Post-op implant inflation to mitigate "coffin effect"

[Lost Sheep]

After any surgery there is scar tissue that forms. The scar tissue that forms around an implant (a "capsule") that restricts full inflation (sometimes referred to as the "coffin effect") can be painful to free up. (Similar to the pain experienced after joint surgery (e.g. rotator cuff repair) where intensive physical therapy is required to prevent "frozen shoulder" syndrome.) Needless to say, a "frozen penis" syndrome is undesirable.

Earlier, I posted an article that suggests pre-op vacuum therapy can help with with the post-op recuperation period. Tonight I found this article suggesting post-op residual inflation may have significant influence in easing the post-op period as well.

Does anyone have any source material or first-hand testimony to illuminate the pertinent issues? Especially as it may pertain to a diabetic 67 year-old 5.5" penis being implanted with (probably) an AMS LGX?

Some surgeons leave patients inflated to as much as 80% of capacity to make the capsule as large as possible to ease the rehabilitation discomfort. Other surgeons leave as little as 20%-30% inflation. This appears to make a difference, but I have no authoritative sources yet.

Early activation of the implant vs later seems to make a difference, too, in comfort and ultimate size (length and girth).

This article refers to the differences that early activation vs no early activation of the inflatable prosthesis
Title" Pseudo-capsule “coffin” effect: How to prevent penile retraction after implant of three-piece inflatable prosthesis
Authors: Enrico Caraceni, Lilia Utizi, Giovanni Angelozzi; Department of Urology, Civitanova Marche Hospital, Italy.
Short Summary: http://www.ncbi.nlm.nih.gov/pubmed/25017596
Longer summary: http://www.ncbi.nlm.nih.gov/pubmed/25017596
with this sentence: "The result is a penis bigger in flaccid state but smaller in erect phase, when early activation is not performed"
Full article: https://www.researchgate.net/publicatio ... prosthesis

This article was obviously translated from the original Italian, so there may be some grammar issues to overlook.

I am a participatory patient and my surgeon is willing to listen to and consider my input as long as it is well-supported by reliable evidence. I can use all the help I can get. Thank you.

Lost Sheep

[FlaDon]

Hi Lost Sheep,

Although I don't have diabetes, I'm close to you, size-wise, so I went into the implant surgery wanting to know everything I could about it so as to be an "informed" patient. In some ways, the doctor appreciated it, and told me he marveled at the number of guys who don't even know the 'basics' of male anatomy. But while he appreciated it, sometimes I think he was a little annoyed at the plethora of questions I sometimes had, and learned to "back off" a bit....particularly post-op.

My personal experience is probably biased, as my doctor was Martin Dineen, one of the co-authors of the VED protocol paper that is referenced here quite often. I was VERY concerned about losing length, feeling that I could not afford to lose anything. He told me that if I followed his instructions, I 'shouldn't' lose anything, that complaints of size-loss have become virtually non-existent in his practice. So I did....followed the VED protocol to the extreme, doing it twice a day, ten minutes at a time. I had stretched the VED length to 6.5" prior to surgery (not an accurate measurement of either natural or post-op size). He did talk to me about the "coffin" effect and encapsulation of the cylinders. They tried to activate me at 9 days, I wasn't ready and could not do it. So they put it off a week, and I was activated and started cycling at 16 days. At first, I thought I had lost size due to swelling and not being able to pump to maximum. They wanted me to pump at least once a day, and try to leave it inflated for about 45 minutes. If I could go an hour, even better. I tried....but I'll admit I missed a few days. Eventually, within a couple of months, I was back to my "youthful" length of 5.25" pumped.

So, it worked for me. Don't know if this helps, but it is my experience and I don't have anything else to compare it to, other than the experiences of others here at FT. Best of luck to you, just don't "over-think" the whole thing. As some others have said, "It's just plumbing".

[dg_moore]

And as I've mentioned here before, back when I got my implant (2008) I recall no mention of any post-op inflation protocol. When I was finally able to inflate at about 12 weeks (due to a slow healing scar) I was at my original pre-op length on my first try. Since then I rarely inflate the implant - maybe once every couple of months - and when I do it's for no more than a minute or two, but my length remains unchanged.

[oddjob]

Lost Sheep

I too am a Diabetic (type II) implant patient, so I can give you my perspective on pain/healing/infection risk...

But I did not do the pre-op inflation bit as I had my surgery done at the Tripler Army Regional Medical Center and they did not offer nor support my request to have this done prior to my surgery...so it was not an option for me.

The diabetes (at least in my case) increased my post-op pain/swelling and lengthened my recovery period quite a bit.

My swelling did not recede until a full 4 weeks had passed, so my cycling of the implant did not start until week 5...and then I had trouble finding the deflation button due to "thickened skin" near the lateral scrotal incision...

Your results might vary, but I have found that having diabetes makes every medical procedure much, much more complicated.

v/r
Joe

[Lost Sheep]

Lost Sheep

I too am a Diabetic (type II) implant patient, so I can give you my perspective on pain/healing/infection risk...
(Edited for brevity)
Your results might vary, but I have found that having diabetes makes every medical procedure much, much more complicated.

v/r
Joe

May I ask if your blood glucose was under good control at the time and what your BMI was? PM me if you like. My BMI is 27 and glucose under fair to good control.

Also, how is the implant working for you and would you do it again, knowing then what you know now? (I realize it has only been two months now.)

Thanks each of you. Neither of the two Doctors I have consulted are very helpful answering my (admittedly deep and time-consuming) questions. So, I am designing my own Standard of Care Protocols.

Lost Sheep

[oddjob]

Lost Sheep

My blood glucose was high during the surgery/recovery period for a couple of reasons:

1. I am also on Coumadin (blood thinner) and to do the surgery, I had to do a 'bridging' where I stop the Coumadin and start giving myself Lovenox shots twice a day...this 'bridging' allows my blood to "thicken" enough to clot so I don't bleed out from the surgery...

2. I had to stop taking certain blood sugar medicines as they would have a bad interaction with the anesthesia that was used for my surgery.

I honestly don't know what my BMI is, but I am 5'10" and 200 lbs. and since the surgery, my blood sugar has stabilized to fair levels now that I am back on my full regimen of meds.

The AMS 700 LGX is working fine for me and I cycle the implant at least every other day now...sometimes every day depending on how busy my life is...

I would do it all over again, despite the pain and swelling as before the surgery, my penis was a limp noodle and despite the Viagra, Levitra, and MUSE, it just would not get hard ever.

Now after the surgery, I have a fully functional penis that gets super hard and does not go soft even with orgasm...which is a great benefit for a guy like me who still appreciates the female form in all of its glory...!

v/r
Joe

[Electrician]

Lost sleep , thanks for the great article,I wish I had did more home work before my surgery. I had a good friend that worked for a urologist and I just went there based on her recommendation said the guy was the best. Although so far I'm one of the lucky ones and everything worked out just fine.My doc had me inflated on day 13 and told to pump away. HERT LIKE HELL SO I pumped up daily as prescribed never look back . NOT SURE if it made any difference staring that early nothing to compare to I know now 9 mos everything starting to work better as the weeks go by.

[ableman28]

My opinion, based more on thinking about it and my own experience, is that the sooner you can activate after surgery the better.......and then keep activating. That reduces the chances of significant scar tissue building up that is difficult if not impossible to stretch out later.

I was 6.25" stretched and with ICP presurgery. That was the post surgery length I was promised. After about a week of post surgery inflation, starting on day 13, I was back to that length.

But I followed the aggressive inflation protocol closely. And, in my case I needed an implant due to a heavy band of scarring due to an accident preventing complete erections without a major dose (1 cc!) of Quadmix. I believe aggressive inflation also stretches out scarring from Peyronies or other injuries. In my case I'm now out to 6.5-6.75", yes, I'm actually longer post surgery than I was. No shortening.

I was originally 7.5" long before my accident, lost almost, 1.5" as a result of it. And, I believe that aggressive pumping, pump till it hurts, and leave it there til you can't stand it, has, at least for me, stretched out my scar tissue to help me recover some lost length. I don't think that an implant can make you larger than you ever were. But I do believe it can help people with scarring recover lost length and actually increase size over the presurgery size.

[roninhouston]

Lost Sheep, I posted this on another thread September 2015 ......

Was activated on Tuesday and started the Post-Op VED protocol. Those on Dr. Dineen's VED protocol start cycling at 9 to 12 days however I followed what Dr. Cornell told me, which was 33 days.

From Dr. Dineen's paper...................
" on the VED protocol the patient started to use the device at 9 to 14 days, they are instructed to daily inflate the device as much as possible for a period of up to one hour. Initially many patients will only inflate for 7 to 10 minutes due to discomfort but the theory is that as much inflation as possible, for as long as possible, influence the cylinder capsule to form around the inflated cylinder rather than the deflated cylinder. Post-operative inflation is emphasize strongly if a lenghtening cylinder is implanted. Capsule development is thought to be complete at three months following surgery and the daily inflations can cease." (from Dr. Dineen's paper " vacuum preparation optimization of the cylinder length and post-operative daily inflation reduces com..plaints of shorten penile length following implantation of inflatable penile prosthesis")

I started the VED protocol 9 weeks before my operation in the hopes that it would minimize the pain and limit the loss of length. In Dr. Dineen ' s paper he talks about the patients uses the vacuum pump pre-op, to the point of feeling a slight burn, this is the stretching of the penis tissue. Post-op inflation feels the same for me as you are breaking the encapsulating scarf tissue built around the cylinders.

Was activated on Tuesday, Dr. Cornell suggested inflating and deflating three times a day, each time increasing the pumps by one. By Thursday was able to flatten my pump bulb for 60 minutes, Friday for 45 minutes and Saturday 90 minutes. So maybe the reductions in pain is working for me. NOTE: it is the pain is similar to pre-op vacuuming to the max pressure limit, after nine weeks mine was 15 (in.hg) and trying to hold it there. Actually when it became uncomfortable I would do things that distracted me from watching the clock. Plus I do my Kegels, if I think I need to push the deflate button. According to Dr. Cornell I still have some swelling which probably accounts for some soreness especially around the incision went activated.

I do not agree with Dr. Dineen when he said that maximum benefits were reached at 3 months. Probably about the time his study money ran out. Those on FT have said that enlargement has continued up to 18 to 24 months. That said, I will try to do a minimum of 1 hour each day for the next 2 months. I find it relatively easy to pump up during my morning shower and maintain it through my shaving & grooming.
----------------------------------------------------
Lost Sheep, there is a another paper which followed up on Dr. Dineen patients I posted this about it ........

Urologist Dr. Dineen says he starts his patients at 9 to 12 days after the op. However other papers found most patients were not comfortable (read painful ) inflated that soon. One paper said the average person started the VED Protocol Therapy was 43 days. Dr. Cornell activated me at 33 days, was able to pump to the max two days later and have been going for a total of 60 minutes every since. Since you are breaking the scar tissue you will have some discomfort for brief periods of time. You can always push the deflate button if it is to painful.
======================
BTW Tom Sellars is mentioned as a co-author of the paper. He is Dr. Dineen's assistant and works with Post-Op patients, i.e. helping them get inflated.

[ableman28]

Here is the research study I mentioned in my prior post:

https://www.ncbi.nlm.nih.gov/pubmed/25872574

Everyone contemplating getting an implant or who has had one done recently should read this article about the most effective way to recover length. I followed this protocol early on and added about .75" to my pre surgery erect (with ICP) size.