Questions to ask DR

[exr001]

Guys, back again and going to take he wife with me to the urologist this week to discuss options. We've talked about it several times and the timing was just never right and we still had a passable sex life. Now I think we are both getting closer to making the real decision to go with an implant.

Looking for advice from you all of what questions to ask the doctor. They aren't one of the high volume providers, but did serve under a very well respected and mentioned one on this board. In prior conversations I've learned they do about 4-5 implants a month so I know that already.

What else should I be asking and what questions did your wives/girlfriends/significant others have?

All replies appreciated.

[wilsonmill]

My wife does not want a malleable, she says that the malleable will be hard to hide, doesn't bother me but it does her, will be going soon to a urologist to get a revision since the titan failed after 5 yrs. Maybe ask the doctor about the least problematic unit that they have implanted, they will all have an opinion but you should find out theirs.

[Bigdog4all]

Some Questions…..

1. Insurance Medicare…..Has insurance been approved?
2. Communications – How & When? Texts or Phone communications.
3. How many PT surgeries within the past year?...50 - 60.....
4. 3 Piece Implant…..AMS700
5. Type of Antibiotics…..
6. How to operate unit
7. Does it make a pumping sound…..
8. Sensations / climax – Any changes?.....
9. What is it made of
10. Solution – Does it need to be replaced
11. Location of parts…..Pump…Cylinders…Reservoir
12. Timeline – To start use…..depending on healing.
13. Do you use Nerve Block?.....Pain is based on individual
14. Swelling
15. How long before training use ?....Depends on person and healing
16. What is the average lifetime…..
17. Risks – Infection?.....Mechanical (Take out and Replace)
18. Operation – How long?.....2 hrs. or less
19. Blood test / Screening…..
20. Blood sugar levels…..To promote better healing
21. Nervousness…..
22. Pain meds…..Oxy, Tylenol Extra Strength, Ibuprofen 800, Tramadol
23. Swelling / Ice…..15 minutes ON …..15 minutes OFF
24. Ice on / Ice off…15 minutes intervals
25. Stool softeners…Maalox or Colax
26. Rest / Relaxation….Much rest but walking around dining room table - exercise
27. Recovery…..Ice Pack, etc
28. Follow up visits…..
29. Meds – Oxycodone, Hydrocodone, Ibuprofen 800, Tylenol Extra Strength
30. When to therapy - Pull on pump
31. Bulb positioning…..Right handed position
32. Will Tadafil assist Glans & Implant…..
33. Catheter is needed…..Removed next day
34. Stay overnight in hospital…..I chose YES, for any precautions


Other questions…..

1. Can I go for a ride, as passenger…
2. How long numb?.....Possible 3 – 4 days
3. Ice & anti-biotics
4. Pain meds?

[Jage64]

The Boston Scientific (AMS) product is different from the Coloplast product. They both have pros and cons. I would ONLY consult with doctors that offer both and have experience with both. Otherwise you're only getting half of the story. Penis implants are not "one size fits all" in terms of what's best for your anatomy, lifestyle and outcome.

What approach will they use for installation? Infrapubic or penoscrotal? Pros and cons to both.

Catheter or no? Catheter can add a lot of discomfort and pain and apparently is not necessary (Dr. Clavell does not use a catheter normally)

'No touch' surgical technique or not? If not, why not? If you're not familiar with what that is, watch some youtube videos and become educated. This technique seems to drastically reduce infection issues, which is your #1 post-op concern.

How soon do you recommend starting to cycle the implant?
How soon for sexual activity if all is healing according to plan?
Nerve block is a good question, I only had discomfort that alternating Tylenol and Advil took care of, even flying 4+ hours 42 hours after surgery. I attribute my very easy recovery to Dr. Clavell's pain management regimen, a nerve block and ice, ice, ice.

You have to be your own advocate, watch every video, read every post and develop your own questions. Write them down, take them to your doc.

I've written this before, but this surgery is NOT something you shop price or convenience on.

[Journeyman]

Penoscrotal or infrapubic surgery ? Imo , and I am probably biased, but I think Penoscrotal is the way to go . Why ?....From what I read on this site, it seems there's more problems/ dissatisfaction with the infrapubic. Examples. .1) possible damage to the nerve bundles on top of the penis 2) high riding pump ...3) visible scar above the penis. The only pro I can think of with the infrapubic is faster healing which means cycling sooner . Any members that has had the infrapubic surgery, please correct me if I'm wrong. Dr Clavell ( my surgeon ) only does penoscrotal , I believe. The pump placement is perfect and the scar isn't noticeable at all . I think the surgeon is able to measure you better for the size implant you'll need . Having said all that , I thought I read that Dr. Perito does infrapubic surgeries. That's what I would ask and research

[Tokyo_123]

'No touch' surgical technique or not? If not, why not? If you're not familiar with what that is, watch some youtube videos and become educated. This technique seems to drastically reduce infection issues, which is your #1 post-op concern.

If the doctor does not do "no touch," run for your life.

[Juerhareb]

The Boston Scientific (AMS) product is different from the Coloplast product. They both have pros and cons. I would ONLY consult with doctors that offer both and have experience with both. Otherwise you're only getting half of the story. Penis implants are not "one size fits all" in terms of what's best for your anatomy, lifestyle and outcome.

What approach will they use for installation? Infrapubic or penoscrotal? Pros and cons to both.

Catheter or no? Catheter can add a lot of discomfort and pain and apparently is not necessary (Dr. Clavell does not use a catheter normally)

'No touch' surgical technique or not? If not, why not? If you're not familiar with what that is, watch some youtube videos and become educated. This technique seems to drastically reduce infection issues, which is your #1 post-op concern.

How soon do you recommend starting to cycle the implant?
How soon for sexual activity if all is healing according to plan?
Nerve block is a good question, I only had discomfort that alternating Tylenol and Advil took care of, even flying 4+ hours 42 hours after surgery. I attribute my very easy recovery to Dr. Clavell's pain management regimen, a nerve block and ice, ice, ice.

You have to be your own advocate, watch every video, read every post and develop your own questions. Write them down, take them to your doc.

I've written this before, but this surgery is NOT something you shop price or convenience on.

I dont think the catheter is that important. I had the catheter placed for 1 day and It is uncomfortable, but thats It. Its 1 day only and It prevents you to have to go to the toilet.

[exr001]

Thanks for the feedback, please keep it coming.

Not too worried if the catheter is only overnight, I've had other surgery down there that had me with one in for a couple weeks. OUCH, but livable.

[sswinsfba]

BigDog provides a great list of Q's to ask your doc. Jage64 & Journeyman also make good points.

FWIW, there has always seemed to be a preferential bias towards AMS & penoscrotal implants on this site. However, I got a Coloplast Titan that was implanted infrapubicly without any problems whatsoever.

You can read about my experience in the "15 Month Update" thread that I just posted and in my post-op diary where you can find a link to that thread.

I'm not here to trash AMS or the penoscrotal method but here's what I know & have to say:

1) My surgeon -- Dr. Karpman in Mt. View, CA -- previously used AMS but switched to Coloplast because his patients were having too many problems w/AMS -- mainly due to leakage at various connections which have been reported by men here who also got AMS implants -- which required revision which he got tired of needing to do.

So, I agree w/Jage64 that you should consult w/a doc who has used both AMS & Coloplast to understand the differences pro/con between AMS & Coloplast.

2) I considered but rejected the penoscrotal method mainly because it takes more surgical time to perform (which means you are under anesthesia longer which puts you at greater risk) and also because the recovery time was longer &, based on what I read, possibly more problematic than for infrapubic.

Before I found Dr. Karpman, I consulted w/a surgeon who only did penoscrotal but who had relatively little surgical implant experience which is mainly why I chose to go w/Karpman (who has a lot of experience & only did infrapublic) but I also did a lot of research on the penoscrotal method and it just didn't appeal to me when compared w/infrapubic.

3) Also, based on my research, I felt that there are fewer risks of post-op complications w/the infrapubic than penoscrotal method. You can read up on both methods and decide about that for yourself.

Regarding Jouneyman's concerns in re: infrapublic:

I don't think there is any risk of nerve damage if you have chosen an EXPERIENCED surgeon who does infrapublic implants frequently.

As for the scar, your public hair will regrow to hide it. If you happen to be "smooth" down there (like I am), while the scar is visible, it is hardly noticeable when I look at myself naked in the mirror everyday.

My squeeze ball placement is also fine. Right in the middle of my balls where it's supposed to be. My balls were never low hangers and do ride higher now but I don't find that a problem.

------------------------------------------------

Good luck in making the "right" choice for you but don't rush into it.

Take the time to do the research that you need to do and to find the "right" surgeon to do the job.

Don't choose a surgeon just because he's close by. Men here have flown thousands of miles to get the implant done by experienced surgeons. Jage64 was one of them.

Choosing the "right" surgeon is the most important decision that you have to make. So, make that choice wisely.

You won't regret it if you do but almost certainly will regret it if you don't.

Again, good luck & best wishes to you.

[Rider1400]

Penoscrotal or infrapubic surgery ? Imo , and I am probably biased, but I think Penoscrotal is the way to go . Why ?....From what I read on this site, it seems there's more problems/ dissatisfaction with the infrapubic. Examples. .1) possible damage to the nerve bundles on top of the penis 2) high riding pump ...3) visible scar above the penis. The only pro I can think of with the infrapubic is faster healing which means cycling sooner . Any members that has had the infrapubic surgery, please correct me if I'm wrong. Dr Clavell ( my surgeon ) only does penoscrotal , I believe. The pump placement is perfect and the scar isn't noticeable at all . I think the surgeon is able to measure you better for the size implant you'll need . Having said all that , I thought I read that Dr. Perito does infrapubic surgeries. That's what I would ask and research

With a good surgeon there’s extremely little risk of damaging nerve bundle, yes Perito does the infrapubic and he is one of the highest volume implanters in the country. Measurements are take exactly the same way no matter which way it’s done. Coloplast has a specific cylinder for infrapubic installation which puts different lengths on the tubing for that specific purpose. Healing is much easier in my opinion and had little to no swelling in my scrotum and less bruising