WHAT HAPPENS DURING IMPLANT SURGERY

There has been some debate on the peyronies society forum about what happens to the corpus cavernosum (CC) during penile implant (IPP) surgery. You may hear that the CC is removed among other things that are not true. To answer that question I sent an email to Todd Doran at Vanderbilt. Below is his responce.

This is one reason a man with peyronies or other penile damage should use a well qualified Male Sexual Function Specialist, not a general practice urologist. To my knowledge right now there are only 3 or 4 well qualified doctors for this procedure in the US.

The most common complaint from men with peyronies is loss of penile size. The only implant available to help restore this is the AMS 700 LGX length expanding implant.

Jack


February 15, 2012 11:28 PMFrom: "Doran, Todd James" to "Jack Pinner"
Tunica albuginea is an elastic thick fibrous outer covering of the erectile body and the inside are expansile sinusoids and collectively they are called the corpus cavernosum. We have a right and left one. Peyronie's disease can cause dysfunction, plaque, scarring of either the sinusoids or the tunica albuginea. Placement of IPP cylinders are more complex and tedious to perform in a man with PD. There are tools to dilate the sinusoids thereby causing their destruction through the dilating process. Sometimes we need to use cavertomes (resembles a cylindrical cheesegrater) that are extremely sharp. They are used to dilate/surgically cut open a space within the corpus cavernosum. The destruction of the architecture of the erectile bodies in order to place the inflatable cylinders are why you can't get an erection at all after an IPP. We don't remove any of the corpus cavernosum to place an IPP, we dilate and create a space to place the cylinders.

Feel free to place this on site verbatim.


Todd

Todd J. Doran, MS, PA-C
Associate in Urologic Surgery
Vanderbilt University
Dept of Urologic Surgery
A-1302 MCN
Nashville, TN 37232
615-322-2880

Norman's Feelings

This was posted by my friend Norman yesterday on the Impotance Group. With his permission I an adding it to my blog.

Good morning men,


Once again it is one of those times of year when the expression of love and
pro-creation is abundant in the world. I cringe and shake at times because the
accusation comes to mind that I am an outcast to these activities. The
previous past 4 years I continually descended into a deeper state of depression,
frustration, self pity, anguish and eventually torment.

I want to share a portion of an email I sent at the height of my depression when
I was looking for help. And I wantto share my first steps to a comeback.


*** 6/30/08 Heal my Perspective

I have suffered what I call dignity abuse. It is the assault of my self
perception. I am in search of seeing myself as whole and not broken. I have
many 'cut to the bone' experiences.
In this affliction I live a life hiding and fleeing all my days.

I have problems with concepts and statements like 'Live life to its fullest'.
I am exhausted and no longer trust hope. I am as a man that hides from a savage
wild beast. It see me and I see it.

Impotence is crushing me. It is killing me slowly. Has anyone had growth or
life to their withered blossom? Can you help me heal my perspective. It is
always from the torment of brokenness and never from the state of a good
beginning.

Hope has made me lie to myself. I fear accepting this because it is not the
real me. It is a disease or an affliction but it is not me. I have it but I
can't get rid of it. I am like a blind man who has sight for 15 seconds and
then returns to blindness.

How can I understand manhood and the natural use of the sex. For those of you
who have read the Bible. I am in distress as the man at the pool of Bethesda.
Someone always gets in before me and I have no one to truly help me. Year after
year I know, wait, and hope but in the end I am just unhealed and let down.

I don't know how to do this anymore. I need closure. Existing in the state of
continual trying is a sore evil and daily vexation. Help me escape the prison
of my mind. The scars of heart, the let downs and the mis understanding.

The initial joy when I see men who are whole; and then the sorrow for to me it
is withheld. Rejections, poverty, death- Nothing hurts me more than this.

If you have the power of truth-Please set me free.


***

12/24/2011 Perspective in Healing

Men we are more than the sum of our parts. Today I am reminded of Master Po.
A fictional character in a old Tv show called Kung Fu. Fully blind but every
other sense in his body was maxed out to its fullest. Hearing, smelling,
tasting, touching, mental prowess.

If he were able to see yet was impotent he would use all of his other senses to
live out and maintain a wonderful relationship. He would appreciate her beauty,
her scent, her voice, her person. He would caress her with tender love and he
would sexually stimulate her. He would hold her close and he would smile and
delight to be in her presence.

He would receive and give necking with all the joy of youth;as a boy reaching
first base. He would enjoy the tickling as she touched him, the hardness and
sensuality of their firm nipples with all the joy of a youth;as a boy reaching
second base.

She would stimulate him in the perineum and prostate if he had one. The massage
between the thigh and groin would ever so move him. He would stimulate her
clitoris and caress her vagina. He would receive this with all the joy of
youth; as a boy reaching third base.

Together they were fulfilled one climaxing bodily, one climaxing in the heart
both climaxing in spirit for the two are more than one part.! He would recieve
this with all the joy of youth; as a boy reaching fourth base.

***

Whether your impotence is temporary of permanent in physical ability. Follow
the example of Master Po and re align your perspective. Be not mis informed by
mis informed people. Often a NO is a Yes somewhere else.

It feels GREAT to be on the road to recovery. Both mentally and physically.
If I had a friend like the analogy of Master Po. I would have never wasted 4
years of my life and damaging 4 years with my wife. I could have been as the
joy of a youthful boy running around the bases!!!!


Try it. Allow it to happen. It's Truth.


Merry Christmas and Happy Holidays,

I walk with you!


Norman

THE PHYSIOLOGICAL ASPECT

MEN OBSESS ABOUT OUR PENIS

I posted this on the Peyronies Society Fourm and it needs repeated here.

Re: She didn't notice
« Reply #5 on: December 03, 2011, 09:47:33 AM » Quote Modify

--------------------------------------------------------------------------------
Can I say something:

We guys obsess about our penis our ladies are just glad to be with us no matter what. Like I have told many a young man "The size of your penis does not make you a man."

The beautiful green eyed lady I have been married to for over 43 years, (no she is not blond), has been with me through all my journey with peyronies, ED, venous leakage, corporal fibrosis. Then a failed implant attempt. Now a successful implant. The one statement she made to me still brings a joy to my life. "Jack, I did not marry you for your penis." She was by my side through my journey.

I lost over 1 1/2" inches to peyronies. It concerned me but never bothered her. When I came out of surgery at Vanderbilt she had talked with Dr. Milam. I saw that gleam in those beautiful green eyes and knew all was well.

The first night I was home after my implant was activated I lay on my back with a hard on sticking straight up, no pills, no shots just me. I was still 1 1/2" shorter than before peyronies but it did not matter any more.

Over the last 3 years I have been able to gain about 90% of the loss back because of the skills of Dr. Milam and the LGX. I asked her how I felt sexually now to her than before. She told me she never noticed the difference I feel just the same as always.

Guys, we have to stop obsessing over our problems. The women that love us don't care about the size or shape of our penis. That is a man thing. They love us for the man we are.

I have had the privilege of talking with many men that had progressed to the stage with this mess I have. It takes time for implant surgery to heal. One single young man kept telling me I can't a girl will reject me, I can't I have lost too much size to satisfy her, just on and on. Well about 2 months ago he meet a young lady and it was love at first sight for her. One evening after a date he was with her and she started to try to get into his pants. He told he whoa! you need to know something. She asked what? He told her "I'm Bionic." She asked what did that mean, he briefly told her he had an implant. She told him I don't care I want you anyway.

That night he learned a couple of things. The fact he had an implant did not matter, the size of his penis did not matter, that he could satisfy her and he could go longer than any guy his age. Since then they have been almost constant companions.

What I am trying to say is we can not let this damn disease get us down. There is help and hope for all of us. Love the lady you are with and she will give you more than you ever expected. The most important thing is NEVER - EVER / NEVER - EVER / NEVER - EVER - EVER GIVE UP!!!!

Just my feeling this morning.

Jackp
http://jackp-penileimplant.blogspot.com/

IMPROPER IMPLANT SIZING

It has recently come to my attention that some doctors are not implanting the AMS 700 LGX properly. They are not putting in a full length implant with the rear tip extenders, when needed, to fit the corpora's. This will quickly lead to problems.

This is a copy of an email I received recently regarding implanting an AMS 700 LGX or a Titan. Also a responce from Todd Doran of Dr. Milam's staff at Vanderbilt. The only editing I did was the doctors name.

This is how some doctors give the LGX a bad name. Be aware and put it on the list of questions you ask your doctor.

Jack

--------------------------------------------------------------------------


Hi Jack,
Did you say you'd be seeing Dr. Milam soon? I wonder if you could ask him a certain question for me?
When I talked toDr. Mxxxxxxx, he said he could do either a Titan or a AMS700LGX, but he said if he put in an AMS700LGX, he'd have to put one in that was shorter than the corporas (because of the expansion in length).

I wondered if you might be able to ask Dr. Milam if he does the same thing, or something different, such as filling the corporas, which is what would be done with the Titan,I believe.
I just wonder if all doctors do this ,or only Dr. Mxxxxxxx, or what.

----------------------------------------------------------------------

Responce from Todd Doran MS PA-C


Here's the bottom line regarding RTE/corporal length, etc. Dr. Milam's philosophy is to measure the corporal length from rear tip to distal tip. We then place a cylinder that equals that length but sometimes RTE are used because the cylinders typically come in 2 cm increments and I can add RTE in 0.5 cm increments so we have infiinite possibilities to accomplish the goal. Here's an example-pt measures 15 cm so we place a 15 cm LGX cylinder with no rear tip because it's available in that size. We'd add 1.5 cm RTE if corporal body was 16.5 cm since next cylinder size is 17 cm. Hope that clarifies a simple concept that is complex for pts to understand and another concept that is misconstrued by surgeons and patients. The advantage of an LGX is that if you need 0.25 cm which is unavailable then we know that the expansion properties will achieve the desired goal where a Titan or CX wouldn't. That's our philosophy. Never agree with placing a device that's too short or too long, you're setting yourself up for disappointment right out of the box.


Todd Todd J. Doran, MS, PA-C Associate in Urologic Surgery Vanderbilt University Dept of Urologic Surgery A-1302 MCN Nashville, TN 37232 615-322-2880

Implant Protocal Helps Reduce Penile Shortning

Larry was kind enough to send me the article from the October 2009 Issue of Urology Times.

Included is the update and VED exercise I used developed on the peyroniessociety.org forum. A personal comment. IT Works.

Implant protocol helps reduce penile shortening Pre-procedure use of vacuum device can restore penis to original length, data shows
Publish date: Oct 1, 2009
By: Mac Overmyer
Source: Urology Times


Key Points
The average length of virgin implants and rear tip extenders grew 5.5 cm during the period that the protocol was used.
Daytona Beach, A new noninvasive vacuum protocol for erectile dysfunction patients using an inflatable penile prosthesis can prevent penile shortening, according to results of a study presented at the AUA annual meeting in Chicago.

Cylinder length of a penile prosthesis reflects the length of the penis at the time of the procedure. Penile shortening associated with implants is not an insignificant problem. The average length of implanted cylinders has increased 5.5 cm in patients who have undergone the new protocol.

"There is no question that overall implant length has grown anywhere from 3 to 5 centimeters," said study co-author Martin Dineen, MD, of Atlantic Urological Associates, Daytona Beach, FL. "The vacuum protocol in our hands has virtually eliminated patient complaints of penile shortening."


Dr. Dineen and co-author Steven Wilson, MD, of the Institute for Urologic Excellence, Indio, CA, credit Thomas Sellers, a physician's assistant working in Dr. Dineen's practice, with identifying and refining the protocol.

"It [the initial idea] came from listening to non-implant patients who were using vacuum devices for erections," Sellers said. "They were telling me that they thought they were getting larger. The key to the idea came when I started having the patients mark the device with a felt marker where the end of their penis reached. That is how the protocol was created."

Under the protocol, patients anticipating an implant are instructed to use a vacuum device once daily for 10 minutes, beginning 2 months before the scheduled procedure. Patients with Peyronie's disease should use it twice daily.

"Those who were using it for around 10 minutes without the constriction bands seemed to be getting the most length," Sellers said. "Those who were using it longer did not appear to be gaining any additional length, and those who were using it for a shorter period were not getting as much of a return as they might be."

Sellers and the doctors caution that patients should be told that while they may regain their original length or a length close to it, they should not expect any gains beyond their original length.

After implant surgery, the penile implant is left 50% erect for 2 days and then deflated to 25% for 9 to 14 days. Following that exercise, patients are advised to inflate the device daily for 2 months.

Dr. Dineen and Sellers conducted a review of cylinder sizes they have implanted beginning in 2002, the year the protocol was initiated, through December 2008. the average length of virgin implants and rear tip extenders grew 5.5 cm (from 18.4 cm to 23.89 cm), an increase that reflects both expanding use and modification of the protocol over those 6 years.

High rate of compliance

"When a patient does not have an erection for a long time... the tissues foreshorten," Dr. Dineen said. "The idea behind the pump is that it stretches these tissues back to their normal length gradually. I explain it to patients as having their arm in a cast for 8 weeks. It is a bad idea, a painful idea, to stretch it back out immediately after the cast is taken off."

Despite the rigors of the protocol's schedule, patient compliance is more than 95%, Sellers estimates.

"Having [patients] mark the cylinder every week allows them to see their penis growing longer," he said. "These become motivated patients."

The protocol is now a standard aspect of therapy for patients anticipating an implant in Dr. Dineen's practice. Dr. Wilson uses the protocol only in patients who voice a concern about penile length. He says he feels that patient motivation is important for compliance. An independent, randomized, prospective trial designed to test these initial data is under way.

Drs. Dineen and Wilson are consultants/advisers for American Medical Systems, which provided funding for the study and manufactures the implant used by the researchers.


Penile Implant Protocol Update

Tom Sellers (physician's assistant), an assistant to Dr. Martin Dineen, MD of Atlantic Urological Associates, one of the two researchers involved with the Penile Implant Protocol Study published in Urology Times) (2009), telephoned me on 7-19-2011 after receiving a letter regarding my questions about their protocol being used for patients prior to revision surgeries to replace their old implants. Here is what I was told about the protocol:

1. Through further studies, the protocol is now only needed to be used for 3-4 weeks, as opposed to 2 months prior to surgery. It was found that one month was sufficient. The results achieved should be nearly the same.

2. The Penile Implant Protocol is just as effective for those patients having revision surgeries, as those who are having first-time penile implant surgery.

Prior to First-Time Penile Implant and Penile Implant Revision Surgery:

3. The new Penile Implant Protocols are as follows:

· Use the VED twice a day, holding for 10 min. when fully erect.

· Allow a minimum of one hour between use of the VED.

· Use the VED for 3-4 weeks minimum, but no longer than 2 months.

· Upon first use of the VED, when fully erect, mark on the outside of the clear plastic vacuum tube the length of the penis. This first mark will be used for comparison to subsequent length gains in the penis.

· Weekly take a measurement and mark a new line on the clear plastic vacuum tube (same day of week), marking out the steady progress being made.

· With limited penis sensation (quadriplegic and paraplegics), pump up the VED until a normal full erection is achieved, then stop.

· Gradually continue to increase the vacuum pressure to stretch the penile tissues and rehabilitate them. Again, continue to bring yourself to full erection, then stop.

· The vacuum pump may bruise the blood vessels just below the surface of the skin, which may cause petechiae (very tiny spots beneath the skin) when you first begin using your System. This is a response to placing the penis under vacuum pressure too long, too quickly or after a long period of inactivity. If this happens, discontinue use of the System until discoloration completely disappears – about five to seven days.

· There could also be some blisters appear upon the penis or water appear just under the surface skin of the penis. If this happens, reduce the amount of vacuum suction being used for a while.

After First-Time Penile Implant and Penile Implant Revision Surgery:

4. The new Penile Implant Protocols continues:

· After implant surgery, the penile implant is left 50% erect for 9 days. Following that exercise, patients are advised to inflate the penile implant device daily for 3 months, for 1 hour duration. Add extra pumping every few minutes to increase the stretch.

This protocol should aid in bringing a patient's penis size to near their normal erect size. This is highly advantageous outcome for the patient in that a maximized length and width of a penile implant can be chosen by the surgeon during surgery.

Surgery should be performed by a doctor who has done a lot of penile implant surgeries and revisions. It should be done at a Center of Excellence.

There are many types of VED's available for purchase. Manual pumps are better most usually than those that are battery or electric powered.

A patient recommended high-quality VED is from a company named Firma Medical (www.firmamedical.com). A moderate priced $199 VED Classic model (no prescription needed) was offered as a good option. It has the greatest suction and ease of use, compared to other VED's.

--------------------------------------------------------------------------

This is the VED exercise I used starting in 2005. It was developed by men with peyronies on the peyroniessociety.org forum.

VED EXERCISE
FOR
ED, PEYRONIES, CORPORAL FIBROSIS AND VENOUS LEAKAGE

RECOMMENDED BEFORE PENILE IMPLANT SURGERY FOR A BETTER OUTCOME

The theory behind this exercise is the more fresh blood you can get to your penis the healthier it becomes.

As some of you know the instructions that come with the VED can be vague. Old Man at Peyroniessocitey.org developed this exercise to me.

NEVER PUMP TO THE POINT OF PAIN OR EXCESS PRESSURE!! I did at first and caused a bruise on my penis that took weeks to heal. With this more is not better. Also hair can be a problem getting a good seal. Some of us just keep it trimmed back and others shave around the penis, what ever works for you. Do Not use a constriction ring for exercise.

VED for exercise. Every day.
Start with a good seal and pump to about 80% erect. Hold for 15-20 seconds then release for 15-20 and repump, (do not break seal). Do this for about 5 minutes.

Over the next 5 minutes pump up to a 100% erection using the pump hold and release for 15-20 second method. Do Not Break The Seal.

The next 5 minutes keep pumping to 100% erection using the pump, hold and release. Cautions do not over pump to the point of pain. After about a month you should start to see results.

No you don’t need a stopwatch, approximate times are fine.

VED for sex.
Start by properly placing the constriction ring on the cylinder. Get a good seal and pump to about 80% erection using pump and hold about 5 times. Then increase to about 90% erection and place the constriction ring.

Constriction Rings.
Constriction ring fit is a personal thing what may be right for me will not work for you. It will not be comfortable the first few times you use it. Trial and error are the only way to find which ring holds you best. Do not use over 30 minutes.

IMHO Osborn makes the best constriction rings. I had severe venous leakage and corporal fibrosis so I had to use the Osborn D ring. (Very tight.)

Any questions just let me know.

Jack


7/29/11 Footnote: In response to questions and comments from others I added this footnote. Remember I am a layperson and not affiliated with any doctor, hospital, or device manufacture. Just my own personal research and opinion.

I recommend this exercise for at least a couple of months before implant surgery. It will help keep your penis healthy and you will have a better outcome. Dr. Milam told me to keep up the exercise until about 2 days before my surgery and be careful not to hurt myself.

If you have read my story I call “One Mans Journey” it tells of my 10day hospital stay and recovery where I did not use the VED for almost a month. It looked like I had lost all the progress I had made with the VED exercise. When I was able to start back using the exercise within a week I had recovered the gains I had made.

Peyronies and Implants

Published on modernmedicine.com April 1, 2011

Implantable penile prostheses aid curvature, function in men with Peyronie's disease, erectile dysfunction
Two prostheses avoid perceived or real loss of penile length, research showsPublish date: Apr 1, 2011
By: Mac Overmyer
Source: Urology Times

In men with erectile dysfunction due to Peyronie's disease, use of a girth-expanding, length-extending implantable penile prosthesis appears to improve both erectile function and curvature while addressing the frequent problem of real or perceived shortening, researchers say.

Researchers from Vanderbilt University Medical Center, Nashville, TN, presented a study on two such prostheses at the 2010 AUA annual meeting in San Francisco. The devices—the AMS Ultrex and AMS LGX (American Medical Systems, Minnetonka, MN)—significantly improve curvature and erectile function and "contribute substantially to the patient's sexual health," said Benjamin Whittam, MD, a urologic surgery resident at Vanderbilt working with Douglas Milam, MD, and colleagues.

Dr. Whittam told Urology Times that being able to model during the implant procedure, coupled with the device's ability to enhance both girth and length, plays an important role in improving patient self-perception and subsequent sexual health.


In presenting the study, Dr. Whittam noted that some other prostheses allowed for length extension but were associated with concerns about achieving adequate rigidity for modeling and straightening. Other prostheses that allow a degree of modeling and straightening are associated with perceived or real shortening.

Of the two main types of penile prostheses, girth-expanding devices are currently supported by the Peyronie's disease literature, Dr. Whittam said. These devices include the CX (American Medical Systems) and the Titan (Coloplast, Minneapolis).

"However, neither of these has length-expanding attributes," he said. "Length- and girth-expanding devices such as the AMS Ultrex and AMS LGX are associated with risks of urethral dilation. There is also a concern that these devices might not tolerate intraoperative modeling and because of this, would not be that useful in patients with severe curves."
See Footnote

To define the potential benefits of the Ultrex and LGX, the Vanderbilt team conducted a retrospective review of 49 patients who had undergone an Ultrex or LGX implant procedure between 2006 and 2009. The patients had ED associated with penile curvature, and the average curvature was 52.9 degrees. A total of 37 patients received the AMS LGX, and 31 underwent modeling during the implant procedure.

Curvature, SHIM scores improve

The benefits associated with the device were substantial. Of 40 patients with sufficient follow-up (those who presented for activation at 6 weeks), 22 were without any residual curve, and 18 had an average residual curve of 17.7 degrees. Scores on the Sexual Health Inventory for Men (SHIM) improved from a mean of 6.97 preoperatively to 18.54 postoperatively with a mean follow-up of 7.3 months. The percentage of men able to have intercourse increased from 30.8% preoperatively to 97.3% at 7.3 months' follow-up.

There was no incidence of aneurysmal dilatation or device infection observed. One patient had a hematoma that resolved spontaneously, and one patient evidenced reduced glans support. This was resolved with a revision.

"We feel that the use of these devices allows a significant improvement in penile curvature and benefits erectile function as well as sexual health. This is now a standing clinical strategy that allows both girth expansion and length extension and is a viable therapeutic option for patients with Peyronie's disease," Dr. Whittam said.

Dr. Milam is a consultant/adviser for American Medical Systems.

-------------------------------------------------------------------------

Footnote from a email from Dr. Milam's assistant Todd Doran MS PAC 7/26/11

The argument to use a CX in severe peyronies/modeling is due to aneurysmal dilation seen in older Ultrex (predecessor to LGX) and the false belief that an LGX will accentuate the curve. We disagree with that argument and it's still a largely held belief by a lot of implanters. Remember that there are few that have the volume like Dr. Milam, especially with concurrent Peyronie's Disease. The large volume implanter peer group would be less critical in using an LGX in that setting in 2011 than 3 yrs ago even due to success and spreading of the word.

Todd

Todd J. Doran, MS, PA-C
Associate in Urologic Surgery
Vanderbilt University
Dept of Urologic Surgery
A-1302 MCN
Nashville, TN 37232
615-322-2880

I am happy to report that my case was included in the above mentioned study.

Jack

Ever consider an implant? Here's some entertainment. By LGX Man

Ever consider an implant? Here's some entertainment.


So much talk of ED. Thought I'd give you guys an encyclopedia of "the flip side". It's lengthy, it's fun! ;-)



I've been the proud owner of an AMS 700-LGX Penile Implant for nearly 7 months. It has turned out to be an amazing, life-changing product. I do notice a big difference in size now, After so many years living with ED, it had become a turtle. The new implant is 21cm. plus base extenders, which hold the whole shebang together. I've got some length and yes, it does grow your penis. Here's a truth that not many implanted men talk about. To put these new chambers into your penis, they cauterize, dilate or "hollow-out" the old corpora cavernosa. The "CC" is the part of your penis that has swollen up when sexually aroused. "used to be huh? heh" They then install the new chambers into the "dilated right thru the middle" old chambers. This is the part that causes the increase in girth, right off the bat. After working with my penis for many months, it gets BIG now. Magnum XL size in girth. I had previously been considered about normal, 6" regular. The length is worked on every day and is definitely growing. Read on...
I've followed all instructions from the doctor & manufacturer since the day I had it installed. Nowadays, I keep it inflated to the MAX twice a day for as long as I can stand it. I often go to sleep with it fully inflated. Sometimes I can stand it for an hour and other times I can go all night and have spontaneous sex. The mind once again works with the penis and there are times when the mind "just knows" that it will be having sex in the middle of the night. This is one of my improved thoughts since being implanted. Yeah … nice! I have the AMS LGX (stands for Length/Girth Expansion) and it grows. The more it’s used, the more it gets broken-in (a very good thing, kinda like an old leather jacket). After a period of uncomfortableness (based on your level of tolerance, but 1-3 months average), you will suddenly wake up one day and it will all be working again. Loss of sensation? Not necessarily. I became much more sensitive because it had never really gotten hard enough before to sense the new zones that I’m feeling nowadays. This has caused a huge boost in my self-esteem and confidence level. Before all of this happened, I had gotten to the point of using depression meds. and psych counseling. Suddenly one day I just realized: Many things in my life seem wrong. Many of them are caused by my low self-esteem. Why don't I quit bitching about it do something about it. I decided to use a proven method to fix, at least, the biggest problem. ED. It sure couldn't be much worse than where I was at, right? Those were bleak times.

I watched the chatter on the penile-implant and other discussion forums, as well as the enlightening ED chatroom,at FrankTalk.org. It's clear that people prefer one type (AMS/Titan) over the other. The debate goes on over which one is better, especially with the newer guys who do not read the backlog of postings in the message banks, and have similar new questions all the time. After the operation is done life gets back to normal and guys often just go on with their new lives. The forums go round and round.

DOCTORS AND COSTS: After a short period with my newest BFF, I could honestly say that I LOVE MY LGX I have no regrets and nothing but good things going on in my life now. So MUCH has changed! I've also met many nice men on these forums who LOVE their Titan. The key is finding the right doctor and the right implant. That begins the journey. Hopefully you have insurance as the operation can run up to around $32,000. Maybe you're lucky enough to have insurance that will cover the best of the best doctors. It seems that there are increasingly fewer of those doctors and health plans around. The "best of the best" ones are called SEXUAL FUNCTION SPECILISTS. They perform MANY of these operations per year. Some say as many as “thousands” per year. You can get lists of doctors here, just ask and a list will be sent to you. Perhaps your insurance is more limited, as was mine, and you’ll have fewer doctors to choose from. In that case you want to research each of the doctors in your plan as carefully as you can. The amount of research done is up to you. I’m part of a medical foundation on the west coast and found the doctor who had done the most work with implants for the foundation. If you ask here, you’ll get many names of doctors from satisfied IPP recipients. But guys, know when to decide! Too much research can just get you nauseous. Be informed and ask questions of us implanted guys. Believe me, I had new questions each and every day and the guys here on the forums got me through it all.

After checking out doctors, reading as much information as I could get my hands on, and reading the blogs, forums and discussion rooms, I chose to just do it and took that big chance, with great worry, trepidation and fear. Luckily, I had also developed lots of confidence in my doctor through many of his chats, tests, emails and demonstrations. He showed honest excitement to get me fitted into an implant, but had made sure that every other conceivable option was exhausted beforehand (pills, pumps, injections with various mixes). It was determined that I had venous leakage on one side, which kept my penis from staying hard. There are many theories and reasons for ED so I won’t go into it, research!

I worked on myself (swimming often) for a few months to get as healthy as I could be before I underwent surgery. My muscles and skin were toned up, and my veins were standing at attention, ready to have intravenous needles stuck in them, joy!. The operation was a success and I spent the night in the hospital so that they could remove the catheter in the morning, when needed. I was lucky, and was treated like a king all night. I was sent home to recuperate. All was fine until about the 4th day when the intensity of what I had done sunk in. This is where I learned the smart use of ice or something cold. Personally, I kept a bowl of ice water and a few white towels nearby. I had a thick towel underneath me. After wringing the towels out, I used the cold towels to wrap around my scrotum and penis, causing an immense amount of relief. Whatever your method for getting the swelling to subside, do it. Very important at this stage. Ibuprofen and other meds may be necessary, based on you.

Since my first inflation, I've been instructed to "work it" at least twice a day. For the first 2 to 4 weeks, this just meant to inflate the penis and leave it there for 10 to 20 minutes. After that, or when your doctor instructs you to ...you can start keeping it pumped to the MAX whenever you want. The material of the pump is strong and it can take whatever you want it to do. You SHOULD do this at least 2x daily for the first 18 months. It's an investment in time, but heh it's not really so bad now is it? Some days it does seem like a chore but once it's inflated, that’s usually all quickly forgotten or I leave it up and play with it. This is when you can start working on keeping your newly dilated corpora cavernosa (cc) chambers inflated or, in the case of the LGX-700, start pumping it to stretch/grow your penis. It’s pretty much the same idea as how muscles are made. Pump it! I work on keeping the LGX chambers aligned from the shaft into the GLANS. I work on keeping the shaft free of scar tissue growth. Scar tissue grows in immediately and throughout the first 2-6 months after the IPP operation, and is always a threat. You’ll know what it is when it sets in. if you don't WORK IT on a regular basis, at least for the first year to 18 months, you will regret it later. The more you work it, the better the results! Make sure the head of the penis get a full workout. Am I stressing the importance of this task guys? Talk about a wicked new set of feelings during the first few weeks! Now, when I use my penis, it's finally doing exactly what I want it to do, on command (on command of my fingers pumping it up that is) and for however long I want it to perform. I think of the daily routine as something that’s been prescribed and MUST be done. Twice a day! I have to admit that this is one chore that I’ve really grown happy to get done quite often nowadays!

KEEPING THAT PESKY PUMP IN PLACE: You need make sure that you keep that new testicle, known as the pump, adjusted to wherever it has to be in your scrotum. It's up to YOU to follow your doctor and manufacturer’s orders and get the new equipment to where it needs to eventually rest. If you have problems, get to, email or call your doctor! When it comes time to get the pump into the correct position in the scrotum, I found that taking warm showers with lots of soap or better, conditioner and working the pump (and shaft) to where it’s intended to be helped a lot. If the pump is already where it needs to be, you got very lucky but need to make sure that it stays in the proper place in your scrotum. While in the shower, pull gently on the pump and direct it to where you want it to be. You only have just so long before scar tissue forms and that pump takes up residence wherever it has ended up.

WHY I CHOSE THE LGX: My medical foundation ONLY uses the LGX. Why? Because all of the urologists from the foundation (some more skilled than others) went to a few conventions sponsored by each of the two IPP companies. Many did operations based on what type of IPP the various patients had requested. Then they compared results. The doctors at Kaiser, together, as a team, decided that the LGX-700 would be the implant of choice, and the one sponsored by the foundation. I’m not sure if this would be fair to our brother’s with a large penis, who are better suited for a Titan. Luckily, The LGX is generally suited for guys around the normal range, 6” more or less. The Titan is for the bigger guys. Both work differently, research!

After about 3-1/2 months of general aching and re-arranging, suddenly one day it all suddenly “stopped” and my new always half-stiff penis "dropped" about 20 degrees. I stood looking at it in disbelief! Yaay! I was able to get it nearly back to normal flaccid droop. The penis never gets small again, it is always a bit of a shower after one of these implants. Most guys don’t mind that too much for some reason. The chambers are just larger! Whatever pain that had remained was gone and my mind was once again free to start thinking of other things, besides JUST my penis! Guys, LGX / Coloplast Titan, either way... how comfortable are YOU to do the utmost research that you can do, get all the information that you can from the doctor and his staff, and then just do it!

FINDING DOCTORS: We can worry all we want and ask and argue and debate but let's get real. Like most things, it's the luck of the draw when finding a good doctor. If you have fantastic insurance plan, finding the best is probably a lot easier. If your insurance is limited, then you need to find the best that you can get! My LGX was FREE just because the foundation states that all that’s needed is for the urologist to state that it’s needed. Had I realized this, I probably would have approached the subject years earlier. Sticky point: The size of the implant is up to the doctor and any representative of the company that may be there assisting. Make sure that you discuss your options with the doctor that will be performing the operation. The doctor SHOULD BE giving you the proper sized implant for your particular penis. YOU HAVE ONE TIME TO GET THIS RIGHT, MAKE SURE YOU AND YOUR DOCTOR ARE IN SYNC WITH THE SIZE ISSUE. Don’t give yourself reason to complain afterward!

RETURN OF THE CORPORAS: The “corpora spongiosum" (cs), the one surrounding the urethra (around the pee canal, underneath the penis) and also the GLANS. They are supposed to (and HAVE in me) come back to life. When really "aroused", as you often will be after receiving an IPP, you'll suddenly notice that your entire shaft will become engorged. The bottom of your penis as well as the head will finally again fill up with blood as the penis is made to do naturally. This may not happen to everybody, but it WILL happen to many. Once the rest of your penis is working, eventually you will be able to have a fully hard (what many implantee's begin to think of as "natural") penis, not the oval penis that we live with for the first 18 to 24 months after the operation before the CS returns to life. Truth be told: Most guys will eventually get full use of their penis back after a length of time, living with their new implants. The confidence level can become so good that the old parts (CC) may eventually come to life and join the party! Seriously, just do it

Well, that's my story. Now I'm having lots of FUN in life. Picture the PERMANENT BIG SMILE! I hope that you'll consider the fact that it all could be a lot better just by doing it, like I did?

Now, back to the show...