Pre-op Appointment Tomorrow - what ?'s do I ask?

[rglassva]

My pre-op appointment with Dr. McCammon is tomorrow at 11a - here are the questions I plan to ask:

Based on your knowledge of my situation, history (aborted surgery last summer), and the resources you have at your disposal (smaller implant, grafting, etc.), what is your best educated guess on the percentage chance that you'll be able to get the three-piece implant in with both cylinders? (realizing there are always some unknowns until you get in there). At what point do I cancel? 50/50 shot? 60/40? I do NOT want to wake up in recovery again with "sorry, I wasn't able to get one in" - I also really don't want to hear "I was only able to get one cylinder in"
Would you mind pulling on my wanker with the same strength you plan to when you decide on the size of the implant? What if it's cold in the operating room and there is "shrinkage" - do you take that into account when sizing?
Should I keep pumping until day of surgery?

Any other questions you guys think I should ask?

Thanks gents.

Rick

[dirtman1993]

You need to have more confidence in the doctor then it appears. The implant will only fit in the god given area you have. Take the time, go to YouTube and find videos from Dr. Krame and watch as many as you have time for. Write down question have for whoever is doing. Put off till you have a 100% trust in the doctor you select.

[Lost Sheep]

I am at the start of the process of addressing my erectile dysfunction. Here is my list (so far)

I appreciate your time as you appreciate my concerns. This is a surgery not necessary for life, but important for quality of life and so I am carefully weighing my options. I also want to stay with the same clinic from diagnosis all the way through to ultimate solution (which, from my research, appears likely to be an implant). I know we have a lengthy process of diagnosis before considering this option. I do very much want to stay with the same clinic and Physician throughout the process.

Thank you for your attention to my questions.

Prospective patients are strongly advised to seek surgeons who have done many, many implants. What are your feelings about this advice and may I ask how many each of you have done in the past year?

Are there surgeons whose techniques you have adopted or under whom you have trained?

Are there any patients who have volunteered to give testimonials?

Do you do the surgery as a team (all three or two) or just one surgeon at a time? (The clinic I sent this email to has three surgeons who do the implants)

What philosophy do you follow in sizing the implant and determining the ratio of rear tip extender(s) length to inflatable length? What are the deciding factors?

What factors do you consider when choosing maker/model/type of penile implant, AMS or Coloplast (or others?), Inflatable or malleable/semi-rigid?

Regarding the Malleable/Semi-Rigid vs Inflatable question: In your experience, does the VA exert any influence over this choice?

I saw an interview with Dr J. Francois Eid and Dr Paul Perito. Those two surgeons use very different techniques. Dr Eid. uses a "no touch" procedure which minimizes skin contact and avoids having a drain. He goes in through the scrotum with a vertical incision and finishes with a water-tight closure. Dr. Perito uses a 1.5" to 2" lateral/transverse incision above the penis in a procedure which minimizes exposure time, and utilizing a drain. Each has advantages, of course. Are there other procedures? Do you use one or the other exclusively?

There are sometimes issues with nerves being cut (particularly with a scrotal approach and transverse incision). Can you comment?

Thank you again.

[rglassva]

Well, pre-op appointment went as well as I expected it to - doc answered all of my questions to my satisfaction - I am moving forward with the surgery in two weeks. He told me to definitely keep pumping every day until surgery. He'll have a CX, a CXR, and a malleable implant ready and waiting along with grafting material in case he needs or can use that to help get the cylinder(s) installed. He's 70-80% sure he can get ONE cylinder in . . . wouldn't go beyond 50/50 for two until he gets in there but he knows how much I want it to be two - if at all possible. Malleable will be the last resort. Surgery scheduled for 1p and he says I'll definitely stay overnight - I can stay up to 23 hours and still have it be considered outpatient surgery. Countdown continues - two weeks and a day. . . .
Rick

[David_R]

I can stay up to 23 hours and still have it be considered outpatient surgery.

I had the same thing post-implant insertion. Isn't it amazing that 23 hours can count as outpatient?

[stringerbell]

I saw that video too between those 2 surgeons, I also saw a younger Dr. Kramer in the video discussing the importance of training younger surgeons, etc. He looked like at the time he was early 30's, seemed to young and police- no big video library or BiG VIP practice like now. maybe just seemed obvious he was the heir apparent at that time to be the king of the implant world, just needed a few years. That was 10 years ago, and I do think that's what happened.

[Lost Sheep]

Here are some I will be asking Sept 2, 2016. Please add your comments/suggestions.

Are you giving too much confidence to my (lay) opinion?
 
 
 
I may appear to be knowledeable and confident, but I am far from either.  There are certainly gaps in my knowledge and my judgement that I hope you will fill and provide certainty.  I know that the implant operation is likely to destroy most, if not all, spontaneous erectile response in the shaft, but my knowledge of anatomy is limited, so the effect on glans response is unknown to me as are any other effects.  Likewise, mechanical operation of the device is unknown and (being mechanically minded) I hope to examine the operation of a device like mine before it is inside me.
 
Sep 19 is quite a bit sooner than I had expected.  We are not skipping any steps are we?   I have done a lot of research, but I am still a layman, so could miss what a medical professional would find obvious (and what you might think I already know, but don't).  Also my clinical observations are just that, my observations and subjective without any quantitative or objective measure.  I had expected a battery of tests (Doppler ultrasound, etc.)  Non-invasive diagnostics are a lot safer than radical and irreversible surgery.
 
I am OK with going ahead on Sep 19, but wish to have assurance that I/we have not left a stone unturned (except VED and injections, which I am comfortable skipping), particularly any pre-op treatment that promised to improve the odds of an optimal outcome (e.g. VED for pre-op elasticity optimization seems as if it might be a good idea.  I would scrupulously follow a regimin if it might be beneficial).
 
 
 
Miscellaneous confidence level.
 
 
 
I am assuming the AMS representative brings (or has in storage here in Anchorage) an inventory of devices and sizes.  Is there an inventory of devices sufficient to guarantee the right size for me will be on hand?  I would not like to have the patient before me take the last one of my size.  Also would not want "old" inventory if improved models are available.  
 
The AMS rep will be coming up from Seattle.  Would I have a chance to meet?
 
 
 
 
What can I expect?  Normal recovery path, complications and general hand-holding.
 
 
 
 
I have enough confidence in your surgical skills to go ahead and Robyn and ____ have been wonderful but my encounters with the rest of your team have been less than reassuring.
 
I would like to have a map of what I can expect post-op as well.  My interactions with Laura have been minimal and if I have questions for you, I am doubtful of getting them answered timely.  What I should do in the event of alarm has me concerned both for post-op worries (days) and for questions weeks or months down the road.  I have read testimonials with many such questions, pump location, tubing wrapping arount testicles, sticky pump valves, etc.
 
Should I be doing anything to restore any lost elasticity (vacuum device, exercises, using up the last of my oral medications)?
 
 
 
 
So much for my confidence level.  Here are substantive questions on my mind.
 
 
On Franktalk.org a member posted photographs of his (reported to be an) AMS CX implanted penis that shows length growth from 3" uninflated to 5.5" (inflated).   I did not think that possible.  Is this (expansion ratio) something commonly seen or is this a rare case?
 
I expect that the AMS 700 LGX, having some length increase during inflation, would allow for the possibility of regaining lost penile elasticity over the months and years following implantation.  Is my thinking correct?
 
Is the AMS 700 LGX forgiving of over sizing?  Since it is purported to increase in length when inflated, I wonder.  I would be conservative in inflation pressure, as I believe inflating to the maximum has the potential to shorten the service life of the device.  (I would love to be able to ask the AMS representative how usage and pressure affect service life.)
 
Is the main issue of sizing one of balancing "floppy head" syndrome against erosion?
 
Tell me about the potential for tissue erosion (glans), adhesion and any other long-term issues.   What about regaining penile elasticity (and length) over time.  I assume expanding girth is not an issue.
 
I also expect the AMS 700 LGX to be amenable to a small degree of undersizing without risk of "floppy head syndrome".  Is my thinking correct on this matter?
Does the LGX length flexibility reduce the likelihood of "floppy head syndrome"?  By the way, how DOES length and girth ratio work?
 
On Franktalk.org a member posted photographs of his AMS CX implanted penis that shows length growth from 3" uninflated to 5.5" (inflated).   I did not think that possible.  Is this (growth ratio) something commonly seen or is this a rare case?
 
I have asked (around) this question before, but want to understand fully.  Besides I have never seen an implant, only photographs that do not give much detail and no tactile information at all.  The AMS 700 LGX, with its length expansion has the ability to "grow" with any regaining of lost penile length?  
 
You said you size aggressively.  Can you tell me about how we make that decision?  How measurements are made, etc?
 
In one case, a surgeon first inserted 22 cm cylinders without RTEs. After inflating (during surgery) he thought there was room for more and inserted 1 cm RTE. After another inflation, he still thought there was room for more and took the 22 cm Implant out and inserted a 24 cm implant without any RTE. He found that to be just on the borderline of oversizing, but went ahead anyway and the patient reports satisfaction.  What would you do?
 
Sept 19 is near the close of my best window of convenience for this surgery.  How long do you think I would be
1) effectively bedridden (unable to sit upright for 8 hours straight)
2) off work (sedentary work seated in front of a computer involving a 6-mile 15 minute drive each way and half-days a possibility)
3) able to return to full everyday function including light exercise (exclusive of sexual activity)
This is largely to schedule my leave time and also to schedule friends to look in on me, grocery shop, etc.
 
How deep do you install the reservior?  What are the issues governing placement?  I do intend to continue my (conservative) weight loss regimen to a target weight of 170#-175# or so and as lean as is healthy.  A visible 6-pack would elevate my self-image nearly as much as erections, especially since the 6-pack would be organic and not surgically restored.
 
I have read of men who, with an implant, still use oral medications (Viagra/Sildenafil, Cialis, Tadalafil/Levitra) so that they will get engorgement of the glans.  How common is that?  I would be somewhat disappointed to still depend on oral medifications AFTER an implant.  What is my realistic expectation?
 
Do you prefer the patient awake or asleep during the surgery?  I am thinking that if I am awake, I could have input in any choices you need to make.  On the other hand, being awake during a surgery is a bit stressful.
 

[David_R]

Does your doctor have a satisfied patient who is willing to talk with you about (and maybe even show you) his implant? Maybe the implant manufacturer has an implanted man you can talk with. It is one thing to know about implants; it is another to actually have one inside your body.

[Lost Sheep]

Does your doctor have a satisfied patient who is willing to talk with you about (and maybe even show you) his implant? Maybe the implant manufacturer has an implanted man you can talk with. It is one thing to know about implants; it is another to actually have one inside your body.

There are 20 in the local area who could give testimonials but I do not have contact information for any of them, yet.

I have 3 people with experience with this doctor. Two of them like him and 1 recommends against. None have had this procedure.

I have talked on the phone with one man in the local area who has an implant but not done by this doctor it was done out of state. I will be talking to him again in a few days.

Thanks for the thoughts and for reading through my rather long post. You can tell I'm kind of nervous.

Lost sheep

[roninhouston]

Does your doctor have a satisfied patient who is willing to talk with you about (and maybe even show you) his implant?

Most doctors have a list of clients, mine did, and I called them. Now I am on the list.