penile implant thoughts

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curly805
New Member


Date Joined Jul 2009
Total Posts : 9
   Posted 7/22/2009 12:11 PM (GMT -6)   
I have been reading all of the posts regarding ED injections and implants for awhile now. They have been very helpful to me in thinking about my options.
 
Diagnosed 8/06
Gleason 3+3
Robotic surgery 10/06 @ City of Hope by Dr. Yoshida
Clear margins, etc in pathology
PSA tests have all been clear
 
I am fortunate to not have incontience issues, except a tiny squirt every now and then when I get excited (usually sexually).
 
I have not been able to maintain an erection firm enough for intercourse.
 
I have used all the pills. Cyalis gave me bad delayed neck and shoulder pain. They all gave me a bit more blood flow and size, but that was it. 
 
I tried the vacumn pump with the constriction bands for 90 days (money back guarantee period), and found the bands could not hold the erection. Snap...painful too! Close but no cigar.
 
So I am left with the injections or implant.
 
My insurance doesn't cover the injections, so even if I was one of the 40-50% for whom they work, and assuming I could get used to doing it, I don't think I would be willing to pay as much as they want.
 
Except for a somewhat shorter erection and some sensitivity and/or engorgement issues with the head, The implant seems like the way to go.
 
Am I missing something based on your experiences?
 
How does an implant affect urination? or continence?
 
Thank you for supporting all of us going through this unfortunate issue.
 
Steve

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 7/22/2009 12:28 PM (GMT -6)   
Steve, welcome to the forum. Hate to see ya here..lol

I can't address the implant question, other than to say that the cost of the surgery runs in the 30K to 80K range, and when the added expenses of out of town hotel, travel and aftercare costs, I think the injections will compare very favorably.

I'm guessing you haven't gone the injections route so far? If not, then the cost of the drugs isn't really that much. Few men are able to tolerate and use the Caverject (very expensive form of alprostadil) at around $40 per shot. However, the cost of Bimix is low, around $55 per 5 ml. vial, which will yield around an average of 20 injections at the .25ml injection. Trimix costs around $94 per 5 ml vial, mail ordered overnight with cool pack, and yields an average of 50 doses per 5 ml vial, at a dose of .10ml or cc per injection. Insulin nedles are around $10 per 100, so the cost of Trimix for the average user is around $1.98 per dose, including the syringe, and Bimix is around $2.60 for the same. Much cheaper than pills and much less problematic and costly than implant, in my opinion. smilewinkgrin I think the success rate for injections are in the 85-90% range, also. No, insurance doesn't pay for injections,of course, but out of pocket isn't really that bad.

The implant guys may wander in soon, so they can address your other questions. I understand you looking in this direction, you being a long term ED sufferer. After 22 months of complete zero results, I am slowly beginning to turn my thinking in that direction myself. At 4 to 5 years, I may be looking seriously at it.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
21 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months

Post Edited (James C.) : 7/22/2009 12:35:59 PM (GMT-6)


curly805
New Member


Date Joined Jul 2009
Total Posts : 9
   Posted 7/22/2009 12:36 PM (GMT -6)   

Thanks James.

I am waiting to hear about implant coverage by my insurance.

My urologist gave me a prescription yesterday for 2 injections of edx 20mg caverjet (?). I went to the costco pharmacy and they told me the Anthem(BC) would not cover the meds, and that it would cost me $259.  I asked my urologist about cost and bimix/trimix and he just shrugged it off.  I like the prices you talk about, but this dr. may not be the right guy to advise/help me. I would try the injections for ahwile before doing the permanent implant.


Smokie
Regular Member


Date Joined Oct 2008
Total Posts : 46
   Posted 7/22/2009 12:58 PM (GMT -6)   
Curly805,
I think you are right to try the injections first. I had an implant installed 2 1/2 months ago. I think I will be happy with my it, but man, its a lot to go through.
The implant does not effect urination.
My insurance co paid for the implant, but I understand that not all companies do.
Size is the million dollar question. Some men lose size, some don't. I have a model installed that gradually expands over the first year, so I'm not sure where I'll wind up. I'm guessing that I will be shorter than before.
I think its too early to judge sensitivity also. I think it may be less now, but so far its a good thing, as it prolongs sex. It still feels great.
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
 
 


curly805
New Member


Date Joined Jul 2009
Total Posts : 9
   Posted 7/22/2009 1:20 PM (GMT -6)   
Thanks Smokie. What model do you have?

Forgot to add that I am Age: 58

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 7/22/2009 1:25 PM (GMT -6)   
I would suggest that you push the Uro. to talk about the injections of Trimix and Bimix.  He needs to work with you, (and for you) in finding something that will be acceptable.  If he isn't willing, then I'd be looking for a doc who was willing to be more supportive.  Maybe there's ED specialists available locally?  They are much more up to date and more willing to work with patients than some Uro's, who may not have the latest info or inlcination to go those extra steps in care.  This doc may just need you to let him know that you are interested and want more from him.  It isn't like it's rocket science... smilewinkgrin
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
21 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 7/22/2009 6:08 PM (GMT -6)   
Those guys who have had implants do speak highly of them. But once you have one, there is no going back, so you need to be really sure your ED is otherwise permanent.

I'd also strongly suggest Bimix and/or Trimix. Both are relatively cheap. I use Bimix and find it to be highly effective, so much so that if I need it forever, I will be happy -- but of course while still hoping for some recovery on the ED front.

The way I see it, I have to contend with two little pricks twice a week, maybe for the rest of my days. The implant involves serious surgery, with probably at least a week of serious discomfort. No contest!

Don't give up on injections without a good trial -- you need a fair degree of practice and experimentation to find something that works for you. Also don't don't give up on the pump -- I am a fan of the cheapie pump with office rubber bands for constriction -- very adjustable.

Obviously an implant is a very individual decision. Only the potential recipient can place a value on the plus and minus factors as they effect him. Good luck with your decision.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
ED:
After a learning curve, Bimix injections (0.2ml) are working well. VED also works but we find it inferior to Bimix.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 7/22/2009 8:34 PM (GMT -6)   
I just bought 10 ml of tri-mix which should give me 20 shots at .5 ml for $55 including 30 syringes at my local compounding pharmacy.

I probably won't live long enough to use $30-40,000 worth. At $2.75 per shot, it is probably a better deal, and may be more real than an implant in its effect.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


curly805
New Member


Date Joined Jul 2009
Total Posts : 9
   Posted 7/22/2009 8:40 PM (GMT -6)   

I obviously need to pursue the injections before I go with an implant. I just need to find a doc who will work with me and figure out the cost issue.

Thank you for all your advice.

Steve


Bob D
Regular Member


Date Joined Mar 2008
Total Posts : 199
   Posted 7/22/2009 11:20 PM (GMT -6)   
After watching a video of a man getting an implant, I would try the other methods first.
    1. Age 59, psa 4.7 in Jan. 08. Biopsy: one positive sample out of 13. 1% of one sample cancer. Prostate removed on 3/5/08. Open Surgery. Northeast Georgia Medical Center, Gainesville Ga. Nerves spared. Cath out 12 days later. Continence good. No pads needed since 6/10/08. First PSA: Less than 0.1 on 6/17/08. First erection five days post op and have been improving well since then. Full erection now possible (less than four months post op) with the assistance of Cialis.  Post Op Biopsy : No malignant cells in lymph node. Gleason 3=4=7. Tumor on both lobes. Urethral margins/apex free of neoplasia. Right and left seminal vesicles free of neoplasia. No invasion of prostatic capsule of the resection margins are noted by the tumor. Tumor occupies 10 to15% of the prostate gland. Path staging T2c, NO, MX- Group staging II.  Focal areas of perineural invasion by tumor are noted. 80% natural erections and full erections with 10mg Cialis. 9/22/08-Took 10mg Cialis on Monday night, had very usable full hard erection at night, the next morning, and the following Thursday morning, 60 hours after original dose !! Orgasm quality Excellent.!!!!! I am pleased with the progress so far. Married to same wonderful woman for 39 years. She is still beautiful and sexy as ever. A great help in my recovery !!: 3/12/09: Full natural erections with penetration. 10mg Cialis makes them easier to maintain but I have had several med free full erections lately, Yipieeee !!!!!!!  3/24/09: One year PSA <0.1.  3/28 & 3/29: had sex with full naturals with no meds. Erections are gained and maintained with very little manipulation. Getting more like pre op every day. 5/30/09, I take only 5mg Cialis every 2 or 3 days. This greatly assists my full naturals and provides great staying power and no manipulation required and allows sex anytime !! Lenght and girth are back to pre op size due to regular "workouts".
    1.  


      Smokie
      Regular Member


      Date Joined Oct 2008
      Total Posts : 46
         Posted 7/23/2009 6:19 AM (GMT -6)   
      Implants are certainly the last option to consider. They require surgery, and are irreversible. However, for those of us who have run out of options, its good to know that they exist.
      To answer your question, I have an AMS 700LGX. It is the only model available that allows for length and girth expansion over time. However, there are several models available, and of course, some are better suited to certain patients than others. Like everything else concerning PC, ED, etc..., a lot of research is involved.
      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
       
       


      Gene214
      Regular Member


      Date Joined Mar 2007
      Total Posts : 422
         Posted 7/23/2009 7:05 AM (GMT -6)   
      Curly,
       
      Looks as if most bases have been covered here in the above posts.  I can say by experience that the erection does  restrict urine.  After sex, if I do not deflate before urination, it is restricted.  As soon as I deflate, it flows freely.  You will notice in my extensive Q & A post that I ejaculate a small amount of urine.  Not all do, but I do.  As mentioned in my post, I've learned to deal with that.
       
      Gene214
      PC diagnosed 12-06 @ age 63
      Radical open removal 2-14-07, Gleason 3+3=6
      Post-Surgery psa  -- .011
      Removal of stricture 6-07, incontinence continues
      01-15-08 psa -- .05
      AUS, IPP implanted 07-16-08
      AUS, IPP activated on 08-18-08.  They both work!
      10-20-08 went back to surgeon for a follow-up.  Both devices work well.
      10-20-08 psa -- .05
      05-15-09 psa -- .07
       


      curly805
      New Member


      Date Joined Jul 2009
      Total Posts : 9
         Posted 7/23/2009 7:01 PM (GMT -6)   
      followup from steve.

      went to the local compounding pharmacy and showed them the prescription. they said they compound it themselves and it would cost $60 for 10 injections (vs. quoted $259 for 2 at costco). after i got up off the floor....i made sure my appt. with my doc was still set for monday to do a demo injection. we'll see if I am in the 40-50% that it works for.

      thanks again for you input. i will update either way monday.

      goodlife
      Veteran Member


      Date Joined May 2009
      Total Posts : 2691
         Posted 7/23/2009 9:40 PM (GMT -6)   
      Still sounds a little high. Check another compounder if you have one .
      Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
      Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
      0/23 lymph nodes involved  pT3a NO MX
      Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
      Neg Margins, bladder neck negative
      Living the Good Life, cancer free  6 week PSA  <.03
      3 month PSA <.01 (different lab)


      lifeguyd
      Veteran Member


      Date Joined Jul 2006
      Total Posts : 677
         Posted 7/24/2009 8:57 AM (GMT -6)   
      curly805 said...
      followup from steve.

      went to the local compounding pharmacy and showed them the prescription. they said they compound it themselves and it would cost $60 for 10 injections (vs. quoted $259 for 2 at costco). after i got up off the floor....i made sure my appt. with my doc was still set for monday to do a demo injection. we'll see if I am in the 40-50% that it works for.

      thanks again for you input. i will update either way monday.
       
          You have been given some good advice here.  If your prescrption is for Edex, that is another name for Alprostadil.  If you read some older posts here, you will find that many men cannot use 100% alprostadil (edex, caverject) because it causes some significant pain and aching.  If that is the case for you, do not be discouraged, you will just need to change your prescription to bi/mix or tri/mix.
       
      The bi/mix has no alprostadil and the tri/mix has a smaller quantaty of it plus two other drugs.  A penal implant is a major life decision that entails tramautic surgery and a long time period of rehabilitation. Read some of the older posts here about implant problems.  You should exhaust all other possibilities before you go down that road.  I have great results with Bi/mix.
       
      By the way, I needed to educate my urologist (he prescribed only caverject) about bi/mix and tri/mix and he has thanked me for opening a new treatment for some of his other patients.  Even great surgeons have a limited focus and can learn something every day.
      PSA up to 4.7 July 2006 , nodule noted during DRE
      Biopsy 10/16/06 ,stageT2A
      Very Aggressive Gleason 4+4=8  right side
      DaVinci Surgery  January 2007
      Post op confirms gleason 4+4=8 with no extension or invasion
      no long term continence problems
      Post surgery PSA continues to be "undetectable"
      One side nerves spared
      Bi-Mix for ED 
      born in 1941


      curly805
      New Member


      Date Joined Jul 2009
      Total Posts : 9
         Posted 8/1/2009 6:27 PM (GMT -6)   
      Almost a week later. Have used the generic Edex (pge-1) 3 times. Doctors office; by myself at home (can't believe I gave myself a shot!); and then this morning with my ladyfriend. It works! First lasting erection in 3 years. Some aching, so will probably try the bi-mix or tri-mix when I am done with this Rx, but even if not, it is WORTH IT.

      I was on the edge of pursuing the implant...thanks for the info you guys gave me.
      Diagnosed 8/09 Gleason 3+3 =6
      Robotic RP @ City of Hope 10/09
      Problems with "abnormal anatomy"
      Clean pathology
      Catheter for 6 weeks
      Followup PSA negligible
      Incontinence.. a small squirt every now and then
      ED - yes
      Pills didn't work
      Vacumn pump w/bands hurt and didn't hold erection
      7/09 Just starting injections


      goodlife
      Veteran Member


      Date Joined May 2009
      Total Posts : 2691
         Posted 8/1/2009 7:49 PM (GMT -6)   
      Curly,

      Some guys in here hace been trying Muse, for those that don't like to inject. It's a pellet you insert in your urethre.

      Glad the injection worked. Yiu may have to experiment with doage. Maybe try a little less and see if resuts are satisfactory and pain subsides.

      Keep us informed on what works for you .
      Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
      Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
      0/23 lymph nodes involved  pT3a NO MX
      Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
      Neg Margins, bladder neck negative
      Living the Good Life, cancer free  6 week PSA  <.03
      3 month PSA <.01 (different lab)

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