For younger guys who will need multiple surgeries throughout their lives - what are the risks of choosing IPP over MPP?

[pumpless_mtfckr]

Popcorn and beer is ready. Thanks for your entertainment!

You're welcome

[AussieGuy81]

Haha, very good observation. I saw some pieces of this puzzle but this makes sense now. Thanks.

I have to admit, another brother turned me on to the idea. But like you say many of us have had our suspicions. I’m sure a little more legwork can confirm more.

I’m sure more leg work would turn up some more wierd stuff. For example, I just noted this. Pumpless alleges that he has had Urofill done by Perito:

viewtopic.php?f=6&t=22235&p=250519&hilit=Perito#p250519

viewtopic.php?f=6&t=22235&p=250578&hilit=Perito#p250578

Tooyoung generally hates Perito. His posts are filled with accusations of his bias. But! Early on in his posting life he advises two different brothers that they can discuss Urofill with Perito:

viewtopic.php?f=6&t=26413&p=252240&hilit=Perito#p252240

viewtopic.php?f=6&t=20691&p=252635&hilit=Perito#p252635

Super weird dude with some serious psychological issues, haha. Likes to joke about how Perito owns a strip club. No idea if that’s true. But if I were Perito I might wonder if I had a stalker.

Does it make me weird that my views change over time?
Man, if I were convicted of murder and you were the last lawyer on Earth, I still wouldn't want you to represent me.

It does make you weird when you go back and edit all your own posts.

We still don't understand why you're on this forum?, no one of reading your cherry picked anti IPP posts.

Why don't you have a signature?, you put plenty of effort into writing all these posts. I think it's because you don't want some of the new guys that you offer 'advice' to that you don't have an implant

[tooyoung]

I have to admit, another brother turned me on to the idea. But like you say many of us have had our suspicions. I’m sure a little more legwork can confirm more.

I’m sure more leg work would turn up some more wierd stuff. For example, I just noted this. Pumpless alleges that he has had Urofill done by Perito:

viewtopic.php?f=6&t=22235&p=250519&hilit=Perito#p250519

viewtopic.php?f=6&t=22235&p=250578&hilit=Perito#p250578

Tooyoung generally hates Perito. His posts are filled with accusations of his bias. But! Early on in his posting life he advises two different brothers that they can discuss Urofill with Perito:

viewtopic.php?f=6&t=26413&p=252240&hilit=Perito#p252240

viewtopic.php?f=6&t=20691&p=252635&hilit=Perito#p252635

Super weird dude with some serious psychological issues, haha. Likes to joke about how Perito owns a strip club. No idea if that’s true. But if I were Perito I might wonder if I had a stalker.

Does it make me weird that my views change over time?
Man, if I were convicted of murder and you were the last lawyer on Earth, I still wouldn't want you to represent me.

It does make you weird when you go back and edit all your own posts.

We still don't understand why you're on this forum?, no one of reading your cherry picked anti IPP posts.

Why don't you have a signature?, you put plenty of effort into writing all these posts. I think it's because you don't want some of the new guys that you offer 'advice' to that you don't have an implant

All my posts ? I've few edits and they are usually for grammer correction and few touches..why is editing bad anyway ?

You are mixing things up...letoman says i used to support HA injections but I no longer do..and says this by itself is weird...so my question is why changing views overtime or even editing bad ? And why having an implant validates one's opinion otherwise you should sit at the back seat watch all this stupidity silently

Not all members have signatures...And for me it's not deliberate...it's just I've nothing to say in a signature...only a guy with refractory ED opting for an implant....and this notion is implicit by being on this forum.

Guys for God's sake offer meaningful discussions...stop with the empty ridiculous accusations and stupidity...thank you.

[daddel]

Popcorn and beer is ready. Thanks for your entertainment!

You're welcome

Ok tooyoung-multi-fake-account

[LastHope]

Hey everyone! I’ve just wrapped up an ultrasound with Dr Hakky’s team that confirmed I’ve had a venous leak - likely my whole life! I’m trying Trimix over the next few weeks but anticipate that I’m going to just pull the trigger on an MPP or IPP.

I’m in my early thirties - I haven’t had a chance to deep dive into the risks and long-term strategy of implant surgery with Dr Hakky just yet (I have my next appointment in early October) and I intend to ask him all the questions that I have… but until then, I wanted to get some thoughts and feedback from the guys here.

The big question: for younger guys who need an implant, does the MPP make more sense than an IPP? What are the arguments for and against for each, in the context of a younger patient who will need multiple surgeries throughout his lifetime?

Dr Hakky did tell me today that with the IPP - assuming no device issues - that a patient should GENERALLY anticipate needing a surgery every 8 - 12 years.

Assuming an IPP lasts me on the lower end (8 years ish), that’s 6 - 7 surgeries throughout my lifetime I’m anticipating (assuming I’m lucky enough to live to see my 80’s!). That’s a lot of surgeries - and I think it’s fair to assume that there WILL be some complication along the line (at least one of those IPPs might fail early, etc).

With the MPP, I know that it’s simpler and there’s way less risk surface area (less infection risk, less failure risk. Erosion risk may be marginally higher). Hakky implied these might last more like 15-20 years. That would only yield 3-4 surgeries throughout my lifetime. Not bad!

Taking into account a bit more significant recovery timeline required + a higher out of pocket cost if insurance won’t cover it, it has me wondering: is the juice worth the squeeze?

Make no mistake - I do suspect in my case, an IPP could be AMAZING. For starters, I’m on the smaller side both length and girth wise. Hakky did feel that I could actually improve my length and girth overall with an IPP, on account of the nature of my ED (the venous leak has likely prevented me from EVER reaching my full erection potential). This is a very attractive thing to me! I know the analogy on these forums tends to be that the IPP is the “Ferrari” of implants, whereas the MPP is the old reliable car that isn’t fancy but will get you there. I have to ask myself - would I be super happy with an MPP? Am I attracted to the potential gains from an IPP purely from an emotional standpoint? That I want to absolutely maximize the performance of my implanted penis after spending my whole life without “good wood” ? At this stage, it’s really hard to say - I’d feel obviously so bummed out if I pulled the trigger on an IPP only to have an early failure. At that point, I’d be REALLY wishing I had just gone for the damn MPP.

Then I know there’s the argument that the IPP is much easier to conceal. That all sounds fine, but to be honest that doesn’t worry me too much if I go with the MPP route, especially since I’m slightly smaller to begin with.

For my case personally, I do think there’s a chance that the implant is covered by insurance. I have Anthem BCBS PPO, I’ve tried pills, am trying shots, and have diagnostic proof that my ED is physiologic in nature. This definitely complicates things for me, because originally I was planning out of pocket payment and was leaning HEAVILY towards MPP. But if insurance would cover the IPP? That does make it more appealing to maybe take a chance on it.

Anyways, I’m sorry for the word-vomit gentleman. I’ve been obviously really thinking about all this today after my diagnostic appointment. It’s exciting and terrifying all at once! I read the success stories from both the IPP and the MPP bionic brothers, and it all seems very encouraging. I just want to make sure I adopt the right long term thinking and strategy. I know there’s no “one size fits all” when it comes to the implant strategy. Just need to really start weighing out the options and facts.


Thoughts?

My perspectives are slightly evolving (for better or worse!) on this hot topic.

Personally, if I have the extra cash (new + potential revisions) or a stellar insurance plan like yours that covers this procedure along with multiple follow-up revisions with high volume surgeons, I'd absolutely go for the "gold standard" IPP, as long as I could shake off the anxieties about mechanical malfunctions or having to go under the knife again and again (worst case scenario).

You have to take a deeper look at your personality too! TooYoung made an excellent point about his. Buyer's remorse is also not good!

In the US, surgeons are high-volume for IPPs and low-volume for MPPs. Wise dudes in this forum advise seeking a high volume surgeon. Your high-volume IPP specialist may be a low volume dude for MPP. Please also ask his/her annual numbers for IPP vs MPP to factor into your decision making. Higher volumes mostly correlate well with lower complications and horror stories.

Remember - "high volume" means "high volume" for your specific device and brand (MPP vs IPP / AMS vs Colopast vs Rigicon)!

I like the often touted BMW vs Toyota example, but there are also absolutely lemon Toyotas and recalled Toyota engines. Look at the new Toyota Tundra Twin Turbo V6 issues! Toyota is recalling and replacing 100,000+ engines. I've also heard about fractured Genesis and Tactras. Fractured in less than 1 year for God's sake.

If you plan to change jobs or make significant career shifts, consider how insurance changes can affect your ability to get revisions from mechanical malfunctions.

From my personal experience, even great Aetna and Cigna plans from Fortune 10 companies didn't work out in my favor in my state for this.

Somebody pointed out infection scenarios above, that's also worth considering. Infections can result in three back-to-back surgeries: new device + removal (if excessive purulent discharge) or salvage MPP + replacement IPP. This just underscores the importance of having good insurance and job stability with that good insurance. Or course, infection rates are non-zero for both IPPs and MPPs, but these are still worth considering when planning ahead in an unstable market or economy.

To me, this is not a "one and done" procedure either way. It's a lifelong project and our preferences can evolve and shift in either direction. I think it's good to keep an open mind even after the procedure. Until we try both in our own bodies, we will never be able to tell which one is better for us and our psychology.

[JohnnyBorg]

Hey everyone! I’ve just wrapped up an ultrasound with Dr Hakky’s team that confirmed I’ve had a venous leak - likely my whole life! I’m trying Trimix over the next few weeks but anticipate that I’m going to just pull the trigger on an MPP or IPP.

I’m in my early thirties - I haven’t had a chance to deep dive into the risks and long-term strategy of implant surgery with Dr Hakky just yet (I have my next appointment in early October) and I intend to ask him all the questions that I have… but until then, I wanted to get some thoughts and feedback from the guys here.

The big question: for younger guys who need an implant, does the MPP make more sense than an IPP? What are the arguments for and against for each, in the context of a younger patient who will need multiple surgeries throughout his lifetime?

Dr Hakky did tell me today that with the IPP - assuming no device issues - that a patient should GENERALLY anticipate needing a surgery every 8 - 12 years.

Assuming an IPP lasts me on the lower end (8 years ish), that’s 6 - 7 surgeries throughout my lifetime I’m anticipating (assuming I’m lucky enough to live to see my 80’s!). That’s a lot of surgeries - and I think it’s fair to assume that there WILL be some complication along the line (at least one of those IPPs might fail early, etc).

With the MPP, I know that it’s simpler and there’s way less risk surface area (less infection risk, less failure risk. Erosion risk may be marginally higher). Hakky implied these might last more like 15-20 years. That would only yield 3-4 surgeries throughout my lifetime. Not bad!

Taking into account a bit more significant recovery timeline required + a higher out of pocket cost if insurance won’t cover it, it has me wondering: is the juice worth the squeeze?

Make no mistake - I do suspect in my case, an IPP could be AMAZING. For starters, I’m on the smaller side both length and girth wise. Hakky did feel that I could actually improve my length and girth overall with an IPP, on account of the nature of my ED (the venous leak has likely prevented me from EVER reaching my full erection potential). This is a very attractive thing to me! I know the analogy on these forums tends to be that the IPP is the “Ferrari” of implants, whereas the MPP is the old reliable car that isn’t fancy but will get you there. I have to ask myself - would I be super happy with an MPP? Am I attracted to the potential gains from an IPP purely from an emotional standpoint? That I want to absolutely maximize the performance of my implanted penis after spending my whole life without “good wood” ? At this stage, it’s really hard to say - I’d feel obviously so bummed out if I pulled the trigger on an IPP only to have an early failure. At that point, I’d be REALLY wishing I had just gone for the damn MPP.

Then I know there’s the argument that the IPP is much easier to conceal. That all sounds fine, but to be honest that doesn’t worry me too much if I go with the MPP route, especially since I’m slightly smaller to begin with.

For my case personally, I do think there’s a chance that the implant is covered by insurance. I have Anthem BCBS PPO, I’ve tried pills, am trying shots, and have diagnostic proof that my ED is physiologic in nature. This definitely complicates things for me, because originally I was planning out of pocket payment and was leaning HEAVILY towards MPP. But if insurance would cover the IPP? That does make it more appealing to maybe take a chance on it.

Anyways, I’m sorry for the word-vomit gentleman. I’ve been obviously really thinking about all this today after my diagnostic appointment. It’s exciting and terrifying all at once! I read the success stories from both the IPP and the MPP bionic brothers, and it all seems very encouraging. I just want to make sure I adopt the right long term thinking and strategy. I know there’s no “one size fits all” when it comes to the implant strategy. Just need to really start weighing out the options and facts.


Thoughts?

My perspectives are slightly evolving (for better or worse!) on this hot topic.

Personally, if I have the extra cash (new + potential revisions) or a stellar insurance plan like yours that covers this procedure along with multiple follow-up revisions with high volume surgeons, I'd absolutely go for the "gold standard" IPP, as long as I could shake off the anxieties about mechanical malfunctions or having to go under the knife again and again (worst case scenario).

You have to take a deeper look at your personality too! TooYoung made an excellent point about his. Buyer's remorse is also not good!

In the US, surgeons are high-volume for IPPs and low-volume for MPPs. Wise dudes in this forum advise seeking a high volume surgeon. Your high-volume IPP specialist may be a low volume dude for MPP. Please also ask his/her annual numbers for IPP vs MPP to factor into your decision making. Higher volumes mostly correlate well with lower complications and horror stories.

Remember - "high volume" means "high volume" for your specific device and brand (MPP vs IPP / AMS vs Colopast vs Rigicon)!

I like the often touted BMW vs Toyota example, but there are also absolutely lemon Toyotas and recalled Toyota engines. Look at the new Toyota Tundra Twin Turbo V6 issues! Toyota is recalling and replacing 100,000+ engines. I've also heard about fractured Genesis and Tactras. Fractured in less than 1 year for God's sake.

If you plan to change jobs or make significant career shifts, consider how insurance changes can affect your ability to get revisions from mechanical malfunctions.

From my personal experience, even great Aetna and Cigna plans from Fortune 10 companies didn't work out in my favor in my state for this.

Somebody pointed out infection scenarios above, that's also worth considering. Infections can result in three back-to-back surgeries: new device + removal (if excessive purulent discharge) or salvage MPP + replacement IPP. This just underscores the importance of having good insurance and job stability with that good insurance. Or course, infection rates are non-zero for both IPPs and MPPs, but these are still worth considering when planning ahead in an unstable market or economy.

To me, this is not a "one and done" procedure either way. It's a lifelong project and our preferences can evolve and shift in either direction. I think it's good to keep an open mind even after the procedure. Until we try both in our own bodies, we will never be able to tell which one is better for us and our psychology.

Thanks as always LastHope, really appreciate the perspective. Also everyone else who has replied, thank you for your perspectives as well, I’ve caught up on everything the last few hours.

These are really considerations for me. I’m actually glad I’m taking at least another month to break down what I want to do.

I have to really ask myself what my risk tolerance is - I’m fortunate right now to have a great job with flexibility and fairly solid security. But even with that in mind - and even if insurance would pay for the procedure - it might still make sense for me to go with the MPP. Especially if I end up finding myself anxious about malfunctions.

I do think the MPP might eventually be inevitable for me - i think if I went with an IPP, if eventually down the line I ran into issues (early failure, infection, etc) I think I’d take that as a sign and make the switch. At least that’s where I’m leaning right now.

The question for me is if that’s my long term thinking, does it even make sense to start with an IPP in the first place? (Again, is the juice with the squeeze?).

I think that for me, the appeal of maximizing size and girth is very compelling. But at the same time, if the potential for losses in those areas are actually fairly minimal with an MPP, and if the MPP is sufficiently rigid to provide both my partner and myself with excellent pleasure during penetration, I don’t know why I’d go with the IPP over the MPP.

Anyways, just more ramblings on my end.

[LastHope]

You're welcome, JohnnyBorg!

Your thinking is very reasonable.

Let’s also look at it from another angle: what if your first IPP lasted over 20 years (even 10 years would be a win for me!)? With this approach, you could always switch to an MPP later if you get sick and tired of too many revisions due to malfunctions.

By choosing an MPP first, you might miss out on the gold-standard option during the prime years of your life.

With the IPP first approach, you'll also have the internal satisfaction that you tried the best from the market. Just another thought to consider, given your favorable insurance situation.

[JohnnyBorg]

You're welcome, JohnnyBorg!

Your thinking is very reasonable.

Let’s also look at it from another angle: what if your first IPP lasted over 20 years (even 10 years would be a win for me!)? With this approach, you could always switch to an MPP later if you get sick and tired of too many revisions due to malfunctions.

By choosing an MPP first, you might miss out on the gold-standard option during the prime years of your life.

With the IPP first approach, you'll also have the internal satisfaction that you tried the best from the market. Just another thought to consider, given your favorable insurance situation.

I do like your thinking around this, and I’ve thought similarly. With that strategy, I think the next layer would be this: how much do I stand to lose if my first IPP surgery doesn’t go well (infection, erosion, or early device malfunction requiring revision)?

I’d like to think that because I’m younger, fortunate to be in good health, etc that I could make the switch to an MPP in the event of an early setback with the IPP and it wouldn’t be a huge issue. But I also know there are risks anytime you go under the knife.

I think what i might need to do next is gather some of the raw data around the failure rates, the impact on infection potential as you get more revisions, etc and see how that all factors into my decision.

[LastHope]

You're welcome, JohnnyBorg!

Your thinking is very reasonable.

Let’s also look at it from another angle: what if your first IPP lasted over 20 years (even 10 years would be a win for me!)? With this approach, you could always switch to an MPP later if you get sick and tired of too many revisions due to malfunctions.

By choosing an MPP first, you might miss out on the gold-standard option during the prime years of your life.

With the IPP first approach, you'll also have the internal satisfaction that you tried the best from the market. Just another thought to consider, given your favorable insurance situation.

I do like your thinking around this, and I’ve thought similarly. With that strategy, I think the next layer would be this: how much do I stand to lose if my first IPP surgery doesn’t go well (infection, erosion, or early device malfunction requiring revision)?

I’d like to think that because I’m younger, fortunate to be in good health, etc that I could make the switch to an MPP in the event of an early setback with the IPP and it wouldn’t be a huge issue. But I also know there are risks anytime you go under the knife.

I think what i might need to do next is gather some of the raw data around the failure rates, the impact on infection potential as you get more revisions, etc and see how that all factors into my decision.

All great points to factor in! I think we are accepting all risks simply by being prosthetic patients. It's just the nature of the beast!

While retrospective studies have their limitations and can be debated due to confounding variables, I think they provide good discussion points. Here are a couple:


IPP Mechanical survival rates:
This is how the AMS 700CX mechanical survival looks like for example: (attached Kaplan-Meier survival curve). This is from a recent study in Spain.

Survival rates:
1 year - 95.2%
5 years - 90.6%
10 years - 82.2%
15 years - 58.5%

https://journals.lww.com/ajandrology/fu ... e.284.aspx

Moncada, Ignacio1; Krishnappa, Pramod1,2; Martinez-Salamanca, Juan Ignacio3,4; Palma-Hendges, Luiz Pedro3; Gonzalez-Garcia, Francisco Javier3; Hernandez-Fernandez, Carlos5; Lledo-Garcia, Enrique5
Asian Journal of Andrology ():10.4103/aja2024112, February 14, 2025.

Erosion rates:
https://www.nature.com/articles/s41443-020-00376-6
Khera, M., Mulcahy, J., Wen, L. et al.
Is there still a place for malleable penile implants in the United States? Wilson’s Workshop #18.
International Journal of Impotence Research 35, 82–89 (2023)

"The rate of erosion with IPP and MPP has also been studied. The AUA ED Guidelines reviewed the rate of erosion for MPP and IPP in 7 and 20 studies, respectively. The rate of erosion for IPP was on average 2.5% (range 0–6.5%) and for a MPP was on average 4.1% (range 0–17.5%)."

Infection rates for revisions:
Hebert KJ, Kohler TS. Penile Prosthesis Infection: Myths and Realities. World J Mens Health. 2019 Sep;37(3):276-287.
https://wjmh.org/DOIx.php?id=10.5534/wjmh.180123

6. Revision surgery
Surgical failure can be attributed to device malfunction and/or infection. IPP revision surgery, whether due to either cause, comes with increased risk of postoperative infection. Estimates of infection rates following revision surgery have been as high as 10.0% to 13.3% compared to 0.46% to 2.00% in virgin cases [17, 18, 19, 20, 21]. Interestingly, during IPP revision surgery for device failure, Henry et al [22] found positive bacterial cultures on 70% of clinically uninfected devices suggesting biofilms are a significant source of infection risk with revision surgery. In a small, retrospective series (n=44), Montgomery et al [23] noted a step-wise increase in rate of postoperative infection after stratifying patients by the number of prior IPP surgeries: 1 (6.8%; 3/44), 2 (18.2%; 4/22), 3 (33.3%; 4/12), 4 (50.0%; 4/8), and 5 (100%; 2/2). The increased incidence of postoperative infection following revision surgery is likely multifactorial with scar formation, reduced host resistance, and biofilms each playing a role. Assessment of biofilm formation and organism speciation at time of device explant for clinical infection has shown predominance of gram positive organisms, most commonly coagulase negative Staphylococcus [18, 21, 24, 25]. However, more recent multi-institutional data by Gross et al [26] evaluating culture results at time of clinically infected device explantation or Mulcahy salvage showed no growth in 33% of cases, gram positive isolates in 73% of cases, and gram negative isolates in 39% of cases. Candida (11.1%), anaerobes (10.5%), and MRSA (9.2%) accounted for one third of positive cultures. Furthermore, preoperative antibiotics provided adequate coverage in only 62% to 86% of cases based on culture results at time of explant, suggesting that broadened antibiotic prophylaxis and review of AUA/European Association of Urology guidelines is necessary [26]. There is level 2 evidence of increased risk with revision surgery based on the number of separate studies with concordant findings, their large sample size, and prospective nature.

[neisseriaceae]

Hi!
check My post, You might find your answer

viewtopic.php?f=6&t=27116