Seeking advice or reassurance

[Underd0sed]

I’m 8 months out from my first penile implant and I’m at the point where I’m trying to make some very important decisions about revision surgery. I’d really appreciate hearing from people who have been through something similar, especially those who have had complex revisions.

My implant is an AMS 700 CX, placed infrapubically. I was sized at 15 cm + 3 cm RTEs.

Unfortunately, I’ve had several problems since the surgery.

The biggest issue is what appears to be inadequate cylinder length/position. One cylinder has migrated downward, and there is approximately a 1.7 cm difference in the position of the two cylinders. Neither cylinder seems to provide adequate distal support for my glans. As a result, I have significant floppy glans/hypermobile glans with an approximately 90° downward angle deformity.

I also have a pump that feels tethered in a high position, and I can see/feel tubing protruding in the pubic area. The whole thing feels poorly positioned compared with what I expected from an implant.

At this point I’m scheduled for revision surgery toward the end of October.

My biggest concern now is making sure the revision is done by someone who has substantial experience dealing with implant complications and revisions, rather than simply having another surgeon replace the device without addressing why the first implant ended up this way.

This is where I’m getting nervous.

I’ve been trying to research my revision surgeon extensively, but I’m having a surprisingly difficult time finding much independent information about his experience with penile implant surgery. I can find very little in terms of patient reviews, detailed revision cases, published data showing his implant volume, or anything that gives me a good sense of how frequently he performs complex IPP revisions.

I understand that the absence of information online doesn’t necessarily mean a surgeon lacks experience. Doctors obviously don’t publish their entire surgical history on the internet, and patient reviews aren’t exactly scientific evidence. But when you’re facing a revision after a complicated first implant, it is difficult not to want some objective reassurance that the person doing the surgery has a lot of experience with this specific type of reconstruction.

So I’m hoping the guys here can help me think through what I should be asking before I proceed.

For those who have had a revision, particularly for undersizing, cylinder migration, floppy glans/SST-type deformity, or significant asymmetry:

• What did your revision surgeon do to determine exactly why the first implant failed?

• Did they review your original operative report and sizing measurements in detail?

• Did they physically measure the corporal spaces again during revision?

• How did they determine whether you actually needed longer cylinders, different RTE configuration, repositioning, or reconstruction of the distal corporal space?

• If you had floppy glans or a major downward angle, what was ultimately done to correct it?

• Did anyone perform glanulopexy or another glans-support procedure?

• How was cylinder migration corrected and prevented from happening again?

• What did they do about a tethered or poorly positioned pump and prominent tubing?

• Did your revision surgeon explain what they believed caused the original problem, rather than simply saying that the implant needed to be replaced?

• How important was your surgeon’s actual revision volume compared with their overall implant volume?

And probably my biggest question:

How did you evaluate whether your revision surgeon was actually experienced enough to take on your case?

If you were in my position, what specific questions would you ask the surgeon before agreeing to the revision?

I’m not looking for someone to tell me that everything will definitely be fixed. I know revisions can be complicated and that there are no guarantees. I’m trying to go into this surgery as informed as possible and avoid making the same mistake twice.

I’d especially appreciate hearing from anyone who has had a successful revision after an undersized or malpositioned implant. At this point, real-world experiences from guys who have actually gone through this would mean a lot to me.

[prguy3]

You're in Texas.. go to Clavell. High volume surgeon and well known to handle complex revision surgeries.