3-4 weeks recovery, ready to use your equipment. I can talk about this at length... three surgeries in less than a year due to errors have given me some first-hand experience that I would have preferd not to gained them. However, it gives me different perspectives that I feel it is my duty to share them as needed or requested.

2. I really do not see any kind of "change" in Kramer's approach. At least since I have been following him on his YT channel, he has been consistent on the decision of using RTEs; he uses them as needed based on a case-by-case situation. I cannot imagine anyone here as a patient that has decided to take this step saying or asking him or any surgeon that you would preferred to be undersized in order to avoid any RTEs.

Honestly, after so much rumbling about RTEs during the past couple of weeks or so, I would like to understand the basis for the whole discussion about them, in the context of high volume surgeons. I may have missed a specific discussion about it here, but I do not recall nor I have heard of anyone having a revision of a surgery done by these two fine professionals (Eid or Kramer) due to the RTEs. If the discussion is based on conjectures about reports, or based on non-factual based opinions, I think we really have better areas that are much more needed to share with the people that are going through the same things we already tackled.

This statement is in no way intended to dismiss or rank Kramer or Eid; just a clarification to a previous post. Without claiming any expertise at all, but having some medical background at different levels, I can appreciate from a surgery footage the quality of the work done. Important things such deliberate movements while performing different surgical procedures (scapel movement, suture manipulation, etc) that are indicative of the surgeon's ability and self confidence that he/she has gained through extensive repetition of the procedures. Well, when that is added to the successful outcomes, it can paint your a good picture of the surgeon's quality.

Again, I think we all bionic brothers posting here have two choices; either share our experience and lend our hands to others that are in the same position or worst that we were before surgery, or use this forum to try to make our cases or "this" vs "that" without having the whole picture. The first can bring comfort and hope, while the latter brings more confusion and anxiety to the people that do not need them at all.

Respectfully,

ThePlumber

[Cnidium]

ThePlumber,

I agree its not about ranking Eid over Kramer or Kramer over Eid. And you are right, more than likely going into this much depth between the two will probably cause more anxiety than help, since one is already considering the two best in the world.

But you know, being in my 20s, and having lost 4 years of the prime of my life, then coming to a incredibly difficult decision to execute, I sometimes feel obligated to know all the facts, all possible senarios, and all potential outcomes. I want to be absolutely confident in my decision when I make it. And thats exactly what it seems to be about for a lot of us, confidence in decision. We have already filtered the potential bad surgeons (im not saying every surgeon with the exception of Eid and Kramer is bad), so we are now left spending the remaining 99% of our energy on the 1% difference that may or may not exist between the surgical outcomes of Kramer and Eid.

And its funny because I have already stated on here that I would be happy with either, and yet I find myself trying to find which is just slightly better than the other.

So im going to stop worrying about the RTE use rate between Eid and Kramer, since its known that they both try to minimize their usage. So that leaves me to figure out anesthesia use between them, and potential insurance coverage.

[GiRn56]

Tell anesthesia when they talk to you before they take you back for your procedure. Unless it's medically contraindicated they will do whatever you want. General / spinal it's up to you. The surgeons have preferences but that's it. Dr Eid prefers spinals, but my back is trashed , he didn't care. In fact I'm 4 days post op and I feel I could cycle mine now if they would let me, marginal swelling and pain now. Just pick one that fits you and go with it....

[Cnidium]

GiRn,

Let me get this straight, Eid let you choose between general and spinal? Do you think that when I talk to Kramer again that there is a potential he will let me choose too? If so, this is great news. General scares the shit out of me, more than anything else I can think of.

[GiRn56]

GiRn,

Let me get this straight, Eid let you choose between general and spinal? Do you think that when I talk to Kramer again that there is a potential he will let me choose too? If so, this is great news. General scares the shit out of me, more than anything else I can think of.

There was no choice in my case as I can only have epidurals under fluoroscopy, He was aware and didn't care, even stated the case before was general. So that's what I had a general.His preference is spinal, if they can give it to you that's what you'll get, it's more work for anesthesia to do spinals as well as recovery room care as they can't discharge you till you get feeling and movement back. That's why you stay in recovery forever, I was like out in an hour after I was done, but I am a nurse and can manage my own care. Ask Kramer your preference and see what he says, if he leans towards an general then there's your answer on who to pick...

I asked Eid how many cases he does on his OR days, he stated 4, and that's because of the time spinals eat up, and also the nursing care on the back end, he does spinals to give you the best possible sizing / results in his mind, I think Kramer does more cases in a day than 4, in my mind asking for a spinal from Kramer would really slow the boat down as he is used to cranking cases out when he is at the wheel... JMHO