Tunica Expansion Procedure / Revision / doctor & Questions

[peyroniesjr]

Good Morning,

I got a few questions for the group. I am in need of a revision. I sometimes wondered if my penis stretched to the point that I outgrew my implant or if there was not enough fluid in the reservoir. after about 6 months I didn't feel the stretching & i could cycle it & leave inflated for 1 1/2 hrs. I felt like there was more skin to stretch.

I had a tele-med consult with a doctor that does implants & is noted for TEP. He charges an additional for the TEP not covered by insurance. I'm just wondering when you have a revision done will a TEP really help 2nd time around. I've gain an inch easily from prior to having my implant the first time. I am using a VED at the present time not to lose length & girth. For the guys that have gone through the TEP was it worth the extra pain & money? Do you feel that you got more length & girth? Keep in mind that I had PD & a RALP.

Secondly, I asked the doctor if the reservoir has to come out & he said it depends if it isn't leaking then they leave it. My implant is a little over three years old, for those of you that went through a revision, did they remove everything?

Lastly for those of you who had the revision, did you go back to your original doctor?

Thanks - would like your input!

Junior

[jwitten567]

I did a lot of research on this - I don't think its going to give you much more length/girth. I think it was about 1-2 cm of length gain that you may achieve with expansion type procedure, but then there are some possible side effects (temporary sometimes permanent numbness). If your erection with the previously implant is fairly straight then it didn't make a lot of sense for me. But if you have pretty significant curve - you need a plaque incision at the time of implant.

[2435tjklAS]

I did a lot of research on this - I don't think its going to give you much more length/girth. I think it was about 1-2 cm of length gain that you may achieve with expansion type procedure, but then there are some possible side effects (temporary sometimes permanent numbness). If your erection with the previously implant is fairly straight then it didn't make a lot of sense for me. But if you have pretty significant curve - you need a plaque incision at the time of implant.

I have done a small amount of research on TEPs but what I have found sounds like reasonable gains - mean length of about 2.8cm and girth of 1.6 cm:

A total of 32 patients with Peyronie's disease from the larger cohort underwent the modified TEP. Mean increase in length of distal corpora was 2.8 ± 0.8 cm (range 2.0-3.4 cm) (measured using Furlow before and after penile eversion with TEP), while mean increase in girth (measured at midphallus prior to prosthesis insertion and after IPP inflation) was 1.6 ± 0.4 cm (range 1.2-2.2 cm). There were no reported complications. A scrotal approach to TEP is an easy to perform technique that can be used to restore length and enhance girth in men with Peyronie's disease undergoing insertion of IPP. Additionally, it is a customizable approach that can also be used to correct mild penile angulation.

S, R., A, Z., & R, V. (2022). Scrotal approach for tunica expansion procedure (TEP) for penile girth and length restoration during penile prosthesis implantation in patients with penile angulation due to Peyronie’s disease and erectile dysfunction: Technique and outcomes. International Journal of Impotence Research. https://doi.org/10.1038/s41443-022-00652-7

I'm curious peyroniesjr, about what are your length and girth gains from the TEP? You said you've gained at least an inch - of length? What about girth? I don't entirely understand this post because I thought that after the TEP is done then it's done - it lasts for life and it's unrelated to whether your implant needs a revision or breaks. But I don't know these things, so I'm curious how it's been for you.

[peyroniesjr]

HI 2435tjklAS,

I haven't done the TEP. The inch that I recovered after the implant, I had lost it from PD & the Ralp. But I probably lost another 1/4 - 1/2 inch. Not sure what I lost in girth, maybe 1/4 - 1/2 inch.

Not a big guy here, just trying to not lose any more.

Thanks for your input!

Junior

[peyroniesjr]

Hi jwitten567 ,

I'm pretty straight now, but when I use the VED or when I'm flaccid, I lean to the left, almost as twisted & not head on.

May I ask why you didn't go to Dr Valenzuela for your revision? When you had your revision did they replace the reservoir?

Thanks for your reply!

Junior

[JohnHC]

I had a revision roughly 2 months after being implanted. They removed everything because it was defective and they didn't know where the defect was. Found out it was a pinhole in the left cylinder and my Dr thinks it was either a manufacturer defect or that something happened during it's prep outside the OR, he told me they prep it in the back room and bring it in once they're ready to place it. Hope that helps

[aussiePeyronies]

I had the TEP procedure, 5 months poster surgery and 3 weeks post revision (for pump replacement and removing some fluid from reservoir). My surgeon advised I should receive an extra 1cm of length. If you have had a lot of girth loss, they are able to make cuts in the tunica to restore girth.

Keep in mind there are risks involved. The TEP procedure is longer (more risk of infection), it also requires immobilisation of the neurovascular bundle which can pose a risk of nerve damage.

usually TEP requires a circuncusion. Check my journal, theres a lot of my journey in there.

I can’t yet tell you if it’s worth it as I am still cycling and restoring size.

J

[jwitten567]

Hi jwitten567 ,

I'm pretty straight now, but when I use the VED or when I'm flaccid, I lean to the left, almost as twisted & not head on.

May I ask why you didn't go to Dr Valenzuela for your revision? When you had your revision did they replace the reservoir?

Thanks for your reply!

Junior

I had a good relationship with Dr. Valenzuela and the reason that I sought him out when I was living in New York. When COVID hit I decided to relocate to Orange County. I would have had no problem flying back to get revision with Dr. Valenzuela but he kind of blew off my concerns initially and his front office is absolutely terrible, coordinating the logistics was going to be a nightmare. I decided to find a "local Urologist" here in California. Understanding the risks of having a revision I met with several doctors (Dr. Mills, Yafi, Doyle, Goldstein) but no one really seemed as invested and personable as Dr. Patel who is fairly new at UC San Diego. He spent a lot of time with me, answered all my questions, and brought up some good points about different implants and approaches that I never thought of before and no other surgeon had pointed out. Ultimately was very pleased with the outcome all things being said.

[peyroniesjr]

Guys thanks for your replies, hopefully I'll make the right decision. I'm really not looking forward to the revision. I'm not sure my original doctor stiLL my insurance. About the TEP, trying to find if it would be a good choice or not for me.

thanks,

Junior

[rdnkbiker]

my revision was July 10th my doc wanted everything out all new in they tried to get the old revivor out but the first doc put it so deep they were afraid to take it out he said he doesn't even understand how he got it there so they tied it off left it .........but told me i need to explain that if a MRI or something they will thinks it's a tumor or something.....so both my wife and son know just in case I'm unconscious lol they dont hurry and do a surgery... something to remember
Jim