How many is enough? (Surgeon's Experience)

[Lost Sheep]

The usual advice is to find a surgeon who has done implant surgery many times, so he ihas a lot of practice. How many is enough? No one mentions a number, though Drs Eid, Kramer and Perito, who seem to specialize in implants, appear to do hundreds, if not thousands per year and are the "gold standard" for well-rehearsed surgeons.

I met with a Urologist Wednesday. He uses both Coloplast and AMS and both Scrotal and Infra-pubic entry. I asked how many surgeries he has done in the past year and he replied "20". Is that enough to consider him well-practiced or am I taking a risk? I have not yet quizzed him in his philosophies regarding sizing, choice and options, as we are just beginning to evaluate my E.D.

Because of my "insurance" coverage, switching physicians might not be easy, or advisable. I also found him pleasant and comfortable to talk to.

Any advice?

Dr Robert Allen in Anchorage Alaska.

Lost Sheep

[RelievedofED1]

That is a hard question (pun intended). But it really is. Ideally someone that does 25-50 a year so that it isn't weeks since the surgeon and surgical staff have done one as not only the surgeon but surgical team need to have a routine that minimizes infection and maximizes size. I am concerned that he does both approaches annd would hope he has a preference and frankly that it is the scrotal approach. That is just my opinion and likely will have some pushback from others but less chance of nerve issues. I would be sure the facility does more than 20 implants a year to be sure they stock all sizes of implants to avoid using extra rear tip extenders to make up for not having the larger size if they only stock every other one. Using RTEs should be to make an 18 fit a 19cm space (18 plus 1 cm RTE) not an 18 fit a 22 cm space (18 plus 4) except in rare circumstances. You need to know their failure rate % and why ie infection rate. If infection rate is more than 1% you should reconsider. And how did the last 10 go? And you need to be sure the surgeon is OK with all the questions as you will have more after surgery especially if you have any complications. If they don't like you politely asking about the one time you get to have your first implant then run away. All that said there are many very competent surgeons out there who don't do 100s a year. Based on my experience I would go to Dr Kramer no matter the travel it required or in my case did require but as you say your insurance may not allow that so do your homework and if the answers are acceptable, he is ok with questions then go with your gut.

[mouseco]

I believe the most important thing to consider is a doctor's infection rate. If you get infected things get complicated and go downhill very quickly. Be aware that the implant success rate is 95% and the satisfaction rate is 85% of that. I would choose the most experienced high volume Doctor available.
I believe in an earlier post you mentioned you were limited to the VA. University of Maryland hospital in Baltimore is adjacent to the Baltimore regional VA hospital. Dr Andrew Kramer consults with the VA.

[charlesr]

I had my urologist who completed my robotic radical prostatectomy also perform my penile prosthesis. He did an excellent job and I have never had any complications. He sized it perfectly. I have no idea how many implant insertions he did annually and I didn't care.

I feel that a competent urologist / surgeon is usually in a position to pull off a decent implant surgery. I watched videos on both radical prostatectomies and penile implant insertions. Frankly, next to the prostatectomy, the implant procedure looked so simple that I felt that even I could do it.

[mouseco]

Charlesr, If a decent implant is ok for you that's great. Personally I prefer a perfect result. Penile implants have a 95% success rate and an 85% satisfaction rate. I've determined from reading posts on this site that two of the biggest complaints from implants are Floppy head, because the Doctor is too conservative in placing the cylinders, and loss of sensation because of how and where the incision is placed. High volume Implant doc's are generally more experienced in these procedures. I'd rather shorten the odds of success with the most experienced implant Doctor I can find. Just my feelings.

[dirtman1993]

Kramer was my choice and have never looked back if I made the right decision. Everything has been excellent. Didn't want NY and the expense of going there. After watching Dr. Kramer work and what another doctor said as to watching his hands perform, that made my decision very easy. This doctor said to "Watch His Hands".

Watch the videos and you will see.