I have answers: TEP, Rigicon, Expandables, Pump Position etc etc

[splitpeach]

So I had my appointment with Prof David Ralph at UCLH and I got as close to an interrogation as I could.

I know some people find his approach cold and perhaps if you're from the US or even in Europe then you might find that, but I like it. I like that it is matter of fact, no ambiguity, direct to the point and clear. It feels like he has nothing to prove, nothing to gain by any bias and comes across as totally experienced, knowledgeable and confident. My preference over smiles and reassurance tbh.

This is what I recall from the appointment. I may have misremembered in some places so don't sue me if I've confused something but I think it's all pretty correct.

I asked about further investigation (Cavernosonography, Cavernosometry, Doppler). I'd already had a Doppler test. He said it would not reveal anything further. I still had infrequent morning erections and could establish an artificial erections with injections. This, he says, evidenced that my condition was not related to inflow of blood to the penis.

This meant that the issue was related to the outflow of blood from the penis. And so the remaining surgical procedures other than an implant may be considered but are unlikely to be effective long term. But to review, he advised that I undergo an MRI on the penis with artificial injection instead of Doppler or DICC.

I asked about the Vertica device. He is listed as a consultant I believe on their website, however he has simply said he has nothing conclusive to tell me about that as trials and data is not yet available.

We are having supply issues with certain injections here in the UK. Notably caverject and so I asked him about alternatives. For some reason Duomix, Trimix and Quadmix are not available here. Invicorp is but he was not particularly encouraging of it.

He was not really enthusiastic about Shockwave treatment either.

Then we got onto talking implants.

I asked for a Rigicon. But rigicon IPP is not yet cleared on the NHS. He said that there was incentive for the NHS to offer it as it is apparently cheaper than either the AMS or Coloplast, but that progress with clearance on the NHS, likely similar to FDA, is slow moving. He said that that may change however and so when it comes to the time of my surgery it may be available.

He said from being placed on the surgery waiting list today, the wait time for a surgery in that department is 9 - 12 months.

This is perfect for me as that is an ideal amount of time to do my MRI and my other tests and to try any other options whilst getting my head around this procedure. I understand for others that may be too long a wait.

He described the Rigicon as being similar to the AMS and that he has fitted some privately. And he confirmed that the AMS devices are more limited in the girth that they can produce against the Coloplast.

He did however confirm that the Coloplast has a less natural feeling material and therefore less natural flaccid state quality.

He said that at around 6.5 inches length, I would possibly likely suffer the "dog ears issue"

He advised that, being fairly young, I could expect to have three or four implants fit in my lifetime. He stated that I could expect the life of an implant to be around 15 years.

I asked about the expanding implants. AMS LGX and Rigicon AX. He said they're a nonsense. They don't work. He said they're useful as a contingency for surgeons that undersize the implants and allow room for error and that otherwise they're just a marketing ploy.

He suggested I get a Coloplast Titan. Reasons where that I was young and this would be the most rigid implant. I said I'd heard of people saying that was too hard at full inflation and that they only needed it at 80% and same with the AMS.

His response was that most people that see him want it as hard as possible! Also Titan will allow for better girth and a more stable / rigid erection.

He said that Coloplast had been saying for some time that they would resolve the unnatural flaccid feeling and dog ears by introducing a softer implant to the market. But nothing had arrived yet. (And unlikely to by the time of my surgery)

I asked about pump placement. He said as standard he places the pump below and behind the testicles. Those that do horse riding, cycling etc he would place in front.

I asked about reservoir placement and particularly about martial arts, sports etc. He said it would have no bearing unless you took direct impact to the reservoir which would really mean direct blow to the penis. He takes a retzius placement as standard. He said he has had patients with damaged reservoirs present after taking falls and landing on something directly to the reservoir, otherwise he says there's no issue.

I asked about possible natural engorgement and erections post implant. He advised that this is unlikely and particularly so with a Titan as the tissue would be so compressed following implantation that no blood flow would be sufficient to cause any activity. Usually when there is erection activity or engorgement it is because the implant has been undersized.

I asked about tissue thinning. He said I wouldn't have to worry about that for another 30 years when I'm in my 60s.

I asked about optimizing size prior to surgery and he said VED. I said how long before surgery and he said that if you have ED you should already be doing it around 3x times per week.

He takes a Penuscrotal approach as standard

Guys, to anyone wanting to specifically be worked on by Prof Ralph and especially on the NHS I'd say you need to get in right now. He's at the end of his career and I would say retirement is not far off at all.

He seemed totally knowledgeable. I feel like he doesn't give a shit about money at all. The feeling I have is that he's been there and done that but is truly competent in what he does.

I fucking hope so anyway! Haha

[Implant2025]

Dr Ralph knows his stuff! I’m mentally comparing what you’ve reported v what my Dr (a high volume IPP specialist) told me before my surgery - which was 2 weeks ago.

- My surgeon also uses the penoscrotal approach, though there are high volume surgeons in the US who prefer the infrapubic approach.

- The corpora determines the length of your penis. Any good surgeon is going to put in an implant that is exactly the same length as your corpora at the time of surgery. So the AMS marketing spiel that you can grow up to 25% with an LGX is just BS.

- If I were young and 6.5” erect my doc would recommend I get a Coloplast too. Mine also assumes that guys want an implant that can get them as rock hard and girthy as possible. He also said Coloplast was more prone to dog ears and is not as soft when flaccid.

- After discussion, I ended up going with an AMS CX implant - more supple when flaccid that a Titan, but also less girthy. I’m 73 and about 5.5-6” erect. So I’ll probably never need a revision.

You’re doing the right things - research, asking questions, open to alternatives. You got this!

[splitpeach]

I think what is great about a public health service like the NHS is that you know that you're getting totally unbiased advice from the medical professional.

Not only are they not making any money from you but there are seriously strict guidelines they have to follow. I have had a number of treatments both privately and on the NHS and my experience has been that the standard of treatment and care on the NHS was always much better than privately. The issues are the wait times, bad food and no whistles and bells.

You know that the treatment and advice you're getting is rock solid and tested with no financial incentive and no placating the patient.

They don't need to pander to you with fancy devices that are overhyped or tap dance for you. They don't care if you do the surgery with them or not.

That's why it was so useful picking Ralph's brains like this as it was as straightforward as you could have hoped for.

I am however curious about his Veritas device. I don't think someone that esteemed and respected would tarnish their career by associating themselves with a snake oil device. For £1,500 vs a lifetime of wondering what if, maybe I need to try it. Wonder if there's anyone out there thats used it.

[Thisworld]

Implant lifetime of 15 years? Isnt a bit too optimistic?

[splitpeach]

Implant lifetime of 15 years? Isnt a bit too optimistic?

I did think the same... He may have said "up to" but I don't think so. Either way he said I'd need about three in my lifetime and I'm mid 30s.

So yeah I think he said 15 years was what he usually saw from his patients.

[IndianRasputin]

Implant lifetime of 15 years? Isnt a bit too optimistic?

I did think the same... He may have said "up to" but I don't think so. Either way he said I'd need about three in my lifetime and I'm mid 30s.

So yeah I think he said 15 years was what he usually saw from his patients.

For a malleable?

[splitpeach]

Implant lifetime of 15 years? Isnt a bit too optimistic?

I did think the same... He may have said "up to" but I don't think so. Either way he said I'd need about three in my lifetime and I'm mid 30s.

So yeah I think he said 15 years was what he usually saw from his patients.

For a malleable?

No, inflatable.