Journeyman wrote:Infrapubic surgery vs penoscrotal surgery is a pertinent question ! I said it was my opinion AND to research it . I would definitely want to know what method my surgeon was gonna use , why and the pros and cons of it
@Journeyman, my post was not in response to your post. sswinsfba made claims in his post that are his opinions. Unfortunately even 15 months ago this was a concern, his opinions stated as fact. This is what I was warning against, it's up to each man to do his own research and not rely on 'facts' posted by (likely) unqualified people online.
For example, it's entirely possible that Dr. Karpman stated what he did about AMS products to sswinsfba. If he did, that's an example of a complete and utter falsehood, which can be proven by the fact that AMS products are at least 2:1 more frequently installed worldwide than Coloplast which even
includes the Coloplast malleable option. Also, most of the top 10 implant surgeons in the world offer both products to their patients, knowing that both have pros and cons. If AMS was so risky and had such failures, would a high volume doc take that risk? There is at least one published study that states
"While there was no statistically significance in device survival between the two devices, the trend favored AMS 700 CX over Titan (5-year Kaplan-Meier estimates of mechanical survival were 91% vs. 87%," So Dr. Karpman is either just flat wrong, hiding the real reason he doesn't/can't use AMS anymore, or was careless with his AMS installations and was the cause of his purported failures.
AMS products are considerably more expensive than Coloplast from the manufacturer, the surgeon pays more for the implant. Might it be that offering Coloplast results in a larger profit for the surgeon? Possibly. Coloplast might honestly be a better option for the particular patient, but it's not the only option out there. More choices are better than just one.
There are studies that show the infrapubic method can result in a shorter measurement during surgery, and ultimately a shorter implant. Infrapubic results in a more difficult (not impossible) placement of the pump and hoses into your scrotum, but a much easier placement of the reservoir. The opposite is true of penoscrotal, the surgeon can very easily orient the hoses and pump in the scrotum, but has more of a challenge placing the reservoir. Be aware of those differences and choose which one is more important to you.
Here's a video by Dr. Eid explaining some differences:
https://www.youtube.com/watch?v=LoeJC_j1d0gAnd here's Dr. Perito's direct response to Dr. Eid:
https://www.youtube.com/watch?v=aUDjOqarAhc*A good question to ask yourself in response to Dr. Perito's video is would you prefer tubing exiting your penis at 12:00 (topside) and rely on your surgeon to hide the tubing in your particular anatomy when it makes the 180 degree turn, or would you prefer the tubing exiting your penis at 6:00 (underside) right into your scrotum? Notice Dr. Perito does not say that tubing visibility is not an issue, he just in essence states that good surgeons can hide them better than not good surgeons.
The nerve bundle risk with infrapubic was already mentioned, that risk does not exist with penoscrotal.
If you shave your pubic hair, there will be a scar, some men don't want a visible scar.
Again, at least 3 very highly regarded high volume surgeons mentioned here on FT will NOT do an infrapubic installation and have been vocal as to their reasons. Dr. Perito prefers infrapubic, and if you watch his videos he admits that the benefit is mostly due to the speed at which he can do them and how quickly the patient can resume sexual activity. Each man decides if surgeon speed or having sex 2-4 weeks sooner is a big deal. With everything, there's tradeoffs and risks associated with both, or else EVERYBODY would be doing it just one way.
Another study, NOT opinion, found:
"....compared Coloplast Titan® with AMS 700TM CX. They assessed 55 patients who received either one of the prostheses using the EDITS questionnaire. The study found that there was no difference in satisfaction between patients with Titan® and patients with AMS 700 CX "
"Overall satisfaction was very high for both prostheses, and both showed reliability for sexual intercourse. Significant differences, however, were found in three questions. More patients were satisfied with the 700 CX. Only 4% with the 700CX were dissatisfied with the deflation compared to 24% with the Titan"I recommend you look at this table, which summarizes a few articles and their findings:
https://www.ncbi.nlm.nih.gov/pmc/articl ... objectonly"
Conclusions
Inflatable penile prostheses have been used successfully for ED not responsive to less invasive therapy. Both the AMS 700 series and the Coloplast Titan® have three components, infection prevention mechanisms, and valves that make deflation easier for the user as well as prevent auto-inflation. We found little substantial difference between the two types of IPPs, with studies showing inconsistent minor superiority of one over the other. We recommend surgeons use their own clinical judgment and preference when choosing the right IPPs to use. Preoperative expectations may play an important role and further research controlling for this variable is necessary."So, back to Dr. Karpman and the story he told sswinsfba, I don't buy it.
In terms of choosing a surgeon, that choice can result in a longer or shorter dick, and if general anesthesia is a concern the frequent implanter can do it in 1/3 the time:
"The choice of surgeon is likely to have an impact on eventual penile length after PPI. A frequent implanter (widely considered as a surgeon who inserts more than 25 PPIs per year) is likely to use a longer PPI cylinder compared to an infrequent implanter. In an outcome analysis study comparing 57 penile prostheses implanted by a multiple surgeon group versus 57 penile prostheses placed by a single surgeon in a center of excellence (COE), Henry et al. found that the median cylinder length of implants placed by the COE surgeon was 2 cm greater than those placed by the multiple surgeon group. More than 82% of implants placed by the COE surgeon had cylinders that were 17 cm or longer, with 37% having cylinder lengths between 20-22 cm. This was in contrast to the multiple surgeon group, whereby more than 55% of implants had cylinders that were less than 17 cm with only 14.3% having cylinder lengths between 20-22 cm. Median operative time was also considerably shorter for the COE surgeon (34 vs. 94 minutes).EACH MAN NEEDS TO DO HIS OWN RESEARCH IF HE WANTS TO BE PROPERLY INFORMED. I have tried not to include any opinions in this post. Do the research yourself.
2/22/23 AMS 700 CX 21cm + 1.5cm RTEs. 58 yrs old, wife of 37 yrs. Penoscrotal. 100ml Conceal reservoir. Dr. Clavell. Pills failing and went right to implant, skipped the injections. 12 mos. later: 7 1/2" x 5 3/4"
