Which implant to choose? AMS or Coloplast

[Jage64]

Good points Newbie.

I personally think it's important to at least consult with a doctor that offers both manufacturers, as there are pros and cons to each unit, and one that would minimize the cons and maximize the pros. Marketing schemes aside, a doc that is familiar and comfortable with both would be best suited to explain why he/she would prefer one over the other which would result in the patient's ultimate satisfaction. I think it's safe to stipulate that they are both excellent products, there isn't one that's deficient, they seem to address differing conditions.

The urologist I saw in my Kaiser insurance network stated that "we're an AMS shop", he didn't have the choice, so I didn't have the choice. I saw him first and at that point thought I wanted a TITAN (sounds really big), so I was a little disappointed. I continued to do research and was ultimately leaning towards an AMS when I consulted with Dr. Clavell. After looking at my penis, scrotum and discussing my sexual habits, he too was leaning AMS for me. I'm very happy with my CX (only 4 weeks out).

ThailandBound has posted that he had a similar conversation with Dr. Clavell, and they decided the Titan was a better fit for him.

I know that Dr. Clavell implanted a Titan on the same day he did my AMS. To me, that flexibility and attention to which product will provide the best outcome is as important as the talent of the surgeon. I would be hesitant to choose a surgeon that doesn't have all the options at his disposal. At the very least, I would want to consult with a surgeon that was familiar with both, and I may ultimately choose a surgeon that only implants the style I feel suits my needs best.

[Mark1974]

Is there anyone who had both and thinks the Coloplast feels better inside than the Boston Scientific? Because I've only read the opposite

[newbie443]

Good points Newbie.

I personally think it's important to at least consult with a doctor that offers both manufacturers, as there are pros and cons to each unit, and one that would minimize the cons and maximize the pros. Marketing schemes aside, a doc that is familiar and comfortable with both would be best suited to explain why he/she would prefer one over the other which would result in the patient's ultimate satisfaction. I think it's safe to stipulate that they are both excellent products, there isn't one that's deficient, they seem to address differing conditions.

The urologist I saw in my Kaiser insurance network stated that "we're an AMS shop", he didn't have the choice, so I didn't have the choice. I saw him first and at that point thought I wanted a TITAN (sounds really big), so I was a little disappointed. I continued to do research and was ultimately leaning towards an AMS when I consulted with Dr. Clavell. After looking at my penis, scrotum and discussing my sexual habits, he too was leaning AMS for me. I'm very happy with my CX (only 4 weeks out).

ThailandBound has posted that he had a similar conversation with Dr. Clavell, and they decided the Titan was a better fit for him.

I know that Dr. Clavell implanted a Titan on the same day he did my AMS. To me, that flexibility and attention to which product will provide the best outcome is as important as the talent of the surgeon. I would be hesitant to choose a surgeon that doesn't have all the options at his disposal. At the very least, I would want to consult with a surgeon that was familiar with both, and I may ultimately choose a surgeon that only implants the style I feel suits my needs best.

i am glad you were able to do that as many men do not have that opportunity. Not only did my local doctors and a patient I spoke to tell me I would be at least an inch shorter but the business office advised when I went in to check on payment (quoted 4 to 7 k with 3.5k max out of pocket insurance) that many men had the device removed later as the results were so poor by the doctors. I was able to wait and go to a high-volume doctor like you were, but a lot of men do not have that ability. And even doctors who do both brands seem to favor one or the other. Eid a Hakky both told me they would not use a 21cm LGX and wanted to replace mine when I was looking for a doctor to repair my proximal perforation. Eid advised a Titan or CX and Hakky of course just a Titan. Hakky was a Coloplast COE doctor and while he says he will use an AMS produce if the man really wants it I just get the feeling that his best work will be done with a Titan. Karpman is on the other side of this. He is listed on the AMS 700 Penile Implant Education video that was included in my device packet from AMS. All the problems I have had I can find no fault of my cylinder length. I did have a low erection angle at 4-430 before my proximal perforation repair. After the repair it is now at 3:00. Others on this site also have the 21 cm LGX and I cannot remember reading any problems with the cylinders. Clavell may also not want to use 21cm LGX and is why he used the CX instead as Eid said he would. I really wish the study I linked to also had the CX and a lot more sizes. I considered Clavell and read one post were a member posted he was sent to Wang by Clavell for his surgery, but I cannot remember the reason. I have noticed that Clavell as a longer wait for activation whereas other well-known doctors have tried to shorten the time due to the paper about the Coffin Effect that links longer wait times to size loss. And I have seen and read a bit that leads me to believe he uses preconnected Titan implants where the cylinders are preconnected to the pump and only the tubing to the reservoir is not connected and is used to fill the device. This means that in the case of a deep Crus RTE's may need to be used to prevent a high pump and in the case of a shallow Crus there may be extra tubing in the scrotum going to the pump. I don't know for sure, but it is a guess on my part from his videos and posts made on this site. As the Titan has had tubing problems, I can understand the reason behind that.

I am not sure who I would go to if I needed another surgery. The problems I had going to a well-known high-volume doctor have me strongly questioning other well-known doctors. Are they really that much better or is it just self-promotion. I would have to travel as none of the local doctors do replacements. I am sure there are some great doctors out there that are not as well-known.

Not only do I find it strange at the difference in the way the top doctors do this surgery but it baffle's me to how my local doctors can have such poor results. And the great differences in treatment. Insurance is a state-controlled product. And it seems Insurance companies are a lot more powerful or there is more corruption in some states than others. I just do not understand how medical care for this can very so much. There should be minimum standards that are much higher than seems to be taking place. Even now the way things are with vast differences from state to state and doctor to doctor, reports show a high approval rating even for low volume doctors. No doctor is perfect, and the best doctors have problems and infections. It all has me thinking it is just a matter of luck. No matter what we do or how much time we spend on this it is still a crap shoot.

[Gt1956]

Newbie443, you raise lots of points in your post. Let me tell you what I ran into. When working on my apnea about 15 years ago. My pulmonologist was finding it hard to treat. He referred me to the medical college for a second opinion. I now think it was a way to get rid of me. Despite numerous visits with the lead teaching doctor & 1 of his leading clinic md students. No real diagnosis or effective treatment was made. I was left using a cpap on a mid range setting. My pcp was never a fan of my pulmonologist so he kept watch for a new one. Finally one showed up. I went through all the sleep study stuff again. The new doc prescribed me a bipap. Said all the data was in my first sleep study but the 1st doc just gave me instructions for a basic treatment.
My take on all this is that yes the doctor is important. But where he does his advanced training is probably more important. Basically I decided that my local medical school had a poor pulmonology program.
My guess is that your local urologists might of all graduated from the same teaching program. Thus they only can do what they were trained to do.
I've mentioned several times that when looking for an implant surgeon. Add points for one that gets ongoing training or attends seminars.

[Stupid]

AMS does the job just fine. Some doctors only use one model.

[newbie443]

Newbie443, you raise lots of points in your post. Let me tell you what I ran into. When working on my apnea about 15 years ago. My pulmonologist was finding it hard to treat. He referred me to the medical college for a second opinion. I now think it was a way to get rid of me. Despite numerous visits with the lead teaching doctor & 1 of his leading clinic md students. No real diagnosis or effective treatment was made. I was left using a cpap on a mid range setting. My pcp was never a fan of my pulmonologist so he kept watch for a new one. Finally one showed up. I went through all the sleep study stuff again. The new doc prescribed me a bipap. Said all the data was in my first sleep study but the 1st doc just gave me instructions for a basic treatment.
My take on all this is that yes the doctor is important. But where he does his advanced training is probably more important. Basically I decided that my local medical school had a poor pulmonology program.
My guess is that your local urologists might of all graduated from the same teaching program. Thus they only can do what they were trained to do.
I've mentioned several times that when looking for an implant surgeon. Add points for one that gets ongoing training or attends seminars.

I have been thinking about this and trying to work through a reply so sorry for the delay. I really do think that my assessment of insurance company power in my state is mostly to blame along with the groups policy not to have specialist doctors and for each one of the doctors to do all procedures for the patients they see. That means those doctors have a lot of training to keep current on all the new different things. I think insurance companies hate to pay for these devises and it is alluded to with the setting policy prices to the point where many companies will have exclusions for the procedure. In my home state with market place plans having the coverage the companies use other tactics such as not covering some of the cost for the procedure and low and slow reimbursement rates. They may even give rewards for keeping the number of devices implanted below a certain point. Just a matter of keeping the rent and light bill paid and with low numbers of this surgery then it is low on the list when the doctors are receiving advanced training. 12 doctors in this uro group with training from all over the country.
https://www.wichitaurology.com/our-team/ These doctors have to be skilled to do the surgeries they do. And you would think that out of 12 doctors there would be a few who really want to be able to provide quality implant surgery and care. And had the skill to do the more difficult replacement surgery. I went from self pay health insurance a year ago to Medicare. With self pay it was basically a drug plan. Whatever the problem I was given a script for pills and sent home. Now with Medicare every doctor I ever went to wants me to have some tests. I have tried to find other reasons but it seems to all keep pointing back to insurance companies.

I shattered my heel back in the mid 80s and require special shoes. Made by the same people who fit prosthetic limbs. Doctors in this area of medicine are very poor and few where I live. This would to me be more like what you explain with your sleep issue. A very specific and maybe low staffed field due to the best doctors doing other things that pay better. These guys were so bad that everyone in town knew it. And other Heathcare folks I talked to said so. There was a decent doctor that set up his own shoe store and did customer payment only. No filing of insurance by them. This was back when I had group insurance and coverage for this. I could spend $450-$500 to him for good shoes that I could walk in with very little pain or go with the other guys and spend $250-$300 for crappy shoes that hurt a lot more and deal with the insurance BS. In less time than it took to get an appointment with the insurance covered place I could go to the decent doctor and be wearing new shoes.

One last thing to point out is t hat I did read my policy when I bought my own insurance and noticed 2 things. It was very lacking for any prosthetic care and had no coverage for shoes. No big deal until the decent guy I went to retired. Another thing is did not cover was sleep studies. Seems like the one thing all three have in common is insurance seems to dislikes paying for the services. Just saying.

[misterecz]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654325/
I refer to table 1. Results seem self explanatory. Btw, it does show that the Titan grows in length when most peple claim that it does not grow.
Btw, Carrion & Hakky were involved in the study.

Ah, thanks for the link GT. I had seen this study but overlooked that table. Mainly because as a young man who likes rough sex i care more about being able to place maximal forces on the cylinders.

But indeed, looks like i was wrong and the AMS LGX does indeed expand in length beyond its specified size. So a 21cm LGX can grow to 24cm.

I'll def need to make a video about this. Still the Titan XL seems to give the best girth, so you're probably better off doing traction to expand the tissue in length and getting a Titan XL cylinders.

[Gt1956]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5654325/
I refer to table 1. Results seem self explanatory. Btw, it does show that the Titan grows in length when most peple claim that it does not grow.
Btw, Carrion & Hakky were involved in the study.

Ah, thanks for the link GT. I had seen this study but overlooked that table. Mainly because as a young man who likes rough sex i care more about being able to place maximal forces on the cylinders.
But indeed, looks like i was wrong and the AMS LGX does indeed expand in length beyond its specified size. So a 21cm LGX can grow to 24cm.
I'll def need to make a video about this. Still the Titan XL seems to give the best girth, so you're probably better off doing traction to expand the tissue in length and getting a Titan XL cylinders.

Carefull about which has the greatest girth. To some extent, your tunica will limit the girth potential to whatever it naturally will allow.
I don't know how to word it correctly. But a guy with a natural 4.5" girth is unlikely to get 6" of girth with either brand/model of implant. Don't forget that the LGX can grow 25% in girth also. When I did the math on that. There was very little girth advantage to the Titan.
Much like the LGX expanding in length. If a guy never gets to the 20psi then I highly doubt that he'll realize all of the length/girth potential. In other words. I think many of the claims thrown around here on FT are not hard rules but more like generalizations.
Another point for guys to think about. If your surgeon only uses Titans then that is what you'll get even if it isn't the best fit for your body. An AMS doctor has 2 models to chose from. A doctor that uses both brands has 3 to chose from.

[misterecz]

Well, just like the LGX can expand the tissue in length one can assume you can expand the tissue in girth. Specially when coupled with VED therapy and aggressive cycling.

According to that table, the Titan could maximally go to 2.2cm in diameter. Which is wider than the LGX at maximal pressure. Top surgeons, Eid, Kramer, Clavell, Hakky can use both.

[Gt1956]

Bad habit. I didn't read the study that newbie443 has graciously posted for us. So I just read the first few paragraphs. I'm surprised that no one has picked this out. Considering how much infrapubic ipp surgery is being talked so highly. This might change a few members opinions.

"Results from a prospective study indicate that surgeons placing IPPs via a transcrotal approach resulted in an approximately 1–2 cm increased length of prosthesis inserted compared to IPP placement with infrapubic approach."

I find this highly interesting. Go infrapubic, go short.