My Dr Visit, Questions asked and answered

Readers:

I had my visit with my urologists yesterday at my two week visit. He had two medical students shadowing him and I allowed them to also feel the pump in my scrotum and feel the tips of the cylinders under the glans penis. They were very gentle so I told them they could squeeze a little harder if they needed to, in order to feel the tips as it wouldn't hurt or bother me. I'm just not that shy anymore, so standing naked in front of three guys doesn't embarass me very much anymore. They asked me about my decision to have a penile implant surgically implanted and I had a very frank discussion about my juvenile diabetes as my probable, primary reason for my ED. I explained my experience with viagra and cialis as being less than ideal and that I've discussed with other men their use and experiences with PDE 5 drugs such as viagra, cialis, and vardenafil and why they don't work for everybody. What the side effects are and my experience with an erection from those agents. I discussed my expereince with caverject, Bi-mix, and Tri-mix and injecting those agents into my penis. That both my wife and I were very satisfied with the erection that the injections produced along with a 2 hour erection being very much appreciated from my wife's point of view. The reasons I had for quitting injections due to fibrosis beginning to occurr in my penis as a result of those injections over a 13 year period. I also spoke of my expectations following my implant surgery. The research that I had done over the past year and of this blog that I'm keeping which really surprised them and my doctor. I gave them the url of this blog and asked for their feedback. My grasp of the pathology of Erectile Disfunction allowed me to speak on their level. I also questioned my doctor about penile length loss by men who had their prostate removed because of prostate cancer. I learned that approximately one third of men who have lost their prostate due to cancer will suffer a loss of one or more inches of length with a penile implant. My urologist explained that doctors don't have a clear understanding of why this happens. It has been discussed at several conferences among urologists and nobody has a clear explaination why thisoccurrs. Dr Weinstein explained that when the prostate is removed, the bladder is repositioned lower in the abdomen, and this compensates the loss of the prostate to conect to the remaining ureter. I asked if radiation treatments affect things. He explained that if the prostate is cancerous, they can watch it, as in someone over 70 with a slow growing cancer. This I know from needle core biopsies that I've processed in hundreds of cases. Another treatment option is inserting radioactive seeds which destroys the cancer if it is caught early enough. And the last option, if the cancer is at risk of growing through the prostate and entering lymph nodes and thus metatstizing through out the body, then complete removal of the prostate is warranted. And radiation is then not needed.
In my case, my doctor's expectations are at most, a loss of up to one half inch to an increase in length of 3 mms. 2.5 mm = `1 inch. Because I only had a small amount of scarring in my penis prior to surgery, the implant will over several months stretch my penis by a small amount. The penis is limited by the corpus spongiosum, the ureter, and basically the rest of the penis from growing longer. The possible loss in length are due to the glands penis or head not becoming engorged with blood as in a normal erection. This can account for 1/4 to 1/2 an inch of length loss which varies among men. What also limits length is the [use it or loose it] principle. When we were younger, we experienced erections all night long. This served to stretch the tissues and provide much needed oxygenation through out the penis. Men who opt for the implant are men who for many years in most cases, have not or do not still experience strong nightly erections occurring on a regular basis. We have erections using most often a vacuum erection device or injections of vasoactive agents which over amplify the erection above normal. Even the penile skin can become semi engorged along with the corpora and the tissue surounding the urethra and the glans penis. This adds extra to the erection and the implant is unable to match that expectation. The implant, if correctly implanted and sized gives an erection length that cannot match the length of when we were younger men. What it gives us is an erection that closely mimics a man's length minus the engorgement of the glans and minus whatever loss is due to fibrosis and aging.
I would have liked to have explored more questions, but my urologist had other patients waiting. The medical students thanked me. I feel that the decision to have a surgical implant is a dificult one. The experience can be made a more positive one if the man goes into it armed with as much knowledge as they can obtain. Knowledge if coupled to realistic expectations brings about a better experience. What I want, boiled down to the smallest point of reference, is an erection suitable enough and hard enough that I can experience full penetrative intercourse with my wife, and that allows both of us to express love to each other, and ends in both of us achieving at some point, a sexual climax that is satisfying to both of us. That in a nutshell is what it is all about.
Bob