Implant + TEP procedure Journal - 34yr old Australian

[wolfpacker]

Very sorry to hear about your pain man. I am still tender after sex at 2 years out. Id imagine it will take you longer to fully heal since you got the TEP.

[jessie24]

Hello, I´m sorry for your troubles but I think I might give you answers you are looking for, I´m dealing with similar problems that you are having and I don´t have implant yet symptoms you are describing are similar to mine and 6321615 others in hard flaccid/chronic pelvic floor issues forum, if you are experiencing burning/pain anus, perineum, balls, hamstrings, tights, pain during ejaculation its some issue with pelvic floor or pundedal nerve that was irritated, pulled or damaged during surgery, you might want to take a break from urologists and go checked by neurologist to get MRI of your pundedal nerve, meanwhile you can try some pelvic floor stretching and relaxing, I probably injured myself during sex or during masturbation but I have these issues for almost 4 months and pain gets bad after ejaculation, nerves heal themselfs but it takes a time, I don´t actually think there is problem in your penis, yes graft is creating issues with proper inflation and can cause some local pain in area but not burning shooting all over these places, I wish you luck because these pelvic floor issues are pain in the ass to deal with and doctors aren´t very helpfull but there is huge amount of people recovering, even someone on the forum got his pundedal nerve damaged and he is enjoying his implant, you probably should stop having sex if its creating pain, also you can easily test what is causing you pain, if its from nerve visit neurologist and get pregabalin or gabapentin, if it goes away after week or two you know, if its just some pelvic floor disfunction after surgery excercises like belly breathing and all those bullshits women are doing all over social medias really work, it makes my pain go away, anxiety can play huge role on this, but I personally hate to even hear that shit, I know I have anxiety but its from the physical issues I´m having, who wouldn´t have anxiety after being in pain for months but in the end it anxiety is really making it worse because your body is creating many hormones that aren´t helping with nerve pain or making muscles to spasm which can create more pain if there is something wrong in that, you can try some benzos, they also work as muscle relaxants so it probably won´t tell you if its worse just because of anxiety but usually people with those problems feel huge relief, but you can´t take them often, you can became addicted and going off them is maybe even worse than heroin so be definitely carefull and if you decide to try it try it just to rule out things not to run away from pain, I don´t know if this somehow can help you but I really wish you to find roots of your problems so you can start to have a life again.

[aussiePeyronies]

Hey guys,

Spoke to Dr Hakky via email (he is very helpful), I am in the process of organizing a video consult with him. I am not sure if he will be able to tell me much without a physical examination but I have emailed him the operation notes. He actually advised that he does not like the Tunica Expansion Procedure.

I also think I may have some damage to the pudendal nerve, this may explain some of my pain.

I am also seeing my GP this Friday to get an appointment with a new urologist to get checked out. This could take a month as they are mostly booked out, and they are reluctant to take on a patient whom they did not perform surgery on.

Still waiting on the original surgeon to advise on whether the results from the fluid found on the pump during revision is all clear.

After doing some research, the scrotal skin sticking to the pump could just be adherence which may clear up, or could be a sign of infection. It seems to be a very small part of the scrotal skin stuck to the pump, this causes some pain and burning when touching it and pumping.

I've been trying to carry on with my life and go to the gym, wear a suit and go to my office job. It's been difficult, by the end of the day, I get a lot of pain and discomfort.

There is also still some backfill which is very uncomfortable. I have tried everything to rectify this, but no matter what I do, it seems to backfill 20-40%. The original surgeon definitely was able to deflate it a bit more with less backfill, only thing that makes sense is he was able to squeeze the cylinder which has thickened due to graft retraction a lot better, causing less fluid to be stuck in the tubing. Also, I was less active in the hospital, seems to be that, the more activity/movement, the more backfill. It almost feels like the cylinders are displaced, this is difficult to show in a pic, so I have added a picture to show with my hands. I will explain below:

Pic 1, normal cylinders: This is how my implant use to inflate initially, the two cylidners would inflate correspondingly and at about 80% inflation I had a nice round implant. With blood flow, it would mimic a nice round natural erection

Pic 2 current cylinders: eventually, my left cylinder would inflate correctly, and right cylinder would inflate in a flat oval way as shown in the pic. So, the right side is flat, oval and softer. This also causes a slant to the left. During cycling, I also mostly only feel the stretch on the left side. When deflated, the cylinders almost look the opposite. Surgeon did advise that he believes its a thickened/retracted graft causing the right side to inflate less. I am starting to find it difficult to trust a surgeon's opinion that places a pump in a worse position after revision to fix it.

When cycling, I get some pretty excruciating pain, mostly on the cylinder which inflates properly (left side), then after cycling I get some burning sensations throughout the shaft. Due to this, I have cut back cycling to 30-40m sessions, sometimes only once, and sometimes twice a day. I do not know if this pain is due to the tissue stretching or the possible stitch granuloma/chronic inflammation/irritation I have by the frenulum and circumcision site.

With the pump placement, the pump has gone poking the left side of my scrotum and the deflate valve is poking my right side testicle, very uncomfortable. I really think that the surgeon may have added extra tubing to try and place the pump lower during revision, however, he either added too much tubing or there was already too much tubing (he assumed he needed to add more tubing as the pump was high, but this was due to it being pointed up on an angle due to having excess tubing from the original operation..maybe). This has caused the pump to move to the far left, and the deflate valve to twist into a horizontal position and move to the far right. This is just a guess and my only explanation to how a high volume surgeon in Australia, via a penoscrotal incision ends up leaving the pump in a worse position than before.

Due to the pain I had after ejaculating from sex, I wouldn't even think about sex atm. I really just want to be out of chronic pain so I can gym, go to work, be social, and resume my everyday normal life.


I will be back when I find some answers. As I really want a good result and my life back, I will keep striving to fix these issues as best as I can.

To anyone reading this considering an implant, I strongly advise going to a world class surgeon.

Appreciate any support and advice.

J

[aussiePeyronies]

Just to add, I also regularly have a very warm flaccid. Another urologist (before my revision) here advised that this was a sign of infection… But, surely, my surgeon would have picked up on it during my revision if there was an infection? He removed the right cylinder and the pump? Maybe the fluid he found on the pump during revision was infectious? This would explain a lot. I haven’t heard back from him yet.

As you can see, I am very confused with these symptoms. TEP + circumcision + implant, is a complex procedure.

I won’t give up yet, I will keep looking for answers and solutions.

For all you guys supporting, thank you, I am grateful for all you and these forums.

J

[frwmw1]

To anyone reading this considering an implant, I strongly advise going to a world class surgeon.

But the surgeon you went to is the highest volume doctor in Australia, from what I know.

[aussiePeyronies]

Thanks guys, appreciate the support.

I dont know about you's, but, with an already large flaccid titan, I think being fully deflated really adds to the comfort. Even being 15% inflated, can be uncomfortable and a little heavy; especially being a shorter guy with a larger implant.

Quick Update

I must say, these issues have been something else. I am trying to forget about the implant for now. I a doing an MRI to try to diagnose the prostatitis issue I had (pain after leaking prostatic secretions randomly). The MRI may also be able to confirm that everything is placed correctly, and if there is anything inhibiting the valve on the reservoir which could be causing some auto-inflation.

As for TEP, with engorgement I am probably just under my pre-op of 6.5 BPEL. So, at this point, I do not think all the trauma of TEP and getting circumcized was worth it. This may change, I really don't know. I tend to believe that it is better to keep it simple, do the implant procedure and don't worry about extra lengthening. The most you will get back is probably 1cm, which no woman (or man) would probably even notice. Is it really worth the risks?

With cycling, I am doing 15m VED twice a day in addition to 15m straight after of just normal cycling, so 1 hour a day. I will eventually up this to 2 hours a day.

Graft retraction/thickening - I saw another urologist here who says that tachosil graft usually retracts or deforms in the first few months, then goes back to normal around 18 months with cycling. Fingers crossed this will be the case.

I might update after the MRI, if anything significant is found.

I will say this though, don't let these issues get the best of you, excel in every other area of your life to the point where penile implant surgery is not only insignificant, but financially, you can afford the best doctors etc in the world.

Appreciate all of you's and am always here if anyone needs support/advice.

J

[shrunken_dick]

Well, if you had a plaque on the ventral side, then TEP would not have helped. TEP was introduced by Dr. Egydio, who is a master manipulator of things. Sadly, other doctors are selling this surgery to fill up their pockets.

[aussiePeyronies]

Side note: A lot of the general pain has subsided, there is some pain by the frenulum which seems to be subsiding. The only time I am in significant pain is after a prostatitis flare up. If the prostatitis was healed, I could probably have an alright sex life. Perhaps, something to look forward to in the future.

[aussiePeyronies]

Hey guys,

MRI results are in, no major abnormalities other than the following:

1. The reservoir is on an angle and slightly scrunched. This could be the cause of the auto-inflating. The urologist advised, there is nothing we can do about it. I assume its not worth another surgery, and this urologist doesn't seem to think that erosion of the tips from auto-inflation is a possibility.

2. Fluid around the pump. The original surgeon when performing the revision also noted this. The urologist I am currently seeing advised that this is no cause for concern.

3. No infection, inflammation or inflammation of the prostate was indicated.

The thing I did do, due to some extenuating circumstances, I took ciproflocaxin, colchicine and naproxen (strong anti-inflammatories for prsotatitis). About four days prior to the MRI, I stopped all these medications. Since then, I have not had any prostatitis flare ups. I am wondering if this skewed the results. Either way, the prostatitis has stopped for now.

Length/Girth

I am cycling about 45m - 60m (includes 15m VED in the session) a day, 5 days a week . I will eventually increase this to 2hrs a day 6 days a week. My length is the same, about 1cm less than my pre-op length (with engorgement + implant fully inflated).

In regards to girth, I have not measured as, the graft retracting on the right side makes it difficult to measure. It's also a bit disheartening, I went through the trauma of TEP for girth restoration and my girth has been compromised due to graft retraction. My current urologist advised that this is common with TachoSil graft and that this should subside about 12-18 months after surgery.

Other issues are the same, sometimes I have pain, sometimes a lot of discomfort when wearing tight clothes. Right testicle is pushed up and forward in the scrotum due to tubing and the deflate valve. May subside in a few more months, we will see.

Final thoughts

I will do a better journal entry with some pics when I hit 1 year from my surgery, and again when I hit 1 year from my revision. All I can say is that, I really think it's worth going to a top surgeon in the U.S.A. High volume surgeons in Australia still only do 75-100 implants per year; this would be considered a low volume surgeon in America.

Just from having one consult with Dr Hakky, I can tell he is much more knowledgeable, concerned, and actually has come across a diverse range of issues when it comes to implants.

I haven't tried to have sex again as I just do not want to risk any more pain. I usually get numb after 20-30m of sex, and after ejaculating, I am in pain throughout the shaft and scrotum for a few hours.

I am a bit concerned that the device auto-inflates and there is really nothing I can do about it. Dr Hakky did advise that he could tell me a lot if I did an MRI, and that he could assess if the valve on the reservoir (not the deflate valve in the scrotum) was causing auto-inflation (which does happen). A consult with Dr Hakky will cost me $800 AUD, so, when things are better, I may book a consult with him and send him the MRI results.

The device auto inflates a bit, to the point where the dog ears are still there, so, I assume this isn't too big of a concern? What are you guys thoughts?

Something to remember

All you guys, especially younger guys, who aren't implanted, just remember - you want to avoid surgery in this area for as long as possible. If complications arise, they are very difficult to ascertain and fix. Further, the more surgeries you have, the more scar tissue, and (with some surgeons) the higher the risk of infection.

Final Final Thoughts

I think the best thing for me to do now, is to just cycle regularly and wait. Focus on my career an saving money so that I am never in this position again. If/when I require a revision, I would just be able to fly to America and use Dr Eid, Dr Clavell, or Dr Hakky.

This year has been a lot, 2 surgeries, prostatitis, was out of work and gym for months, then my childhood friend passed away at 34. Hoping for some better days.

Appreciate all your support and any advice. Always here if anyone needs.

J

[aussiePeyronies]

I wanted to post something positive here, amidst all the issues I have had, the scrotum skin which seemed attached to the pump seems to be better. I believe the skin by the incision site had thickened and was still very tender and sore. Over the past few weeks this has been improving and it is becoming a little bit easier to pump.

I would also like to add that, despite the fact I am 1cm shorter than pre-op, I would be happy if the retracted graft issue resolved. If the retracted graft resolved, I would still have a +5.3 inch girth and close to 6.5 inch penis which I would be happy with.

Over the next 7-8 months, with cycling, if I gained back 1-2 cm, that would be a bonus for me.

Anyone have any info on retracted graft or know of any surgeons who have dealt with this, I would really appreciate it. I might put up some pics later on.

Thank you all for your continuous support.

J