Permanently disfigured?

[DougAnd]

Before implant I researched the subject for over 4 years on and off. I already knew that uneven tips was a dead end problem, a roll of the dice. Few surgeons even cared to try and fix it. Scarring was the leading cause they just could not open up both side evenly. I used VED to eliminate that major cause and still lost. Most surgeons don't see a permanently crooked cock as a problem. Especially if only the head is wonky when inflated.. Their attitude is "and your problem is???????"
I told the AMS rep that I would never have surgery unless my tips were perfectly even. She replied Dr Saracino is an excellent surgeon, his measurements are exact and I will match them to within 1 millimeter. That was not what my research showed. In fact no implant comes in greater than 1/2 cm increments. (5 millimeters) So I asked her again on 2 separate occasions how she came within 1 mm? She finally replied Don't worry about it I'll take care of it.
I thought that the LGX must come in 1 mm increments. It does not. Basically she was banking on the odds that my corporas would be equal like most patients. They were not. She lied to me. Dr saracino's measurements were not exact, he rounded up one side and rounded down the other, gave me the worst case scenario possible. I told him his measurements were arbitrary and he said oh no they are exact. When I called him out on it he admitted well I do make minor adjustments. 1/4" on tips is not minor, it is huge. And 5 7/8 instead of 6.5" is also not minor.
So far no Doc has offered me any solution to my permanently deformed cock. I only see 2 choices to fix this. I can have a redo and have the surgeon deepen my right side to match my left as should have been done to start with or I can have him cut into my corpora on the left side and push the rte up about 3 1/16 of an inch. I don't know about #2 but that would be safer and less invasive.
Any suggestions, ideas, words of wisdom?
Right now the right tip is painful at any given time. It is pushing hard 24/7 inflated or deflated. I am shrinking from lack of cycling but every time I try to use my mis place pump it locks up immediately and it takes me sometimes hours to finally get it to unlock and pumping. Right now I am permanently pumped 3 pumps to hopefully slow down my shrinkage. I am going to try a hot bath and VED in a few minutes but not sure if the VED crushing my pump is a good idea? May be at least some of the cause of my problem.

[Hawkman]

I told the AMS rep that I would never have surgery unless my tips were perfectly even. She replied Dr Saracino is an excellent surgeon, his measurements are exact and I will match them to within 1 millimeter. That was not what my research showed. In fact no implant comes in greater than 1/2 cm increments. (5 millimeters) So I asked her again on 2 separate occasions how she came within 1 mm? She finally replied Don't worry about it I'll take care of it.

What in this world does a rep for a prosthesis company have to do with assuring your implant is the right size ???? I have good friends who are doctors and surgeons. Anytime a surgeon (FOR ANY PROCEDURE) tells you "the rep for product X will be right in the O.R. during surgery that should NOT reasure you. That is a signal to run. It means the surgeon is not an experienced skilled practitioner of that surgery and needs a non-licensed person giving them verbal tips on what to do to you. The rep who would be jailed if they touched you is telling your surgeon how to do the procedure. It is the number one clue you have a novice and not an expert.

[Donnie1954]

No Surgeon would be stupid enough not to have someone assisting him. My AMS rep was also a surgeon. Doug, I am so glad you are seeing my Urologist. He will be up front with you. I pray that this condition can be resolved. Praying for you. I know how frustrating it can be when no one gives you a straight truthful answer. I asked lots of questions when my 9 year old son died. I'm still asking questions 30 years later.
donnie1954@mail.com

[Hawkman]

No Surgeon would be stupid enough not to have someone assisting him. My AMS rep was also a surgeon.donnie1954@mail.com

Donnie, did your surgeon have an AMS rep in the OR with him? If so, I did not know that piece of information.

All surgeons, of course, have their surgical teams in the O.R. but if you are suggesting any surgeon would be stupid not to have a company rep for the product they are installing in the O.R. you are wrong about that. I base my statement on conversations with one of my best friends and the most impressive man I know. He is an orthopedic surgeon. He does a lot of hips and knees and fixes a lot of botched or failed jobs. I have another friend that is a gynecological surgeon who now also does a lot of rep work for manufacturers. Talking to them, surgeons who have operated on me for various procedures, and my family doctor, all have expressed similar thoughts.

If your surgeon does not have his own personal team that is consistently confident of what they are doing without a company rep advising or guiding them then they are unskilled in the process and certainly not experts or specialists in that procedure.

When it comes to penile implant surgery if my surgeon needs a rep from the company to tell him what size implant I need I would rather use my VED until I found another surgeon. The first caveat would be; how would he know for sure whether to have a Coloplast or an AMS rep telling him what to do unless he prejudged what you were getting before he even opened you up? That in itself is a sign you might need another surgeon.

[Donnie1954]

Yes he did and he informed me that he was a surgeon also. I met him before I was sedated. I was asleep the whole time. I could have cared less who was in the operating room. When an AMS is installed, I understood that he always assisted my Surgeon.
donnie1954@mail.com

[Hawkman]

Yes he did and he informed me that he was a surgeon also. I met him before I was sedated. I was asleep the whole time. I could have cared less who was in the operating room. When an AMS is installed, I understood that he always assisted my Surgeon.
donnie1954@mail.com

Donnie, most of those types of reps were, in fact, doctors or surgeons but not necessarily even in that same line of specialty. They can be general surgeons or even urologists but seldom accomplished implant surgeons. Obviously, he was there to advise your doctor so it was obviously the company rep that advised the use of the RTE assembly you have. In your case, I am so glad it came out functional. In many, it does not. I for one would not let a surgeon training under Dr. Eid do surgery on me with doctor Eid standing and advising right in the room much less if you pulled Dr. Eid out and substituted a company adviser that used to be a surgeon. I don't always subscribe to this saying but in these cases I do. ................ "Those that can do. Those that can't teach." ..........It is beyond rare for a great surgeon to walk away from a fulfilling surgical practice to be a rep.

I care VERY much who is in the O.R. with me during surgery. Enough so that I prefer to be awake. I do not want learning hands learning on my body. I have been there before.

[justanotherdrumber]

The article that claimed infection rates of 21% for revisions is quite out of date, and was published in 2011. Most publications are based on data from a few years earlier, which makes these findings even older. I know from a doctor that does revisions, the standard practice is to irrigate the area with antibiotics after the old device is removed, and before the new device is placed. Even with that protocol, the revision rate may be slightly higher than a first-time placement, but I am told that it is no where near 21%.In the past, they sometimes tried to replace a single part, which caused infection problems.

This article has a lot of informative good reading included for those who chose to take the time to actually read it.

It covers most aspects of implants and complications start to finish.

Many of the questions I see asked here are addressed within.

In particular I posted& quoted it pertaining to crossover, perforations & infections.

It isnt Black & White !
It doesnt claim that the general infection rate IS 21% ... !

It does state that the infection rate varies, having a "range" between 1.8% to 21% for certain patients, with certain circumstances , with certain conditions, with certain complications, by different skill level doctors in different hospitals in varying countries around the world.

Quote:
" It has also been demonstrated that the incidence of infection is doubled (18.8%) in re-operation cases and in secondary implantation,

uncontrolled diabetes, and paraplegia, as well as in the hands of inexperienced surgeons.
[9,10]

Overall, infection rates are generally 1.8%–10% for first-time prostheses

and 7%–21% for replacements.[11,12]"

Followed by the resources quoted.

REFERENCES: [ Page 27 & 28 ]

#[9.] Henry GD, Wilson SK, Delk JR, 2nd, Carson CC, Wiygul J, Tornehl C, et al. Revision washout decreases penile prosthesis infection in revision surgery: A multicenter study. J Urol. 2005;173:89–92. [PubMed]
#[10.] Lotan Y, Roehrborn CG, McConnell JD, Hendin BN. Factors influencing the outcomes of penile prosthesis surgery at a teaching institution. Urol. 2003;62:918–21. [PubMed]

#[11.] Jarow JP. Risk factors for penile prosthetic infection. J Urol. 1996;156:402–4. [PubMed]
#[12.] Lane BR, Abouassaly R, Angermeier KW, Montague DK. Three-piece inflatable penile prostheses can be safely implanted after radical prostatectomy through a transverse scrotal incision. Urology. 2007;70:539–42. [PubMed]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296438/

Dr. Angermeier & Dr. Montague [12] presently practice at Glickman Urology at the Cleveland Clinic in Cleveland, Ohio, which within itself is highly rated.

What I personally get out of reading it IS that [ 0%-10%] : [7%-21%] IS that you're appproximately twice as likely to contract an infection on a replacement or revision under the same set of circumstances and conditions as your first implantation.

Uncontroled Diabeties, Parapalegia, inexperienced surgeons and having a prior infection being some of the primary deciding factors

Example:
Normal 1.8% × 2 = 3.6% ( someone quoted 3% )
High Risk 10% × 2 = 20 % ( article quoted 21% ) [average ?, 18.8 % ?? , IDK]

If you were a low risk @ your first implant, you might be at a slightly higher risk on a second surgery; with all other factors being equal to the first.

IF ... you were at a high risk for your first implant you might be a a higher risk on your second surgery; with all other factors remaining equal.

[Donnie1954]

Unfortunately every surgery has risk and infection is one of them. Those of us implanted we're so desperately to feel normal again the possibility outweighs the risk. There are no guarantees in life.
donnie1954@mail.com

[Hawkman]

Unfortunately every surgery has risk and infection is one of them. Those of us implanted we're so desperately to feel normal again the possibility outweighs the risk. There are no guarantees in life.
donnie1954@mail.com

Amen, what Donnie said! We know that risk is there. We do all we can to minimize it in every way possible and hope and pray we are not the one.

[justanotherdrumber]

Unfortunately every surgery has risk and infection is one of them. Those of us implanted we're so desperately to feel normal again the possibility outweighs the risk. There are no guarantees in life.
donnie1954@mail.com

Amen, what Donnie said! We know that risk is there. We do all we can to minimize it in every way possible and hope and pray we are not the one.

I do believe the risk of infection in a normally heathy adult with no complications, either implant or revision is relatively low.

Probably between 0% to 3.6%.

The time the incision is exposed to the air is considered a primary factor in contracting infection.

An experience surgeon that know his sh#t and can get in, get the job done quickly and get out and "close" , will probably have a lower infection rate than one whoo has to read the step by step instructions.

Unfortunately many battling ED are often diabetic or have other complications..