3 & ½ Years Later
I was at my local urologist for my check up yesterday. It has been 3 ½ years since he sent me to Dr. Milam at Vanderbilt. We chatted a while about the urethral puncture by another local doctor and then my progress to date.
Since I was hurt just before Thanksgiving getting hit while walking in a parking lot and having a ruptured disk he wanted to check the implant. At first he jokingly asked, “Do you get to use that thing”. I told him only 4 to 6 times a month.
He inflated my implant and was very pleased with the results and that it was not damaged when I was hit. I said something like peyronies did a number on me and he said you have had a great recovery.
My recovery has been a great gift from God. It restored the pleasure of marital sex that God intended for us to have. I fully believe that marital intercourse is a gift of pleasure from God.
I tell both men and women, yes I have women write me about their husbands, about my progress. All I asked for was a usable erection and with the skills of Dr. Milam and the staff at Vanderbilt I have so much more.
I don’t mind sharing my story and the results of my research. No I am not a doctor and am not any part of a doctor’s practice, hospital, or device manufacturer, just a layperson that has done tons of research and willing to share.
As we all know our penis is our pride and joy. In my case at 18 I was about 6”. At 50 I had gained weight and was about 5 ½”. That was just before peyronies struck. I lost a lot of length. At my stretch test just before my implant is was 4” on my best day. When my implant was activated I was measured at 4 ¼”, at my 3 month check up I was measured at 4 ¾” and at my one year check up just under 5”. At 18 months I had started to regain glands erections and was almost 5 ½”.
Last August I went back to Dr. Milam because of my bladder problems. I was sure I needed another TURP. I had a cystoscopy and Dr. Milam said I had an over active bladder and that another TURP was not in my future all I needed was Enablex. That has worked well for me.
During our conversation Dr. Milam and I discussed many things. One of his comments was he was now seeing men with expansion up to 3 years. When I got home I checked and sure enough I was just over 5 ½”.
I have learned many valuable things along my journey. The number one thing men need to know is the size of your penis does not make you a man. One day I asked the beautiful green-eyed girl I married is how does my penis feel to you now. (We have now been married over 43 years.) She said “Jack, you feel just the same as always.”
The first night home after my implant was activated I lay on my back with a hard penis sticking straight up. No Shots, No Pills, No VED and constriction ring. Just me!! I felt normal again for the first time in years.
The first several weeks with an implant there is a learning curve on using it. At one year I thought this is great how can it get better. Well it did. At 18 months my glands erections had returned. At 2 years I again thought it could not be better but again I was wrong. Today 3 ½ years my wife and I are like young lovers. I am 69 and she is 71. We have more fun now than when we first married.
My advice to any man needing an implant is do not use a general practice urologist. A Male Sexual Function / Urodynamic Specialist is the kind of doctor you need. If you have lost penile size, have peyronies or any related penile problem you need a doctor skilled in using the special instruments. For restoration of penile size the AMS 700 LGX is the only implant that expands in both length and girth. A good graphic is at www.amslgx.com/ To my knowledge there are only 3 or 4 doctors that have these skills so be prepared to travel. Those of us that have used Dr. Douglas Milam at Vanderbilt will tell you he is the best in the world.
Any one that has any questions please don’t hesitate to contact me. Plain language is fine with me, I am not offended.
Remember marital sex is Intended for Pleasure and a gift from God.
Jack
Friday, March 30, 2012
Thursday, February 16, 2012
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
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
Sunday, December 25, 2011
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
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
Wednesday, December 7, 2011
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/
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/
Friday, August 26, 2011
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
Wednesday, August 24, 2011
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.
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.
Monday, July 25, 2011
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
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
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