Desision Time

[newbie443]

I have decided to have an implant. I just need to decide weather to stay local with my young Uro who is new to the local Uro group or travel to the East coast and have it done. I have talked to my Uro's nurse and she said he has done implant surgery's before in OKC, Oklahoma and near me in Wichita, KS but did not know how many he has done. She could not locate anyone he had done the implant surgery on that was willing to talk to me. She did have a guy who had the implant surgery done by another Uro in the group that would talk to me and he said he was happy with the results even though he did loose size. He said I could request to have his Uro at the group do the surgery. I think the Uro group wants my new young Uro to do as much surgery as they can get him to do and that I would have trouble switching. I have an appointment this Thursday to discuss implant's with my Uro. I can find no reviews on him. The only place I can find him listed is on the local groups web site. Insurance will only pay part of the cost if I stay local. Now he may be a great surgeon but I can find nothing to confirm or refute this.

The advantages for staying local for me are that I have 2 grown sons near by who can stop by and help me while I am recovering. I would have follow up care close after the surgery. If this first surgery failed I would be able to have additional surgery as soon as possible. I would not have to travel with in a week after the surgery. Cost would be about 20k less. The disadvantages would be if it were less than perfect I would feel that I could have done much better if I would have traveled out of my area.

The advantages for traveling would be that no matter the results I would know that I had gone to a world class surgeon and done every thing I could to get as good a result as possible. Disadvantages would be traveling out of area and back after the surgery. No near by follow up after I returned from the surgery. Recovery after the surgery while I was out of area alone. If this first surgery fails I will not be able to afford to travel out of area for additional surgerys. Additional surgeries would need to be local for the next 4 years.

I want the best possible outcome with maximum return of what I had. I have read a statement that I should get the best surgeon that I can afford. For that reason I am at about 70% for making the trip east. I have also read that I would be flying over a lot of great surgeons when I do so. That is the 30% that is nagging at me to stay local.

Is there a certain way to approach a new young surgeon to gain insight on how hard he will work for me to have the best possible outcome? Right now I think he as the new guy has a large load of work. Time seems to be limited and I am not sure what to ask or how to ask with out causing ill feelings. I want to know how many he has done and how many he does a month. I just don't want him to take offense at me asking. Is there any make or break questions and answer's I should be aware of.

Sorry for the long book and thank you for taking the time to read it. Any thoughts or information would be appreciated. Maybe I'm still nervous about pulling the pin on this.

[ED2013]

Ask him whatever you want to. You are the patient. You are the customer. Yes I’d ask him how many implants he has done and how many he does per month. Also ask if you will lose any size. Barring any scarring and or peyronies you should not lose anything. If he says you will lose size, that is a red flag.

[warrenw]

She could not locate anyone he had done the implant surgery on that was willing to talk to me.

That's a huge red flag IMO.

Check this thread for some questions to ask: http://www.franktalk.org/phpBB3/viewtopic.php?f=6&t=8280&hilit=questions

[Lost Sheep]

Quiz him thoruoghly. He SHOULD appreciate an involved ans participarory patient. If he is not, that is also a cautionary sign.

See my thread "Experience o Continuity of Care" wherin I posed the exact same question that you have. The answers were helpful.

viewtopic.php?f=6&t=8236

One piece of advice I got from my G.P.'s (primary care physician) nurse is that there is no substitute for experience.

[newbie443]

Ask him whatever you want to. You are the patient. You are the customer. Yes I’d ask him how many implants he has done and how many he does per month. Also ask if you will lose any size. Barring any scarring and or peyronies you should not lose anything. If he says you will lose size, that is a red flag.

When I wrote about size I was referring to what I had when I was younger. I was in a bad marriage and she went through menopause the same time I started having trouble. I did nothing about it as I had nothing to use it on. After the divorce I was really down on women and again did nothing as I didn't want anything to use it on. I have not had a useable erection in over 10 years. I did buy a VED and started using it and have gained some back. If the implant will replicate what I get with the VED I will be ok with that. And maybe with some time the VED will gain back some more. I am diabetic and saw a illustrations somewhere before about damage to the erectile tissue and tunica. Looked like it was just melted away. My memory is not good but that is what I remember. I just want someone that will get me back as close as possible to what I had when I was younger before I was diabetic, and over weight. Again my remember is not good but when I asked about loosing size his reply was no one can make you bigger. At first I thought he did not understand the question as I was not asking to be bigger than I was. I just think he believes he will measure and that is what there is. That there is no way to make it bigger than what it measures.

I will ask again and see if I get the same answer. Thank you for the reply.

[newbie443]

She could not locate anyone he had done the implant surgery on that was willing to talk to me.

That's a huge red flag IMO.

Check this thread for some questions to ask: http://www.franktalk.org/phpBB3/viewtopic.php?f=6&t=8280&hilit=questions

How many implants have you performed in total? I will put this on my list
How many implant surgeries do you perform per month? On my list.
What implant do you prefer, AMS or Coloplast, and why? I have read that this depends on the patient. Not everyone can have either. I will put it on my list.
When will you make the decision on which implant to use for me, during surgery? That goes with the above and may be answered at the same time.
Will you have both brands and a size range available to choose from during my surgery? This is a concern that I have that they will not have all the sizes required and end up using longer RTE's instead of the proper size implant. And maybe going on the short side of the measurement. On the list
Will I lose any length?? On the list.
Will an implant fix my peyronies? Is there extra surgery or modeling required for peyronies?Not sure about this but I do not have any curvature. I have had no tests other than UA and 15 second groping exam.
Penoscrotal or infrapubic and why? {ADDED} I have read that this makes little difference. Pump placement is better with scrotal and reservoir placement is better with pubic. On the list as I want to know which will be used.
Referrals to previous patients {ADDED} No need to ask again. Already said no.

Thank you for the reply and the link. I was helpful.

[cincinnatus1951]

Newbie" I would recommend asking what is his infection rate and what is his protocol for avoiding infection. I would also ask how soon after surgery does he activate and how many and what frequency are his follow ups.
Cincinnatus

[Lost Sheep]

I note that some Doctors maintain a list of patients willing to talk to prospective patients. The Doctors then share that list to prospective patients without the risk of violating H.I.P.A.

Other Doctors will give prior patients YOUR contact information.

I posted a request of Craigslist in the "Personals" section and got help and advice from there. Not from mu urologist's former patients, but helpful nonetheless.

Franktalk's archived threads have been EXTREMELY helpful. I read through about 4 years of old posts. It took a couple of days but was worth it.

[newbie443]

Quiz him thoruoghly. He SHOULD appreciate an involved ans participarory patient. If he is not, that is also a cautionary sign.

Seemy thread "Experience o Continuity of Care" wherin I posed the exact same question that you have. The answers were helpful.

viewtopic.php?f=6&t=8236

One piece of advice I got from my G.P.'s (primary care physician) nurse is that there is no substitute for experience.

Flying back for reactivation is not a problem or staying for a week for a check up. Airfare is cheep enough as long as there is notice. But if there is a problem that needs to be addressed right away I can see some risk. Not sure how my Uro group will be about me going out of area. I could go to urgent care but I'm not sure they would be able to properly address an issue if I had one. Of course we now have e-mail and cameras with photo's that can be sent.

Yup, the experience thing. Having do some reading it seems that has a lot to do with recovery. Maybe even a bad recovery can have something to do with how things go down the road. A lot of swelling and pain has to move stuff around inside and put stress on that stuff.

Most likely I am just nervous about this and pissed at spending the money for something my insurance should kick in on. Should be at 100% for travel now and cancel with my Uro on Thursday. I'll get my list and that way I will know I also did all I needed to make the right decision.

Thank you for the link and help.

[newbie443]

Newbie" I would recommend asking what is his infection rate and what is his protocol for avoiding infection. I would also ask how soon after surgery does he activate and how many and what frequency are his follow ups.
Cincinnatus

Great questions. On my list.

Thank you.