Infrapubic vs Penoscrotal

[ceekay87]

As I am into about the first 50 pages of entries in this forum, it has brought me to this question. I am leaning toward using Dr Clavell for my implant because of the nerve block that he uses and also because so many have raved about the success post immediate surgery. I also like the fact that he will maximize size by filling the penis with saline to make it hard this fitting to the max Dr. Clavell uses the penascrotal approach which requires keeping the dick raised for several weeks.

However, I am reading that Dr. Perito of Miami who happens to be another high volume surgeon uses the infrabubic approach which tends to heal easier (so you guys are saying). Talk to me about which approach and why as I approach a likely implant in 2024. Does Dr. Perito use a nerve block and maximize size like Dr. Clavell?

Im in Georgia.....so a trip to Miami would be closer than a trip to Houston. I consult with Dr. Clavell January 12. Haven't set anything with Perito....at least not yet. Wanna hear from the FT brothers first.

[Bent Ben]

I hade IP because that would give the best outcome for my PD which was issue #1. If I was just an ED patient I would have requested PS because the swelling is less and it hides the scar better.
I was able to activate at around 10 days and had sex at 4 weeks.

If you are in GA you may want to give Dr Hakky a look. He is closer than Clavell and Perrito to you and is a good surgeon.

[Txagq8]

My advice: find a surgeon in whom you have confidence and trust him to use the technique which will give you the best outcome.

Lots of guys on here tend to say PS will get your size back whereas IP won’t etc etc. Four years of being bionic without any issues and being equipped with essentially the same tool I’ve always had says otherwise.

My doc was aware that my biggest challenge would be hanging the reservoir. Between age 4 and age 63 I had 6 hernia surgeries. (One just 2 weeks before my implant). Placing a reservoir via infrapubic and dealing with mesh made IP the method of choice.

When looking for the right surgeon, the things you want to hear are things like:

He will use the technique best suited for your anatomy and medical history

He will install the brand and type of implant that will work best with your anatomy, and will do everything he can so that you end up with the same equipment you had pre-implant

He is accessible during recovery! A lot of travelers miss out on this. And even though I live out in the sticks Austin was just an hour drive. The first 3 weeks I probably made 9 office visits as I learned to operate this thing and heal my way back to normal. I was cleared to cycle on day 3 and sex on day 10.

PS is a tougher reservoir placement. IP is a tougher pump placement. If you end up with IP don’t be surprised or alarmed about having to pull down on the pump for several months. They do settle in at a good spot it just takes some tugging and patience.

I’m sure I’ve overlooked some shit, but the real bottom line is great results can be achieved using either method. When I’m on an airliner I don’t tell the pilot how to fly the aircraft. When having surgery I want to know what’s being done, but I’m typically expecting the doc to use good judgment and his expertise.

[jwdetails]

agree - the technique is only as good as your surgeon and their ability to offer the technique that would make the most sense for your particular situation. There are pros and cons to each approach.

[Jage64]

I believe Perito recommends the IP approach in large part because he can do them quicker. Quicker = more money.
In one of his videos, he sort of brags he can do an IP in 15 minutes, vs. about an hour for a PS. 4x his income is nothing to sneeze at.

My thinking was this:
-The nerve bundle to your dick runs across the top of it. PS requires the surgeon to work around this bundle and not mess something up. They do it all day long, I know they're good at it, but why risk it?

-PS allows for the surgeon to exactly place the pump in your scrotum. Since the pump is what I will be interacting with on a daily basis, what my wife will interact with less frequently that, and will need to be placed to not be visible, I wanted the best pump location outcome. It's tougher for the surgeon to place the reservoir using PS, but I was less worried about where that ended up. For me, the pump is perfect and I never felt where the reservoir was placed, the only reason I believe it's on my right side is because Dr. Clavell pointed to that side during an offhanded comment.

-There's a study that shows that the PS approach results in longer implants being installed. If I'm going to VED for months prior to my surgery to get the max possible, I didn't want to give up any length due to the installation approach or the speed of the surgery.

- My wife and I visit nude resorts and I'm nearly shaved down there. I didn't want a scar telegraphing to all the other guys that I'm a cheater, which is what I would have with IP. My scar on my sack is invisible with PS.

- The 'benefit' of IP is that guys can cycle much quicker and use it for intercourse sooner. Dr. Clavell wanted me to wait 6 weeks before any of that, but he cleared me at 4 weeks based on my healing speed. This seems right to me, I didn't mind at all waiting a month after having my penis cut open and all these things shoved around down there.

- Most importantly, this is what Dr. Clavell recommended for me. He can do both, but he recommends PS. If I trust him to cut open my penis, I trust his judgement. Dr. Eid has a video on his site as to why PS is by far the best over IP.

[Witheringhog]

Im sure the risk was low but i went Clavell because he is a high volume doc and goes through the scrotum. Less chance of nerve damage but longer recovery.

[oldbeek]

MY Dr is a very hi volume with 30 years of experience and he uses infra-pubic.

[newbie443]

Again doctors differ a lot on this even the ones with really good reputations. I has been commonly agreed to that PS has better access and pump placement. And that IP has better reservoir placement. But with a really good doctor it is agreed to that it will not make any difference. Really good doctors are really good no matter which they use. The same with the nerve bundle. If you are going with a lower volume doctor out of need for insurance, you might want to avoid IP for the nerve bundle reason. Also if you shave and do not want the scar detected you might want to avoid IP. So men and doctors differ on this. Either one can be the correct choice.

[Journeyman]

Maybe I'm biased but I think PS is the way to go . When you watch the videos on implant surgeries and the steps the surgeon has to go through, PS seems like the best procedure to produce the best results. Healing time being the deciding factor on which procedure to go with seems silly to me .You'll be cycling and fucking fast enough with the PS approach. Like others have said , the nerve bundle exposed with the IP surgery would concern me . Another complaint with the IP surgery I've read is a high riding pump . The most IMPORTANT decision is the Surgeon ! Everything else is secondary. Clavell, Petito , Eid and Hakky are all high volume surgeons with impeccable reputations . As far as Perito's 15 minute claim , I think it's a little misleading and actually a negative not a positive. If I'm having my dick sliced and diced , I want a surgeon that will take his time with clinical precision and thoroughness my cock deserves . I heard that he puts the implant in ( 15 minutes) and his surgical team finishes the surgery. Don't know for certain if that's the case but it's more plausible.

[jwdetails]

I've found that to be a major red flag for me as well - surgeons claiming they are the fastest or the best. There are many highly qualified surgeons across the country. Although longer surgery times may increase the chances of the infection, a few extra minutes probably isn't going to change things. But if you need to get a revision later, there's definitely a higher risk of infection. Get it right the first time and choose wisely.

I think IP vs PS needs to be individualized to the patient. Each of the guys you mentioned has a preference for one or the other, but each know how to the other approach. They should be able use these techniques to get you - the patient - the best outcome; not be super fast and do more surgeries to make more money.