Dr Hakky

[Donkeykong]

Does Hakky prefer IP these days to PS?

It's not that he prefers it. Told me infrapubic is a quicker recovery but a harder conceal.

[LastHope]

losthope you doing a mallabble? if so Dr. Carrion in Tampa fl does about 50 a year as of last year and he said he was the highest volume implater of the MPP implants in the US.

Thanks easymoney. Yes! Will have to check if Dr. Carrion is under my network.

[LastHope]

Does Hakky prefer IP these days to PS?

It's not that he prefers it. Told me Iinfrapubic is a quicker recovery but a much harder conceal

For skinny folks, he recommends PS as IP is hard to hide the tubing for skinny folks. For Malleable - his YouTube channel had sub-coronal.

[LastHope]

Some say that IP is faster - more patients mean more revenue?
Good for the surgeon?
That's a business justification depending on a physician's value system.
Better operating efficiency at high volume clinics?
Speed and efficiency correlate with lower infection rates?

The IP approach enjoys easier and safer reservoir placement under direct vision.

Reduced risk of reservoir herniation.

Less scrotal swelling. No worries about "grapefruit scrotum" or scrotal hematoma.

Quicker pump activation, faster post-op sex.

Dr. Perito does a ton of IP and trains folks all over the world on IP. These giants are super skilled (hype or hope, I don't know)....they are obviously not destroying their patients' neurovascular bundles. They probably know how to work around it.

For Dr. Hakky, maybe it's natural to do what he is mostly trained on since fellowship and what has worked well so far to stay successful, tweaking it or breaking the norm for a patient's anatomy.

In the IP paper co-authored by Dr. Perito he says....

The disadvantages that have been cited include potential damage to the dorsal nerves of the penis with resultant sensory loss (albeit never documented in the literature), limited distal corporal exposure and the lack of access to the most dependent part of the scrotum for pump fixation. These disadvantages are overcome with careful dissection, the use of hydrodilatation, and the use of the nasal speculum for pump placement.

We begin the procedure with an artificial erection using a total of 60 cc of normal saline or a combination of normal saline plus lidocaine if performing the implant under pure local anesthesia. The first 30 cc are injected while placing pressure directly to the base of the penis in order to identify potential pathology that may have not been evident on physical exam of the flaccid penis. The remaining 30 cc is then injected to accomplish the complete hydrodilatation of the corpora supplanting serial dilation in the penis with no pathology. This hydrodilatation also allows for identification of the dorsal nerve and easy lateral placement of the stay sutures.

A pediatric Yankour is utilized to roll the corpora and thus the neurovascular bundle out of the way before placing a single set of stay sutures bilaterally. This is all made very simple after the hydrodilatation of the penis, providing more corporal topography with which to work.

Vollstedt A, Gross MS, Antonini G, Perito PE.
The infrapubic surgical approach for inflatable penile prosthesis placement.
Transl Androl Urol. 2017 Aug
6(4):620-627. doi: 10.21037/tau.2017.07.14. PMID: 28904894; PMCID: PMC5583056.

[nuance]

I haven’t actually seen hakky patients here with IP surgery, only noticed recently he does that based on YouTube videos he posted and one member mentioning he might use IP approach.

[fucked0ne]

LastHope, do you already have an implant?

Not yet. I'm days away from getting one. Waiting on my new plan to kick in Jan 1st. Wish me luck!

Good luck, buddy! Are you thinking a malleable?

[LastHope]

LastHope, do you already have an implant?

Not yet. I'm days away from getting one. Waiting on my new plan to kick in Jan 1st. Wish me luck!

Good luck, buddy! Are you thinking a malleable?

Thanks F1! Malleable makes the most sense considering my age/device reliability and most importantly, not a great insurance coverage.

[fucked0ne]

Not yet. I'm days away from getting one. Waiting on my new plan to kick in Jan 1st. Wish me luck!

Good luck, buddy! Are you thinking a malleable?

Thanks F1! Malleable makes the most sense considering my age/device reliability and most importantly, not a great insurance coverage.

I think you're making the right choice, though you'll probably need some kind of dermal filler based on the malleable implantees I've spoken with. I actually envy you; the malleable was my original choice (Rigi10), but, like most, I was talked out of it. Now, I'm strongly considering having my inflatable swapped out for a Rigi10. I just don't care for the uncertainty that comes with the inflatable and, still being somewhat young and sexually active, am desiring something more dependable and durable.

You know, I'm noticing more and more young guys who want the malleable over the inflatable; so much so, in fact, that I really think the malleable is the future of penile implants. I just don't think the tech for the inflatable is quite there yet. Actually, I'm hoping, though this is something I highly doubt, that we will start to see more innovation when it comes to the MPP in terms of concealment and also length/girth preservation. There are definitely ways to do it.

[LastHope]

I think you're making the right choice, though you'll probably need some kind of dermal filler based on the malleable implantees I've spoken with. I actually envy you; the malleable was my original choice (Rigi10), but, like most, I was talked out of it. Now, I'm strongly considering having my inflatable swapped out for a Rigi10. I just don't care for the uncertainty that comes with the inflatable and, still being somewhat young and sexually active, am desiring something more dependable and durable.

You know, I'm noticing more and more young guys who want the malleable over the inflatable; so much so, in fact, that I really think the malleable is the future of penile implants. I just don't think the tech for the inflatable is quite there yet. Actually, I'm hoping, though this is something I highly doubt, that we will start to see more innovation when it comes to the MPP in terms of concealment and also length/girth preservation. There are definitely ways to do it.

Thanks for these great thoughts and encouragement F1!

The daily Tadalafil that I'm on, thankfully, is not causing me the undesirable side effects that some report, and I hope I can take advantage of the residual tumescence (after stimulation) to offset the girth limitations that are inherent with malleables. So much of the cosmetic outcome is also dependent on baseline anatomy, and I'm preparing myself to embrace the functional aspects more compared to the limited cosmetic outcome.

The speed of innovation is understandably slower in the field of prosthetic urology. Expensive clinical trials are needed to get regulatory approval. The sales figures of these devices also shape the incentives to dedicate R&D budgets in the device companies. People want superb axial rigidity and excellent bending capabilities at the same time for malleables. It will be exciting to see if electronic features can solve this conundrum, but who wants electronic malfunctions and a bent penis that needs a revision again! It's a tug of war between natural outcome vs a simple reliable solution with no moving parts. A tough puzzle to solve, and like you indicated, the future is certainly exciting!

[Cnidium]

Just so everyone knows, Dr Hakky is the best! He's very straight forward and spends way more time with you to make sure you understand everything and to allow you to ask any questions you might have ( after being through this twice I didn't have any LoL.)
He explained the issue with the longer LGX and why Drs don't like them. They do expand in length by 2cm so they have to undersize you by that amount otherwise they can erode through the glans which explains why everyone loses so much length with them and that they are softer so not as firm. So I'll be getting the CX again.
He recommends that you use a pump for 10 minutes everyday for 4 to 6 weeks before surgery and that you adhere to a KETO diet for 4 weeks after surgery.

Now big thing. His fee is $4550 ( paid upfront before surgery ) and then the hospital fees ( Gwinnett Northside ) are around $24,000 but the hospital fee is different for each patient and might be more or less depending on your situation.
My surgery is tentatively scheduled for February 18th when this whole mess of mine should be finally over. I will be getting the CX probably same length maybe more, but will be getting the Tenacio pump for sure. He said that I've been through hell and he wants to make sure that everything is done right.

If you need a great guy he's the real deal and I highly recommend him for anyone!!!

Just wanted to call out that Hakky is open to looking at things like a Keto diet, which many doctors wont even explore. I think it highlight's Hakky's openmindedness and pursuit of improving things.

My personal research shows that having reduced blood sugar levels help mitigate infections (this was in other types of medical device implants not IPPs), but I think there results can be applied to IPP surgery.