duke_cicero wrote:LastHope wrote:I've attached an example of a study questionnaire design. I've excluded the 2 piece device section to reduce clutter, as most of us here are curious about the comparison between malleable vs 3 piece devices.
Comparison of Long-Term Results and Couples’ Satisfaction with Penile Implant Types and Brands: Lessons Learned From 883 Patients With Erectile Dysfunction Who Underwent Penile Prosthesis Implantation
The Journal of Sexual Medicine, Volume 16, Issue 7, July 2019
https://doi.org/10.1016/j.jsxm.2019.04.013
Thanks, LastHope. I had a feeling you'd know the answer to this. Still, the results are confusing. 90.3% of respondents claim that they are at least "somewhat" to "very satisfied" with their malleable implant, and 89.7% say that they are at least "somewhat" to "very confident" in their ability to engage in sexual activity, but only 12.9% say that they are "very likely" to continue using their malleable?
I love the way you break down the data by adding "somewhat" and "very satisfied" numbers. I'm a black and white thinker and can't process these confusing questionnaires with "very likely", "somewhat likely", "moderately unlikely", etc. So thanks, Duke, for this idea!
If we group the "very likely" + "moderately likely" as Satisfied (positive) as you nicely did and just compare the MPP vs IPP satisfaction %, we get the visual in the attached image.
Now the big question! Why don't 48% of the malleable device users want to continue with their device? BTW, great catch on this dip in the numbers! This is such a twist, and I can only think of the following reasons.
1) Not everyone can tolerate the concealment learning curve and the "hard all the time" lifestyle despite good sexual satisfaction and may want to switch to an IPP soon.
2) The majority of IPP patients who experienced infection and received a salvage malleable might want to go back to an IPP after 2-3 months and may not want to continue using the malleable.
3) A section of users might be frailer and not sexually active; they might have been recommended a malleable due to issues with finger dexterity, presence of an AUS (artificial urinary sphincter), abdominal co-morbidities, poor hand dexterity, weak muscle coordination, arthritis, parkinson's, or being disabled or paralyzed from a massive stroke.
4) Also, what comes to mind is Dr. Eid's explanation regarding the "wobbly aesthetics", which can be off-putting to some patients, leading them to consider switching to an IPP.
To add some context, the answers to questionnaires are from patients in Turkey during their 1-20 years post-op follow-up appointments or phone calls. The malleable devices used in this study period were the good old Genesis and AMS Spectra.
I'll paraphrase from another post where Dr. Eid described this "wobbling" phenomenon in detail.
"Due to the constant hardened state, over the years, the skin around the malleable implant loosens, and the base will eventually wobble, dropping naturally by gravity. So, when you have sex, you will need to physically lift it with your hand and place it into position. The irony is that over the years, a malleable ends up being less firm than an inflatable due to this issue. However, it is not a problem functionally. Over time, the tissue around the malleable will expand, increasing girth. However, because of this tissue expansion, the base will become wobbly over time. After many years, you will need to take it with your hand to place it into position because it will no longer be firm enough at the base. However, the hardness of the shaft does not change. Over the years, some degree of tissue atrophy will occur due to the constant hard state. This means the glans will become smaller and the tissue thinner. This is a major advantage of inflatable over malleable devices. When asked as a follow-up, 'Have you seen a patient with a malleable for 20 years?' he moved his hand side to side, imitating the implant flopping all over the place, and said, 'This is what it looks like'. The implant isn't changing, but the tissue around it is loosening to the point where the base is no longer firm, and it just drops in the direction of gravity. So, you pick it up with your hand, put it inside, and then it stays where it's put, basically. Because the rod is a fixed object, and that hardness never changes over time. The tissue is loosening around the rod due to the constant pressure, and girth increases, but your erection is always as hard as the rod. So, basically, the shaft hardness never changes, but at the base, it becomes wobbly over the years."
I'm biased and what stands out here to me is "it is not a problem functionally" and "the hardness of the shaft does not change".
All that said, when those 48% of them who are on the fence read thedriver's posts, I'm pretty sure a good bunch of them will turn around and will keep their MPPs! The brutal stress tests by his good wife are better than thousands of these questionnaires, and not all MPP users are lucky to learn from someone who switched from 4 IPPs to MPP.
Born early 80s. Congenital ED. Pills worked great for a while. Jan 2025 - Coloplast Genesis. 22cm (1cm RTE)-13mm.
Next thing we'll see is thedriver on the cover of Consumer Reports doing MPP longevity test 