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