NHS Implant - No good if you are a grower?

[Waynetho]

I left the appointment thinking well they must be right. If you have cylinders or rods that don’t change in length I guess they have to size so you don’t end up with pressure points etc.

I’m not worried the implant would make me a shower. That would be fine although I do enjoy cycling (bikes) and I’ve a nose less saddle but I’d still like to cycle for 3 hrs like I do now. The most I’ve read one guy rides is about an hour before they get uncomfortable. But I’d rather have a functional penis!

You are correct that after implantation you will be a shower (approximately your pre-op erect length). You're incorrect in the assumption that you will be your FLACCID length or some relaxed length though. They aggressively size you from the inside with a special measuring tool, after dilating the cavernosa - pushing into the glans from the incision and reading the size, then pushing into the crus from the incision and recording the size. Add up the two (and maybe a bit more for good measure) and that's the size of implant they use. You shouldn't ever wind up with your pre-op FLACCID size after you've healed and "cycled" the implant a bit. You should be close to your pre-op ERECT size.

I think you may be mistaking "cycling" (riding a bicycle) with "cycling" (inflating implant to max then deflating after a specified time).

The "CYCLING" that other men report as becoming uncomfortable after an hour is the latter, inflating the implant to max, waiting and then deflating. Admittedly, the pump may cause some challenges in bicycling but they can be mitigated with the right gear and apparel.

[Yorkie81]

Yorkshire calling!
Reference NHS implanting.
I see that you have mentioned the hospitals at Nottingham and Leicester -
Has anyone heard if Nottingham or Leicester are carrying out implants, now that COVID is keeping them less busy?
Or what are the waiting times like?

[Lost Sheep]

I left the appointment thinking well they must be right. If you have cylinders or rods that don’t change in length I guess they have to size so you don’t end up with pressure points etc.

I’m not worried the implant would make me a shower. That would be fine although I do enjoy cycling (bikes) and I’ve a nose less saddle but I’d still like to cycle for 3 hrs like I do now. The most I’ve read one guy rides is about an hour before they get uncomfortable. But I’d rather have a functional penis!

You are correct that after implantation you will be a shower (approximately your pre-op erect length). You're incorrect in the assumption that you will be your FLACCID length or some relaxed length though. They aggressively size you from the inside with a special measuring tool, after dilating the cavernosa - pushing into the glans from the incision and reading the size, then pushing into the crus from the incision and recording the size. Add up the two (and maybe a bit more for good measure) and that's the size of implant they use. You shouldn't ever wind up with your pre-op FLACCID size after you've healed and "cycled" the implant a bit. You should be close to your pre-op ERECT size.

I think you may be mistaking "cycling" (riding a bicycle) with "cycling" (inflating implant to max then deflating after a specified time).

The "CYCLING" that other men report as becoming uncomfortable after an hour is the latter, inflating the implant to max, waiting and then deflating. Admittedly, the pump may cause some challenges in bicycling but they can be mitigated with the right gear and apparel.

Biker21, the only rods that do not change in length are the malleable/semi-rigid. All the others do change in length at least a litle bit. The AMS LGX is designed to lengthen between its flaccid state and erect state. The AMS CX and Coloplast Titan are not designed to lengthen, but they do just a tiny bit as the cylinder walls can "crinkle" up a bit - like an accordion, but not so drastically.

Waynetho, I have never read of "a bit more for good measure" in any medical journal. Perhaps surgeons might say that, but it would be risky, I think. To the contrary, I have read at least one paper (Montagu, Angermeir, et al) that suggests subtracting a bit from the sum of the two measurements.

[Lost Sheep]

Biker21, you might want to reach out to Toby799 who just had implant surgery. In his most recent post (as of May 28, 2021) in viewtopic.php?f=6&t=17058 he relates that different surgeons have vastly differing opinions of ultimate size.

(edited for focus)

So... Sitting in the recovery room now. Quite sore, but everything seems to have gone fine. Everything is wrapped up so can't really see what it looks like but first impressions are that the length is very similar to what I had before. Everybody has been super supportive and kind here at the Ucl hospital in the UK.

Had a little scare before hand when one of the Surgeons came and did the stretch test on me and barely stretched beyond my flaccid length- like 4.5 inches or so 'this is realistic' she said and then when I challenged her showing just how much more my penis could in fact stretch she launched into a lot of non-sensical talk about how the penis might stretch less in surgery! Arrrrh! It was a proper freak out moment, all the research and expectations out the window and staring down the barrel of a 2 inch length loss. But I demanded to see Prof. Ralph and he stretched me out properly, 6-7 inches. Thank God it was him and not the other surgeon actually doing the op!

[Toby799]

Hi Biker, yes happy to answer any questions you may have. Just to say that all is looking good so far! What I can say at this point (and it is obviously early days, don't want to jinx it!) is that, yes, things can go well in the NHS (touch wood, so far with regard to length retention anyway), but it's so important you get the right team. The initial surgeon who came to see me did NOT inspire confidence! I can't speak highly enough of Prof Ralph! He is definitely a surgeon, don't expect a lot of warm fuzzy people skills, but he seems to know implant surgery inside out which is what counts!

[Waynetho]

Waynetho, I have never read of "a bit more for good measure" in any medical journal. Perhaps surgeons might say that, but it would be risky, I think. To the contrary, I have read at least one paper (Montagu, Angermeir, et al) that suggests subtracting a bit from the sum of the two measurements.

It depends on where in the corporotomy they are measuring. I believe one surgeon who mentioned this was Kramer and he mentioned it on one of his videos as I recall, or maybe it was Perito, I'm not exactly sure who is was now. The total real length is what they are shooting for. If you measure one end half a centimeter too short and the same on the other side, there's a centimeter less on your measurement so if the surgeon does this based on their practiced method, they would likely add that centimeter back.

Think about this, with a one centimeter incision, if measuring distal to the edge of the incision (not the center), then measuring the proximal to the other edge if the incision (not the center) - now you're a full centimeter below the accurate measurement. That's why I say the add a bit in some cases.

[newbie443]

There was a paper in the documents worth reading section that referenced size loss pre vs post op and it did include some information on more aggressive sizing vs less aggressive sizing. Don't know if it is still there and I do not have the time to check now but someone else might want to go over and check,

[newbie443]

OK I found it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708606/

Intra-operative strategies
When choosing the size of cylinders to be used, inadequate sizing or intentional downsizing by surgeons will have a direct impact on the final erect penile length. Before the arrival of IPP, synthetic intracavernosal semirigid rod penile prostheses were used extensively. Surgeons trained in the insertion of semirigid prostheses are often taught to downsize the rods to avoid distal erosions. This is not necessary with IPPs, where the risk of distal erosion is minimal.

In fact, a new length measurement technique for IPP has allowed larger cylinders to be inserted in primary implants with no increased risk of distal erosion after 24 months. The key points of this new technique are the addition of 1 cm length to the total measurement when the dilator does not drop down proximally into the lateral crux of the corpora onto a firm bone stopping point, and the addition of another 1 cm if the dilator does not go all the way out into the glans (12).

[newbie443]

Waynetho, I have never read of "a bit more for good measure" in any medical journal. Perhaps surgeons might say that, but it would be risky, I think. To the contrary, I have read at least one paper (Montagu, Angermeir, et al) that suggests subtracting a bit from the sum of the two measurements.

It depends on where in the corporotomy they are measuring. I believe one surgeon who mentioned this was Kramer and he mentioned it on one of his videos as I recall, or maybe it was Perito, I'm not exactly sure who is was now. The total real length is what they are shooting for. If you measure one end half a centimeter too short and the same on the other side, there's a centimeter less on your measurement so if the surgeon does this based on their practiced method, they would likely add that centimeter back.

Think about this, with a one centimeter incision, if measuring distal to the edge of the incision (not the center), then measuring the proximal to the other edge if the incision (not the center) - now you're a full centimeter below the accurate measurement. That's why I say the add a bit in some cases.

To add there are other factors that can also be added. Such as if the tissue is adequately relaxed by either epidural anesthesia or other drugs to give a more accurate measurement. Also patient history of recent size loss.

All this says one thing and that is to find a really good doctor that has an interest in IPP surgery and stays aware of current studies for the best outcome for the man. One that has all the patients history. Or more importantly to stay away for doctors who do not care at all about size loss or the best outcome for the patient.