Using other than a world renowned surgeon

[David_R]

To me, one of the most important things to do when trying to decide is to talk to patients of the doctor(s). I would certainly recommend my urologist to anyone (no, I am not being paid to say this), and there are other wonderful prosthetic urologists out there beside the two gods. Good luck, brothers.

[merrix]

It is really irritating to hear men who went to a high volume surgeon act like those of us who did not do the same act like we are not as smart or took some huge risk. If you do the research like I did, it is fully possible to find as good a surgeon as those well known doctors.

I suppose you at least partly refer to me.
Well, I am not trying to make anyone irritated. And if I do make you irritated, you are merely shooting the messenger. It is not my personal guess that 50% of people choosing implant surgeons go to a doctor who statistically will give them 6 times higher infection risk than the world class doctors.
That is just what scientific research has shown.
I am just, in the interest of sharing knowledge and doing my tiny little part in helping people make informed decisions, sharing this information.

Your argument is basically that if you choose a low volume surgeon carefully, i.e. you do your research and make sure you pick a low volume surgeon who is better than the other low-volume surgeon, then you will be fine and have the same great odds as going with the proven top class doctors.
I am not going to say you are wrong.
But I am going to say that is a dangerous way to do your choosing.
I am sure everybody will say they did good research. But the problem is, not everybody can improve their odds. Facts are what they are, and total infection statistics among different experience levels of surgeons are what they are.
As a group, we cannot beat the statistics.
So what you are saying then, is that you think you have the power to pick the best among the worst. Again, maybe you can. But everybody can for sure not. The average skill (and infection level) in that given population (low-volume surgeons) is what it is. And for everybody picking a good one, more guys will pick a bad one.
Data says the infection rate is 3% among the 50% of implants installed by the 2 quartiles of lowest volume surgeons. That infection rate will still be 3% no matter how good everybody thought they did their research. Some will win and some will lose, but the average will remain.

You cannot get around that fact that you are working against the odds, relying on luck or being more skillful in choosing than your peers.

I just say the easy way is to work with the odds instead of against the odds.

Have a great weekend all out there, make good use of your robot dicks!

[Greg1956]

No, I was not even thinking of you. It is quite a common reaction from men who have used the high volume doctors. I do think you are taking liberties with what I said to try to prove your point. I said my doctor’s name kept coming up as one the high volume doctors think is a great choice. As I said, I researched a lot of options so I did not take any particular risk. I agree it would be dangerous to choose any old doctor without following the lengthy due diligence process I followed. When you have a great relationship with a surgeon, know him, trust him, and have endorsements from the doctors you say everyone should go to, I do not see the point in starting over and spending more money. If a man has no relationship and doesn’t choose to do any research, of course it would be smart of them to spend the extra money and choose one of the high volume surgeons.

Basically my point is there are people in every profession who do more volume and that one statistic does not make them more qualified. That is one component. It is the total package that defines their expertise and I found that in my surgeon. With the perfect results I have had I just find it interesting when other guys (not you) who did go to a top surgeon and then complain about their pain, pump placement, cylinder tips stopping short, etc. and still tell me and others who did not go to a high volume doctor that we should have.

[robertm]

There are no guarantees. But to some degree, men seeking implants are taking some degree of risk. It's simply about minimizing the risk, not eliminating it. I think in ANY profession, common sense tells you that someone with more experience is more likely to do a good job. Again, no guarantee, just improving the odds by selecting someone with more experience, a proven track record, and many positive reviews from prior patients. I'd think the same way when selecting a contractor to build a home for me. I would not select a contractor who has not built a lot of homes. I would want one who has successfully built many homes over many years.

[notaes]

Thank you fo4 your post. You said everything I wanted to say and more. Thanks again!

[dg_moore]

Sometimes things just happen by luck. While on my ED journey I had many conversations with my internist, who is also an old friend. We went through pills, VED, injections, and eventually got to the place where he said it's time to stop fooling around. What you need is an implant. Let me give you a referral. And he did - to Andrew Kramer, whose office in Baltimore is less than 25 minutes from where I live. So I wound up with Kramer after doing zeto research - I only learned of his implant prowess after joining FT a few years later. A great deal of what happens to us in life is the result of chance.

[Greg1956]

There are no guarantees. But to some degree, men seeking implants are taking some degree of risk. It's simply about minimizing the risk, not eliminating it. I think in ANY profession, common sense tells you that someone with more experience is more likely to do a good job. Again, no guarantee, just improving the odds by selecting someone with more experience, a proven track record, and many positive reviews from prior patients. I'd think the same way when selecting a contractor to build a home for me. I would not select a contractor who has not built a lot of homes. I would want one who has successfully built many homes over many years.

My surgeon is not one of the high volume docs, but has a proven 23 year track record. Lower volume does not mean lack of experience. Likewise, back to my home builder analogy, my wife and I are currently building a new home, using a low volume custom home builder who consistently wins awards. It is a family business that’s been building for 40 years. Meanwhile I know of two high volume builders who whip out entire neighborhoods in a short period who are facing multiple lawsuits for shoddy work. Again, high volume does not always mean better work and lower volume does not mean a lack of experience or lesser quality.

[Gt1956]

To all. I think we each have our own definition of a good surgeon. Particularly who is a high volume implanter. Karpman told me personally that he does 100 a year. I'm sure that the number goes up or down depending on demand. Considering a recent post that seemed to say that many doctors only do a few a year. I consider 100 to be a decent number. Yes, I know that there are at least 3 doctors that exceed the 100, by a lot.
So if a high volume is 500 or so a year. Then there isn't many choices. If we agree to a lower number. But he has 10 or so years under his belt. The pool gets more reasonable. I am neither advocating for or against the big 3. Just pointing out that we are not all on the same page over this.
I'm afraid that there are guys trying to figure this out & we aren't helping them at all cause we don't use the same measurement.

[merrix]

My surgeon is not one of the high volume docs, but has a proven 23 year track record. Lower volume does not mean lack of experience. Likewise, back to my home builder analogy, my wife and I are currently building a new home, using a low volume custom home builder who consistently wins awards. It is a family business that’s been building for 40 years. Meanwhile I know of two high volume builders who whip out entire neighborhoods in a short period who are facing multiple lawsuits for shoddy work. Again, high volume does not always mean better work and lower volume does not mean a lack of experience or lesser quality.

Greg, I never said or meant your surgeon was poor.
I also think that nobody, definitely not me, said that every experienced surgeon is better than every less experienced surgeon.
I am just referring to data, to statistics. Averages. Nothing else.

And this is what the particular study I read says:

Vol Q.png (4.77 KiB) Viewed 1453 times

Out of a 1000 random implant surgeries, 250 will be done by docs doing maximum 2 implants per year. The AVERAGE infection rate in this group will be 3.125%.
Another 250 will be done by surgeons doing 3-7 implants per year. The AVERAGE infection rate among those 250 will be 3.0%.
Another 250 surgeries will be deone by surgeons doing 8-31 implants per year. The AVERAGE infection rate in this group will be 2.63%.
Finally, the final group (quartile) of implant surgeries will be performed by surgeons doing 32 or more implants per year. Their average infection rate will be 1.25%.

This also means that 25% of all implants are inserted by surgeons doing maximum 2 implants per year.
Accumulating this, it means that 50% of all implants are done by surgeons doing 0-7 implants per year.
75% of all implants are done by surgeons doing 0-31 implants per year.

I am not saying that EVERY doctor in the 0-2 implants per year group will have infection rates of 3.125%.
I am (or actually the researchers are) saying that their AVERGE infection rate is 3.125%.
Of course, some in this group will be better and some will be far worse. 3.125% is their AVERAGE.

In reality, there will be a normal distribution in each quartile, with most likely the best one in the lower quartile being better than the worst one in the higher quartiles. And vice verca. That's how statistics work. It is about averages.

So for you to say that there are good docs in the lower volume group is of course correct. But it is meaningless. It is a given. And it does in no way counteract my argument that anybody will have a HIGHER PROBABILITY of finding a good doc if searching in the high volume quartile. The AVERAGE doc there will be better than the AVERAGE doc in the other volume quartiles.

Just added Eid and Kramer myself to that table. They are obviously in the highest percentile of the top quartile. And to prove my point, their infection statistics is even better than the AVERAGE of the top quartile. Meaning the high volume - low infection correlation is robust. It seems to work alll along the volume scale.

So again, my point is not that all low volume docs sucks. Of course they don't. And not all high volume docs are good of course.
I am just simply saying that ON AVERAGE, a high volume doc will give you a less risk of infection.
And that the logic of "I am doing good research" doesn't hold.
Somebody doing good research among a pool of high volume docs would still have a better chance of avoiding infection than someone doing good research among a pool of low volume docs. Because he is picking from a group with their center of their normal curve at a more favorable frequency.
It's just maths.

[jump.ship]

My surgeon is not one of the high volume docs, but has a proven 23 year track record. Lower volume does not mean lack of experience. Likewise, back to my home builder analogy, my wife and I are currently building a new home, using a low volume custom home builder who consistently wins awards. It is a family business that’s been building for 40 years. Meanwhile I know of two high volume builders who whip out entire neighborhoods in a short period who are facing multiple lawsuits for shoddy work. Again, high volume does not always mean better work and lower volume does not mean a lack of experience or lesser quality.

If he has 23 years of experience, but is low volume, they probably have other surgical interests. The housing analogy does not hold. The difference between those two builders is that they both build all day long everyday, but one builds a few houses and other many. Clearly the builder that takes their time and produces less will produce a better building.

That is not the same as your surgeon and, for example, Eid or Kramer. Your surgeon and Eid and Kramer are doing surgeries all day long everyday, but say Eid and Kramer only do implants whereas your doc does an array of different surgeries. This will means that Eid and Kramer's focus will make them better at that particular surgery as your surgeon has spread out their expertise.

Its like fusion restaurants that offer Chinese, Thai and Indian food on the menu. Sure, some of it will be ok, good even. But everyone knows if you want a good curry you're better going to an actual Indian restaurant.