General vs. Spinal Anesthesia for Penile Implant Surgery: Experiences with Dr. Clavell

[sambalamba]

Background/Context (Short Summary)

I’m preparing for a penile implant procedure and have noticed different surgeons have strong preferences regarding anesthesia:

Dr. Clavell commonly uses general anesthesia, though I’m unsure if it’s typically IV sedation (“twilight”) or a fully intubated approach.

Dr. Eid is known for using spinal anesthesia, which is said to provide more pronounced relaxation of penile smooth muscle—potentially helping the penis reach a very limp, elongated state during surgery, making sizing and manipulation easier.

Additionally, Dr. Eid has mentioned a concern that, under general anesthesia, some patients cough violently when the breathing tube is removed (extubation). He believes this could displace the reservoir from its intended position in the pelvis. This is one reason why he advocates spinal anesthesia in many cases, as there’s no need for a breathing tube (and thus no extubation cough).

Questions

Dr. Clavell Patients: If you had surgery with Dr. Clavell, did he use IV sedation (“twilight”) or a fully intubated general anesthesia? How was your experience—especially regarding comfort, recovery, and pain management?

Spinal Anesthesia (e.g., Dr. Eid’s Method):

For those who had a spinal block, did you notice a significant advantage in terms of penile smooth muscle relaxation and ease of implant sizing?
Did you experience any downsides, such as a spinal headache or a time limitation on the surgical procedure?

Coughing/Reservoir Displacement: Have any of you who had general anesthesia experienced—or heard of—issues with coughing during extubation that could potentially shift the reservoir position? Did your surgeon mention or address this concern?

Comparisons: If anyone has had both general and spinal anesthesia (for any urological or implant surgery), can you share the pros and cons regarding comfort, postoperative pain, penile relaxation, and overall outcome satisfaction?

I’d really appreciate any experiences or knowledge on this topic.

[GoodWood]

I sent you a PM and am happy to chat with you since Inhave some experience in this area.

The short answer is: both general anesthesia and spinal anesthesia are very safe for the VAST majority of patients. For the few with significant health issues (usually severe heart valve disease or coronary artery disease the anesthesiologist providing your care for the surgeon should be your guide.

Although the term “twilight anesthesia” is thrown around at times this really isn’t correct here. Sometimes it is used to mean general anesthesia without being intubated. But really twilight anesthesia is a deep sedation where you could still follow a simple command (“roll on your side” for example) if they really harassed you.

Placing the cylinders in the base of the pelvis is WAY too stimulating for twilight anesthesia.

So it’s general (with or without being intubated) or spinal.


The best advise is to do whatever your surgeon prefers. THAT is the person you want happiest during your procedure. You want them to have the easiest time possible. Not changing what they do for your preference.

[Martin25]

The short answer is: both general anesthesia and spinal anesthesia are very safe for the VAST majority of patients. For the few with significant health issues (usually severe heart valve disease or coronary artery disease the anesthesiologist providing your care for the surgeon should be your guide.


The best advise is to do whatever your surgeon prefers. THAT is the person you want happiest during your procedure. You want them to have the easiest time possible. Not changing what they do for your preference.

I agree! I don’t think either approach affects sizing. Don’t overthink it!

[Thisworld]

I think that spinal is generally more safe. Wouldn't Clavell or Hakky offer that option also? Is Eid the only one?

[sambalamba]

I think that spinal is generally more safe. Wouldn't Clavell or Hakky offer that option also? Is Eid the only one?

I think all surgeons want to follow a certain protocol and would not be happy with deviating from that protocol. I had asked Hakky what technique he uses and he said general and reiterated it has to be general because he thinks it's the best for the patient and the surgeon. Proof of different surgeons wanting to stick to their protocol.

[Journeyman]

Dr. Clavell did my surgery. All I know is i was laying on the operating table talking with the nurse anesthetist, answering her questions. Then I woke up 2 hours later s newly implanted man . I didn't even know I was alive for those 2 hours . I WAS OUT !!! . Don't even remember them starting the anesthesia. When they were waking me up , I couldn't believe it was all over and done. It was amazing.

[sambalamba]

Dr. Clavell did my surgery. All I know is i was laying on the operating table talking with the nurse anesthetist, answering her questions. Then I woke up 2 hours later s newly implanted man . I didn't even know I was alive for those 2 hours . I WAS OUT !!! . Don't even remember them starting the anesthesia. When they were waking me up , I couldn't believe it was all over and done. It was amazing.

Have just sent you a PM

[newbie443]

Background/Context (Short Summary)

I’m preparing for a penile implant procedure and have noticed different surgeons have strong preferences regarding anesthesia:

Dr. Clavell commonly uses general anesthesia, though I’m unsure if it’s typically IV sedation (“twilight”) or a fully intubated approach.

Dr. Eid is known for using spinal anesthesia, which is said to provide more pronounced relaxation of penile smooth muscle—potentially helping the penis reach a very limp, elongated state during surgery, making sizing and manipulation easier.

Additionally, Dr. Eid has mentioned a concern that, under general anesthesia, some patients cough violently when the breathing tube is removed (extubation). He believes this could displace the reservoir from its intended position in the pelvis. This is one reason why he advocates spinal anesthesia in many cases, as there’s no need for a breathing tube (and thus no extubation cough).

Questions

Dr. Clavell Patients: If you had surgery with Dr. Clavell, did he use IV sedation (“twilight”) or a fully intubated general anesthesia? How was your experience—especially regarding comfort, recovery, and pain management?

Spinal Anesthesia (e.g., Dr. Eid’s Method):

For those who had a spinal block, did you notice a significant advantage in terms of penile smooth muscle relaxation and ease of implant sizing?
Did you experience any downsides, such as a spinal headache or a time limitation on the surgical procedure?

Coughing/Reservoir Displacement: Have any of you who had general anesthesia experienced—or heard of—issues with coughing during extubation that could potentially shift the reservoir position? Did your surgeon mention or address this concern?

Comparisons: If anyone has had both general and spinal anesthesia (for any urological or implant surgery), can you share the pros and cons regarding comfort, postoperative pain, penile relaxation, and overall outcome satisfaction?

I’d really appreciate any experiences or knowledge on this topic.

I have no experience with Dr. Cavell and have only messaged Dr. Eid on other issues. I did have general for my first surgery and spinal block for my repair. Back some years ago many men on this site were convinced that for proper sizing you needed to have the spinal block. This guarantees that the tissue is relaxed. With general the doctor needs to use another medication to relax the tissue. That or be a good enough doctor to know how much to over size. But if you are using a doctor that is not considered a very good high volume doctor you should request the spinal. Or even if you are using a really well known doctor. I have a bag reaction to narcotic pain meds. When I was in recovery from my first general anesthesia, I had a hugh painful dry heave. I was alone and kept over night. It took me a few days to recover from the anesthesia. I had a catheter in, and it was removed the next morning. I took no pain meds after my first until my flight home. I did take 1 of them to see how it effected me so I would not have a surprise reaction the day of my flight. For the repair I not only requested a spinal block but also requested no sedation and I was awake much of the time. With the spinal block I was to make a 3.5 hour drive home after I was released. I was held in recovery until I could pee and the nurse kept using an ultra sound to make sure my bladder was not so full it would cause injury. As the spinal wore off and I could feel and move my legs I did have some pain. During that drive home (my son drove me home) The pain was bad enough that I did take a pain pill but no narcotic pain meds after that. My first doctor instructed me to take Motrin to reduce swelling. I took one of those with a Tylenol. That was a very effective pain med for me and I have seen doctors recommend that for others. The repair was by far a much nicer recovery. I would like to add that my hearing is very bad and I could not understand anything that the doctors were saying during the surgery. I could not see any thing as they had a drape. I just lay there and looked at the ceiling and took a fer short little naps.

[tomas1]

I absolutely hate it while undergoing a medical procedure and the doc banters with someone or explains what's going on. I prefer not knowing.

[sambalamba]

I have no experience with Dr. Cavell and have only messaged Dr. Eid on other issues. I did have general for my first surgery and spinal block for my repair. Back some years ago many men on this site were convinced that for proper sizing you needed to have the spinal block. This guarantees that the tissue is relaxed. With general the doctor needs to use another medication to relax the tissue. That or be a good enough doctor to know how much to over size. But if you are using a doctor that is not considered a very good high volume doctor you should request the spinal. Or even if you are using a really well known doctor. I have a bag reaction to narcotic pain meds. When I was in recovery from my first general anesthesia, I had a hugh painful dry heave. I was alone and kept over night. It took me a few days to recover from the anesthesia. I had a catheter in, and it was removed the next morning. I took no pain meds after my first until my flight home. I did take 1 of them to see how it effected me so I would not have a surprise reaction the day of my flight. For the repair I not only requested a spinal block but also requested no sedation and I was awake much of the time. With the spinal block I was to make a 3.5 hour drive home after I was released. I was held in recovery until I could pee and the nurse kept using an ultra sound to make sure my bladder was not so full it would cause injury. As the spinal wore off and I could feel and move my legs I did have some pain. During that drive home (my son drove me home) The pain was bad enough that I did take a pain pill but no narcotic pain meds after that. My first doctor instructed me to take Motrin to reduce swelling. I took one of those with a Tylenol. That was a very effective pain med for me and I have seen doctors recommend that for others. The repair was by far a much nicer recovery. I would like to add that my hearing is very bad and I could not understand anything that the doctors were saying during the surgery. I could not see any thing as they had a drape. I just lay there and looked at the ceiling and took a fer short little naps.

Thanks.

Also many many thanks to GoodWood. He explained to me very clearly that there are different types of general anesthesia. If I understood him correctly, the most invasive general anesthesia is where someone is fully intubated where the lungs are not breathing on their own. I think the chance of dry heaving is the most in this form of general anesthesia.

It's interesting that with spinal they didn't insert a catheter for you. They just waited for you to pee and let you leave. I had discussed this with Dr. Clavell. He indicated that with spinal the lower body is completely numb and it takes a while for all the organs to wake up. Hence there is a higher need for a catheter as opposed to general where the whole body is awake much faster. One of the ways he can avoid using a catheter at all is his use of general. Dr. Eid always inserts a catheter and keeps it there for two days I believe. I don't know which is worse getting fully intubated or getting a pipe shoved up your urethra.

Anyhow my wife's cousin had surgery before with fully intubated anesthesia and she also had a bad experience. My wife recently had a surgery where she only got IV general anesthesia and she barely had any after effects of the anesthesia. She was up and about the same day of the surgery.