Malleables revisited

[easymoney]

I do believe the right surgeon makes a difference, my surgeon is the highest volume implanter of mallabble implants in the country and he says he only does about 50 or so a year compared to 100's of the IPP .. he is a big promoter of the mallabble implant.

[LastHope]

I consulted a surgeon (name withheld) in the US who is renowned for his celebrated "high volume" title for IPPs. I was surprised to learn that he did only 8 malleables in 2023, making him "low volume" for MPP.

This made me speculate a theory that the higher erosion rates for malleables reported in US research literature could be due to a lack of specialists doing high volume MPPs.

While I acknowledge tissue atrophy theories, I believe the statistical MPP data on rates of erosion might also be heavily influenced by confounding variables as we may be picking up data sets from low volume centers for malleables. Correlation doesn't always mean causation.

[easymoney]

Yep it appears mallabbles nad facts about them are as rare as sighting bigfoot in the woods ...lol .. Since I have on my 1st revision 6-2024 and it is larger than the first I hope I don't run into those issues in the future. When I mentioned it to my dr. he sort of foo foo's it. But he tends to do that on many things I have questioned about my care including who really did my surgery.

[Mark1974]

As someone who wants to be as conservative as possible the problem is both MPP's and IPP's have a lot of potential risk.

With the MPP there is potentially pressure atrophy to the shaft, pressure atrophy to the glans, loss of axial rigidity over time and erosion.

With IPP's you have a high risk of mechanical failure and with each additional revision the potential of infection increases and with it the associated risks of explantation, scar tissue, dramatic shortening and worse of all necrosis requiring partial or total penectomy.

I'm trying to minimize risk by going with an IPP for the fist surgery and then switching to a malleable on the first revision, but the reality is in 2024 we don't have any really sound options yet.

[LastHope]

The issue with tissue atrophy and the potential loss of axial rigidity over time (5-15 years) can cause the base of the malleable implanted penis to wobble and sag down. This might require manually lifting and positioning it for intercourse. While this isn't a significant functional problem, as discussed in another excellent infection related post, it's worth considering. It's like comparing a new car to a 10+ year old car.

I think of it like comparing solid tires to inflatable ones for a car. Inflatable tires offer better rigidity (since you refill them often), size expansion, ride comfort, and superior cosmesis. However, they do need to be replaced eventually, and you could get a flat tire much sooner if you're unlucky.

The increased odds of infection with revisions should be given serious consideration, as this risk can be overlooked when surgeons downplay it as a 1% problem. It's a 1% problem if it doesn't happen to us, but if it does, it's a 100% problem.

There are pros and cons to both options, and informed consent is very much needed.

[Mark1974]

Yes and it is a 1% potential on the first surgery, but the risk is increased with each subsequent surgery. I don't have the information in front of me now, but I remember reading a study that showed by the 2nd or 3rd revision it starts becoming a significant risk.

And, as you say, if we are one of the 1% it becomes a 100% problem

[LastHope]

Yes, good point. Subsequent revisions present a unique challenge due to the presence of biofilms.

IPP infection rate ranges:
0.46% to 2.00% for virgin cases
10.0% to 13.3% for revisions cases

A different study that stratifies by number of prior IPP surgeries:
1 - 6.8%
2 - 18.2%
3 - 33.3%
4 - 50.0%
5 - 100%

The numbers might be skewed by poorer outcomes from low-volume centers. Nevertheless, there is a trend.

Source:
Hebert KJ, Kohler TS.
Penile Prosthesis Infection: Myths and Realities.
World J Mens Health. 2019 Sep;37(3):276-287. https://doi.org/10.5534/wjmh.180123

[Discovernew]

This all has been gone over many times through out the forums, IPP compared to MPP, concealability, cost, recovery time, differences in size, you name it,
All I can really say about it is The wifey and I are more then happy with the Genesis.
To those that don't know I had 4 IPP's before going to the MPP, It was the quickest recovery of all the surgeries, least painful, it was a day surgery, I lost no length, lost about a 1/2 in girth, just makes it easier for her to deepthroat it, we have tried and tested all the positions and then some.
The wifey will wear herself out riding, jacking, sucking and just plain playing with it as much as she can everyday, fuck I can hardly get away from her to cut the grass nowa days, turned her into a absolute fuck monster.
In the end, the decision is yours, I wasted so much time worried about size loss and concealing it drove me crazy, but for me the IPP's are just not tough enough for any aggressive activity in my world.
In about an hour I (will) hear high heels coming down the hallway,,, and you know what ??? I (will) be ready for her.
Ride on baby, Ride on...............

I am reading your malleable posts. I am curious what about the malleable makes it easier for her to deepthroat? is it because of the lost girth? or because it bends better? If so, couldn't you just inflate the ipp a little less than usual to achieve the same effect?

[Discovernew]

Yes, good point. Subsequent revisions present a unique challenge due to the presence of biofilms.

IPP infection rate ranges:
0.46% to 2.00% for virgin cases
10.0% to 13.3% for revisions cases

A different study that stratifies by number of prior IPP surgeries:
1 - 6.8%
2 - 18.2%
3 - 33.3%
4 - 50.0%
5 - 100%

The numbers might be skewed by poorer outcomes from low-volume centers. Nevertheless, there is a trend.

Source:
Hebert KJ, Kohler TS.
Penile Prosthesis Infection: Myths and Realities.
World J Mens Health. 2019 Sep;37(3):276-287. https://doi.org/10.5534/wjmh.180123

These numbers really make me consider a Malleable if my current IPP fails (i am newly implanted so i really hope it doesn't happen anytime soon)

[LastHope]

Yes, good point. Subsequent revisions present a unique challenge due to the presence of biofilms.

IPP infection rate ranges:
0.46% to 2.00% for virgin cases
10.0% to 13.3% for revisions cases

A different study that stratifies by number of prior IPP surgeries:
1 - 6.8%
2 - 18.2%
3 - 33.3%
4 - 50.0%
5 - 100%

The numbers might be skewed by poorer outcomes from low-volume centers. Nevertheless, there is a trend.

Source:
Hebert KJ, Kohler TS.
Penile Prosthesis Infection: Myths and Realities.
World J Mens Health. 2019 Sep;37(3):276-287. https://doi.org/10.5534/wjmh.180123

These numbers really make me consider a Malleable if my current IPP fails (i am newly implanted so i really hope it doesn't happen anytime soon)

One limitation of that study is its small revision sample size. Additionally, Mayo Clinic may receive some of the most complex revision cases referred from low-volume centers across the nation, which introduces a potential selection bias that could inflate the infection rates.

The key takeaway here seems to be the upward trend in infection risk with each revision.

Dr. Clavell has done a revision on a patient who was on his 10th implant, and he was doing well. Surgeon selection and the baseline health of the patient is also a factor.