New Implant - surgery and recovery

[round3]

I had my implant surgery yesterday, Jul 22, 2021. AMS 700 CX w/ 21cm + 2cm RTE and 100ml 'conceal' (flat) reservoir.

60 y/o, fit, healthy gay male. I had increasing ED over the past 10 years. Viagra stopped working reliably, then tried Cialis and had hit-or-miss results. Finally Peyronies appeared this past February. At first I noticed about a 25 degree deformation. When it increased to 30 degrees I contacted my doc and got a urology referral.

The urologist had a very detailed hour-long video he made about Peyronies and various treatment options (and another 1hr video about ED). I was impressed with his videos, they are very clear and thorough, but concise. The implant option is a good one for the Peyronies/ED combo, especially if the Peyronies is still in the acute phase (still actively developing). When my deformation reached 45 degrees I decided to go for the implant, and he concurred.

He did the 'stretch test' at our office visit. It stretched to 6" or 6.5" max. I asked about this, because when fully erect it's closer to 7" (the Peyronies has taken some length away - it used to be 7.5" to 8"). He answered that the implant cylinders would fill the available space in my tissue. But I'm not overly concerned about length, since 6" is more than adequate, and he assured me it would be as long as the stretch test, and it beats a 7" dick that doesn't stay hard.

He also said that his minimum expectation would be to correct the Peyronies to under 30 degrees. We would hope to get more correction than that, but better to under-promise and over-deliver, and 30 degrees would be the threshold of satisfactory. I asked which brand and model he would use, and he said that for correcting Peyronies/ED combo he would use the AMS 700 CX. My research and perusal of this site led me to conclude that was a reasonable choice.

Also based on my reading in this site, I got a vacuum pump. I didn't do the rigorous pumping schedule I've seen recommended here. I probably pumped twice a week for a month and a half. But it gave me a sense of what might be possible if I cared a lot about length. And I'd never used one before, so I got to rule it out as an effective ED treatment for me - I could get a bigger harder erection, but it wouldn't last.

My surgeon stressed the importance of avoiding infection. I started antibiotics the day before surgery, did a body disinfection with a kit of heavy wipes the night before, slept in clean bedding. My arrival time was 6 am, and it was great to get there so early, with empty streets and quick admittance. I was totally knocked out during the gurney transport to the O.R., and didn't wake up until some time in the post-op area. I had a big jockstrap on with a huge puffed out pouch and a catheter tube coming out the top. The doc left me 50-60% inflated and will deflate in a week. I was pretty groggy and uncomfortable, and crushed ice never tasted so good. (I was intubated during the surgery.)

My partner took me home and set me up in bed with frozen peas for cold compress. (Doc said these are better than ice packs - more gentle & malleable, less likely to burn the skin.) The first 24 hours were uncomfortable - the catheter is a weird sensation, I felt like I was peeing a lot - and I was! I had to get up once an hour to drain the bag until halfway through the night, then every two hours. I had an Rx for pain meds - Hydromorphone (Dilaudid) 2 mg every 6 hours. By the end of 6 hours after taking the narcotic pill I definitely could feel the pain increasing, so I took them at 5.5 hour intervals. I did get sleep between the hourly bathroom visits, and I also slept with an ice pack wrapped in a towel and changed that several times in the night. I normally sleep on my side, but that was too difficult and cumbersome, so I slept on my back (almost sitting up) propped up on a tower of pillows, to give my groin more space. I think I may have to sleep that way for awhile.

This morning I had an appointment to remove the catheter. I hadn't had a bowel movement since day before yesterday, and really wished I could, thinking it would relieve some of the general pressure in the area. The narcotics cause constipation. I had taken Docusate Sodium pills, ate some prunes, used a glycerine suppository, and finally a bit of warm water in an enema bulb. That released a small amount, but not what I expected. I was also concerned that the catheter removal would be super painful because it would involve the whole surgical area. But the removal, while far from pleasant, seemed like only what I would expect w/o the surgery - a sharp, tingling burning sensation as it is dragged out the urethra, then it's over.

I went home and was supposed to drink a lot of water and hopefully pee, then go back again for a 'void' test this afternoon. I drank 30 oz of water, had some coffee, and for a while was getting concerned that I wasn't peeing. That catheter bag had filled so quickly and so often last night! If I weren't able to pee I would have to get another catheter. But then I realized I had so much fluid through the IV's at the hospital yesterday, that's why I passed so much. And I stopped drinking water last night. Sure enough, after a couple hours this morning I had to pee rather urgently. My dick is wrapped in thick layers of guaze and I couldn't get it all pulled away fast enough, so I drenched the top. I cut the wet part away and put some fresh guaze over the tip. My doc recommended peeing in the shower or a hand held urinal or bucket. I used the bathtub/shower and it works well. I bend over as far as I can - I would definitely not want to try aiming for the toilet with my dick pointing up partially inflated.

Went to the void test (which is an ultrasound to make sure the bladder is emptying) and passed. (I'd never imagine myself getting an ultrasound - I had to hold myself back from saying to the nurse "Is that my little reservoir baby?") Since I got back home I feel so much better. I'll probably try to switch to just Tylenol either by tonight or tomorrow. Doc said no Ibuprofen, aspirin, or NSAIDs for a week after surgery, as they thin the blood.

My discomfort level is noticeably improved. My scrotum is tight, tender and bruised. I can feel the pump as a small lump at the base. My right lower abdomen is tender and a little swollen, with a slight red color. I sent the doc a photo of that and assumed it's the reservoir location. He answered yes, and that my red bruising is very mild, he often sees more bruising. My dick is still a bit of a mystery, since I've left it wrapped in the guaze. I've only seen the head and the base at the pubes, and both look fairly close to normal. (My surgery was PenoScrotal, so the incision is on the bottom side, covered by gauze wrapping.)

Tomorrow, at 48 hours post-surgery, I get to take a shower, remove the guaze, remove a plastic film that's over my dick and incision. Then there's glue over the incision, and that remains. Instructions are to keep everything clean and dry, do mild activity but not lift anything heavier than a gallon of milk for the next 6 weeks. I go back for a follow up appointment with the surgeon in a week, where he will deflate me and give further instructions.

I read the materials from AMS that the manufacturer rep sent home with me. (It includes a little plastic mock-up of the pump device with an instruction card on a ring - I guess you could use it as a key ring… surgery bling!) I was pleased to discover that my implant was 21cm + 2cm RTE. I’m not really sure what that means for my final erection results, but I wouldn’t have been surprised if it had been 18cm or even 15cm (those are the next 2 sizes down). There’s a chart on their website with all the models and options. Using my device serial numbers, which are affixed to a card in the AMS packet, I was able to confirm the exact devices I have: 21cm x 12 mm CX Cylinders pre-connected to the MS Pump, with IZ (antimicrobial coating), 2cm RTE, and 100ml “Conceal” reservoir.

My doc called my partner yesterday after the surgery, and he said something about the relationship of the cylinders to the glans that he was very happy with. But not having the insider’s knowledge I’ve gained here, he didn’t really understand it. The doc said “If it was me, it’s the way I’d want it.” So I’m looking forward to finding out what he was talking about.

I still haven’t taken a big crap, but after getting the catheter out and passing the void test, I’m much less concerned about that. I’ll go eat some more prunes now... Didn’t mean for this post to go on so long, but I figured it was worth capturing my experience of the surgery and immediate aftermath.

[AN02020]

Any pics?

[Lost Sheep]

Welcome to the forum, round3. Thanks for sharing.

I advise that you not strain for a bowel movement. You don't want to tear any stitches. Just sit and wait and let your peristaltic muscles relax and do what they do. It worked for me.

[Leebert]

I appreciated your post very much! Very informative and answers a lot of my questions as im booked for a implant in several weeks. Thx

[round3]

I’ll try to post some pix tomorrow. Off to bed now, feeling very relieved - on a recommendation I had my friend pick up Dulcolax suppositories. I’m amazed at how fast it worked and how effectively. Within 30 minutes I was cleared out, and although I could feel rumbling shortly after inserting it, when it was time to go it was easy enough, not a violent explosion. It’s uncomfortable enough down there post surgery without adding the bloated feeling of constipation to it.

[round3]

I was able to sleep on my side last night, I'm happy to report. I just put two firmer pillows between my knees to give plenty of space to the groin, and I got a good night's sleep.

I also stopped the narcotic last night (hydromorphone, brand name Dilaudid) and switched to Extra Strength Tylenol. I think the Tylenol works as well, and maybe better. And it's not supposed to have the constipating effect. I took 2 at 9pm, set an alarm for 3am and took 2 more. When I got up this morning I read the directions a little more carefully, and although it says you can take 2 every 6 hours, it also says not to exceed 6 total in 24 hours. So I'll just be taking one pill, maybe every 4 hours.

I'm not in a lot of pain, mostly just discomfort. The first day it was more tenderness in my scrotum and abdomen, but now it's more in my dick. I'm mostly stretched out on the couch with my head propped up, but getting up and moving around a bit. Sitting up in a chair or at the table is too uncomfortable. Standing is fine. Shortly, I get to finally take a shower and remove the guaze, and get a first look at my dick.

Here are a few pix. Some won't attach, I'll try in another post...
-my former glory from 5 years ago
-initial development of Peyronies this past February

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[round3]

More pix:
-April, flaccid
-recent increase of Peyronies early July
-post surgery jockstrap filled with guaze

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[round3]

And finally:
-mild bruise over area of reservoir
-after catheter removal, taking it out to pee

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[round3]

I took my 48 hour post surgery shower, and got my first look at my dick. Everything is fine now, but the process was temporarily disconcerting. My instructions were:

"Your incision is covered by gauze and a clear plastic dressing. Please leave this dressing in place for 48 hours. After 48 hours, remove the clear plastic dressing and gauze in the shower. When the dressing is removed, you will see surgical glue on your incision. Do NOT peel off this glue."

I had seen the 'clear plastic dressing' when I peeled back the heavy guaze bundle to pee. It was wrapped up onto the lower part of the glans. I assumed that the 'guaze' referred to in the instructions was the big bundle of gauze wrapped around my dick. I didn't really know what the 'surgical glue' on the incision would be, but I guess I imagined it would look like a clear tape layer. I assumed that they used this instead of stitches.

The big guaze bundle simply lifted off my dick, revealing the clear plastic dressing wrapped from scrotum to glans. It's kind of like cling wrap, but much stronger (and pretty tender to peel off). There were two white strips beneath the plastic, a small square below the glans, and a longer rectangle from scrotum up the shaft. I thought those must be glue strips, because they looked kind of shiny silver under the plastic. But when I peeled the plastic away, it was clear they were guaze, and I didn't know whether to peel it away or not. It looked like there might be another layer of something clear under them. Since I was in the shower and not able to look at the instructions, I was pretty upset that they hadn't been more clearly written.

The whole time I am having to hold my dick up with one hand, as the implant is partially inflated, and letting it hang on its own is too tender yet. So with difficulty I dried off, with the now-wet little guaze patches making no sense, and went back to read the instructions. I was very relieved to figure out that, of course, the 'guaze' referred to in the instructions was the little patches, not the big wad wrapped around the outside. So I got back in the shower and gently peeled them off, revealing the stitches underneath. The 'glue' is not obvious.

I'm annoyed that they don't do a better job of writing these critical instructions. A good test for clarity is not: "Can it be understood?" but: "Can it be misunderstood?" They should give clear instructions, step by step, mentioning the big guaze bundle, the clear plastic dressing underneath, the small guaze dressings under the plastic, then the stitches with glue on them. They didn't even mention stitches!

Once dried off again, I found a good pair of old running shorts that are a little stretched out. Happy to get out of that giant, scratchy jockstrap. But I do need something to hold my dick up vertically. Actually, pointed out at 45 degrees would be ideal for comfort, but that's not really feasible.

If I were to compare my pre-op erect dick with this partially inflated post-surgery guy, I'd say it looks pretty small. I measured it (gingerly) at around 5.5" long from the pubes. But I'm not worried about that. There's a lot of healing yet to go. I definitely look forward to getting deflated next week.

Here are a few pix of the results:
-the guaze patches that were under the clear plastic dressing
-the result post shower. There are a couple little bits of plastic that stuck to the stitches/glue, and I'm not going to pull on those. I used small scissors to very carefully cut the plastic.

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[round3]

Monday, 4 days post surgery now.

I’m very fortunate to have my partner here taking care of me. He’s made everything so much easier than it would have been otherwise. He was with me pretty constantly for the couple days around the surgery, and has been able to leave me resting on the couch and go out and do things the past few days.

Saturday night I got another really good night of sleep, on my side. I had to get up 2 or 3 times in the night to pee. During the day I use the bathtub to pee, and kind of do a “plank” pose, with my hands on the corners of the tub at the drain end, so that I can lean as far down as possible to pee easily, since my dick is up at about 2 o’clock position. But the tub is at the front of the house, so at night I use the sink in my back bathroom, just kind of splayed out over the counter, with one foot on the floor. My partner was going to pick up a handheld urinal, but the store only had female ones or plastic bags for men that turn the liquid to gel and get thrown out. I think the tub and sink work fine for now.

He also picked up pineapple, which I read somewhere in here is good for reducing bruising. Sounds like it’s recommended to eat in quantity for some time before surgery, but I’ll give it a try anyway.

I also searched for posts on underwear, as my trunk/briefs mostly have waistbands that are just too low for the soldier standing at attention down there. I had one decent pair of boxer briefs with a higher waist, which I pulled up to wedgie heights to clear the soldier's helmet. Quite the fashion trailblazer. Someone in this forum recommended a brand called SAXX, so my partner picked up a couple pairs. I definitely recommend them! The have a separated pouch they call the “BallPark” with fabric panels inside the pouch that separate your balls from your legs. With all the tenderness combined with the irritation from the surgical shaving, that is exactly what I wanted. What’s even better is that the inner fabric panels run vertically all the way up to the waistband, like a little hammock for the soldier. Not that he's particularly relaxed.

I've had a number of email exchanges with my surgeon since the surgery, and he has responded promptly to each one. I’ll copy them here, my questions and his answers, as it will be easier that trying to explain it all. My first question was in response to the post surgery directions, which mentioned using cold compresses for 20 minutes 4-5 times a day:

Q: I have been keeping frozen peas and ice packs on the surgery area pretty continuously. Is that okay? Also, after I remove the gauze and plastic tomorrow, is there anything I need to do to keep the penis pointing straight up? The AMS pamphlet I took home said something about taping it to the abdomen.
A: Plenty of bags of frozen peas is a great idea. 20 min on, then 20 min off, etc. Careful with ice packs because they can cause a freezer burn to the skin.
You can use a jock strap/underwear with an elastic waist band that will help hold the penis pointed upward. I would be cautious about taping the skin because you have a penile skin incision which I want to keep clean and dry and free of tape once you remove your dressings.
Q: Great, thanks, that makes sense. I'm just back home from the catheter removal. In the process of pulling down the jockstrap I saw a red area that's a little swollen. I'm assuming this is where the reservoir is located, as it's also tender. I'm attaching a couple pix for you to see. I guess it's probably fine, but just thought I'd share it with you to be sure. Also, now that the catheter is out, should I just open the top of the gauze to pee, then wrap it back up (until tomorrow when I shower and remove it)?
A: Yes that red area is the reservoir location. It's actually looking pretty good (sometimes there is much more bruising than that present).
Not sure what you mean about removing the gauze. It shouldn't be covering the penis opening. You may find it easier to pee standing up into the shower or into a hand-held urinal.
Q: Oh good, I'm glad to hear that about the mild bruising. What I meant about the guaze is that it's wrapped around in multiple layers, and it closes over the top of the penis. So I will just open the top to pee. And thanks for the shower suggestion - using the toilet does seem tricky.
A: Gotcha, yes just move the gauze/jock strap out of the way when you need to urinate.
Q: I go back in a few hours for the void test & ultrasound. I am drinking water now, but have not yet peed since cath removal. Would it be a good idea to take a Flo-Max now? I took a single one (as usual) last night before bed.
A: Just keep taking flomax as usual before bedtime.
Q: In your phone call with my partner after the surgery, you said something about the cylinders position relative to the glans that you were very happy with, but he wasn't really clear about it. I imagine you'll go over this with me next week in our follow up appointment, and I don't mean to pester you. But in case there is more info available I'm interested and looking forward to getting it.
A: On the undersurface of the shaft, there was some excess loose skin. I refashioned some of this skin in a way that helped center the glans (head) of your penis over the cylinders inside the erectile chambers. I can explain this when we meet in person.
Q: I took my 48-hour post-surgery shower yesterday. In the process I think the glue over the upper incision (the one closest to the glans) was mostly removed, coming off with the guaze patch. Since the instructions were very clear to NOT remove that glue, I'm a little concerned. I'll attach a photo. I'm hoping the removal of the glue doesn't increase the risk of infection, and if so is there something we can do about it?
A: Everything looks good, just as it should at this point after surgery.

There are two things I had referred to in my earlier posts, that are referenced in these exchanges with my surgeon. The first was my question about what he had told my partner that he was happy with, in the post-op phone call. His response sounds good, and I look forward to getting any more details from him when we meet this Thursday. Another question I'll have for him then is about the curvature. My dick has always had a slight curve to the right, and in this semi-inflated, quite-rigid, erect state it's definitely curving right. I'm just curious how the 21 cm cylinders fit in my tissue and if they will have an effect on curvature. The Peyronies deformation is next to nil, I can't tell if it's there. There's an slight upward curve (which I never had before) starting lower down the shaft near the base, which I assume is caused by the cylinders. In any case, I'm not worried about it, I know there's a lot of healing & working out for all this tissue to do. I'm just curious.

The other question was about my difficult experience with the 48-hour post-surgery shower (which I wrote about above). The day after the shower (yesterday), for the first time, I could clearly see the "surgical glue" that was referenced in the instructions. It's a very thin clear layer, extending out around the lower incision (the main penoscrotal incision) about 1 cm. I really couldn't see it the day before in the shower, which is another place where their instructions were not helpful, as they specifically said "you will see surgical glue on your incision." Now I can see the outline of it, and some places at the edges where it's coming up slightly. (I will post a photo of this in a following post.)

When I saw that yesterday, I realized that the upper, smaller incision must be where the "excess, loose skin" that he "refashioned" was located. And I realized that I had in fact seen a thin clear layer of glue in that area, underneath the small gauze patch, which had been pulled up with the gauze. I was relieved to get his message that it looks okay, even though the glue was removed.

I composed a message about my difficult experience with the post-op shower instructions, edited it several times to reduce apparent indignation, and after I meet with him on Thursday I'll (probably) share it with him. I'll also see who else I could send it to, since I'm pretty sure it's part of standard-issue, boiler-plate post-op documents the hospital uses. I also wrote up a suggestion of how the instructions could have been worded, that would have made them clear for me. Here it is:

“Under the gauze wrapping covering your surgery site is a clear plastic dressing. Under this clear plastic dressing are two gauze patches covering your incisions. Your incisions have stitches and are covered in a surgical glue. Please leave the clear plastic dressing in place for 48 hours. After 48 hours, take a warm shower and remove the clear plastic dressing and the gauze patches covering the incisions. Remove the gauze patches as gently as possible, to avoid lifting the surgical glue on your incisions. The surgical glue covers the stitches and has a thin layer extending about 1 cm around the incision site. It may be difficult to see the glue. Do NOT peel off this surgical glue.”

If I had gotten these instructions I would have had a much clearer idea of what to expect. I would not have had to stop my shower and dry off awkwardly to go re-read them. And I bet I could have removed that upper guaze patch without lifting the surgical glue underneath.

Now I'm just enjoying my life on the couch, frozen pea bags every so often, 1 Tylenol every 5 or 6 hours, plank pose bathtub peeing, and being fed and cared for by the best man ever.