My Journal

[merrix]

Found this very (to say the least) interesting and unique study.
At least three of the authors will be well known to several of the members here. Carrion, Perito, Hakky.

Below is the abstract.

What they did was to take 3 cadavers (i.e. dead guys) and implanted them with 18 cm implants of all three major types (Titan, CX, LGX).
All three bodies got all three implants implanted in them, so all three bodies were tested once with each implant. Due to differences in length (crus+dick) in the three bodies, they had to use different length of RTEs for all of them. 1, 1.5, and 2 cm respectively.
Starting with the implant types, they tested them for longitudinal column strength (i.e. penetration strength), horizontal stiffness (i.e. hinge/base flex, or the "bath towel test", and 3-point bending (i.e. stiffness of the shaft itself).

The LGX, as expected, sucked in all three tests. Especially at less-than-maximum inflation level.
The CX and the Titan showed significantly better results than the LGX with small differences between the two of them.
In the penetration test, The CX was slightly better for short dicks and the Titan slightly better for longer dicks.
In the "bath-towel test", the Titan was the winner, even though by a small margin.
The 3-point bending test had similar to the penetration test, the CX was slightly better in the shortest dick and the Titan was best in the two longer dicks. Titan also outperformed in the cadaver with peyronies.

But - and this is big BUT - what was evident on all tests, and what came as a surprise for the authors, was that when comparing the three setups in the study (1 cm, 1.5 cm, and 2 cm RTEs), there was a clear correlation between longer RTEs and better performance!
This is however not really an apple vs apple comparison as in the three setups did not have the same length. Cylinder size was 18 cm in all cases and then different length RTE was added.
Would the results have been the same if they had looked at 16+4 cm vs 18+2 cm vs 20+0 cm? I.e. with the same total length, just different ratio of inflatable length vs non-inflatable length? Who knows.
It is possible that the improved results with longer RTEs now actually come from longer overall length...

But nevertheless, perhaps this is an indication to review the negative view on RTEs, from the undersigned and others.

This study confirms the results from in vitro studies on which models have better rigidity, but goes against in vitro RTE results. However, those in vitro studies have all been, as far as I can remember, comparing e.g. 20+0 with 18+2 etc. I.e. same total length.

https://pubmed.ncbi.nlm.nih.gov/29960627/


ABSTRACT
Background: Throughout the last decade there has been a growing interest in the biomechanical differences
between inflatable penile prostheses (IPPs) and their significance with regard to the patient experience.
Aim: To present our findings assessing the biomechanical properties of IPPs with and without rear tip extenders
(RTEs).
Methods: This is a biomechanical study of the 3 most commonly used IPPs (AMS CX, AMS LGX, and
Coloplast Titan) as assessed by column compression, modified cantilever deflection, and 3-point bending
methods. The IPPs were surgically placed into 3 fresh cadavers via an infrapubic technique by a single large volume implanter.
A biomechanical evaluation of the properties of each IPP inside the fibroelastic tunica
albuginea was assessed in blinded testing, and analyses were based on industry standard methods for assessment.
Outcomes: Maximum axial load; kink formation; horizontal stiffness; and resistance to 3-point flexure testing
were measured.
Results: At maximum inflation, all 3 implants had similar performance. Differences appear to be most affected
by fill pressures. In fact, only the AMS LGX at less than maximum inflation (LTMI) was unable to consistently
withstand the roughly 0.9 kg (2 lbs) of pressure for column load testing mimicking vaginal intromission. The
Coloplast Titan showed slightly better rigidity than the AMS LGX and CX devices in horizontal load testing,
and, with 3-point flexure testing, the CX showed the best rigidity in the shortest phallus (A). Overall, the Titan
showed slightly better rigidity in the longest phallus (C) and the phallus with mild Peyronie’s disease (B).
Clinical Translations: Penile implants with circumferential expansion had higher rigidity on biomechanical
testing and should be considered in a patient’s decision during selection of a penile implant.
Strengths and Limitations: Strengths include blinding of the biomechanical testing and analyses, surgical
procedures performed by a highly experienced surgeon, and that this is the “closest to” in vivo evaluation (inside
the tunica albuginea) of penile implant function and properties to date. Weaknesses are that this study was
performed in cadavers and not in live patients. It also has a small sample size, including the use of only 3 cadavers,
and there was no correlation of performance to patient satisfaction.
Conclusion: The results of this study support the conclusion that all devices are capable of functionally restoring
erectile capacity. However, we observed that, in general, the 2 circumferentially expanding penile prosthesis
showed greater resistance in biomechanical testing when compared with longitudinal and circumferential
expanding devices. This should be considered as a guide during device selection for a patient undergoing penile
prosthesis

[Agfa13]

Tks for the info Merrix.
My bad. I was laughing my ass off when you said Abstract was below and I started seeing words like 'sucks' and 'bath towel test'.
The highlight of my telework day, lol.

[Lost Sheep]

The LGX, as expected, sucked in all three tests. Especially at less-than-maximum inflation level.
The CX and the Titan showed significantly better results than the LGX with small differences between the two of them.

In defense of the LGX:

I think the "sucked" is ignoring the fact that the LGX is superior in concealability, convenience and comfort when uninflated and MUCH more natural-looking and feeling than the Titan and, when fully inflated, excellent for sex.

Difference between the LGX and the others when uninflated is vastly in favor of the LGX.
Difference between the LGX and the others when inflated is slightly in favor of the others.

All the implants are "adjustable" in rigidity by varying the inflation pressure, so sex with a harder or softer erection is possible with all three models and all three models can get more rigid than necessary (or even comfortable for the partner). Of course, the edge goes to the Titan, but that superiority is worthless if the couple never have the desire to use it...except for bragging rights (e.g. "I can penetrate a brick wall.")

It would be nice if I had an implant that made my partner tell me, "You are too hard.", especially after decades of "I don't think you are going to be able to get in." But it is nice to have the FULL RANGE of rigidity from a (flaccid) comfortable hang, to semi-soft "squishy toy" for my partner to fondle, to full size, but flexible enough for fellatio all the up to "That could split me like a melon!"

It is like the difference between a "rail car" drag racer and a Formula 1 race car. One is pure muscle. The other can drive with a lot more versatility.

OK, down off my soapbox and into the real world.

I like my LGX. But I often wonder if the superior girth of the Titan would yield more fun in the sack or if the slightly longer (by some observers, and reported to be only very slight) service life of either would be worth the tradeoff in versatility of the LGX.

I also had to smile at the limitation of the study regarding not being able to get "patient satisfaction" reports from the study participants.

[merrix]

Yeah...
Maybe you're right LS. Or maybe you're wrong.

Problem with your argumentation is you say that all the proven (in the study) disadvantages of the LGX is minor or negligible.
And that the (non-proven) flaccid advantage is vast.

That's subjective. How to weigh different pros and cons will always be based on what advantages are important to you.

What we know for a fact, or at least what has been shown in studies, is:
LGX has shorter time to failure, i.e. more frequent revisions.
LGX has a larger pump. Could of course be an advantage if you have some disability making it hard to find/use a smaller pump.
LGX has lower column strength (penetration strength)
LGX has lower "hinge strength" (bath-towel test)
LGX has lower 3-point flex strength (softer shaft)
LGX has no real length gaining advantage. Some studies show none, some a few mm.
LGX has smaller girth cylinders.
LGX has inferior ability to straighten peyronies dicks.
LGX underperforms even more (vs the others) at inflation levels below maximum. This is bad for people who prefer to fuck with a less than rock hard dick and those who have or will get poor hand strength/dexterity.

What we then think is that it has a smaller flaccid. Are there any studies actually showing this? Some guys here say the LGX flaccid is smaller, some say it isn't . And this is referring to the few guys who've had both. In theory, I don't see how it can since the instructions in AMS documents (AMS Ambicor. Penile Prosthesis. Operating Room Manual. English - PDF Free Download (docplayer.net)) is clear that sizing is performed in the same way as with other implants. I.e. doctors do not put in a smaller LGX than CX/Titan because it expands when inflating. They put in the same size as the others. So there is no chance to shrink the flaccid. When you get an LGX you get the same size flaccid cylinders as you get from the other two. Then where does the shorter flaccid come from..? Maybe from the fact that some docs are crap or don't trust their ability to size correctly, and uses the LGX expansion ability as an excuse to undersize..?

Also, to say the Titan/CX advantages in terms of hardness is useless because nobody needs a dick that hard, well that is also subjective. I love it. I pump my Titan two-hands, full force full. So at least I am the evidence your statement is not correct in all cases.
I could easily say the same thing about the rumoured LGX flaccid advantage. Useless. Since my flaccid is as soft and pliable as I want/need it to be, and I have no desire for a smaller flaccid, then it is a useless feature to have a smaller dick 23 hours per day.
Maybe some want that but some don't. Then we don't even know if it is smaller...

Then, for whatever it is worth, we have lately a few younger guys who have had their doctors recommend them the Titan over the LGX for various reasons. Hardness, durability etc. Might be biased crap docs, but might also be good doctors talking from experience.

My point is just that I think the hoax of the LGX being a super invention which magically will grow your teeny-weenie flaccid in to a huge John-Holmes dick with super-natural hardness needs to die.
It might be the best choice for some, but probably not for many. Even if somebody doesn't need (or thinks he doesn't need) the better hardness of the other two types - I still don't see why people want to choose the least durable implant. Do people really enjoy hospitals and surgeries that much?

For me, I can't really relate to 75+ year old, multi-diagnosed guys who just want a hard (well, erect) dick.
But how any young guy with an active sex life, would prefer lower max-level hardness, lower girth potential, larger pump, more frequent revisions to maybe get a 1-2 cm smaller flaccid - that goes beyond me.

And finally, I would really be interested in some thoughts on the cadaver study's RTE findings. Any ideas? LS?

[stephen54]

For me, I can't really relate to 75+ year old, multi-diagnosed guys who just want a hard (well, erect) dick.
But how any young guy with an active sex life, would prefer lower max-level hardness, lower girth potential, larger pump, more frequent revisions to maybe get a 1-2 cm smaller flaccid - that goes beyond me.

Super interesting recent discussion here, good shit, merrix, thanks for sharing the study and for the solid provocation.

I'm barely a year in here with my first implant (Titan) so at this point I'm entirely unqualified to weigh in on almost everything which has recently been said here. But those last few sentences did hit home because they go straight at 2 separate conversations I had with my surgeon during my pre-implant research and diligence.

My surgeon is device-agnostic - he uses both company's hardware, has implanted literally thousands of both, and he makes operative device decisions not in a vacuum, not on his own, and not based on some esoteric unshared information with the patient, but rather, via genuine curiosity and via an open, blunt, and what I found to be robust dialogue with me. Us, actually. And I stress: "dialogue".

Meaning - he proactively engaged me (well before I even had a decent grasp on what were all the questions I needed to ask) about my history (sexual as distinct from medical), current status, my (our) goals...and he just spent considerable time asking about and working to understand specifics of our current sex life and, no small thing - about the sex life we sought. This is why merrix's last few words above resonated.

I was 53 when I started talking seriously with Levine about implantation. Everyone has some bias about what that age means in relation to sex. But Levine made zero assumptions on that. He drilled down to find out what our personal and specific sexual behaviors were like and how we hoped and planned to use my dick in our post-implant future. While I don't remember the specific pros/cons dialogue he and I had between the two company's devices, I do very clearly recall him confirming back to me verbally and writing it in my chart that we (I'm paraphrasing here) enjoyed a very active sex life, we engaged in frequent sex, often aggressive/assertive sex, and that a Titan was his recommendation for me based on how I was telling him we behave and what we expected to put the device through in the future.

I remember responding to him at one point something like "We can get pretty aggressive". He asked back, "Tell me what you mean by 'aggressive', what does that mean to you two? Specifically?"

That kind of thing.

This is only anecdotal obviously.

But maybe it underscores the imperative that guys bust their ass and invest the time and energy and scrutiny to find not just the surgeon who's a consummate, verifiable pro with the knife, but to also find the surgeon who endeavors to see them holistically and individually and uniquely in relation to personal behaviors and expectations.

All I know is, that guy really, really talked to me (and at one point, us...because my wife was with me and engaged in this dialogue with him) and he listened and he then...only then...after a couple conversations which went like this...recommended my device and stated his rationale. I forget his exact words of course but the upshot of it was that we needed a device that could keep up with us and support what we do.

For whatever it may be worth. Again...LGX guys...I'm not castigating anything. I'm sharing an experience. Maybe there's a broader applicability to how my guy thinks and maybe your doc sees through another lens, I don't know. I share this only because Levine has done so goddam many of both devices and I just found his curiosity and thoughtfulness in drilling down on real world applicability to a specific patient/couple to be reassuring.

Oh...forgot...the flaccid thing. And I find this funny actually.

In the early months after my implant when I had gone in for a check-up with him, maybe at the 90 day mark or something, I was like, hey what the fuck seriously is with this big ass flaccid I'm sporting these days, doc?? And at that point I was still annoyed at my new flaccid. It was a royal pain in the ass to lodge it into pants, I couldn't lay on my stomach, etc. And I said to him, yeah I sort of wish I'd known about this.

So he did two things...first, he reassured me my Titan flaccid would evolve and soften and hang more naturally over time (it's in fact now slowly begun to do so) and second, he read me back from my chart/notes on how, the year prior, he had advised me pre-op that Titans trend toward larger flaccid and that I had agreed the trade offs in rigidity and durability cast the deciding vote. He's like, "you said something like 'who gives a shit about flaccid just give me the hardest more durable dick'..." something like that.

Just funny to me. Glorious that he had listened and written it down and then used my own words back against me to shut me up about bitching about my 90 day flaccid. He was like, "Hang in there, let's see how you feel about the flaccid AFTER you really get down to business with the inflated".

He was right. It's been an absolute fucking trooper this thing.

[LookingUp]

I've read every AMS/700, every Titan, every Hard, every Flaccid post on this site. The Dead Dudes Speak post is the most Bizarre/Bogus/BS.

The results of this study are based on:

3 dead dudes. 1. They are not identical by any measure/factor. 2. did they implant all 3 implants in all 3 to insure measurements where averaged across all 3 Dudes. 3. If all 3 products where implanted in all 3 dead dudes, repetitive implantation rules out any "real" data. 4. They are fcking dead. zero blood, zero natural tissue/muscle/tendon action/reaction . Stop for 1 second, think about the applicability of anything in this published "research".

The study that took hydraulic/pressure data using the same machine is somewhat more believable.

Dead Dudes with Artificial Dicks providing guidance for my implant selection? GMAFB (Give Me a Fcking Break)

Pure Rubbish.

Rant off.

[merrix]

I've read every AMS/700, every Titan, every Hard, every Flaccid post on this site. The Dead Dudes Speak post is the most Bizarre/Bogus/BS.

The results of this study are based on:

3 dead dudes. 1. They are not identical by any measure/factor. 2. did they implant all 3 implants in all 3 to insure measurements where averaged across all 3 Dudes. 3. If all 3 products where implanted in all 3 dead dudes, repetitive implantation rules out any "real" data. 4. They are fcking dead. zero blood, zero natural tissue/muscle/tendon action/reaction . Stop for 1 second, think about the applicability of anything in this published "research".

The study that took hydraulic/pressure data using the same machine is somewhat more believable.

Dead Dudes with Artificial Dicks providing guidance for my implant selection? GMAFB (Give Me a Fcking Break)

Pure Rubbish.

Rant off.

Well... Not sure about your background in research, maybe it's vast. But to start with, this was published in a renowned scientific medical journal. Meaning it has been peer-reviewed and judged reliable and valid by a group of other doctors/researchers.
And your questions above:
1. No. But that's the same as in real life. By definition no two persons in any study are the same. They shouldn't be. One person can't be measured twice...
2. Yes they did implant all three implants in all three dicks. Results for each implant is average in all three dicks.
3. Repetitive surgery. You mean revisions?
4. Yes, no blood flow. That is different from real people. But I doubt that the tiny blood flow left in a dick after implant would have any influence whatsoever on the factors measured here. Hardness. My guess is useless though of course, but the doctors doing the research and the doctors approving the article for publishing apparently think the results are valid. And that's good enough for me.

And the stop exhortation, the thing is I am not so sure any of us laymen need to think about the applicability. I rather trust the ability of the review board in the journal to do that better than any of us.
I think it is the best study ever made to really try to see the difference in hardness between the types. Previous studies have been on the implant only, not on implants in a dick. This is dead dicks, sure, but still dicks. Not just the raw implant itself.

So to call the study pure rubbish is... probably pure rubbish.

Merry Christmas!

[LookingUp]

3. Surgery definition.... Surgery: The branch of medicine that employs operations in the treatment of disease or injury. Surgery can involve cutting, abrading, suturing, or otherwise physically changing body tissues and organs.

Revision definition... the action of revising. While this definition is Global. The common usage of the word on this website is "to fix or repair something that is 1. not correct 2. unpleasing 3. hurtful/painful.

4. My reference goes beyond "a little blood in the dick". Tissues are damaged during an implant. Let alone 3 implantations in a row. What is the impact on the crus of repeated implantation? Unknowable.

My issue with this study is the implication that a Live Human can use the outcomes stated as guidance as to which implant is "the hardest".

Why not use dead bulls? They have dicks and balls.

As I stated, the Hydraulic machine study, posted on this site by you - I believe, has a level playing field of using the same apparatus.

At least all Alive involved in the performance of the Dead Dick study got paid.

There is nothing in this study I can use in deciding between Coloplast or Boston Sci. If I were Dead, I would include the study in my decision.

Lastly, I take no research as "Gospel" no matter which Organization publishes it. Not all Science is right just because it was Published.

Merry Christmas to you as well.

LUp

[Lost Sheep]

?

I did not quote your entire post, but anyone can find and read it based on the date/time stamp

Thu Dec 03, 2020 2:05 am

I am usually long-winded. For this, I make an exception.

Hyperbolic.

[merrix]

Since I know from all the PMs I get that a lot of people read this thread from first page to last and find it very useful, I will duplicate this post I recently did in another thread.
I spend a few minutes on it and I think personally that it is reasonably good general advice to someone struggling with the implant decision.
It is basically copied from this thread: viewtopic.php?f=6&t=16143&p=144922#p144922

Even though I understand all the questions, doing endless research and wanting to know everything - there is a problem with that approach. A few problems actually.
I'll take myself as an example.
I like to do research. I am the guy who can run anything in Excel.
If I get my mind set on something, I go all in and I get as much information/knowledge as I can as fast as I can get it.
I am the same professionally. I am a Managing Director of an Industrial company, and deal with the whole spectrum of decisions - HR, Finance, Production, Sales, Product Development, etc.
I want to base decisions on facts and data.
But - and this is the big fucking but I want to highlight to you.
All that research and analysis is useless if no decision is taken.
I always live by the device that it is better to take 10 decisions which were 80% perfect than to take one that is 100% perfect.
Decisions, actions is what create progress, what drives a business, a career, a relationship, one's health forward.
Without decisions and actions you stand still.
And as the saying goes, standing still is to relatively move backwards.
That's what I did when I got implanted.
I did research for 8 hours per day for 1-2 months.
Then I took a decision. I picked Eid, booked an appointment and just got fucking on with it.
If I had stayed in that research phase for a couple of years, I would have gone nuts. Totally crazy.

So get your thumb out of your ass and come to a decision.
After all this time, there is no magic information that will suddenly make you know exactly what to do, that will erase all your doubts and fears.
You do already know enough, you have thought about this enough.
What do you want to do?
Decision time.

And when taking that decision, remember this:
Your young pre-ED dick is gone. Gone. Vanished. Disappeared. And will never come back.
You can make the longest list ever about all your fears and doubts and all the disadvantages with an implant.
But don't compare that list to your pre-ED pornstar dick.
Compare it to the lame, soft, crap dick you have now.
And if you think that your current dick is better, if you think you are happier with that dick, then back off all the implant research.
Get off this forum. Stop the painful pondering.
Just get on, go out there, have sex, enjoy life.

With an implant, you could for sure have plenty of sex. You will always be able.
And if you think it is important to have sex, and still chooses the dick you have now, then I'm sure your current dick is providing you with that sex.
If it doesn't - then I'm not sure what you're thinking.

An implant will come with some drawbacks vs a perfect natural dick.
Of course. You didn't expect anything else I hope.
No surgical fix will leave you better off than when things worked great naturally.
A surgical fix will always be the second best solution.
But in the case of an implant, the improvement vs a natural non-working, unreliable ED-dick is enormous.

In my case, I could have sex with pills. 9/10 I could penetrate, often needing oral sex first to get hard enough to get in.
Once inside, I could bang on pretty well for 10 minutes or so. Not too slow, not changing positions, not stopping the in-and-out.
That would risk my dick went down.
And so it did maybe 2-3 times out of 10 and I just had to give up.
But still, 7/10 I made it. Fucked, orgasmed and rolled over.
I doubted my ass off as well whether an implant was the right choice.
Would I turn into some kind of freak with a plastic dick which would feel totally unnatural and any woman would laugh at me as the freak I had become?
I fought those thoughts 24 hours per day. For 1-2 months.
Then I decided that I had no choice.
Stories on Frank Talk indicated I would not turn into that freak. Even though I still had my doubts since most posters here were old, and honestly quite often weird, people I didn't really relate to.
But I decided I had no choice. Not doing the surgery, keep going as before, and slowly get worse - would drive my insane.
It would consume me. It would eat me alive.
So I decided that I'd just fucking do it.
And I did. 3 months after I found out implants even existed, I had one in my dick.
I thought hard, but I thought fast.
And I have never looked back.
Today, would I change?
Now I have a perfectly straight 18 cm dick that is always hard, which gives me the ability to be the best lover any woman I sleep with has ever had.
It gives me the luxury of only focusing on pleasure. For me and my partner. No worries, no limitations.
I have a dick, which when I am out at some bar/club, I can inflate to whatever level I want in my pants. If I want nobody to see it, fine. If I want a big fucking semi in my pants which girls come up and ask if they can touch - fine. Have it.
I can fuck anyway and anywhere I want. On my back, standing, hanging fucking upside down if I want to. And I can do it anywhere any time, drunk or sober.
All I need is 60 seconds and two free hands. Then I'm ready for anything. Any time. Anywhere-
Would I change that for my unreliable 16.5 cm, heavily curved crap dick which made me feel like shit everytime I had sex. And even more crap every time I did NOT have sex because I didn't even dare to try?
No. Fuck no. No way.

So to come back to your question.
Does it matter?
I understand it as that now you can masturbate with a blood filled glans.
Fine.
But you can't have good sex.
So what you are asking then is what is better:
Sitting in your sofa watching porn and jerking off with a blood filled glans, or having sex for two hours with a real woman but without the pulsing feeling in your dick????
I think you know yourself what will make you more happy for the coming 50 years out of those two options.