Implants and ligaments

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Smokie
Regular Member


Date Joined Oct 2008
Total Posts : 46
   Posted 1/5/2009 3:58 PM (GMT -6)   
Hello all
Well, here I am, 44 years old and 2 1/2 years post op. And still making no wood. I'm leaning heavily to implant surgery. Insurance has agreed to pay, I have just have to pull the trigger.
 
My question concerns size. I know, I know, all the literature says that I'm probably not as abnormal as I think. Trust me, I am. Especially after 2 1/2 years of non-use. Even the pump is not helping. I'm not looking to go into the adult film industry or anything. My extremely understanding wife of 22 years will be happy with anything that works. I'm just not certain that what I have now will be enough.
 
My implant Dr. (Dr. Knoll, Centenial Medical Center, Nashville) indicated to me during my last visit that he could cut the suspensory ligament during the implant surgery to possibly regain some length. I did not ask any questions at the time, because there was too much being discussed. And I will, obviously, ask him more. However, after researching and seeing a lot of varied material and opinions, I'm wondering if anyone out there has had experience with this.
 
I would appreciate any input.
 
Smokie
Age: 43
Diagnosed at 41 by routine blood test
PSA at diagnosis: 5.1
Pre-op Gleason: 3+4=7
Post-op Gleason: 6 (different labs?)
No luck finding local experience with DaVinci
Scheduled RP at Vanderbilt: 8/06
Insurance trouble, rescheduled at Centennial Hospital, Nashville
Prostate removed 9/06
Robotic, nerves spared, no positive margins
PSA since RP: good (less than .05)
Currently suffer ED
 
 


Art662
Regular Member


Date Joined Sep 2008
Total Posts : 54
   Posted 1/5/2009 8:09 PM (GMT -6)   

Hey smokie -

As you see in my signature, I've had that procedure. It had absolutely no effect for me. From what I have read, the cutting of the ligament is more effective if it is put under tension after the cut. This was not done in my procedure. Perhaps that is why it had no effect on my length. If it needs to be under tension to be effective, I'm not so sure you could do that at the same time as the implant, as it would be impossible (I would think) to put it under tension while trying to recover from the implant surgery.

Just my experience -

Art

 


1979: Organic impotence at age 25 from drug reaction to coumadin.
1979 Half shunt & vena cava clip emergency surgery - 4 weeks in Ohio State Medical Center
1981 IPP implanted - 3 1/2 weeks Baylor U. Houston by F. Brantley Scott
1981 IPP replaced - 10 days Baylor U. Houston by F. Brantley Scott
1985 IPP replaced IPP due to implant shift - 1 week Mayo Clinic by William Furlow
1985 IPP replaced, penile degloving to correct scarring, shortening and cylinder contracture. Suspensatory Ligament procedure - 2 1/2 weeks Mayo Clinic by William Furlow
1989 IPP replaced, repair of Tunica albuginea around corpora cavernosa . Degloving to relive penile shortening - 10 days Baylor U. Houston by F. Brantley Scott.
2000 IPP removed due to fluid loss and possible infection - 6 days Cleveland Clinic by Dr. Karl Montague
2000 IPP replaced - 4 days Cleveland Clinic by Dr. Karl Montague.
2002 IPP replaced, penile degloving to correct penile shortening due to IPP removal for 2 months. Repair of Tunica albuginea around corpora cavernosa - 3 days U of Washington, Seattle Dr. Richard Berger.


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 1/6/2009 1:17 AM (GMT -6)   
Does cutting that ligament cause the penis to hang down even when erect? If so, I would see that as a definite downside -- excuse the pun!

I have seen mention elsewhere of extenders that you apply to stretch the penis prior to surgery -- perhaps that might be another option for you?
Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week and 7-month PSAs: 0
Bimix injections working well 


Smokie
Regular Member


Date Joined Oct 2008
Total Posts : 46
   Posted 1/6/2009 7:43 AM (GMT -6)   
I also was curious about the stretching. Art, did you pump after the procedure? I was hoping the pump might replace the tension that stretching exercises provide.
As far as the 'downside', from what I have read, that was a problem with the procedure in the past. But, from what I understand, is now much improved through newer surgical techniques.
Once again, I will be seeing my doc sometime in the near future, and will post his answers to these and other questions for those interested.
By the way, if anyone has suggestions for other questions concerning this subject, fire away and I will try and get answers.
Smokie
Age: 43
Diagnosed at 41 by routine blood test
PSA at diagnosis: 5.1
Pre-op Gleason: 3+4=7
Post-op Gleason: 6 (different labs?)
No luck finding local experience with DaVinci
Scheduled RP at Vanderbilt: 8/06
Insurance trouble, rescheduled at Centennial Hospital, Nashville
Prostate removed 9/06
Robotic, nerves spared, no positive margins
PSA since RP: good (less than .05)
Currently suffer ED
 
 


Art662
Regular Member


Date Joined Sep 2008
Total Posts : 54
   Posted 1/6/2009 9:05 AM (GMT -6)   
Hey Piano and Smokie

It's true, a lot of my problems were because they were done years ago. Even the best at the time had limited techniques available. There was no requirement for pumping or other stretching protocol. Several years ago I started with the pump from the recommendation of Dr. Fishman in Houston - F. Brantly Scotts old partner. It had little effect, probably due to the time delay. I have been using a vacuum & weight system for the last several months, anticipating my next surgery. This system uses weights to stretch the tissues. It seems to be more effective, as it puts direct downward tension - the pump alone seems to expand the tissues outward as much as lengthen, which in my case is not desirable, due to my weakened penile walls. I'm not sure how effective these things are.
As to the ligament cutting, from what I understand if not under tension it will heal back and effectively do nothing for length. It never effected the stability of the erection.
Art
1979: Organic impotence at age 25 from drug reaction to coumadin.
1979 Half shunt & vena cava clip emergency surgery - 4 weeks in Ohio State Medical Center
1981 IPP implanted - 3 1/2 weeks Baylor U. Houston by F. Brantley Scott
1981 IPP replaced - 10 days Baylor U. Houston by F. Brantley Scott
1985 IPP replaced IPP due to implant shift - 1 week Mayo Clinic by William Furlow
1985 IPP replaced, penile degloving to correct scarring, shortening and cylinder contracture. Suspensatory Ligament procedure - 2 1/2 weeks Mayo Clinic by William Furlow
1989 IPP replaced, repair of Tunica albuginea around corpora cavernosa . Degloving to relive penile shortening - 10 days Baylor U. Houston by F. Brantley Scott.
2000 IPP removed due to fluid loss and possible infection - 6 days Cleveland Clinic by Dr. Karl Montague
2000 IPP replaced - 4 days Cleveland Clinic by Dr. Karl Montague.
2002 IPP replaced, penile degloving to correct penile shortening due to IPP removal for 2 months. Repair of Tunica albuginea around corpora cavernosa - 3 days U of Washington, Seattle Dr. Richard Berger.


Gene214
Regular Member


Date Joined Mar 2007
Total Posts : 422
   Posted 1/6/2009 11:20 AM (GMT -6)   

Art,

I'm sure you've mentioned your next surgery or procedure in past posts, but I don't recall what it is to be.  What will it be?  And I too am curious about what you are doing now in "getting ready".  Although my implant gives me a good erection, I still struggle emotionally somewhat with a shorter penis than I had previously.  My wife says she cannot tell any difference, but I can.  Since I was larger than average before pc surgery and before implant surgery, I still have an "average" size, if what I read about "average" size is correct.  But sometimes it's difficult to get the friction needed for the intercouse to be as satisfying as I would like.  I also wonder with all the years and years of marriage with the same lovely lady and with the thosands of sessions we have enjoyed together, have I stretched her to the size that I used to be?   

So can you explain what you are doing now with the weights, etc.?  Do you suppose something like that would help someone like me who already has the prosthesis implanted?  I suppose I know the answer already, but would like to hear what you think since you're certainly the most experienced of any of us who have an implant.

Gene214


PC diagnosed 12-06 @ age 63
Radical open removal 2-14-07, Gleason 3+3=6
Removal of stricture 6-07, incontinence continues
Scheduled for AUS & IPP 05-08
Surgeon cancelled one day pre-surgery, due to cardiac concerns
Nuclear stress 5/13/08
3 stents 5/27
AUS, IPP implanted 07-16-08
AUS, IPP was activated on 08-18-08.  They both work!
10-20-08 went back to surgeon for a follow-up.  Both devices are working very good and surgeon was very pleased that I am very pleased.
 


Art662
Regular Member


Date Joined Sep 2008
Total Posts : 54
   Posted 1/6/2009 7:01 PM (GMT -6)   
Gene214 said...

Art,

I'm sure you've mentioned your next surgery or procedure in past posts, but I don't recall what it is to be.  What will it be?  And I too am curious about what you are doing now in "getting ready".  Although my implant gives me a good erection, I still struggle emotionally somewhat with a shorter penis than I had previously.  My wife says she cannot tell any difference, but I can.  Since I was larger than average before pc surgery and before implant surgery, I still have an "average" size, if what I read about "average" size is correct.  But sometimes it's difficult to get the friction needed for the intercouse to be as satisfying as I would like.  I also wonder with all the years and years of marriage with the same lovely lady and with the thosands of sessions we have enjoyed together, have I stretched her to the size that I used to be?   

So can you explain what you are doing now with the weights, etc.?  Do you suppose something like that would help someone like me who already has the prosthesis implanted?  I suppose I know the answer already, but would like to hear what you think since you're certainly the most experienced of any of us who have an implant.

Gene214

Hi Gene -Well, it's almost time to get a new implant - fluid loss I fear. I am doing the stretching as I can't pump up the implant as full as before - so hoping that the tissues will benefit from the vacuum and weight combination. I might add the vacuum system and the weight systems were prescribed by the physician at the time. Again, I have no idea if this will help, but am doing it - to do something. As I have the implant in place, the vacuum and weight system (which places the penis within a cylinder - not the ones that wrap around the penis) works ok. The weights that just wrap around the penis, or a sling like contraption seem like they would not work for guys that are implanted. I know there is ongoing research by Dr.M about implanting stretching cylinders (walls are thicker to prevent buckling) and after several months are removed and a conventional implant placed to try to increase length.

Will it work? I have no idea.



1979: Organic impotence at age 25 from drug reaction to coumadin.
1979 Half shunt & vena cava clip emergency surgery - 4 weeks in Ohio State Medical Center
1981 IPP implanted - 3 1/2 weeks Baylor U. Houston by F. Brantley Scott
1981 IPP replaced - 10 days Baylor U. Houston by F. Brantley Scott
1985 IPP replaced IPP due to implant shift - 1 week Mayo Clinic by William Furlow
1985 IPP replaced, penile degloving to correct scarring, shortening and cylinder contracture. Suspensatory Ligament procedure - 2 1/2 weeks Mayo Clinic by William Furlow
1989 IPP replaced, repair of Tunica albuginea around corpora cavernosa . Degloving to relive penile shortening - 10 days Baylor U. Houston by F. Brantley Scott.
2000 IPP removed due to fluid loss and possible infection - 6 days Cleveland Clinic by Dr. Karl Montague
2000 IPP replaced - 4 days Cleveland Clinic by Dr. Karl Montague.
2002 IPP replaced, penile degloving to correct penile shortening due to IPP removal for 2 months. Repair of Tunica albuginea around corpora cavernosa - 3 days U of Washington, Seattle Dr. Richard Berger.

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