My Story Through Implant on 3/3/10

[ben1948]

I'm 61, and very happily married, with my 40th anniversary coming up in June. I have been dealing with ED since I was in my mid-40s. By the mid-90s, I could still get a firm erection, but it would go away with lightning speed (I'm sure that was what I eventually learned was called venous leakage going on), so I had to get it in quickly and never stop moving at a good pace (which I hated, we both prefer a style of intercourse with a slow in and out, accompanied by lots of kissing and touching). The refractory period after orgasm was hours, so more than once in the same session was no longer possible.

Being a physician, I was aware of Viagra when it first came out and started using it in 1998. What a miracle that was! Firm erections and a refractory period as short as a few minutes. 2 orgasms became my norm, extending to 3 occasionally, and 4 on one special occasion. I would get mild headaches and slight blueing of my vision from the Viagra, but I hardly cared--I was more capable than I had been even in my 20s.

This continued to work beautifully for 3 years or so, and then the effectiveness began to fall off. Over a 5-6 year period beginning in 2002 I consulted urologists for the first time, and eventually figured out that the average urologist knew less than I did about ED by this time, so I told them whatever I wanted to try and they prescribed it.

I tried Cialis and Levitra and found the Cialis slightly better than the others for me and started using that. I tried the intra-urethral Muse product, which felt awful and didn't produce an erection. My testosterone level was steadily dropping during this period of time, and got below 200, so we added first Andro-gel, then Testim to the mix. That clearly improved my libido (which had really dropped dramatically), but had no effect on the quality of my erections, which was sufficient for "stuffable" intercourse, but not very firm at all.

I tried tri-mix injections into my penis which improved things somewhat for a while, but is the most likely reason I developed Peyronie's disease (in which scar tissue on the inside of the penis bends it in different directions). Prior to my recent implant surgery (which straightens the penis and essentially cures Peyronie's), my penis was curving upward approximately 15-20 degrees, and 10-15 degrees to the right--on those fleeting occasions when I had an erection firm enough to see it, or while under vacuum.

I tried a vacuum erection device combined with a cock ring. I never could get this to work very well and both of us really hated it. Besides, you can't leave the cock ring on very long, and it leaves your penis numb.

In late 2007 I became aware that a Dr. Larry Lipshultz, here in Houston, Texas, was one of the pre-eminent specialists in the treatment of ED. I learned of him from a couple of patients who sang his praises.

With him, I underwent a quite thorough evaluation. He determined from injecting the penis and doing a Doppler ultrasound that blood flow into my penis was relatively normal, but that the mechanism to capture the blood flow to produce an erection was not--the dreaded venous leakage. Venous leakage doesn't respond well to typical ED treatments. He didn't push the idea of an implant and I wasn't yet ready to consider that. He had a regimen of medications which he said had been successful in reversing venous leakage in some individuals--so over an 18 month period I took 25 mg of Viagra every day, Cialis when intending to have sex, and 2 or 3 other supplements he recommended as good for penis health.

By the fall of 2009, it was clear that I had no significant improvement from that, and I asked him about an implant. He thought I was a perfect candidate--I had tried all the other options, I had conditions which an implant is optimal for--venous leakage and Peyronie's disease, and I was otherwise in excellent health. My fall and early winter schedule simply didn't allow time for having the procedure done, so I saw him again in January and scheduled an implant for 3/3/10.

Around 85% of implants are the 3 piece type, and that is what I chose. They are mechanically more complicated than other types, but produce the firmest and most natural looking erection of any of the choices. More than 90% of men and their partners are satisfied with implants when all is said and done, which is far higher than the satisfaction levels with any other ED treatment.

As I type this, I am 4 days post-op. I have essentially been pain-free at rest since the catheter was removed on Thursday morning, 3 days ago. I have had minimal swelling and bruising, no pain at the incision site (3-4 cm horizontal incision high in the scrotum underneath the penis). I have mild to moderate discomfort from the pump in my scrotum, but others who have had this procedure say you eventually will be unaware it is there. I would just like to fast forward through the next 4-6 weeks, and ride my new bicycle.

Hardly anything is written about the psychological side of ED these days, and most ED is now thought to be organic rather than psychogenic in origin. However, whatever the cause, failure to perform certainly results in some degree of performance anxiety in probably everyone, which doesn't help. I think, however, that it would be unlikely that a primarily psychogenic cause of ED would end up in an implant. I would think that the pharmaceutical approaches would typically handle that well. But in the end, it doesn't matter, if nothing else works, then an implant will--barring surgical complications, infection, etc.

I think that my story is a fairly common one, based on what I have read on a variety of sites on the web. If I had it to do over again, I would have found a top specialist in ED much sooner, and probably had my implant 5 years ago. That is also a quite common comment by those who have had implants--that their only regret is that they did not do it sooner.

Your average doctor, or even average urologist, isn't much help past the point of prescribing Viagra, Cialis, or Levitra. Once you educate yourself about ED, you will know more than most of those doctors on the subject. If one of the pills works well, I see no reason to do anything more for as long as it continues to work. If one of those doesn't take care of the issue, then I would find the nearest real specialist I could find. If you have to drive a long way, so be it. From this website, and others similar to it, you should be able to find what top ED doc is nearest you. Don't choose a doctor for implant surgery who isn't doing them every week. It is critical that your surgeon be very knowledgeable and very experienced. This is not a place to cut corners!!

My wife has been 100% supportive of whatever I wanted to do each step of the way in dealing with ED. We have certainly become better lovers as our focus has been less on penis-in-vagina sex. However, one of the clinching moments for going ahead with the implant was a conversation in which I asked her how long she envisioned us having sex and how important it was to her. She couldn't come up with a specific number but said she was nowhere near ready to do without sex in the forseeable future, so I should plan on 15 years or more! And, like the majority of women, she has never been able to achieve orgasm from intercourse alone, but loves the feel of it nonetheless. I know younger people don't like to think about their parents or grandparents having sex, but given good health, the majority of people are sexually active into their eighties or even older that that. And let me promise you that you never feel as old as you look, and that for most of us, desire never goes away.

Although I think it is foolish, guys tend to be obsessed with the size of their penis. I think women would tell you that the 5 most important things about a penis are:

1. Hardness (outstanding with a 3 piece implant)
2. Hardness
3. Hardness
4. Hardness
5. Girth (which the implant will most likely increase noticeably)

I don't think length is something your partner is likely to be concerned about if you are 3" longer or more. As a physician who has done pelvic exams on women, I can feel their cervixes with my middle finger, which is 3.5" long (I have long fingers). The only spot inside the vagina which possibly causes pleasurable sensation for the woman is the famous "G spot", but it is only about 2" inside (and on the front wall of the vagina for the geographically impaired). A penis which is too large will typically be a much greater concern for a woman than one which is too small. Comments are welcomed on this point from any women who lurk on this site.

You can NOT increase your length with an implant, and you risk some nasty complications if am implant which is too large is used. The head of your penis may be softer (thus smaller) than previously, and the biggest implant which isn't too big might be slightly shorter than your natural cavity, but I would think the most you would lose in good hands is 1-2 cm.

My implant is an AMS CX, which has the capability to expand in girth, but not length. Probably the most common implant currently is the AMS LGX, which has the capability to expand in both girth and length--to the maximum size of your natural cavity. This might give a slight increase in length in some cases compared to the CX (likely not more than 1 cm). My surgeon's opinion is that the CX has fewer complications than the LGX for patients with Peyronie's, such as myself.

The best predictor of your post-op length is your stretched flaccid length. Stretch it out, plant the butt of the ruler firmly against your pubic bone and measure. This is the most you should expect.

I think that men who say they have lost substantial length are thinking of their penis as it once was, before being shortened by disease, disuse, or as a consequence of prostate surgery. Unless of course, they had an incompetent surgeon. I think that those who claim to have increased size have not obtained their natural maximum in so long that doing so seems like an increase in length.

Also remember that the more belly fat you have, the more of your penis is concealed. Reaching a trim weight will maximize the apparent size of your penis. Lots of other good medical reasons to maintain an optimal weight, but perhaps this one will register more than some of those other very good reasons.

My pre-op flaccid length was about 3 inches, post-op partially flaccid length is 4.5 inches and clearly more girth. My implant was kept inflated to around 80% until the day following the surgery. I didn't have my ruler at the hospital (imagine that), but partially inflated it felt stiffer than I have attained in a long time, very straight, and appeared to be 5.5 to 6". My stretched flaccid length pre-op was about 6.25 inches with the base of the ruler pressed firmly against the pubic bone. I'm totally confident that size will be fine. Now comes the really hard part, impatiently waiting while things heal before I can use it.

I hope this information is useful. I certainly pored over every account I could find anywhere on the web before making my decision, and greatly appreciate everyone who has shared their story.

I have some pictures I can post if it is possible to do so on here. I'll check with the moderator about that.

[ben1948]

Pix as promised. The pre-op ones are the ones with hair. Afterwards you will be bare as a baby and get to endure the hair growing back in.

[ben1948]

More pix.

[ben1948]

And more pix.

[ben1948]

And 2 more.

[jackpTenn]

Ben

A good and well written story.

There is only one thing the good doctor has missed. The LGX is now recommended for peyronies patients. I have peyronies and that is the implant I have.

Dr. Douglas Milam at Vanderbilt in Nashville TN has an article in The Journal Urology coming out in the next few month about it. Once it is published I have his permission to post it on this or any forum I choose. I will post it just as soon as available.

Since my surgery 10/23/08 at Vanderbilt with the LGX I have a firm straight erection and have gained 90% of my length back lost to peyronies. Part of my stats are in the article coming out by Dr. Milam.

Good Luck. Take it from me that with the implant you will be more than well pleased.

Enjoy

JackP

[Marvin]

Thanks for the post. By the time you read this, I should be on the table getting my implant. My Doctor Leroy Jones is here in San Antonio, Texas. His office says he in the number two man in doing implants, the only one that really concerns me is the one is going to do at 11:45 on March 09.
Take care and I will more to this post when I am up and ready.
Marvin

[ben1948]

Following are some notes I posted on another web site the day before my implant procedure and in the immediate post-op period:

3/2/10

I know this is the right thing for me, but the closer I get to my actual surgery on 3/3/10, the more nervous I get (and the more trouble I have getting the small percentage of surgeries with complications out of my head).

My wife is totally supportive, which helps immeasurably.

Dr. Larry Lipshultz here in Houston (and by any measure one of the top implant docs in the country) is my doc. He didn't push me at all during the 2+ years I was seeing him (and 10+ years of gradually worsening issues, and a couple of different urologists before seeing him) before making the implant decision. Once I made the call he was very supportive and said he thought it was really the only satisfactory solution for someone like me with venous leakage and Peyronie's disease.

I plan to post something on a daily basis following the surgery, in an attempt to give back a little for all that I have learned from others on here and a few other places. If anyone has any questions whatsoever, please don't hesitate to email me.

I am a physician myself, so I may have a few extra insights by the time I get done.

One minor difference in terms of the surgery. I think most docs use general anesthesia, but I am of the opinion that local, regional, or spinal anesthesia is always safer, and the recovery quicker. Dr. Lipshultz was quite willing to do my procedure under an epidural block (like women get during labor and delivery) plus IV sedation to put me to sleep.

Dr. Lipshultz keeps everyone overnight (my procedure is at 8:30 a.m. on Wednesday), so hopefully I will be able to post by Thursday.


3/4/10

Well, I'm feeling excellent at this point.

The anesthesiologist had difficulty getting the epidural catheter threaded for the spinal anesthesia, involving several sticks, which wasn't a lot of fun, but eventually got it in. Shortly afterward the sedation went in and I was out until I woke up in the recovery room around 12:30 p.m.

About 2 hours after I woke up, around 3 p.m., the discomfort got pretty bad and I asked for hydrocodone, which worked well and put me to sleep for a while. Then I was moved from recovery to a regular room for overnight (standard practice of my doc).

The next several hours were quite uncomfortable, mostly due to 2 factors, the catheter was uncomfortable, and I was tethered to an IV, a catheter and tubes to pump air to the compression devices on my calves which this hospital routinely uses--air is pumped to each compression device sequentially to promote blood flow and reduce the chance of clots and emboli.

All of which made it difficult to find a comfortable position and I had a lot of back and muscle pain--op site wasn't bad at all, but catheter and back had me up to a consistent 4 or 5 on the pain scale of 0-10. I took hydrocodone about 9:30 p.m. and it really didn't help.

I watched TV and gingerly tossed and turned and suffered until about 3:30 in the morning, when I called the nurse for pain medication. It was only at that point that I learned that my doc's orders included a one-time use, if requested, of Toradol--a very potent anti-inflammatory drug which has been found to be very effective when given IV and especially post-op. That worked wonders, and allowed me to sleep solidly for the next 3 hours and really relieved the back and muscle discomfort. Some quick research reveals that a number of studies show IV Toradol to be very effective for post-op pain, possibly more effective than morphine, and not a narcotic.

Yesterday was more uncomfortable than I anticipated, but today is much less uncomfortable than I anticipated. I was discharged at 11 a.m., and have been pain free at rest without using any further pain medication. I am able to ambulate to go to the bathroom, or anything else I have to do. It twinges when going from sitting to standing or standing to sitting, and it burns a bit when I urinate, a legacy of the catheter which I should resolve quickly. The implant is minimally inflated, and that may be what is causing my urinary stream to be at a lower flow rate than usual.

Unless more shows up later, I have very minimal bruising and swelling. Dr. Lipshultz uses the scrotal approach, and I have about a 1.5 inch horizontal incision high in the scrotum underneath the penis. The incision site isn't painful at all, probably because there is no tension on that skin.

Dr. Lipshultz left the AMS 700 CX (he does not believe in using the LGX in patients with Peyronie's disease) inflated to about 80% overnight, and I was VERY pleased with the size and appearance of my penis. It looks like I will lose little if any length (I'd guess no more than a centimeter), and gain in girth.

I think guys tend to be way too concerned about length. I have long fingers, and my middle finger is 3.5" long, which as a physician I can tell you is long enough to feel the cervix during a pelvic exam. The vagina does expand in size when the woman is excited, but there are few nerve endings inside the vagina. It looks like I will have 5.5 to 6" with increased girth--more than enough for all the fun I can handle. I can't wait for the next weeks to go by!

3/5/10

Slept well last night. No pain at the incision site. The only noticeable discomfort today is continued burning on urination (but less discomfort than yesterday), and occasional squawks from my left testicle about sharing space with an interloper. I'm left-handed, so they put the pump on the bottom of my scrotum on the left side. Still no major swelling or significant bruising. I don't know if my surgeon was that good or I was just lucky, or both, but I expected much worse.



3/6/10

Today is pretty much the same as yesterday. Some aching from the pump, still some burning with urination. No pain or discomfort at rest. Still minimal swelling/bruising.

Did all of you who have already had implants have some burning after the catheter was removed? And how long did it take to go away.

My pre-op flaccid length was about 3 inches, post-op flaccid length is 4.5 inches and clearly more girth. My implant was kept partially inflated until the day following the surgery. I didn't have my ruler at the hospital (imagine that), but partially inflated it felt stiffer than I have attained in a long time, and appeared to be 5.5 to 6". My stretched flaccid length pre-op was about 6.25 inches with the base of the ruler pressed firmly against the pubic bone. I'm totally confident that size will be fine. Now comes the really hard part, impatiently waiting while things heal before I can use it.