Titan / AMS decision, considerations..

[Gt1956]

That is a false belief. My pumped girth is 6 inches (15cm). This belief of poor girth with at least the CX model is clearly wrong & won't seem to die despite several members with 6" or more girths.
My dr is well connected to Boston Scientific. He told me in person that the CX does indeed expand. Just BS chooses to not advertise it for some reason.

Totally agree with you, I read that the Titan is so much more rigid, gives you bigger girth, etc... I now have had both mfgs and AMS LGX", quote" is The only penile implant on the U.S. market with cylinders designed to expand in girth up to 20 mm and length of up to 25%. The Titan was good for my Peyronie's first time around, the revision both surgeons recommended the AMS. I will say this that when I pump up as much as I can you will not bend it, same as the Titan, but I will continue to cycle and see if I do get 25% more length.... And maybe 3/4" in girth.

Ah, many thanks; just oone more question: And what is the difference between the LGX and the CX? I have a 30 degree congential curve, not Peyronies, and I am wondering if that alone would be a reason to choose the Titan....

The CX will treat peyonies, just works slower than the Titan. Based on that. I'll say a congenital curve should slowly go away.

[wilsonmill]

That is a false belief. My pumped girth is 6 inches (15cm). This belief of poor girth with at least the CX model is clearly wrong & won't seem to die despite several members with 6" or more girths.

My dr is well connected to Boston Scientific. He told me in person that the CX does indeed expand. Just BS chooses to not advertise it for some reason.

Totally agree with you, I read that the Titan is so much more rigid, gives you bigger girth, etc... I now have had both mfgs and AMS LGX", quote" is The only penile implant on the U.S. market with cylinders designed to expand in girth up to 20 mm and length of up to 25%. The Titan was good for my Peyronie's first time around, the revision both surgeons recommended the AMS. I will say this that when I pump up as much as I can you will not bend it, same as the Titan, but I will continue to cycle and see if I do get 25% more length.... And maybe 3/4" in girth.

Ah, many thanks; just oone more question: And what is the difference between the LGX and the CX? I have a 30 degree congential curve, not Peyronies, and I am wondering if that alone would be a reason to choose the Titan....

I agree with GT, I have read where guys with Peyronie's got the CX and had success, my first implant was a Titan recommended by my surgeon, the second both recommended the AMS, ask your surgeon what he prefers and why, even get a second opinion, I did and very happy that I did. We all are different and maybe they will see something that makes more sense to them. Best of luck and which ever one you choose you will thoroughly enjoy it..

[2435tjklAS]

Many thanks for all your helpful answers... hard to decide, but:

Well, I measured a circumference of the penis of 5,7 inches (= 14,5 cm), that means, the AMS woudnt fill it, so it will be the Titan i guess...

That is a false belief. My pumped girth is 6 inches (15cm). This belief of poor girth with at least the CX model is clearly wrong & won't seem to die despite several members with 6" or more girths.

My dr is well connected to Boston Scientific. He told me in person that the CX does indeed expand. Just BS chooses to not advertise it for some reason.

I can believe but I'm curious why I recall several others claiming the same as me. There was one point I remember hearing others state they lost some girth with AMS 700 LGX and were now 5.5". I also recall one guy saying he was 5.6". You got the CX and maintain 6" but do you know of others with LGX who managed to keep more girth when people like me did every necessary exercise but it just stopped at the start and never came back?

I'm fine with this because of the length increases, because my girth wasn't much bigger before, and because the tunica expansion procedure (TEP) exists for me to get it back. Plus the Titan dog ears thing seems bothersome but I don't know.

A few years ago when I started here I was also told my choice of implants was surprising since Titan is recommended for bigger guys, and I said I chose nothing and did no research but my urologist recommended it so that was enough for me.

Main question: girths of 6" or larger might be maintained by CX. Is that also true from AMS 700 LGX, and why did mine and others simply drop with nothing we could do about it?

[Jage64]

If you've gone back a ways on the board you've probably seen my post from awhile back, but if not, here it is, I'll cut and paste it. I'm still 100% happy.

"I chose AMS based on a few things, and was happy that Dr. Clavell recommended AMS before I told him what I was leaning towards. I wanted his separate opinion, not a confirmation of mine. I know for a fact he installed a Titan just prior to my surgery and many here on FT have a Titan by Dr. Clavell, so I feel comfortable that he based his recommendation on me as a person what would be best for my lifestyle.

I think it's very important you see a surgeon that can and does install both Titan and AMS. Only then can you truly get the implant that is best for your needs and not just the one the surgeon has a business relationship with.

My extensive research on FT and reading white papers and studies for the 6 months prior to my surgery led me to choose the AMS CX. It has been said and repeated here many times on FT that "I didn't choose my implant for the flaccid", as if the man will be erect 100% of the time and want the thickest and hardest penis available, with absolutely no other considerations. If that is your criteria, then probably the Titan is for you (plus it has a much better and more impressive name than AMS CX, they really whiffed on naming the AMS implants). I believe that although this is machismo at it's finest, it's a bad phrase that blurs proper decision making.

Here's my thinking:

In the BEST case, I will use my penis for sexual activity 3x per week, for 2-3 hours per session. 9 hours out of the 168 hours in a week, BEST CASE. Which means that AT MOST 5% of the rest of my life will involve an erection. That's if I can still talk my wife into it 3x a week for 3 hours each time until the day I die...probably not realistic. So, it will be flaccid for at minimum 95% of the remainder of my life. For 95% of my time left do I want to be reminded of my implanted penis, worried about my grandkids on my lap, shifting my bathing suit to hide a semi, dealing with dog ears, crinkly noises, loud pumps, auto inflation, semi-rigid flaccid in nude situations or stiff cylinders? I don't even know how often I'd have to be using my dick to accept many or all of those issues, but I can guarantee you it's probably closer to the 50% mark than 95%.

If the tradeoff to having the thickest and hardest implanted penis is having to deal with all those things, then count me out. Both the CX and Titan get FAR harder than necessary for penetrative sex. As a matter of fact, my wife enjoys ~80% inflation of my CX, any stiffer and she's uncomfortable. So the ability to get nominally harder than a CX for me is of zero value.

Girth-wise, I wasn't particularly girthy to begin with, and I'm really no different now than I was pre ED. Average male erect penis girth in the US is 4.6 inches. I was bigger than that before, and I'm still bigger than that now (5.75", the 99th percentile)). Just for kicks, I put on one of those girth enhancer jelly tube things over my pumped up penis a few weeks ago before having intercourse with my wife. I wanted to see what her reaction would be. She made no mention of it, apparently she couldn't really tell I was wearing it. Once I showed her she said she thought maybe something was a little different, but it certainly did not enhance her pleasure or enjoyment one bit. For my needs, girth is not an issue, and even if it was, the difference between AMS CX and a Titan is negligible. I'm not convinced a recipient would be able to tell the difference.

Failure rates are similar, one is not appreciably better than the other. A study I read showed the AMS CX at a 5 year failure-free rate of 91% and the Titan at 87%.

Similarly on infection rates, a 2010 study found that the Titans using vancomycin/gentamycin coating had an infection rate of 4.4%, and the AMS Inhibizone impregnated implants was 1.3%. The rifampin/gentamicin coated Titans at that time had not had any infections. So, IMO the infection rates are either 0 or 1%. Not a factor in my decision making if I just keep my grubby hands off the incision until it's healed.

There are FAR more AMS units installed worldwide than Titans, so I believe the depth the data to be stronger just due to sheer volume of implants deployed.

Also, a consideration that likely won't be applicable to many, my wife and I frequent nude resorts and the last thing I want is a penis that looks unnatural or semi-erect when it shouldn't be. Whether it's the dog ears or the half mast, I don't want to be that guy. My AMS flaccid looks completely natural, hangs naturally, moves naturally, and feels pretty close to natural when flaccid. I'm now a shower rather than a grower, which is a very nice development which I wear with pride.

So, that's my story. I KNOW everybody has a different need, which is why Dr. Clavell will implant both. If he thought one was head and shoulders above the other I'd trust him to tell you. I don't think that's the case, each application, each person, each lifestyle and each penis is different. Educate yourself."

[Sempiternal]

If you've gone back a ways on the board you've probably seen my post from awhile back, but if not, here it is, I'll cut and paste it. I'm still 100% happy.

"I chose AMS based on a few things, and was happy that Dr. Clavell recommended AMS before I told him what I was leaning towards. I wanted his separate opinion, not a confirmation of mine. I know for a fact he installed a Titan just prior to my surgery and many here on FT have a Titan by Dr. Clavell, so I feel comfortable that he based his recommendation on me as a person what would be best for my lifestyle.

I think it's very important you see a surgeon that can and does install both Titan and AMS. Only then can you truly get the implant that is best for your needs and not just the one the surgeon has a business relationship with.

My extensive research on FT and reading white papers and studies for the 6 months prior to my surgery led me to choose the AMS CX. It has been said and repeated here many times on FT that "I didn't choose my implant for the flaccid", as if the man will be erect 100% of the time and want the thickest and hardest penis available, with absolutely no other considerations. If that is your criteria, then probably the Titan is for you (plus it has a much better and more impressive name than AMS CX, they really whiffed on naming the AMS implants). I believe that although this is machismo at it's finest, it's a bad phrase that blurs proper decision making.

Here's my thinking:

In the BEST case, I will use my penis for sexual activity 3x per week, for 2-3 hours per session. 9 hours out of the 168 hours in a week, BEST CASE. Which means that AT MOST 5% of the rest of my life will involve an erection. That's if I can still talk my wife into it 3x a week for 3 hours each time until the day I die...probably not realistic. So, it will be flaccid for at minimum 95% of the remainder of my life. For 95% of my time left do I want to be reminded of my implanted penis, worried about my grandkids on my lap, shifting my bathing suit to hide a semi, dealing with dog ears, crinkly noises, loud pumps, auto inflation, semi-rigid flaccid in nude situations or stiff cylinders? I don't even know how often I'd have to be using my dick to accept many or all of those issues, but I can guarantee you it's probably closer to the 50% mark than 95%.

If the tradeoff to having the thickest and hardest implanted penis is having to deal with all those things, then count me out. Both the CX and Titan get FAR harder than necessary for penetrative sex. As a matter of fact, my wife enjoys ~80% inflation of my CX, any stiffer and she's uncomfortable. So the ability to get nominally harder than a CX for me is of zero value.

Girth-wise, I wasn't particularly girthy to begin with, and I'm really no different now than I was pre ED. Average male erect penis girth in the US is 4.6 inches. I was bigger than that before, and I'm still bigger than that now (5.75", the 99th percentile)). Just for kicks, I put on one of those girth enhancer jelly tube things over my pumped up penis a few weeks ago before having intercourse with my wife. I wanted to see what her reaction would be. She made no mention of it, apparently she couldn't really tell I was wearing it. Once I showed her she said she thought maybe something was a little different, but it certainly did not enhance her pleasure or enjoyment one bit. For my needs, girth is not an issue, and even if it was, the difference between AMS CX and a Titan is negligible. I'm not convinced a recipient would be able to tell the difference.

Failure rates are similar, one is not appreciably better than the other. A study I read showed the AMS CX at a 5 year failure-free rate of 91% and the Titan at 87%.

Similarly on infection rates, a 2010 study found that the Titans using vancomycin/gentamycin coating had an infection rate of 4.4%, and the AMS Inhibizone impregnated implants was 1.3%. The rifampin/gentamicin coated Titans at that time had not had any infections. So, IMO the infection rates are either 0 or 1%. Not a factor in my decision making if I just keep my grubby hands off the incision until it's healed.

There are FAR more AMS units installed worldwide than Titans, so I believe the depth the data to be stronger just due to sheer volume of implants deployed.

Also, a consideration that likely won't be applicable to many, my wife and I frequent nude resorts and the last thing I want is a penis that looks unnatural or semi-erect when it shouldn't be. Whether it's the dog ears or the half mast, I don't want to be that guy. My AMS flaccid looks completely natural, hangs naturally, moves naturally, and feels pretty close to natural when flaccid. I'm now a shower rather than a grower, which is a very nice development which I wear with pride.

So, that's my story. I KNOW everybody has a different need, which is why Dr. Clavell will implant both. If he thought one was head and shoulders above the other I'd trust him to tell you. I don't think that's the case, each application, each person, each lifestyle and each penis is different. Educate yourself."

That study is interesting. Dr Eid says that the Titan has much stronger / more durable cylinders, pump, and reservoir. CX has more durable tubing. He says he’s had to do less revisions with Titans, on those 3 parts. Titan revisions are for the tubing.

[Gt1956]

Sempiternal. It appears that Eid has you confused. If I missed it, please point where Eid says the Titan produces more girth. It seems that you might be reading Eid's words then adding your own feelings that he does not say.

For what little this might mean on this topic. My dr uses a preassembled implant/tubing. He has very few tubing failures. But the preassembled IPP does come with a few down sides. In my case, I have a very deep proximal measurement. So some of the tubing is used up just to get up to my scrotum. Thus my pump is high. A fellow FT member had his done about 2 months after mine. BS had just come out with a slightly longer tubing assembly. His pump is a bit lower than he'd like. If I had a choice, I'd like my pump a bit lower. But it wasn't available at my surgery date. Everything works great so I hesitate to get the pump lowered. My dr did say he could lower it some. But I'm not sure its worth it. Its hard to get cut on again for an IPP that works so well.

I'll likely live with it. But never say never.

[nuance]

How common are pre-connected units or is it up to the doctor to make adjustments? If there’s a connection point, feels like one could pull on it (unexpectedly) and end up with implant failure.

[Gt1956]

How common are pre-connected units or is it up to the doctor to make adjustments? If there’s a connection point, feels like one could pull on it (unexpectedly) and end up with implant failure.

There isn't much info about that part of the surgery that I know of. Splices were commonly shown in the old Dr Kramer videos. He used Titans at that time. Several posts here have mentioned failed splices. There has alway been some talk of preassembled IPP's. Its the addition of a model with the same total length of cylinders but some extra tubing which seems to be a new development. If you read very many of my old posts. I've said IPP improvements will be in small increments. Not radical changes. This is a small improvement.

Preassembled is a good way to reduce, maybe even eliminate tubing failures in my opinion. My post was meant to show that fixing one problem can cause different problems. In my case, the drs plan is if a guy measures 21cm.an LGX is not an option anymore. He just won't use a 21cm LGX. So a 21cm CX is his go to implant. Its my feeling that if he had used a 18cm CX with 3cm of RTE's. That should of created 6cm of slack in the tubing. 6cm of slack would of lowered my pump, maybe too much. Again, its an anatomy issue. Dr says I have a large scrotum but its a tight scrotum. So there is a narrow window to fit the pump in perfectly. Getting a good pump location is harder than us patients understand.

I might schedule a nurses appointment to talk about it after I pass the 2 year mark. Been too busy with other life issues to worry about a high pump on an implant that is otherwise nearly perfect. I mean compared to other FT members. 15 pumps to rock hard, easy to deflate, I have almost all my girth, length seems original. I don't have much to complain about.

[2435tjklAS]

Gt1956, no further thoughts or info about my last reply? From what I've seen and heard I have good reasons for believing AMS 700 LGX does have a maximum girth of about 5.5", but the CX can maintain at least half an inch more if not even more than that.

This seems like really important information for men choosing between Titans and AMS, as well as choosing between LGX and CX, so more reliable information would be appreciated.

[Gt1956]

Gt1956, no further thoughts or info about my last reply? From what I've seen and heard I have good reasons for believing AMS 700 LGX does have a maximum girth of about 5.5", but the CX can maintain at least half an inch more if not even more than that.
This seems like really important information for men choosing between Titans and AMS, as well as choosing between LGX and CX, so more reliable information would be appreciated

I don't have a LGX. I don't think I've ever given info that implies that I do. I stand by my signature line which says a 21cm CX with no RTE's. I've had 6" girth since just before my 3 month exam. Maybe it was at 6 weeks. I can't remember which date it was. Like many men, your anatomy may give you different results. I'm sure that you have read Rodsman's posts.

My belief is simple, stating that aTitan will get you more girth everytime is false. A better indicator is your historical girth. Which in my case was 6", pehaps a very slight more. My CX delivered my historical girth. I'm happy & don't see any reason to question my results. I really doubt that a Titan would of given me more girth. I think the tunica limits both brands.