Lost of Length in Prostatectomy Patients

Dear Readers:
I've been busy moving my daughter for Grad School, so I havent written anything for a while. I found this article publish in the Harvard Medical School Journal that may shed light on Prostatectomy Patients. It may also have ramifications in men with long standing ED who don't regularly experience erections to loose some length of their erections:

New Theory About Preserving Erectile Function After Prostate Surgery
Prostate Surgery

Erectile dysfunction after surgery to remove the prostate (radical prostatectomy) has traditionally been attributed to nerve damage that theoretically should heal over time.

But it can take as long as two years for the nerves to recover enough for a man to have an erection without the aid of drugs or devices. By that time, other damage may have occurred, according to an article in the latest issue of Perspectives on Prostate Disease.

The Harvard Medical School bulletin notes that when the penis is flaccid for long periods of time, it is deprived of a lot of oxygen-rich blood. Recent research suggests that this low oxygen level causes some muscle cells in the penis's erectile tissue to lose their flexibility. The tissue gradually becomes more like scar tissue, interfering with the penis's ability to expand when it's filled with blood.

Therefore, the traditional advice given to men -- to wait for erectile function to return on its own -- may not be adequate. Simply put, erections seem to work on a use-it-or-lose-it basis. To prevent the secondary damage that may occur if the penis goes too long without erections, researchers now think it's better to restore erectile function soon after prostate removal. Treatment options include using a vacuum pump device or taking erectile dysfunction drugs by mouth or by injection into the penis.

According to Dr. Marc Garnick, editor in chief of Perspectives on Prostate Disease and a Harvard oncologist, "Although the evidence supporting this 'penile rehabilitation' isn't perfect, you may want to ask your doctor about the options. Such early intervention may help increase the odds that you will regain erectile function."

Peyronies' Disease, Tom's Story

Dear Readers:

I've been in touch with a gentleman that I'll call Tom as he has asked me not to use his real name. Tom just got home from the hospital yesterday after having had penile implant surgery on Friday. Tom developed his ED from Peyronies Desease and has graciously given his permission to post his story on this site. With each man's story, all of you out there can receive a sense of what other men have gone through in their struggle with their particular ED. And also how they have reached their personal decision on implant surgery. So a special thank you to Tom, and here is his story.

Bob,
great blog. I have been reading it all day after getting my AMS 700
implanted yesterday. I also had peyronies....not sure why. It just
started at 43 yrs old and kept getting worse every month.
Cialis started to make me
irritable and sleepless, then i finally gave up when tissue shrinkage
started this year. i used to be 4.5 flaccid and 6.5 erect. As of a
few days ago,i was down to 3.75 flaccid and about 6 erect. That cold
shrivel caused me more stress than the lousy erections and the curve!

I have a few questions for you:
when did/how did your peyronies come about? and how did it progess?
How old are you?? Your libido sounds realy good and most guys with
implants are a lot older than me (46) Is it true that ams 700 can
achieve 20% additional length?? where did you hear that? My doc said I
may gain length, but i thought he was just trying to sound positive??

Thanks
Tom


Tom:

I had ED due to Juvenile Diabetes, but developed scarring after thirteen years of injections of caverject, Bi-mix, and Tri-mix. My libido was considerably lower while using injections. Even though I've been injecting several hundreds of thousands of shots of insulin, the experience of possible pain from the injection and having to get up and take the ^$#&&* shot kind of took away the desire where as now, just a few pumps and I'm ready to go. I'm good for once a night. My wife's libido over the years has been much, much higher than mine. It's only with the implant, that my confidence level is really high. Sex is no longer a chore, but much more spontaneous. The AMS 700 Ultrex has the ability to expand upwards of 20% of the length of the cylinder. As Fred attests, and I can attest to, most men may lose some length following surgery due to scarring or from lack of use, contraction of the tissue etc. But over time, the Ultrex puts pressure on the tissues of the penis to stretch in length and what I've heard from other men, their penis grows in length some. During the day, I keep a little tension on my penis by pumping it up a bit to keep things full all day long, but not to the point where it is uncomfortable to bend. I leave it comfortably full. This in effect put some slight pressure on the tissues. Over time, tissues will begin to grow to relieve the pressure on the them. I didn't have much luck either with Viagra and Cialis. Cialis left me with a sour stomach and Viagra gave me a headache and a so so erection. You and your girlfriend are going to love the implant when you get healed up. At 6 weeks, you are healed enough to engage in intercourse, but you need to take it easy at first or you will experience some discomfort in the head of your penis. I'm hitting the 12 week mark and that is about the ideal point in the healing process. Sex becomes very pleasant and enjoyable at this point. Congratulations on the implant. If you ever want to contribute to my blog, I would be very appreciative. You are the first Peyronie's patient that I've heard from who has had the Ultrex implanted and it would greatly benefit others who are walking in your shoes and looking for information to make a decision on the surgery. My eventual goal is to create a website with men's stories filed under Peyronie's, Prostatectomy, Diabetes, and miscellaneous of reason's for their ED and what their experiences with implant surgery has been. I'm also looking for pictures so that men can see what the penis looks like shortly after surgery, through the recovery period, and what the end result looks like. Did you experience much pain after surgery. Your thoughts and feelings on having the surgery and was what you expected. What you are happy about, not happy with. It's your story and I don't want it sugar coated. The men who read my blog are looking for the truth and I've tried to do that. I've also tried very hard to describe my experiences and the response has been overwhelming. I've heard from men from all over the world and I'm just blown away by the outpouring of emotion. So if you would like to help other guys, especially Peyronie's patients, send me from time to time your experiences and if you are comfortable with, include pictures. Many of the men have told me the pictures are invaluable. Hearing a story separately is great. Putting a picture with it is off the charts. This blog that I have started is the only one of its kind anywhere on the internet. It covers a topic that is very difficult for men to contemplate. Implants basically mutilate the penis permanently. And there is no turning back, so men really want to be sure of this before going into this surgery. That was my motivation for creating this blog and eventually, I want to turn it into a permanent website. So Tom, thank you for your email.
Bob

Thanks for your response Bob.

My story and recollection of pain is very fresh as I am still at home recuperating.....I had the surgery Friday afternoon!

I was TOTALLY freaked out about this condition and possible solutions to it. It became a mad obsession for the past 2.5 years. After losing my wife in 2002, I was as healthy and horny as any guy in his early 40's. But within 6 months, I started getting a strange coldness in the tip and left side of my penis.
NOBODY could tell me what it was. Not ONE UROLOGIST ANYWHERE....they all said it was probably mental!

In retrospect, what I think was feeling with the beginning coldness was the beginnings of scar formation from years of competitive biking. A few months after the coldness started, I finally met a beautiful girl and started dating. After the first 2 weeks, I noticed that the coldness problem was now interfering with normal erectile response. So I started occasionally relying on a low dose of cialis....seemed to be a solution for a time.....but within 4 months, this became less reliable and I noticed a shrinking flaccid state and a left curvature starting to develop at low pressure levels of erection. It was then that I first started to worry that my problem could be Peyronie’s Disease.

Despite this presumption, it took me over a year before I travelled to see my first Urologist who specialized in Peyronie’s. Then I travelled some more,....I saw 5 guys around the country who claimed to be specialists in Peyronie’s cases. However, even with this specialty designation, I found most of these guys to be quacks who just wanted to do endless tests before cutting on you in some way or starting you on some bizarre drug cocktail or herbal regimen. Despite what any of them said, my own research was slowly convincing me that the only true reliable cure for the Peyronie’s condition was a penile implant. Most of these docs would not tell you that,....mainly because none of them were implant surgeons! And none of the implant surgeons "specialized" in Peyronie’s because it was such a small subset of the implant market that it was not worth their time......Peyronie’s patients were just another customer to them. It took me 2 years to figure this out.

The story from there is very long and tedious, because changes took place microscopically over the next 2.5 years. Sometimes I actually thought I was getting better,, then it would take a turn for the worse.
Despite what you may read about Peyronie’s running it's course in a year, it’s often is a progressive disease that just keeps getting worse. Fast fwd to 2007 where I found myself this Spring with a constant, noticeable curve while erect, less sensitivity on the left side, unreliable responses to a constant (3x per week) regimen of Cialis (I too hated the side effects) and a flaccid state that was so shriveled, cold, curved and insensitive that I felt feelings of inferiority around other men. It actually affected my ability to sleep, relax, and to just be myself around family, friends and co-workers. I could still have sex, but it was with great anxiety, not as much feelings of pleasure (Cialis makes it harder to orgasm) and a penis that would become embarrassingly small and lifeless just minute’s after intercourse (I had to hide it from her view). My girlfriend was aware of the Peyronie’s problem,, but discouraged me from surgery as most would. She was NOT aware of how much I gulped down drugs and how miserable I was through every day frantically digging in my pockets, worrying about my dwindling flaccid state.

Oddly, my final decision was based not on the desire to be ABLE to have sex (I still could with heavy Cialis) but to ENJOY sex again, enjoy passive intimacy (holding hands, cuddling on the couch, pressing hip to hip while kissing) and to walk around the office, the gym and home feeling like a man again who has not had his penis amputated!

As of right now, I am laying around in great pain, but already satisfied with the feeling of 100% of me restored in my underwear! It is like what I am sure a breast cancer amputee must feel like after getting breast implants. Bob, I even think I am still capable of getting a little hard as I can feel it down there when my girlfriend cuddles with me in her night gown while I am on the couch recuperating....it gets engorged! But best of all, I feel like I finally have something pushing back against all that damned scar tissue that has been slowly and literally squeezing the life out of my penis for the past 3 years.

Even if it shrinks (my doc say he thinks I may actually gain length), even if it has a softer head (it looks and feels good already), even if it has a slight curve (it still does now, uninflated), then that will all be ok, because It feels SOOOOO good to have my normal flaccid size back in my crotch. My state of mind in the past 3 days has been nothing short of remarkable....I am me again!! Even with 4-5 hours sleep from the pain of recovering I am in a great mood, i am joking and confident,......cocky!
Maybe that is where the term comes from?!

I will keep you posted, but for now all i can say is that after obsessing about this decision for over 2 years....all the way up to the moment before they put me under sedation, I have no regrets.

Feel free to use my story, but not my name.

Talk soon,
Tom

Fred's Penile Implant Pictures

Fred is a frequent reader of the Penileimplant website and has submitted the story of his experiences with his Penile Implant. Please read his story below.




Fred's Penis in the flacid state with an implanted AMS 700 Ultrex Penile Implant





Fred's Erection: AMS 700 Ultrex Penile Implant

Fred's Penile Implant Experiences

Hi Bob!
I did a little recapping without trying to write a book. I could probably reduce it down further if you need but here are the highlights of my trip....what a trip!

Dear Readers:

A couple of weeks ago, I asked for your submissions and pictures and detail your experiences with your Erectile Dysfunction and how you came to have a penile implant surgically implanted to cure your ED. Today I am happy to introduce to you Fred who took me up on my request. It is only through sharing our experiences, can the men who are coming behind us can learn what to expect should they choose this form of treatment.
Fred had his first implant way back in 1991 and has recently had an AMS 700 Ultrex implanted to replace that first implant which failed. I wish to thank Fred for submitting his story and for furnishing pictures of what is a successful outcome. Fred lost his prostate due to cancer as have many of you who read this website. This is Fred’s story



I will highlight my adventure with the AMS 700 Ultra planted firmly within. The story began with a late night call from my MD in effect said get your house in order. In '91 not much was known about prostate cancer other than take it out. After surgery, a month later, it was just as iffy. I still felt healthy except I couldn't get an erection any longer. So much for "nerve sparing!" By this time I had shed a lot of inhibitions from my redneck days while attempting all kinds of experiments which included looking at a lot of 'dicks' on-line to see if I was normal, and did a thing with a prostitute that didn't work to well.
During the after surgery years, I ran my butt off, drank gobs of water, ate different, built muscle, got rid of my company, got in on trials with a new thing called Caverject, went into UCLA Emergency three times with the biggest, (and most painful) erection the world (emergency waiting room) has ever seen and did even more experiments with herbs, pumps and lots of reading. By this time I was ready for one last try before the needle...gads...a gay thing! I was willing to try anything. So I went to a bath house in LA where a guy worked me over in ways I never thought of. I did in fact rise to half attention with a blast off. But, most important I knew it was the final straw. I had a problem (slow learner). The final, really final straw was that I was stuck so many times that the trimix became unreliable. Clearly, something different had to be done!
'Stage right', implant time. After surgery ('93) this cute nurse removed my bandages and I became depressed. What a mess! Dinky little dick, bruising all over my pelvic...."gads what have I done to myself now". A few weeks later, bruising was gone, dick was still swollen (too bad it wouldn't stay fat that way", and it was stretched to full length,(about 4 3/4 inches)...like big deal! Making the best of it over the months the swelling went down and the length would stretch to about 5 1/2 inches...hmmmm usable. But at least it worked! Prior to surgery, I used one of those cheap pumps and kept pumping it to the max and leaving it pumped up. Apparently that did some good in that it might have assisted the surgeon in installing the max size.
About 5years later, dick size was almost 6 inches x about 1 5/8 dia. One evening, the tire went absolutely flat! I felt a little pop and nada! Went to a new urologist who said it needed to be replaced. Here we go again! So, I used the pump for two weeks prior to surgery in the attempt at keeping what I had. After surgery, very little bruising and a fat swollen weenie. After the bandages were removed, it looked like I lost ground and complained to my urologist that he short changed me. He was supposed to remove the old and measure against the new. Well, make the best of a 5 and a halfer'.
Today, two years later I am up to a respectable 6 1/2 inch by 1.3/4 and when I am really up to it, I can hit almost 7 x 1 /78. Now I'm a happy camper........and so is my wife of 43 years. After all of the experiences, I am a different person. No mo redneck, but I still vote republican, and a whole lot looser and tolerant of the people around me. I am sure that each has his own story to tell and I am equally sure to each, it was as adventure he never though about until it was happening. And of course there are stories within stories.
To anyone reading this and contemplating the installation of an implant. if you have a problem...................fix it. The odds are you will not be unhappy.....well after it's its all done anyway! You will embark upon a journey whereby you cast aside things you learned in Catholic school or your parents taught you, and you will be a more understanding person......and, that ‘isn’t all bad!”
Fred
Don’t have any before pics but here it is pumped and unpumped. Know this, after installation your dick no longer goes into the body when it’s cold, it always hangs out. Also, for those having had prostate surgery the bladder gets tied to the pelvic floor. The result is the penis tends to bend down and will never point up again....tears. Some, like me, have complained of it being shorter. Give it time and keep it pumped up. Dam thing grows...nice huh.

Request for questions, comments, and suggestions for future topics

Dear Readers:

I have asked several men who are actively interested in the subject of Penile Implants, what can I add to this blog that might be of interest to other readers to see. I've received a few suggestions and I plan to research and add my thoughts on several different topics of interest that have been requested.

I also send out the same request to all of my readers to feel free to post requests, questions, and suggestions in the comments section of this blog that you would like to see or would be of interest to the other readers of this website.

Also, please feel free to give to your doctor, the address of this website and explain to them that it has a great deal of information for men considering penile implants. Tell them why you find the information useful and why you believe it might help other men seeking information on Penile Implant Surgery. I built this blog website to benefit all men who have severe ED and are now considering possible penile implant surgery. Fear occurs due to the unknowns in life.

And tell them that I would welcome their comments, suggestions, and advise for men considering implant surgery as well. They to can post them in the comments section of each entry or submit their comments or concerns directly to me via email.

The website address is: http://penileimplant.blogspot.com

My email address is: bbacon15@yahoo.com and my name is Bob.

I do respond to all submissions and I really do appreciate your comments. They serve a purpose in educating other men in this difficult subject. Impotence is a difficult burden to carry for any man. And it seriously effects our partners. They suffer the pain that you have whether we realize it or not. Many are kind, patient, and understanding. My wife is the love of my life and I really appreciate her love, support, patience, and understanding more than she will ever know. Please let your partner know how much her help and support means to you. I know she or he will appreciate hearing it from you.
Thanks to all my readers.
Bob

Size after Penile Implant Surgery: A Discussion

-----Original Message-----
On Behalf Of grrich2763
Sent: Monday, August 13, 2007 6:36 AM
To: Bob
Subject: Hi Bob

I am wondering what you think of the letters from the guy who lost 2", only starting with 5". I'd be very disturbed at this, and be talking to my surgeon. My Urologist said whatever you can produce with a VED we can produce with an implant. I can get my cock out to between 6 and 7 with VED, but can't stretch it flaccid quite that long. I'd be very content with 6, esp if hard all the time, and when I want.
I also would not worry about a little bulge in my package when I was dressed, I'd probably figure out how to enjoy that.
Gary



Good Morning Gary:
I'd be one pretty pissed off guy. Somebody didn't size that implant correctly. With the AMS Ultrex, it can expand out to about 20%, so say the guy has 5 inches, that's an inch at least that it can potentially correct. I haven't got the tape measure out since my six week post op anniversary and I was within a quarter inch of my pre implant size. That's because in order to pump the implant up hard enough to reach my original size, it's going to hurt under the glands where the end of the cylinders are, That area is going to have to build up sufficient scar tissue between the tips of the implant and glans tissue and then expand out around the cylinder walls somewhat surrounding the tips of the implant. That takes time. I pump my implant up every morning and evening to keep things stretched out and flexible and to keep the scar tissue capsule pushed back in order for the cylinders to expand to their fullest. If his implant had been sized correctly, the average loss, other than men who have had a prostatectomy was a tenth of an inch average after 6 months Post Op in the studies. I keep in touch with my uro and bounce questions off him from time to time, Dr Weinstein has been doing this surgery for over 25 years at the University of Missouri Hospitals and Clinics, and he has informed me that a properly sized implant should not cause more than a half inch loss in size, other than in Prostatectomy patients. Further, he told me that the above average loss in length with prostatectomy patients occurs in 1 out of 3 men where they loose an inch or more. Doctors don't have an answer of why that occurs. 2 out of 3 Prostatectomy
patients have outcomes like all the rest of the men with an implant who are properly sized. I prefer reading Euro Today which is the European version of the Journal of Urology that we have here in the U.S. and as they tend to be more realistic and don't gloss over the disadvantages like American Urologists sometimes do. One of the studies that they did on size is at:

http://www.urotoday.com/42/browse_categories/erectile_dysfunction_ed/european_urology__penile_length_alterations_following_penile_prosthesis_surgery.html

The other group of men who have size problems with their implants are men who have severe Peyronie's Disease in their penis, and the amount of problems they have is based upon how bad their scarring becomes. Scar tissue impacts severely the ability of the penis to stretch out and expand in both girth and length. All of the two
piece and three piece implants can expand the girth with some men experiencing a thicker girth after implantation. I personally have experienced at 6 weeks an increase in girth of a quarter inch. The Ultrex manufactured by AMS is the only implant currently on the market and approved by FDA to expand the length of the implant. Over time, it can expand the tissue of the penis in both length and girth providing there is not scarring to prevent the stretching of the penis. I expect that the Ultrex will bring me back to my original length and I know I've gained a little in the circumference of my penis. We guys who have had the implant and those men considering having an implant have to realize that when we are at the point of having this surgery, many of us no longer have the healthy penis we had as young men. Time and disease has taken a toll on us. That said, if the doctor does a good job sizing the implant,
we should expect an outcome of an erection that is pretty close to the stretched length that should be taken prior to surgery. And it should be agreed with the doctor that we realistically expect an outcome of no more than one inch or less loss of length of that stretched length. The surgeon also ought to be honest and up front with every patient about these realistic outcomes. He should inform the patient and their partner if present, about the state of the glans penis or head will not, in most cases become engorged with blood during the erection and instead will remain soft. The cylinders are placed just under the surface of the glans. Mine are approximately a little over a quarter of an inch from the surface of the head of my penis. The outer glans tissue on the sides of the head of my penis remain soft with the hard tips in the middle and on each side of the urethral opening following my pumping to an erection. I can't get any more specific than that to describe what the head of the penis is like after the implant is installed. The head is only hard where the ends or tips of the cylinder is placed in the glans. The rest remains soft for most men. I did ask Dr Weinstein about whether or not Viagra or muse would help to engorge the head of the penis. He told me that he would not prescribe muse in that you have to insert an instrument into the urethral opening and this could introduce bacteria into the urethra that could potentially cause infection of the implant. He told me that Viagra might cause engorgement in some men. There is a company doing trials with a cream that has alprostadil in it which is the same ingredient used in caverject. If that becomes approved in the US, then that drug will have a real capability of causing engorgement of the glans for us implantees. It's sold in other parts of the world under various names. The one that I'm familiar with is Aprox TD. It's in phase 3 trials currently, I believe. I hope it gets approved soon. Will have to give it a try if it does.
Bob

Posting from a fellow Penile Implantee

This is a message from Court H who had his implant procedure back in April 07. Court has his implant procedure performed by Dr Perito, a world renown implant surgeon who practices in Coral Gables, Florida. Dr Perito performs hundreds of implants a year. Court and his wife Beth have allowed me to include previous posts on my blog.

Well, it's been since April 26 th since I had my implant. My initial
reaction was not good. I was not prepared by my surgeon for the initial
loss of an inch of length and the loss of the rigidity of the glans. So,
effectively, I really lost an inch and a half of effective erectile tissue.
My initial reaction was great dismay at the loss of length and finding out
that the loss of the rigidity of the glans left my wife feeling like I
wasn't effectively making contact with the roof of her vagina and therefore
she couldn't feel me inside her anymore was depressing to say the least. I
sent several emails to my surgeon explaining the situation to him and he
assured me that, in time, some of my length would return did give me reason
for hope. He suggested daily genital massage, which my wife without fail,
performs nightly for about 10-15 minutes and a regimen of cycling the device
5-6 times a day, keeping the erection for about 2-3 minutes per cycle would
provide us with our maximum outcome. I have regained about a quarter of an
inch of length so some improvement has been seen. As far as the loss of
firmness of the glans is concerned, my wife came up with a fantastic idea.
We bought the smallest silicone beaded cock ring we could find and placing
it directly behind he ridge of the glans does give a little rigidity back to
the glans but most importantly gives back the sensation of ring of the glans
making contact with her G spot.
One thing I want to stress to anyone considering this procedure, discuss
with the surgeon who will be performing the procedure the potential loss of
length and have them perform a stretch test to see what you are actually
able to achieve. I have been in contact on other forums with others who
have had this procedure for a variety of reasons, prostatectomy, extreme
vascular degeneration and severe diabetes among other reasons and the
majority of them were not prepared adequately by their surgeons for the loss
of length and rigidity of the glans. Some have reported getting goodly
amounts of their length back, some have not. I'm not trying to pour cold
water on anyone considering this procedure I just want each of you who are
considering this procedure to make as informed a decision as possible.
My wife and I are learning how to make love to each other, to a degree, all
over again and we are having success and I do see a bright future ahead so
it was worth it even with the initial shocks and adjustments. I hope I have
made a positive contribution to this board and will continue to post as time
goes on.
Best wishes to all of you,
Court182

Coment from a Reader

new comment on your post "Just some comments about using my implant.":

Very encouraging Bob, this sounds like the function I am seeking, just need to get by the worries expressed occasionally, cockhead limp, loss of length, etc. Staying hard and in after while spooning sounds great, never could do that b4; your wife now has the best sex toy. If she's ok with you telling, like to hear more. Can you talk about your experiences with it now masturbating?? How about partial pumping while just walking around, to give you that fullness for the sake of eroticism. Can you pump it some without undressing, just grab the pump through your slacks and squeeze for some filling. How long can you leave it like this, no discomfort, etc? I don't have google acct yet, so will leave this anonymous, you know me on Y as grrich

Gary:

Thanks for posting and asking.

Men who have had a prostatectomy often lose some length of their erection. My Urologist, Dr Stephen Weinstein of the University of Missouri, Hospitals and Clinics was asked by me about this. Dr Weinstein told me that one in three men loose length with the implant following a prostatectomy. He told me, that what he does is he resects the bladder and repositions the bladder lower in the abdomen to make up for the lose of length of the ureter that went through the prostate. Now that sounds likeit should be standard procedure Gary that all Uro's should be doing. And they may be doing just that. I just don't know. Yet, there are guys reporting some significant loss of length with thw implant who have lost their prostate gland previously. I just wish I knew the answer. I haven't lost any real length of my erection following my implant surgery. I'm within a quarter of an inch to my old Bi-mix length. I've also gained a quarter inch increase in the circumference of my penis. With the Ultrex implant, thats or a pretty typical finding among men with severe ED like me from diabetes or other causes. Men with Peyronies, usually experience straitening of the penis from the implant. There is a procedure for severe scarring with in the corpora involving making an incision length wise about 2/3's the length of the corpora and removing the scar tissue within. The surgeon then places the cylinders of the implant within the corpora and then sutures the corpora and sutures the penis itself. This is a much more involved surgery and takes much longer to heal and recover. But this is supposed to be very beeficial for men who have had severe Peyronies Disease. I don't have any figures off the top of my head on how many are being done or who's doing this type of surgery, but I read a couple of articles in the medical library at where I work in a couple of the urology journals about this particle procedure and how effective it is for men with severe fibrosis. How this might effect future erections would be a question to the doctors who perform this particular surgery. Your typical implant uro might also be able to answer questions on it as well.
As to your questions concerning masturbating with the implant.
I have masturbated several times since my implant surgery, and I find that while I pump my penis erect, I don't pump it nearly as hard as you need for intercourse. I like a little flexibility in my penis during masturbation, expecially when I'm not particularly in a hurry and want to lazily play with myself for awhile. I also find that I'm not pumping my implant really hard when my wife is going to perform oral on me. My girth is thicker than average, and by not pumping my girth as thick as it can get, it makes it easier for my wife to perform oral on me. You don't have to have a rock hard erection to ejaculate most satisfactorily by either oral sex or masturbation. And by leaving your penis semi hard, you can hold back coming a lot easier and go longer. And if your partner tires easily trying to perform oral on you, give them a break and leave yourself less firm. My wife suffers from a dry socket in her jaw and this causes her discomfort if she has to open her mouth as wide as she can to accomadate my full size. Women who experience discomfort why performing oral sex will appreciate you doing this, and I'm finding my experience with my wife giving me oral to be much better for both of us. She doesn't tire as bad from stretching her mouth to accomadate me and I don't get nicked by her teeth as she would do with a very firm erection. Walking around with a so so erection is fine also. When I first started pumping, the head of my penis was extra sensitive and if I left things anything but totally flacid, after awhile the head would get sore within my underwear and under my clothes from the friction and pressure of my clothes. It was more comfortable at first to be completely flacid. That is getting less and less of a problem the longer in the healing process I get. Within a month, that should be a distant memory for me.
Also, you've got to understand that you have two cylinders running the length of your penis so I never become totally flacid anymore. I'm usually sticking out there about 4 inches all the time now where as before the implant, I would only be 2 1/2 to sometimes 3 1/2 inches flacid. With the implant, your going to be showing a package all of the time. What you see in my pictures of my flacid cock is what I have showing all the time now. When I undress in the locker room or take a leak, I'm going to show about 4 inches of cock. Thats the minimum size I can get anymore. It's not really noticeable unless your wearing tight clothing, but it's there. As for pumping through your clothes, I can do that without too much trouble. The pump ball lies in the bottom of your scrotum and it is easy find and access. I can even deflate through my clothes. You are going to find out that after you are healed up, you can inflate yourself to whatever firmness you like, anytime and for however long that you want with out harming yourself. I sometimes like to walk around in my underwear with a partial erection just to catch my wifes eye and give her some ideas.
Before the implant, the spongy tissue that filled with blood, needed to have blood exchanges or the tissue would die, and scarring would occur if an erection lasted for over 4 hours maximum. In reality, I think 3 hours maximum was even better. With the implant filling the corpora, you don't need blood exchanges, so you can stay hard as long as you want. You still need to empty the implant and expand the reservoir as the body builds a capsule arouond the reservoir. You don't want to collapse the reservoir so that it can't collect the fluid from the implant. If that happens, you'll be walking around with a hard on all of the time and that won't look or feel natural. Gary, the confidence that I now feel with the implant has jacked up my sex drive to unbelievable heights. I have sex on the brain all the time now. I feel better about my sex drive and sexual satisfaction now more than at any time of my life. Maybe I'm a kid right now with a new toy. But I've never had this much fun with a toy before. Good luck on your future implant surgery. Bob

Testosterone Replacement

Dear Readers:

I'd like to touch on a topic that I've researched heavily and have lived with for around 14 to 15 years and that is Testosterone Replacement Therapy, (HRT) or Hormone Replacement Therapy as it is also called. One of the syndromes that people who have autoimmune diseases have is a greater likelihood of having other endocrine problems. I have Juvenile Diabetes or Type 1 diabetes which is an autoimmune disorder where antibodies attacked my Beta Cells in my pancreas and destroyed them. Without Beta Cells, there is no insulin production. In my thirties, I discovered that my libido was starting to take a nose dive. After finding that there was adequate hormone to stimulate my testicles to produce testosterone, I opted for a needle core biopsy of my testicles and it was discovered that the cells that produce testosterone were slowly being destroyed, so I started taking shots of Testosterone Cypionate. As time went on, a single shot a month left me going up and down and I felt on a roller coaster of emotions. I was as PMSy as my wife. So my doctor put me on a schedule of taking a shot every two weeks. Then I went to every week just so I didn’t have too great a fluctuation. Ahh, the not so fond memories of jabbing an inch and a half, 23 gauge needle into my butt. Those days ended approximately 6 years ago with the advent of Androgel. Androgel is a topical gel containing 5 grams of testosterone that you rub onto the skin of your body. It came in 2.5 gram and 5 gram packets at the time I started using it. I would apply mine every morning after my shower. Androgel now has a more convenient pump bottle in addition to the packets that supplies you 1.25 grams with each pump and I really like using the pump. It’s so much easier to use than tearing open foil packets everyday and the price is cheaper. Also, it is much easier to titrate your dosage so that you are not getting too much or too little testosterone each day based upon your blood tests. I like to apply the testosterone to my skin and then have blood drawn two hours later. I like having a testosterone level around 800 milligrams for my am level. I know that is the level where I feel my best. A testosterone level below 300 mg is too low for any man and yet many doctors don’t want to start replacement therapy until a man’s level is 200 mg and below. If your doctor won’t treat you and shoot for a morning level of 600 mgs to 900 mgs, find yourself a different doctor. The best doctor to see is a Urologist and have your prostate checked at the same time. Low testosterone exhibits itself by symptoms of depression, low sex drive, poor or no erections, high cholesterol readings, and feelings of lethargy or no energy. Low testosterone will slowly result in significant bone lose. Men who have low testosterone also are at a significantly higher risk of cardiovascular disease, i.e.; heart attacks and strokes. Low testosterone just makes everyday suck in so many ways, that it leaves you feeling like why even get out of bed. A word of caution, if you are having problems with obesity and diabetes, you need to get off your butt and exercise along with replacement of testosterone. Having too high a level of body fat results in too much aromatase being produced by your body fat. Aromatase is an enzyme that breaks down testosterone and the end product is estradiol or a form of estrogen that is produced. Estrogen has a higher affinity for testosterone receptors than testosterone has. What testosterone that doesn’t get converted to estradiol, is bound with Sex Hormone Binding Globulin and become non bioavailable or in other words, your body can’t use. What this means is the amount of bound testosterone cannot attach to testosterone receptors and is thus useless to you. The amount of free bioavailable testosterone that is available to your body to do all of the anabolic things that testosterone does along with sex drive and physical well being just isn’t there. This results in two things happening. You need free, unbound testosterone to attach to testosterone receptors to obtain the full effects of the testosterone. If all your testosterone is converted to estrogen or becomes bounded testosterone, you don’t have any effect from the testosterone no matter what your levels are. And two, estrogen starts breast development and depositing fat in the hips. I have a good friend who has this problem. His breasts are so large, that they fill his wife’s D cup bras. Thats bad and he knows it. Unfortunately, he chooses not to try and change anything.
Take care
Bob

Just some comments about using my implant.

Dear Readers:

I just received a comment from an anonymous poster thanking me for my candor and for having this blog. I know exactly what he means about finding any information from actual implantees and their experiences along with pictures on what everything looks like and feels like following surgery, recuperation, and actually enjoying sexual relations with the implant. There just isn't anything like my blog out there on the internet. That was my motivation for creating this blog in order to help men and their partners learn from me and others in order to make an informed decision on a treatment that can really have a significant effect on a man for the rest of your life. I'm very happy that I chose to have implant surgery and I am advising any man to give this surgery some significant thought. I'm really enjoying both oral sex and intercourse with my wife as is she. It's like being 20- again. No more getting up and taking a painful shot or planning sex and taking a pill and waiting for results. No more worries of whether or not I'm going to get an erection and stay hard to completion. It takes 6 to 12 pumps and I have an erection as hard as any 20 year old guy, but with one difference. I can stay hard for hours with the implant. I can fall asleep spooning my wife, with my erection inside her. We both love that feeling of staying connected. I've woken up to my wife moving back and forth on my cock in the middle of the night and she's having an orgasm!!
Sometimes I wake up in the middle of the night, and just enjoy thrusting into her vagina for awhile, sometimes to ejaculation, sometimes not, and while I'm moving inside of her, shes asleep, but she'll moan and I know a part of her is enjoying this and all this is just in the past few weeks. I'm finding that the implant is opening up a whole new sexual world for me and my wife as I can now do things with the implant, that I never could do before. It's like having the 6 million dollar bionic penis. One of the topics of concern on Penile Implants Support group is possible partner rejection of a man with an implant. In my case, I don't have a large scrotum, so on my right side you can feel the pump for the implant. I've talked to men with larger scrotums and the pump isn't as noticeable as mine is. I'm pulling and tugging on my scrotal skin in hopes of stretching it to a larger size and it may do that on it's own. Who knows. But guys, let me let you in on a secret. Women fight self esteem issues their whole lives. Are they pretty enough, is their butt too large. Are their breasts too small, too big, saggging. Do they look too fat. They have to live with periods and all the charming surprises that it throws their way. They worry how their vagina looks like to us, tastes like, and does it smell bad to us. God, if they only knew how in heaven we guys are when we get anywhere near their vaginas. With all the self esteem issues that they carry around all their lives, expect them to be curious about your implant. Answer their questions honestly and after they experience all the advantages that your implant offers them, the vast majority of women are going to accept it as a normal part of you. As my wife has comented on mine, I'm harder, slightly thicker in girth, my penis still tastes the same. My ejaculate is the same. I ejaculate with force and with the same volume. My sensitivity hasn't changed any. My genitals still look quite normal as the pictures that I have posted as well as Dan's photos. And for some reason or other, I have been horny as hell over the past several weeks since I got the ok for sex. I have a new sense of confidence in my sexuality. I may be making up for all the missed oportunities that I had because taking a shot just didn't seem worth it at the time or was maybe more hastle then I wanted to deal with. Sex for me is fool proof. I can't loose. I know without any doubt that I can perform anytime, anyplace, and if I was so inclined, with anyone. No man has that kind of security unless they have an implant. There were a couple of times in my life, when I was younger, I had to pass on a couple of good looking opportunities because I had too much to drink and she was very willing. I was very willing, but the the man down below my belt would not wake up. I'd have donated a testicle to have this implant then. Take care all.
Bob

Talking about Implant Results

Below are pictures taken on July 28th of my genitals following a two month healing period following Penile Implant Surgery. I've had an AMS 700 Ultrex implant surgically implanted. The Ultrex allows for expansion in both length and girth of the penis. The implant allows a 20% enlongation and while it takes up to 6 months to obtain the maximum possible expansion of the device, I am very satisfied with my current erection from my implant. I've enjoyed great sex with my wife and it has been very enjoyable for both of us. I have the same sensations that I felt prior to the surgery. The orgasms are strong and my ejaculate is the same volume and force as I've always experienced my whole life. The glands of my penis stays somewhat softer than what I used to experience, but because the ends of the cylinders are located just under the glans or head and furnishes the hard feeling to my wifes vagina. We've experienced intercourse about a dozen times in the past two weeks and I've asked her to close her eyes and concentrate on the feelings of my penis thrusting into her. I asked her, do you feel any difference from before the implant with how I feel inside her now? Her asnswer is no difference what so ever. It feels great. The only way that she can tell that I have an implant is when she can feel the pump within my scrotum. Guys With an implant, you have the best penis that modern science can build. It looks natural, feels naturals, is warm, and tastes perfectlly natural to your partner. You have the ability to bring pleasure to your partner for as long as they want, as hard as they want, and as often as they want. Anywhere, anytime, you are the ultimate male lover. Your orgasm does not change. It's the same as it was when you were a young man. The only difference is when my orgasm pushes my ejaculate out, my penis stays wonderfully hard and erect. Ladies. No longer do you have to be frustrated because the guy has his orgasm, and you are so close. Don't stop, you urge him, but he can't because he's gone soft before you can finish. Well, never again for the guy who has an implant. Ladies, he is going to keep thrusting hard into you until you stop having exploding orgasms. You are really going to enjoy your guys new ardor. Don't wait. Don't hesitate to have this surgery if you really need it. My spouse and I are glad that I had this surgery. I now wish that I had not endured the injections as long as I did. As you can see from my pictures and from another implantees pictures, our genitals look entirely normal following the surgery. Both flacid and erect, I'm not at all ashamed of any one seeing my genitalia. I'm not ashamed to make love to my wife, or if I were single, make love to any women. I have complete confidence, more than I have ever had in my entire life, to have long, hard, and satisfying sex with any women. I can satisfy any women. There is absolutely no doubt in my mind of that.

Two Months Post Op Erection from Implant

2 month Flacid Post Op Pictures

Penile Length Following Implant Surgery

Dear Readers

An often heard discussion on Penile Implants is the discussion of size following implant surgery versus size prior to implant surgery. A lot of factors enter in the length of the penis following the surgery. This topic should be covered fully by any Urologist who does implant surgery so that men who are about to have this surgery, have realistic expectations and knowledge of possible outcomes. I would dare say, that a realistic outcome by the patient is the number one reason to influence how a patient and their spouse perceives whether or not they are happy they had the implant surgery. Prior to any surgery, men ought to know that the glans or head of the penis does not become engorged with blood during sexual intercourse with the implant. This is often the reason why the length of a man's penis is shorter than the length he experienced with either a natural erection or with intercavernosal injections. Expect to loose a 1/4 to 1/2 of an inch in length due to this very reason. Also, expect the penis to be shorter in length 1 month post op than at 6 months post op. Men who cycle the implant daily, will stretch the penis. A least in the size of the girth, but should also see some improvement in length as well. Their is only one implant that expands length wise and that is the AMS 700 Ultrex. All of the other implants are pretty much sized to the maximum length that a man has that can be achieved when the tissues are stretched. That is why I went with the Ultrex implant. It can achieve a possible increase of up to
20 % in length. A man who penis is 5 inches could potentially increase one inch. That is probably not going to happen as the penis can only be stretched so much, so each man's experiences will be different. For men who received a prostatectomy prior to the implant, you men need to realistically expect to permanently lose an inch or more. Below is an article that appeared in the European Urology website detailing a study on realistic penile length results of men who had the surgery. Participants were measured post surgery for flacid stretch length and then measured at post surgical at one month and six months. Each man's final results are going to vary some. I hope you find the study informative.

http://www.urotoday.com/42/browse_categories/erectile_dysfunction_ed/european_urology__penile_length_alterations_following_penile_prosthesis_surgery.html

Paste the above address in your web browser. This site really gives a good explanation on penile length following implant surgery.
Bob

Dave's Pictures

Erect 4 weeks

2. Flaccid at 4 weeks

Flaccid at 7 weeks

Flaccid 1 at 7 weeks

Erection at 7 weeks

Erection Pic 5 at 7 weeks

Erection at 7 weeks

Erection Picture 3 at 7 weeks

Erection 2 at 7 weeks

Erection Pic1 at 7 weeks

Erection Pic at 4 weeks

I wish to thank Dave for submitting these pictures of his genitals at Post Op Week 4 and Week 7 following Daniel's Penile Implant surgery. Read his Story below.

These pictures are copyrited and are posted for educational purposes for men with long term erectile dysfunction and their partner's who are giving serious thought to possibly seeking a penile implant as a solution to their ED problems. I began this blog as an aid to men to hear first hand accounts of penile implantees as well as their spouses views. I welcome all submissions.

Bob, here are pictures, flaccid, 1 semierect, and several erect, at 4 weeks, just after I began to pump, and this week, which is my 7th week. The flaccid at week 4 was 4 inches, the erect was 4 1/2 inches. The flaccid now is 4 1/2 inches and the erect is right at 5 inches. You'll notice that it points slightly to the right for some reason...all of the tubing is just to the right of my pubic area, and then goes into the abdomen, and the pump is on the right side of the scrotum.

Dave's Story Followed by pictures

My name is Dave J. In January, 2005, I had a TURP, after having had years of recurring prostate infections. A week later, at my follow-up visit to the urologist, he informed me that the tissues they took from the TURP and sent to the lab had cancer..a Gleason of 6. My options were to do nothing, (watchful waiting), which he did not recommend at my age (58) at the time; have radiation, or surgery. I felt my best choice was to be rid of the cancer so I chose the surgery. I had a Radical Prostatectomy in March, '05.

I immediately began using Viagra/Cialis to assist in resuming normal erections. I had a few times of "fullness" over the course of the next couple of months, but nothing near an erection. In June '05, I began using Edex injections. They worked well, but I had terrible pain and 3 hour erections each time. Intercourse had to happen quickly, because once the pain began, it was too painful to do so. I also began using a VED for therapy in July '05.
Within a few weeks, I noticed that my penis had decreased in length and girth, and was bending to the right. In October, the urologist insisited that I discontinue the injections because I was damaging the tissue within the penis, causing fibrosis. So, I did. I continued to use the pump, and had only 1 successful intercourse with it, as the rings could not keep the blood in the penis.

I used the VED as therapy every night for at least 15 minutes over the next 19 months. Natural erections would occur only occasionally, during the night, but never sustainable for intercourse. And, because of the fibrosis, they were very small both in length and girth.

My urologist wanted me to have the implant, but I was reluctant. We had at least one very "tense" discussion, but he insisted it was my last option if I wanted intercourse. So, in April, I agreed to have the surgery, and scheduled it for May 21, 2007.

Recovery was painful for the first two weeks, but began to be less so by the third week. At the 4 week followup, he pumped it up, and told me to continue to do so daily until my next visit. I did as he said, sometimes several times a day, to try and stretch the tissue.

Before the prostatectomy, i was 5 3/4" flaccid, and 7 1'2" erect, and often when I was REALLY in the mood, 8". After the surgery, I was about 4 1/2 - 5" flaccid, and erections (with injections, before damage) was about 6". After the implant, I was only 4" flaccid and 4 1'2" erect. I've gained about 1/2" in both as I've been stretching, and hopefully will gain at least another 1/2" or more. Sex is different being so much shorter, but still most enjoyable.

It's a difficult decision, and there is no return, but I'm glad I made the choice.

Penile Implants--What to expect and how to prepare

Penile implants — What to expect and how to prepare

Penile implants are artificial devices implanted inside the penis that allow men with erectile dysfunction (ED) to achieve an erection. They're also sometimes used to treat Peyronie's disease, a disorder that causes bent or painful erections. There are two basic designs:
Inflatable. Also called hydraulic, inflatable implants can be pumped up to create an erection and then deflated.
Semirigid. These implants are always somewhat firm.
First introduced in the 1970s, penile implants were the most reliable treatment for erectile dysfunction until the 1980s when medications injected into the penis became available. In the 1990s, oral agents such as sildenafil (Viagra) were introduced. These medications have since become the most popular erectile dysfunction treatment, but they don't work for all men with erectile problems. About two-thirds of men with ED will respond to oral medications — but some men can't take them, or the medications don't produce satisfactory results. For these men, penile implants are an additional option.
Penile implants require complex and permanent surgery, and there is a risk of infection and a risk that the device will malfunction. But, since these devices were first introduced, new materials, designs and surgical procedures have greatly improved outcomes for penile implants. Most men who have the procedure and their partners say they're satisfied with the results.
Penile implant surgery can be costly but may be covered by Medicare and other types of insurance.

Who is it for?
Erectile dysfunction can be caused by a number of health problems and injuries, and can be a complication of certain surgeries. Depending on the cause of erection problems, implants may be the best treatment choice. Penile implants are a good option for men with erectile dysfunction who can't take medications or for whom medications don't work. Some men make the personal choice to receive an implant rather than using alternative means to restore sexual function.
Implants are also used to treat some cases of Peyronie's disease — a condition that causes internal scarring that can lead to a bending of the erect penis, painful erections and other problems with sexual function.
Most men with erectile dysfunction opt for a penile implant only after other less invasive methods prove ineffective — these include oral medications, medications injected into the penis with a needle or via the urethra (the tube that carries urine and semen through the penis), and use of a vacuum pump device.
A penile implant procedure may have a higher risk of failure if you have immune system problems, a chronic health condition such as diabetes or are at high risk of infections.

How do you prepare?
Penile implant surgery is usually done at a surgery center or hospital by a urologist.
Most candidates for penile implant surgery are evaluated by their surgeon to determine the cause of their erectile dysfunction and to assess their risk of a surgical procedure.
Once you and your doctor have determined that a penile implant may be a good choice for you, your doctor will help you understand the procedure, the risks and potential complications, and the type of implant that suits you best. Include your partner in the consultation with your doctor, if appropriate.
Follow your doctor's instructions about taking medications before and after your surgery. Often, during the two weeks before and after penile implant surgery, your doctor will tell you not to take medications that can alter the function of the platelets in your blood and can increase the risk of bleeding. Your surgeon should review your medications and suggest alternatives if you're taking medications that might make the surgery riskier.
Your surgeon might suggest that you bathe with antibiotic soap for three nights before your surgery to reduce the risk of infection. Do not shave the surgery site yourself.
You may be dismissed the day of surgery or may stay overnight, depending on the circumstances. Arrange for someone to drive you home from the surgery center or hospital.

How is it done?
Penile implant surgery usually takes between one and two hours and can be done under a general or spinal anesthetic.
Normally, spongy tissue inside the penis fills with blood to create an erection. To insert the penile implant, your doctor will stretch these tissue-filled chambers inside your penis (corpora cavernosa). After measurements are made and appropriately sized prostheses are selected, the cylinders (either inflatable or semirigid) are then inserted into the two chambers. With an inflatable implant, your doctor will also place a pump inside your scrotum, and possibly a fluid-filled reservoir in your lower abdomen, depending on the type of implant you receive.
There are two basic types of penile implants:
Inflatable implants There are two- and three-piece inflatable implants.
Three-piece implants use a fluid-filled reservoir implanted under the abdominal wall, a pump-and-release valve placed inside the scrotum, and two inflatable cylinders inside the penis. Before you have sex, you pump the fluid from the reservoir into the cylinders to cause an erection. After sex, you release the valve inside the scrotum to drain the fluid back into the reservoir.
The two-piece model currently available in the United States works in a similar way to a three-piece design, but the fluid reservoir is part of the pump mechanism implanted in the scrotum.
Semirigid rods This type of implant is always firm. The penis may be bent away from the body to have sex and toward the body to conceal the device.
In the United States, inflatable devices are the most common type of penile implant.
Three-piece inflatable devices are used in about 80 percent of penile implants.
Two-piece inflatable devices are used about 15 percent of the time.
Semirigid devices are the least used, accounting for about 5 percent of implants.
Although less commonly used, semirigid devices are less complicated, easier to place and have less risk of mechanical failure. Inflatable devices are more costly than semirigid types are, but they're more natural because they can be inflated to create an erection — and deflated at other times. Inflatable implants also reduce the possibility of damage to the inside of the penis due to constant pressure — which can be a problem for some men with semirigid implants.
Although semirigid implants are mechanically simpler — and early inflatable designs often had problems — improved design, materials and construction have made modern inflatable designs much more reliable.
The decision about which type of implant you should have is based on both your preference and your medical situation. Your doctor may advise one type of design over another based on factors including your age, risk of infection, and health conditions, injuries or medical treatments you have had in the past.
Type of implant
Advantages
Drawbacks


Three-piece inflatable
Creates a more natural erection than does a semirigid implant
Creates a firmer erection than does a two-piece implant
Can take pressure off the inside of the penis by deflating the implant when not in use, reducing the chance for injury
Most costly of all implant types
Has more parts that could malfunction than does any other design
Requires the most extensive surgery of any implant design

Two-piece inflatable
Creates a more natural erection than does a semirigid implant
Mechanically simpler than a three-piece inflatable implant
Less costly than a three-piece inflatable implant
No need to implant a separate reservoir in the abdominal wall, as with a three-piece design
Can take pressure off the inside of the penis by deflating the implant when not in use, reducing the chance for injury
Requires more extensive surgery than does a semirigid implant
Mechanically more complicated than a semirigid implant
Results in a bulkier scrotum than with a three-piece device

Semirigid
Requires the least extensive surgery of all penile implant types
Less parts than any other design, so less of a chance of malfunction
Least costly of all implant types
Penis always semirigid — not entirely hard or entirely flaccid
Less easy to conceal under clothing than other devices
Constant pressure on the inside of the penis, causing injury in some men

The three-piece inflatable penile implant consists of inflatable cylinders inside the shaft of the penis, a fluid reservoir under the abdominal wall, and a pump inside the scrotum.

The two-piece inflatable penile implant consists of inflatable cylinders inside the shaft of the penis and a combined fluid reservoir and pump unit in the scrotum.

The semirigid penile implant is bent upward for sex; and toward the body for concealment under clothing.

What can you expect during the procedure?
Immediately before surgery
Penile implant surgery is usually done under either spinal or general anesthesia administered by an anesthesiologist.
Within a couple of hours before the surgery, you may be given antibiotics to reduce your risk of infection.
A tube called a catheter may be placed into the bladder through your urethra to drain urine. In most cases, the urinary catheter is removed the in the first 24 hours after surgery.
During surgery
Your surgeon will make an incision below the head of the penis, at the base of the penis, or in the lower abdomen.
Next, your surgeon stretches the spongy tissues in the penis that would normally fill with blood during an erection. This tissue is inside the two hollow chambers called the corpora cavernosa.
After flushing the area with antibiotic fluid to prevent infection, your surgeon will choose the correct size implant and seat the cylinders inside the penis.
If your doctor is implanting a two-piece inflatable device, the pump and valve mechanism are placed inside the scrotum. For a three-piece device, your surgeon will also implant a fluid reservoir under the abdominal wall through an internal incision.
Once the device is in place, your surgeon will sew the incisions closed.

Recovery
Most men go home within 24 hours of surgery.
You will need to take antibiotics as directed by your surgeon to prevent infection.
Following surgery, wear loosefitting underwear and clothing. Men with an inflatable device will need to make sure the scrotal pump stays in place during healing.
Most men can resume strenuous physical activity about a month after surgery. You can resume sexual activity four to six weeks after surgery depending on the type of implant you have and the instructions of your surgeon.

Results
New designs and surgical procedures have improved the function and safety of penile implants. Although implants are the most invasive and least often chosen treatment for erectile dysfunction, they have a very high satisfaction rate. Over 90% of the men who have the procedure, and their partners, say they're satisfied with the results. Many use the devices to have sex several times a week. Men with Peyronie's disease who have the procedure report slightly lower satisfaction rates.

While most men are satisfied with their penile implant, there are some things men should know before choosing to have the procedure:
Implants cause an erection, but they don't increase sexual desire or sensation.

penile implant will be shorter than the erection you had naturally in many implantees. Some implantees recover their length in time. But for others, they can loose an inch or more. And some men will have a 1 to 3 cm increase with the AMS 700 Ultrex. Know this and understand this before your implant surgery. You have to expect that some length will be lost and you will have to live with it. Prostate surgery for cancer causes the worst loss. Stretched flaccid length prior to surgery is a good indicator or predictor of final length.

Also understand, the glans penis does not become engorged with blood and remains soft in most men. Some men use viagra or cialis to engorge the glans penis (head of the penis) during intercourse.

Some partners feel that sexual pleasure is diminished by their lack of involvement in creating an erection.
This surgery is permanent. If your implant is removed, you will not be able to get an erection.
Infection is a possibility, especially if you have diabetes or certain other health problems. An infected prosthesis has to be removed and replaced. Currently less than 2% for antibiotic coated implants.
You may have reduced sensation in the head of your penis. In some men, this improves when they also take phosphodiesterase type 5 inhibitors, such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra).

Risks
Infection Penile implants sometimes become infected. Surgery to replace the prosthesis is almost always necessary to treat an infection.
For men who are not already at higher risk of infection because of an underlying health condition, infection rates are low — about 1 percent to 3 percent.
Men with diabetes are at higher risk, with an infection rate of about 8 percent.
Men with a spinal cord injury have about 9 percent risk of infection.
Men having revision surgery — surgery to adjust or replace an implant — have about a 10 percent risk of infection. Men with diabetes who have revision surgery are at higher risk.
If an infection occurs, it's usually not until weeks or more after surgery. In some cases, an infection occurs years later. Symptoms can include long-term pain, a component of the prosthesis sticking to the skin, or rarely, a component that breaks through the skin of the penis. With inflatable models, the entire prosthesis can also become infected.
More serious infections — which in most cases start within weeks of surgery — can cause swelling of the scrotum, drainage of pus and fever.
Malfunction Although new penile implant designs are very reliable and may last a lifetime, they can malfunction. For example, in some semirigid devices, internal parts can break down over time, leading to a prosthesis malfunction. In inflatable devices, fluid can leak or the valve or pump device can fail. Surgery is necessary to repair or replace a broken implant.

Looking ahead
New implants coated with antibiotics have reduced the incidence of infection, but more studies are needed to determine how effective they are.
Manufacturers recently released a three-piece inflatable implant with a lock-out device to prevent the device from accidentally inflating on its own. More research is needed to see how well this device works, but initial results are promising.
Because some men who have their prostate removed to treat prostate cancer have erection problems, experts are studying whether implanting a penile prosthesis at the same time the prostate is removed is appropriate.
The best solution to erectile dysfunction would be to repair the damaged tissue that caused the problem in the first place. Research is currently ongoing to devise injections of materials that would repair damaged penile tissue to allow natural erections to occur.

Husband and Wife speak of experience with Penile Implant

Dear Readers:
I've been corresponding with Beth & Court and they wish to share their experiences. Court received his implant, the end of April 2007. His doctor was Doctor Paul Perito from Coral Gables, Florida. Dr Perito performs hundreds of implants annually and is a highly skilled surgeon who does a lot implant surgery. Beth and Court are a loving couple who feel that having a full sex life is an important part of their marriage. It is the way men and women can express their love to each other and give of themselves. They, like my wife and I, have suffered with Erectile Dysfunction for many many years. After all the other treatment for ED failed them and us, we, both couples looked to penile implant surgery as the finale solution to fix that all important sexual part of our lives. But as we've found, some doctors view the surgery with higher expectations than what the majority of patients are going to achieve in real life. What both couples hope to achieve is for you the reader to learn from us. We want you going into the decision with a realistic knowledge of what an implant can acomplish and what are its limitations. No ED treatment up to this point is a full proof solution. I was told that I would not lose any length from erections with the implant. In reality, I'm about a 1/2 inch short in length, but the circumference of my penis has gained at least a 1/4 inch in girth. In time as I use the implant, things may change. Am I satisfied with my present results. My answer would be an unqualifying yes. Just understand going in, your result might be diferent than what your doctor may optimistically tell you. But do keep an open mind.
Regards to all and thank you Court and Beth for your candor and help. As I've said before. I would like this blog to be a learning resource that tells it like it is. Please send me your stories and be honest. No bragging allowed and no flaming other posters.
Thanks all
Bob



From: Badnessneeds@yahoo.com [mailto:badnessneeds@yahoo.com] Sent: Thursday, July 05, 2007 4:59 PMTo: Bob BaconSubject: Re: How is your husbands progress

Dear Bob,I'd be honored if you chose to cobble together some of the things I've written and put it up on your blog. It needn't be anonymous, I am not ashamed or feel uncomfortable discussing this subject from ANY angle. I'll discuss any aspect of this from the physical, the emotional, the roller coaster ride for the last 17 years that lead us here. I consider my husband (and you) to be the bravest, most committed guys I know. I could not conceive of a life that didn't include feeling my husband inside me - there is no substitute for making love with the person you love most and like best in the world. Nothing I've written is off limits. I wish we'd taken some photos of Courtney during all this, but it just never occurred to me. Last night, after a warming and massage, then a tugging and a pump-up of the device, I can say that Courtney has, in the last month, regained 1/4 of an inch (I only let him measure every few weeks, so as to avoid yet another dick obsession). It's not all of what he lost, but by the same token, let's get real - the pills didn't work, I couldn't find a tri-mix formulation that worked for more that a few minutes so "the old Courtney" lives on only in my memory. I was never going to get that back, so I might as well get over it and get creative (like smallish cock rings worn behind the head). This is what we have now, and a quarter inch beats a poke in the eye with a sharp stick, wouldn't you agree?By the way, Courtney learned that "come hither" trick with the finger a few years ago, too. What's so hilarious is that when he hits it, even if I am in the middle of a sentence, I just stop talking like a doll who's string finally wound all the way back in. We now refer to it as "that place that makes me go quiet".As for creating a place for people to go for information - all the shit the doctors just can't seem to bring themselves to get honest about - if you hadn't started your blog, we would have. We can find a plethora of guys who have either had the surgery just recently or are scheduled to have it shortly. What we need to do is encourage a mentorship program - guys who've lived and loved with hydraulics who can help when one of the newbies wants to jump off a bridge because he's left with a lot less than he remembers it being.... So let's keep going - we need to be the voices of sanity, advice and reason in the year to follow - that's where the internet is sorely lacking in resources. So why not have it be a group like us? We're significantly better educated on the subject than most. Courtney and I will help you and Ann in any way we can.
Beth

Bob Bacon wrote:
Beth:

Thank you for the email and for your frankness and no it doesn’t bother me at all. It’s refreshing. Ann and I aren’t supposed to do today what we did, but she couldn’t stand looking at my erection and having had to do without for 5 weeks, I let her climb aboard. It was wonderful. She had a very nice orgasm, but I got just a little sore and decided not to push my luck. I understand perfectly what you are saying. Ann my wife, loves having me curl my finger and give her a come hither with my finger over her g spot while performing oral. It drives her wild. I love your inventiveness and as I was reading your letter, I was thinking along the same lines as you came up with. The studded cock ring was ingenious. I wish you and Court the very best. Making love is the glue that keeps the marriage strong. I’m about a half inch short of what I had, but I know now that with what I have left that I still can do the job so I’m just going to try and take it in stride. I do have a quarter inch of thickness that I didn’t have before. I do wish that my surgery had occurred a week earlier than it did. This resort would make any couple feel pretty frisky. And without the kids around, no interruptions, it’s perfect. The weather is perfect and we’re going to watch the fireworks from our boat tonight. Coming down here, we got to within 20 minutes of the resort and the boat started feeling really different. I couldn’t stop as I was stuck in traffic in a hard poring rain. When we got to the resort, I checked my trailer and the right tire was completely worn out and all of the tread was gone. I’m glad it didn’t happen to me at 70 mph. It would be a lousy way to start a vacation after destroying a boat. One of the bearings disinagrated into little pieces inside the hub. I’ve got a new hub and bearings kit being Fed Ex’ed to me for two day delivery. We have met some really nice people here at the resort. Normally we come here over Labor Day weekend. But now my wife and I think we’re going to come down here 4th of July week as well. Friends of mine who retired to Florida keep wanting my wife and I to join them when we retire. That’s going to be quite a few years from now. We’re still kids. At least I still think so. Keep up working with Court, and he should be back to normal in no time. Like you said, I followed the same regimen that you folks followed. There’s a reason for nightly erections in men and it has to do with oxygenation of the tissues as well as keeping the tissue stretched out. One of the things I learned after I became a juvenile diabetic was to get ambitious, and really take good care of myself. Watching what I eat, exercise and monitoring my blood sugars closely. Even though I have kept good care of myself, the diabetes over time nicks you a little at a time. This implant is going to allow me to continue loving my best friend. Court is truly blessed with having you as his wife Beth. If you ever want to contribute anonymously and tell your story on the blog I’m keeping, I would appreciate it. I’m trying to help other couple learn from my experiences as well as from other men if I can. The doctors don’t tell the whole story. If I can obtain enough stories, I’d like to incorporate it into a web site of truthful information for men and their partner’s looking into penile implants, so that they can make an informed decision. Have a happy 4th of July.

Regards
Bob




From: Badnessneeds@yahoo.com [mailto:badnessneeds@yahoo.com] Sent: Wednesday, July 04, 2007 2:29 PMTo: Bob BaconSubject: Re: How is your husbands progress

Dear Bob,Yeah, our surgeon told us the same thing, that we shouldn't lose any length because whether it was only 3 minutes from a shot of tri-mix or using the vacuum pump, I never let Courtney go more than a few days without an erection, no matter how brief. He was 5 inches to start - perfect for me. Courtney had testicular seminoma (it left a perfect place to put the pump!). It's not just the loss of length - that really is not the issue for me. A couple of years ago, I started becoming more interested in developing the sensitivity of my g-spot. I'd had occasional instances of mind-blowing orgasms and it took me a little while to put A with B. After that, I bought a few books on the subject, and started (with Courtney's blessing and assistance) to develop better control, to learn to "listen" to just the signals my g-spot was sending and how to use my muscles to bring my g-spot more into play during intercourse. It didn't take long to realize the coronal ring of the glans penis was the lynchpin to involving my g-spot. So for me, I wasn't solely upset by the loss of that inch - I was devastated at the loss of the engorgement of the glans. Since you mentioned that you and you wife had played around a bit, I'm sure you also know that above the ring of opening muscles, the tissues of the vagina do not perceive stimulation the same way as do the skin on your arm, or the tip of your nose. It's very difficult to describe, but pressure seems to be the most important stimulus. So when I would squeeze my muscles to bring Courtney's glans into hard contact with my g-spot, nothing happened. I could squeeze him and feel absolutely nothing up there. I felt him perfectly but only at the opening ring of muscles. I was devastated. I didn't know if I could go back to an orgasm that relied solely on my clitoris again, after everything Courtney and I had worked so diligently to learn about those bundles of nerves I'd recently discovered.Day before yesterday, I came up with an idea on my way home from work and I text messaged Court and asked him what he thought and he (of course) said "Do it!" I stopped by an adult shop near our home and looked at all the different cock rings. I knew that I didn't want to use a cock ring at the base of his penis, but I found one company that makes very stretchy silicone rings with small balls embedded in them and one of them was small enough to fit just behind the glans penis. Filled with trepidation, we gave it a try. It was just enough to scrape my g-spot and was the right size that not only did it not move or come off, it did not prevent Courtney from ejaculating. So at least for the nonce, we may have found a solution to helping me "feel" my husband deep inside me again.We have decided that we will continue our regimen until at least this autumn: we have a buckwheat neck ring that can be heated in the microwave, so we start with 10 minutes of warmth, then I massage the whole area, including perineum using both lotioned hands and a Hitachi-style massage wand for about 10-15 minutes. I follow that with hot wet compresses, mopping up the excess lotion, dry him off and while I re-heat his buckwheat ring, Courtney does his tugging exercises. He says they seem to be much more effective now that he's changed his style a bit. He makes sure he has a good grasp on not just the skin, but the implant too, bringing it down as far into the penis as safely as possible.I know I got kind of graphic on all this - if that bothers you, I apologize in advance. But I can't possibly be the only woman on the planet to feel like this, to mourn this loss, to become very inventive in seeking solutions (and occasionally crying in my coffee).

Courtney has his surgery done by Paul Perito at Coral Gables Hospital– the man responsible for about 50% of the implants done in the US and the golden boy of Coloplast. He did not address the loss of length in advance, and for that I am angry – but because, like you, Courtney was sexually active right up until his surgery, he says we have ever reasonable expectation to regain the length that’s been lost. In my reading, I found one interesting thing – did you know that the European Union’s version of the AMA published a position paper stating that all penile implant recipients should be counseled extensively regarding the loss of length associated with receiving an implant? Interesting, huh?

Have a wonderful vacation – we’re just hangin’ around the shanty, watching movies and writing letters to friends, as I am doing now. Please give our best wishes to your wife.Beth (and Courtney – I read this to him before I hit the SEND button!)
Beth Crosby & Courtney Hazelton

Bob Bacon wrote:

Beth &Court:
I've been watching your posts and really feel your pain. To have your hopes demolished like you have is very difficult. I have been in contact withDan J and we've been corresponding back andforth. He to has lost several inches in length.Dan had a radical Prostatectomy last year and was rendered impotent as a result. I jumped my doctor about why where men who had a prostatectomy losing so much length with the implant. I understand about the loss in length that the prostate covers. Most prostates are like a large egg in shape and size, and the ureter passes through the prostate almost through the longest portion of the prostate. I worked 17 years in clinical pathology and I would receive the specimens from the operating room.weI would do a description of the specimen and then dissect the specimen for further study under the microscope after processing. So I asked my doctor if this was the reason for the loss and he told me no. He told me that doctors really don't know why one in three patients who have loss their prostate, experience significant loss in length. I told him about my blog and the Yahoo penile implants site and it seemed that people who had loss in length and were upset because no one had informed them exactly what to expect. That the doctors had toldthem to expect the best possible outcomes and just barely mentioned to them what the worst outcome would be. When I talked to him about what I should expect, he told me that I shouldn't expect to lose any length at all. That I may gain some length because I had been experiencing sexual relations up to my day of surgery. From what I have heard and read, just about everyone loses a little from the head of the penis because the head of the penis doesn't become engorged with blood,so that's at least a quarter to a half an inch of lose in length. I just started inflating my implant and I have gained a quarter inch in the girth but have lost almost a half inch in length. Dan has had significant loss of a couple inches.You folks have also lost significant length to the point of it having a significant effect on you both enjoying sexual relations. I really feel that my doctor would not have been up front with me either if I had lost my prostate and then opted for an implant. My doctor explained to me that they resect the bladder and reattach the bladder lower in the abdomen to regain the lost space where the prostate covered previously. After giving it much thought, I wonder if the internal organs don't push the bladder back up into the abdomen pulling back on the urethra and pulling the penis back into the body causing a lost of length that is in reality inside the man's body instead of outside. That is my best guestimate of the causer of Court's and Dan's lose of length. That lost length is somewhere. The penis doesn't just shortened or gain in length. It's fixed during puberty for the length a man will have forthe rest of his life. You and Court have something really special together just as my wife and I share. People have some really goofy ideas about what pleases a women. After a whole lot of study, the average length of a man's penis is 5.1inches. In playing around, my wife and I know that the depth of her vagina is 5 and a half inches deep. And yes, the vagina may stretch to accommodate something longer, each women is different just as we guys are different. When you both fit perfectly together, nothing can bebetter. Beth, did Court have his surgery at UniversityHospital in Iowa City? If not, you might want to set up an appointment there with a Urologist to see what options can be done for restoring Court's length. Like I said, Court's loss in length didn't disappear into thin air. It's hiding somewhere. I once applied there and was made an offer at the same time as the University ofMissouri and that was back when Iowa was being hit hard by the farm crisis and the state froze salaries across the board. I was given a tour ofthe hospital and it's an impressive hospital.
. My wife and I are on vacation this week. We're just outside of Branson Missouri vacationing on Table Rock Lake and just enjoying each other. We're at the 5 week point in my recovery so we're just enjoying each other in other ways. Please stay in touch, and email Daniel at: (omitted) and you will find him to have a great outlook on life and very easy to correspond with.

Sincerely yours,
Bob Bacon
Bbacon15@mchsi.com