Important considerations for picking your surgeon and after surgery support

[gene308]

I have been told that I cover too many different topics in my posts, This makes the reader search through the post for what interests them. I feel my last post had very valuable information for the men looking at at an implant.

This information is based on 6 years of experience working one-on-one with IPP candidates in the AMS Champion program.

In addition to your regular surgeon screening practice I suggest you consider the following issues and approaches below:

Issues:

Surgeons skill and experience dealing with complications
Surgeons ability and willingness to set reasonable expectations on size
Surgeons availability and support after your surgery

Recommended approaches/questions:
The typical (complication free) implant surgery is relatively simple. The need for a highly qualified dedicated implant surgeon becomes essential when complications arise. If you have decided on getting an implant and looking for a surgeon and facility, please consider these screening questions for surgeon qualifications and after surgery care and support.

Ask prospective surgeons these questions to evaluate their ability and experience with complications:

• If I need revision surgery, will you do revision surgery or will you refer me to another surgeon? Who?
• How many revisions have you done and why
• If you encounter fibrosis in the corpora cavernosa how will you break through and ensure tips go fully into the glands?
• How will you deal with pyronines?
• If an infection were to occur, will you handle this yourself? Or by referral?
• What is your procedure for dealing with infection should it occur?
• Most surgeons will say they aggressively size the implant. How will you set reasonable expectations prior to surgery?
• Dr.Andrew Kramer’s youtube channel ( Dr. Andrew Kramer - YouTube) has many surgical videos showing revisions and complications. I include this for educational purposes. I encourage you to look at some of the more complicated surgeries. You may not need this level of expertise but maybe you will?

After surgery care and support:

I have surprisingly found that after surgery care and support can be problematic for patients I have worked with. It is advisable that you set clear expectations with the surgeon on after-surgery availability and support

Recommendations:

* Make arrangements for after surgery direct communication (bypass call center) to surgeon or PA/nurse.

• Set expectations that should you have after surgery concerns, you can have direct access to expertise. I recommend you get a direct cell phone number. This way you can take a picture and send it for review. The surgeon has done this many times, this is your first time and you have every right to have your concerns addressed in a professional timely manner. There is no reason you be worrying about “Is this normal?”

• Make arrangements to have the ability to make urgent office visits if needed (bypass call center and office scheduler)

[JohnHC]

Great info. I was lucky in that I had been doing research on implants when I starting taking Trimix just in case Trimix didn't work for me just like the other treatments. My Dr pretty much answered most of those questions during the consult before I asked about them. Any competent Dr will not take offense or shouldn't take offense by any of these questions or suggestions. This will show your Dr that this isn't some thing you want done on a whim and have taken the time to seriously research the procedure.

I tell guys who ask me about it, that for me this was the last thing I could do, that I had put it off as long as I could and that this is the nuclear option, there is no going back to a normal erection if you don't happen to like the implant. I've had guys ask me, can't they just take it out, sew up the incision, and have it work again? I use a watermelon as a analogy - you have the hard outer skin of the watermelon, think of it as your cavernosum. Think of the inside of the watermelon as the spongy tissue that gives you the erection. Now just cut the end off of the watermelon and stick your hand inside and wallow it out. That's pretty much what happens when the implant is put in, all that spongy tissue is gone and can't be replaced, all that supporting tissue is gone so even if you could get the blood back in there, there won't be any support to give you that erection again. That's what the cylinders do, give you that fullness and firmness needed to make your penis erect again. And that kind of opens their eyes, I think some of the guys just like the idea that hey I can just pump it and have an erection that lasts forever without really thinking about what the consequences of having this surgery does to you and that you can't just wave a wand and go back to normal erections.

[gene308]

Thanks JohnHC

[easymoney]

I can't stress enough how important after care is when picking your surgeon and his care team for your follow up care. Had a Rigicon implanted 6-2023 .. 18 days later implant was perfect, nurse predicted using it on Aug 11th it had healed so well. Two days later woke up to my penis swollen as large as my hand, rushed to the practice had to make them understand that it was an emergency that should be looked at there and not in the ER since they would have limited experience with it. Dr. came in an looked at it the first words out of us mouth were "what did u do to it" Accused us of trying to us it causing the issue, it was still so sore was hard to handle it to pee let alone use. Long story short ended up in ER week later doing massive doses of antibiotics for 3 hours per the Dr's request to see if the swelling would improve. Following week was worse went to the ER again per the doctor's request was admitted, more antibiotics .. next day cut it all back open looking for infection .... they found nothing even after doing extensive penile exploratory surgery. Made me stay overnight no warning of keeping me, and I have never seen the dr. or heard from him again. My follow up care was with a NP. who appeared to have limited knowledge of my case and seemed reluctant to get too involved. At the 4 week mark all healed up and I asked her how to use it and not use it. Gave vague instructions and to this day I still don't know 6 months later how to bend it and not bend it. Contacting the company Rigicon only reply from rep was "ask your Dr." hope I never need warranty service with his attitude. I will be making an appointment in Feb to see the surgeon about that subject among others .. The Dr. is a great surgeon but he is also a lot of smoke and mirrors when questions are asked he wishes not to answer or give vague answers to.

[Never_Enough]

Which surgeon and what did they say had happened

[Never_Enough]

I can't stress enough how important after care is when picking your surgeon and his care team for your follow up care. Had a Rigicon implanted 6-2023 .. 18 days later implant was perfect, nurse predicted using it on Aug 11th it had healed so well. Two days later woke up to my penis swollen as large as my hand, rushed to the practice had to make them understand that it was an emergency that should be looked at there and not in the ER since they would have limited experience with it. Dr. came in an looked at it the first words out of us mouth were "what did u do to it" Accused us of trying to us it causing the issue, it was still so sore was hard to handle it to pee let alone use. Long story short ended up in ER week later doing massive doses of antibiotics for 3 hours per the Dr's request to see if the swelling would improve. Following week was worse went to the ER again per the doctor's request was admitted, more antibiotics .. next day cut it all back open looking for infection .... they found nothing even after doing extensive penile exploratory surgery. Made me stay overnight no warning of keeping me, and I have never seen the dr. or heard from him again. My follow up care was with a NP. who appeared to have limited knowledge of my case and seemed reluctant to get too involved. At the 4 week mark all healed up and I asked her how to use it and not use it. Gave vague instructions and to this day I still don't know 6 months later how to bend it and not bend it. Contacting the company Rigicon only reply from rep was "ask your Dr." hope I never need warranty service with his attitude. I will be making an appointment in Feb to see the surgeon about that subject among others .. The Dr. is a great surgeon but he is also a lot of smoke and mirrors when questions are asked he wishes not to answer or give vague answers to.

Which surgeon and what did they say had happened?

[frank66665]

I have nothing against gene308 but it's all just talk, the surgeon promises you everything, then once the procedure is over he no longer knows if you have a problem, he even denies that there is a problem, as if for a patient, complaining that he has a problem would be like going to a restaurant, the truth is that there is no legislature where if the surgeon makes a mistake, he is taken by the ears by the institutions and forced to repair the mistake made, I agree with everything that johnHC says, mine denies that there is a problem , as if I would like to be operated on to solve the problem

[gene308]

I am truly sorry for your troubles easymoney. It is difficult for us as patients and consumers to evaluate medical providers before entrusting them with our health and well being. I often wondered why there isn't a database with information on how often a doctor has been sued and how often lost. The medical profession has prevented this legally I believe.

So for penile implant surgery consumers: what are we left with? I don't believe Franktalk will allow us to generate a database of experiences with surgeons. I have talked with AMS and they will definitely not rate or recommend surgeons, they will give you a list

I believe we have two general approaches:
A) high volume dedicated surgeons familiar to Franktalk members
B) less well know surgeons that may be more convenient and accessible

Key points in my post:

If you chose a less qualified non dedicated implant surgeon:
1) If complications occur the surgical result may be less that optimum
2) If you need revision surgery you may be referred

The questions I suggest will help asses the risk

For all implant surgeries I highly recommend establishing commitments for post surgery support

[easymoney]

My Dr. is well known and regarded as one of the best high volume implanters in the Us as well as the highest mallabble implanter in the US. Based on reputation I expected more from him personally and his staff as an extension of him and his practice. And the fact that the company Rigicon which i have implanted the area rep will not say a peep or answer a question. Nor will the main Rigicon office in NY standard answer ask your Dr. I should not have to make an appointment pay a co pay just to see a Dr. who should have explained everything to me or had a competent staff that could have done it. But I agree with you should be some sort of standard of care and information for this type of surgery.

[Txagq8]

Caveat emptor. Let the buyer beware.

Thieve words are true regardless of whether you are buying a used car or buying an implant to slay your ED once and for all.

A guy, as the patient, needs to approach this procedure with several things in mind:

The patient is the customer. He (or his insurance) is paying the bill. Doctors might like to think of themselves as Gods but they are still very much in the customer service industry.

It’s not necessary to get nasty or confrontational but never, ever remain silent if you don’t think you’re getting your money’s worth in the way of service.

Go to your consults and post surgical visits prepared. Write questions down. Ask them and expect an answer. One of those questions ought to be what to expect in terms of after care. Some guys get installed, climb on a plane, fly home, and do great. Others feel more comfortable with multiple in-person visits the first few weeks. I give a lot of credit for my really quick and totally uneventful recovery to my surgeon and his staff’s attitude. I’d say “when do you want to see me again?” And they’d ask “how soon do you want to come back?”

I think the three weeks after my surgery I went to the clinic 8 times. The vast majority of that time was spent cycling under the supervision of a nurse or PA. I was worried (needlessly) that I’d pump it up and not be able to find the deflate button in my swollen nutsack. Having them nearby for guidance, to answer questions, to reassure me that what I was seeing/feeling was normal —- made the whole thing a piece of cake.

You don’t have to go to New York or Atlanta or Florida. But it does pay to deal with a surgeon who does quite a few implants and it’s essential to spell out your expectations before you’re on the table with them shaving your balls.