Me & My Genesis Malleable

[Mark1974]

Shitty surgeon i would go to someone else

If he shook his head like a jerk like that i would never see him again

No, he is actually one of the best in the world

There a lot of potential problems with malleables and one must be realistic about them.

I just can't stand the idea of the pump and tubing and reservoir, so I either will deal with the challenges of a malleable or not get an implant

I agree the pump, hose's, reservoir are a bitch to have moving around in your body, I never did get use to that feeling.
What was his reasoning for advising against it ?
If he can install a IPP he certainly can do a MPP, you don't want to go without anything, the MPP is a easier surgery, chance of erosion is very low as long as your sized right at the time of surgery, infection chances are lower, no pumping, tube, or dexterity issuses involved with the MPP.
What did he say were the problems with them in his explanation ?

Dr Levine and a training physician were in the room from what I remember

I brought up malleables and he shook his head and then the training physician explained how they were used for placeholders and for extreme cases where patients have dexterity problems

It was brief, because most of the focus of that visit was discussing the differences between the AMS and the Coloplast

That was in 2022. I'm going to see him March 12 and ask about the Rigi10. If he is against it I will ask if there is another doctor in the midwest (hopefully Chicago area) who does malleables

[thedriver]

these implant doctors are involved in a vortex of money, they have lost the sense of duty and of being a doctor, they have forgotten that they have sworn to do the best for the patient, in fact they install the brand and model of the most convenient prosthesis for them

I agree with you on that,,, after 4 IPP's failures,,,, my surgeons team was just assuming that I was there for a 5th IPP,,,,, and on top of that the surgeon tried to pretend like he remembered me,,,, which it was painfully obvious that he didn't remember me at all,,, kind of insulting after making tens of thousands off from me and these IPP failures.
When I finally got a chance to sit down with him the day before surgery and I told him I wanted to go to a MPP,,,,,,,,, he looked at me like I asked him for a divorce.
Then he simply told me that there is a rep, in the surgery room from coloplast that will have the right MPP for me as the surgery is in progress,,, and with that he seemed like he was done with the appointment,,, I pressed him on a couple of other questions and he would just sort of agree with me and asked if there was anything else as he would be standing up looking at the door.
He told me that my next appointment with him could be done on the phone,,, and if things looked good and no sign of infection that I didn't really need to keep that appointment either.At this point the surgery wasn't even done yet and I knew I made the right decision.
It all comes down to the all mighty dollar now,,, and it is because of the medical community trying to push patients thru there system like a herd of cattle.
And now I seen on the Mayo clinic portal site that if you even send them a message and ask a question that there would be a $50 charge for there response.
Fucking WOW !!!

[easymoney]

Welcome to my world as far as the Dr. answering questions or being open about anything ..makes u wonder at times does it not?

[Islanderboy58]

No, he is actually one of the best in the world

There a lot of potential problems with malleables and one must be realistic about them.

I just can't stand the idea of the pump and tubing and reservoir, so I either will deal with the challenges of a malleable or not get an implant

I agree the pump, hose's, reservoir are a bitch to have moving around in your body, I never did get use to that feeling.
What was his reasoning for advising against it ?
If he can install a IPP he certainly can do a MPP, you don't want to go without anything, the MPP is a easier surgery, chance of erosion is very low as long as your sized right at the time of surgery, infection chances are lower, no pumping, tube, or dexterity issuses involved with the MPP.
What did he say were the problems with them in his explanation ?

Dr Levine and a training physician were in the room from what I remember

I brought up malleables and he shook his head and then the training physician explained how they were used for placeholders and for extreme cases where patients have dexterity problems

It was brief, because most of the focus of that visit was discussing the differences between the AMS and the Coloplast

That was in 2022. I'm going to see him March 12 and ask about the Rigi10. If he is against it I will ask if there is another doctor in the midwest (hopefully Chicago area) who does malleables

I've had my consultation with Dr Levine and he will be doing my ipp on April 10th.
I must say he was above and beyond professional, very informative and patient with all my questions regarding the procedure.
I know he has performed over 4000 ipp procedures and is regarded as one of the best in the world .
Just my 2 cents.

[LastHope]

You're lucky. When I inquired my "Center of Excellence" urologist about the perks of MPP compared to IPP, he yelled "IPP and forget what you hear in the internet!" as if it was a reflex and rushed out faster than someone desperately avoiding a puddle in their pants. I learnt more about MPP from the awesome franktalk members here.

[Mark1974]

You're lucky. When I inquired my "Center of Excellence" urologist about the perks of MPP compared to IPP, he yelled "IPP and forget what you hear in the internet!" as if it was a reflex and rushed out faster than someone desperately avoiding a puddle in their pants. I learnt more about MPP from the awesome franktalk members here.

I don't think it is because the doctors are trying to make us repeat customers in the hopes that the IPP breaks. I think this type of thinking is far too cynical and simple.

Satisfaction rates with IPPs are a good deal higher than with MPP's and the differences are even more stark with partners

In fact one study I read I remember seeing female partners had a less than 50 % satisfaction with MPP's, but it was in Latin America where there is a huge focus on a big penis...even more than here if you can believe it.

I think most of the dissatisfaction is driven by size loss.

The second issue is concealment which is a real challenge with MPP's. The best way to mitigate that is to get smaller cylinders, but this means even narrower girth

And then there is the issue of pressure atrophy. Again the best way to mitigate that is with a smaller implant...which means a smaller penis...which means lower female satisfaction rates

So they have a good basis for advising patients against it

Even so, for some of us I think it is a better option

I would rather deal with a much smaller penis than deal with multiple components and imminent eventual failure

[LastHope]

You're lucky. When I inquired my "Center of Excellence" urologist about the perks of MPP compared to IPP, he yelled "IPP and forget what you hear in the internet!" as if it was a reflex and rushed out faster than someone desperately avoiding a puddle in their pants. I learnt more about MPP from the awesome franktalk members here.

I don't think it is because the doctors are trying to make us repeat customers in the hopes that the IPP breaks. I think this type of thinking is far too cynical and simple.

Satisfaction rates with IPPs are a good deal higher than with MPP's and the differences are even more stark with partners

In fact one study I read I remember seeing female partners had a less than 50 % satisfaction with MPP's, but it was in Latin America where there is a huge focus on a big penis...even more than here if you can believe it.

I think most of the dissatisfaction is driven by size loss.

The second issue is concealment which is a real challenge with MPP's. The best way to mitigate that is to get smaller cylinders, but this means even narrower girth

And then there is the issue of pressure atrophy. Again the best way to mitigate that is with a smaller implant...which means a smaller penis...which means lower female satisfaction rates

So they have a good basis for advising patients against it

Even so, for some of us I think it is a better option

I would rather deal with a much smaller penis than deal with multiple components and imminent eventual failure

Well, do I believe folks tend to be more satisfied owning a Porsche 911 compared to a Toyota Camry? Of course! The consensus might be that the Porsche offers more thrills and excitement, which is a given. However, this thrill ride comes with a catch - it's all fun and games until the car breaks down. At that point, the joy quickly fades as you deal with the complexities and costs of repairs (revisions) or shell out more money on a new one. So, while the Porsche 911 might initially seem like the more appealing choice, its reliability issues could make the steady, less glamorous, boring Toyota Camry a more satisfying choice in the long run. I don't believe it's about being cynical, rather, it's about laying out all the options and providing patients with informed consent when they ask reasonable questions.

[LastHope]

You're lucky. When I inquired my "Center of Excellence" urologist about the perks of MPP compared to IPP, he yelled "IPP and forget what you hear in the internet!" as if it was a reflex and rushed out faster than someone desperately avoiding a puddle in their pants. I learnt more about MPP from the awesome franktalk members here.

I don't think it is because the doctors are trying to make us repeat customers in the hopes that the IPP breaks. I think this type of thinking is far too cynical and simple.

Satisfaction rates with IPPs are a good deal higher than with MPP's and the differences are even more stark with partners

In fact one study I read I remember seeing female partners had a less than 50 % satisfaction with MPP's, but it was in Latin America where there is a huge focus on a big penis...even more than here if you can believe it.

I think most of the dissatisfaction is driven by size loss.

The second issue is concealment which is a real challenge with MPP's. The best way to mitigate that is to get smaller cylinders, but this means even narrower girth

And then there is the issue of pressure atrophy. Again the best way to mitigate that is with a smaller implant...which means a smaller penis...which means lower female satisfaction rates

So they have a good basis for advising patients against it

Even so, for some of us I think it is a better option

I would rather deal with a much smaller penis than deal with multiple components and imminent eventual failure

I found this paper interesting:

"Penile Implants: A Lesson from the First 50 Years"

https://www.mdpi.com/2673-4397/3/1/1

4.2. Patients Satisfaction and Reliability

"Despite the high satisfaction rate reported in the literature, a perfect tool to evaluate penile satisfaction in patients with a penile implant does not exist.
Indeed most of the studies used suboptimal or non-validated questionnaires."

[mbambo]

You're lucky. When I inquired my "Center of Excellence" urologist about the perks of MPP compared to IPP, he yelled "IPP and forget what you hear in the internet!" as if it was a reflex and rushed out faster than someone desperately avoiding a puddle in their pants. I learnt more about MPP from the awesome franktalk members here.

I don't think it is because the doctors are trying to make us repeat customers in the hopes that the IPP breaks. I think this type of thinking is far too cynical and simple.

Satisfaction rates with IPPs are a good deal higher than with MPP's and the differences are even more stark with partners

In fact one study I read I remember seeing female partners had a less than 50 % satisfaction with MPP's, but it was in Latin America where there is a huge focus on a big penis...even more than here if you can believe it.

I think most of the dissatisfaction is driven by size loss.

The second issue is concealment which is a real challenge with MPP's. The best way to mitigate that is to get smaller cylinders, but this means even narrower girth

And then there is the issue of pressure atrophy. Again the best way to mitigate that is with a smaller implant...which means a smaller penis...which means lower female satisfaction rates

So they have a good basis for advising patients against it

Even so, for some of us I think it is a better option

I would rather deal with a much smaller penis than deal with multiple components and imminent eventual failure

Downsizing is not right as it will lead to implant breakage and may be erosion also ... As the the implant won't fit its place in cavernosa

Mpp depending on the right size measurements... Not oversized nor downsize

[LastHope]

Paper on patient satisfaction is showing only a modest difference. 1 year satisfaction (really?).


Satisfaction rate at 1‐year follow‐up in patients treated with penile implants: data from the multicentre prospective registry INSIST‐ED
Paolo Capogrosso, Edoardo Pescatori, Enrico Caraceni, Nicola Mondaini, Lilia Utizi, Tommaso Cai, Andrea Salonia, Alessandro Palmieri, Federico Deho’
BJU international 123 (2), 360-366, 2019

Objectives
To investigate scores and predictors of patient satisfaction at 1 year after penile prosthesis implantation (PPI) using the validated Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) questionnaire.

Patients and Methods
Analyses were performed for 142 patients prospectively included in the national multicentre registry Italian Nationwide Systematic Inventarization of Surgical Treatment for Erectile Dysfunction (INSIST‐ED), which provided 1‐year follow‐up data. Postoperative patient satisfaction was assessed using the validated QoLSPP tool. Linear logistic regression analyses assessed predictors of QoLSPP total and single domain scores, including age at surgery, erectile dysfunction aetiology, type of prosthesis, surgical approach, surgeon experience and complications. Locally weighted regression methods were used to explore the relationship between surgeon experience and QoLSPP scores.

Results
Overall, high median functional, relational, social, personal and total QoLSPP scores were reported at 1 year after PPI. Patients implanted with hydraulic devices had higher functional (23 vs 21.5; P = 0.01) and total scores (68 vs 65.5; P = 0.03) than those with a malleable prosthesis. Surgeon experience emerged as the only independent predictor of higher satisfaction scores, depicting a non‐linear association with both QoLSPP total and single domain scores (all P < 0.03). Data suggested that the higher the number of procedures per year, the greater the satisfaction scores, reaching a plateau after l5 procedures/year.

Conclusions
This study reports high functional and patient satisfaction scores at 1 year after PPI surgery using a dedicated tool for the first time. Better outcomes should be expected for patients treated by surgeons with greater experience.