My Final Solution: Penile Prosthetic Implant Surgery

 Here are the highlights, USA Today style:

1. Bottom line IMHO is if you're having success with any ED treatement, stick with it as long as it works, and only when you've tried all alternatives and nothing else is working should you seek penis implant surgery.  It is an invasive, permanent solution to ED that has some advantages but also several disadvantages.

2. Pros: You can have an erection, such as it is, whenever you want one.  You don't need to worry about how many pills/injections you have left, especially while traveling.  You don't have to worry about whether you will get an erection at the critical time, and you don't have to worry about how long you will stay hard.  

3. Cons: There is a lot of pain post-surgery, some of which can last up to a year (Don't just watch the tesimonials on YouTube like I did, look up the post-operative instructions from different medical providers, which tell you what to expect for real). The head of your penis will no longer swell when you're excited like it used to, and a certain condition, "floppy glans syndrome", while not common requires additional surgery to correct.  Although the implants get hard, the surrounding flesh is kind of loose, so the normal feeling of friction in intercourse is a little lessened. The feeling of the erection, generally, is somewhat different than what you're used to; you can also feel the pump and tubing with your hand quite readily.  The pump itself is a little difficult to operate, and for at least the first few weeks your scrotum will hurt from the compression of your fingers against the pump inside it.  The urologist said that they can make the penis somewhat larger depending on how much scar tissue is present, but since I'd had a mild case of Peyronie's Disease with some scarring there was has been some shortening, which is the chief complaint of patients who were less than completely satisfied, me included.  Last but not least, there is some risk of infection, which also happened to me.

The boring details are:

I started with a new (to me)urologist, asked him about penis implants since my Super Bi-mix injections worked but not as well as they used to. and I knew that eventually they would not work at all .  He said I was a good candidate for implants because I am taking Xarelto for A-fib, and the anti-coagulant drugs tend to cause excess bleeding in the penis when the ED injections are used.  After some more consultation we set a date that was about 6 weeks out for the surgery.

Surgery was under general anaesthesia, so I felt like crap when I awoke.  They kept me in the hospital overnight as a precaution due to my A-fib, and for that night and the next day I felt pretty good, not knowing that they had chocked my nether regions full with painkillers.  My johnson and balls were cradled in some sort of cushioned gauze pocket taped to my abdomen, and a Foley catheter had been inserted into my urethra.  By the time I was released, I had three swollen balls:  the pump and fluid reservoir felt like a third ball. The doc tried to remove the cradle, but the gorilla tape they'd used hurt so bad when he pulled on it that it brought tears to my eyes. I was later able to take it off after soaking in the shower the next day. I could barely sit down on the ride home, and though they gave me a week's worth of Tramadol I ached eontinually for a week straight.  Even though the pain began to subside on the 7th day, my balls remained swollen for quite some time afterward.  

The night before my 3-week follow-up doctor visit I developed a fever and shivered violently for almost 2 hours straight. Turns out I had a Urinary Tract Infection, for which they gave me Levaquin, a badass antibiotic with which you can have no alcohol, grapefruit, or several other things, including sunlight.  After that went away, my balls and weenie were all still very tender, so I was unable to use or practice with the device.  When I finally could do so, operating the pump by squeezing the bulb through the scrotum has made it feel bruised and a little sore.  I will say that finally, 8 weeks later,  I had sex with my girlfriend and though awkward and different-feeling, it was in the end quite satisfying.  Maybe with my continued breaking-in of the pump and toughening of my scrotum it will be even better.  We'll see.

Update: It's been seven months since the surgery and the implants are functioning quite well, although as I said there has been some shortening of the penis and it does not have the girth it once had.  I read two interesting articles among a host of dull ones about that:  One said that the use of an ED medication like Viagra or Cialis would induce some swelling of the glans and maybe improve girth somewhat until the medication wears off-- I've noticed that when I get really excited, the ridge on on the underside of my cock actually swells a bit, so the drugs  might indeed help.  I'm thining of re-ordering Rugiet, which is Viagra combined with a nother drug, Apomorphine, that really helps you get in the mood... 

Another article was a case study of a guy whose implants for some reason needed replacing.  He used a vacuum assist device (a penis pump) regularly while waiting for the replacement surgery.  Supposedly it increased the size of his corpora cavernosa enought that the urologist was able to insert a larger set of implants than before, so maybe that's something you could look forward to if things go wrong the first time. 

To sum it all up, the surgery is painful and although most of it goes away in a few days there is still some tenderness here after 7 months.  I and a lot of men find that with the implants the penis is somewhat shorter and a little thinnner than it was before the surgery. But on the other hand, sex with the implants works quite well: My girlfriend seems to genuinely enjoy it, anyway!  There is something to be said for not having that "Will it work or not?" anxiety that began with ED and continued through all the times I used medications and then with the injections, so  now I do have a certain degree of confidence that I can be hard whenever I need to be.

Rugiet: It's The Real Deal!

 So I wondered if maybe the Acoustic Wave treatment might have made the use of oral ED drugs more effective for me, since I have severe ED.  Maybe I wondered aloud and my cell phone heard me, because almost immediately Facebook showed me an ad for Rugiet, a new oral ED treatment.  It is a softgel that dissolves under your tongue, which they claim helps it take effect in as little as 15 minutes.  There are 3 different-strength formulas, the "max" of which contains (I think) 110 mg of Sildenafil (generic Viagra), 40 mg Tadalafil (generic Cialis) and 3 mg of APO, short for Apomorphine, a new one on me. 

Their literature says APO has the effect of preparing the nervous system for sexual stimulation. It is a dopamine agonist (or promoter) that affects dopamine receptors which (I think they said) send sex-related signals through the body.  It's fairly new but has been very effective in clinical trials, with the most common side effect being nausea, which goes away with continued use.  One study I looked at seems to say that it is almost as effective for men with severe ED as for mild or moderate ED....  Okay, to cut to the chase: I think I can attest to that.  There is a comment at the end of the study description that suggests that another reason the APO works is that some of the root cause of physical ED may be in certain areas of the brain.

         ( I've screwed something up in the formatting, can't seem to fix it.) I got the package in the mail and couldn't wait to try it out. I put the little soft square under my                tongue and it dissoved fairly quickly, had a vaguely minty taste which was not bad.  It took longer            than 15 minutes, but not more than 30-- conjuring up some sexual imagery in my mind, my                 mini-me self-initiated a launch sequence which hadn't happened in several years.  I went into the next room to my girlfriend and asked her to help me with something in the bedroom.  With a quizzical expression she did so, and on arrival I took her in my arms and kissed her deeply. At the end of the kiss I dropped my pajama pants and stepped back.  "HOLY CRAP!" she exclaimed, and took the angry little feller in hand and began feeling it...   In truth, it was just almost hard enough for penetration, but that was way beyond anything I'd achieved without an injection in a long time. She stared at it for some time, fascinated, squeezing it and then gently stroking it, making me moan softly.  When I did, she looked up at me with an amused expression, then pushed me back on the bed and went down on me with a vengeance.  I was surprised by the experience, but it put me in a zone where it felt so good I didn't want it to stop, so I didn't come for quite a little while, but when I finally did come it was explosive, and would have set new height and distance records for me had she not completely contained and swallowed it all except for a little dribble that ran down her chin. She stared hotly into my eyes and grinned.  

It's hard to describe the difference in feel between an oral drug-induced erection and one achieved by injection. It just feels more natural, and by extension more exciting.  I felt much like I had back in the day almost 18 years ago when Cialis enabled me to make love with my late wife 5 times in one 24- hour period.  Having had severe ED for the last 10 years or so, it was incredibly surprising.  I'm kind of hoping that with repeated use I may be able to achieve actual penetration-worthy hardness. I admit I've contemplated maybe taking two doses at once:  I don't know about the double Sildenafil and Tadalafil, but the APO study tested doses up to 6 mg, so I think I'd be good, there. Hmmm...

The bottom line is, I would bet that a man with mild or moderate ED would be blown away by how effective Rugiet can be, maybe men with severe ED, too.  But of course, it's not cheap-- the 1-time trial order was $170 for 6 doses, although the regular recurring order option i, I think, a little cheaper per dose.  Right now, though, I'd say it's freakin' WORTH IT, BABY!

 

 

     

I've Started Shock Wave Treatments for ED

 I finally decided to try my urologist's U-Wave treatment even though it is supposedly not as effective for guys with advanced/severe ED like me.  I figured for the new lower price it would be worth a try, and it's good I signed up when I did-- the price jumped from $1500 to $2000 as of January 1, 2022.  This was still much better than the Total Performance Medical price of $5500 I was quoted maybe a year ago (see  past blog post).  

The procedure is very simple: you strip below the waist, the technician applies an acoustic gel to your willy and then he goes over it with the shockwave wand. After that you put your knees up and he gels and wands the area at the base of your shaft behind the testicles, where the artery supplying your genitals is located.  You can feel the pulses, kind of prickly/tingly, but it doesn't really hurt.  My 3rd treatment was given by the actual urologist, and he used a little less gel, which meant I felt it more, like really mild pin pricks but nothing to complain about.  I had my 4th treatment yesterday from the regular tech, and he uses more gel, which means I don't feel anything.  You get 2 treatments per week for 3 weeks.  The treatment takes about 4 to 6 weeks to have its full effect, after which they have a doctor consultation to gauge its success or failure.

As I said, I just completed my 4th session, and I can tell a difference even though I'm far from cured.  I take Super Bi-mix injections to achieve erections, and the tech suggested I induce one every 48 hours and keep it hard for as long as possible while the treatments are on-going, to help the body build and open the penile blood vessels. Before I started this, my injections were kind of hit or miss as far as success was concerned, not sure why.  Since I began U-Wave, however, every erection has been rock-hard and I've managed to make it last 1.5 to 2 hours as long as I put off climaxing... WOOHOO! That much alone makes it worth the $1500 to me.

I'll update this post after the last treatment, if there's anything new to report, and again after the 4- 6 week period.  Now if you'll excuse me, I have an injection to prepare.  ;-)

UPDATE:  My member feels "fatter" than it did, and my erect length seems to have improved, although not to what it was before I had Peyronie's Disease (see previous post).  Alas, I can't see much improvement in my ED in general, still need an injection to get hard. *Sigh*

Fighting ED with Niacin? Hmmm....

So I was watching the TV series Ratched, and there was a scene where a psych hospital patient complains to the nurse that he's had an erection for 3 days, and she says "Oh, that's the Niacin we give you. It affects some guys that way." She then proceeds to jerk him off, but that has nothing to do with this post....  Curious, I googled treating ED with Niacin, and sure enough there is an NIH study that examined just that. It said that test subjects who took 500 to 1500 mg of Niacin (an OTC available dietary supplement you can get from any drugstore) for 12 weeks experienced improvement in their erections, especially those with more severe ED.  I didn't pay attention to the actual numbers quoted though, sorry.

I've been taking 1000 mg of Niacin a day for about 8 weeks so far, and there is a small improvement in my erectile ability.  I have REALLY severe ED though, so I'm probably not a good test subject. A more normal man would probably get a bigger bang from it, maybe.  Anyway, if there is any significant change after 12 weeks, I'll update this post.  Meanwhile, I'm still using injections to get the job done.  I'm on Super Bi-Mix now, and it seems to be working pretty well. 

Is Peakperformanceformen.org a Scam?

I think not, although they definitely pursue the hard sell.  My regular urologist has a low-intensity shock wave machine, and he said it would cost about $3000, so I visited Peakperformanceformen to see what their treatment is like and how much it would cost.  I had to pay $49 for the consultation (it's advertised as $99 on TV, but if you mention their website you get the cheaper price),  They ask you a bunch of relevant questions about your ED to start with, and an assistant then uses a hand-held doppler device to listen to the pulse of your femoral artery and then 2 other arteries which supposedly feed into your penis. My femoral artery had a loud, regular pulse while the other two had almost none at all. Surprise, surprise!

An actual physician came in a few minutes later and said from his review of my history and the doppler test I qualified for the treatment.  I was then ushered into the business manager's office (kinda like buying a car, eh?) and long story short, the fee was going to be $5500 plus a possible maintenance treatment in 6 months for another $900.  What the?  I suppose in my younger years I might have been desperate enough to pay that, but today, MEH, no way.  As a last ditch sales pitch, the business guy said the shockwave treatment could be used on my testicles to get them to produce more testosterone, something neither I nor my urologist had ever heard.  I have since received several follow-up voicemails from the main office of the company offering a lower fee, but I haven't called them back.

Some notes:  1) My dick doc said that for guys with severe ED, such as requires bi-mix injections rather than just oral ED drugs, the shockwave treatment seldom results in enough improvement to stop using the injections, so if I wanted to throw $3000 at it anyway, they could do that. 2) It looks like Peakperformanceformen uses a device branded Piezo Wave.  When I googled them it seems their device is primarily used for torn rotator cuff repairs and the like, but I may have been wrong. 3) I wonder that maybe because this is a relatively new treatment in the US is why it costs so much.  Perhaps like laser vision correction a few years ago, the price of the procedure may come down as it becomes more commonly available and initial demand for it subsides.  We can only hope!

Bi-Mix Rules!

Well I was using Edex, which worked okay but caused a dull ache in my penis the whole time, which was sometimes very uncomfortable.  Then my nice but generally disinterested urologist retired and I was assigned a new, much younger guy who nevertheless seemed very experienced.  He recommended Bi-Mix, which is a combination of my old friend Papaverine and Phentolamine, and is only available from a compounding pharmacy.  He recommended EmpowerRx which is located in Houston, TX and sends the stuff by mail order. It costs less than $100 for an amount that provides 7 - 12 doses depending on how much you need per dose, so its a HECK of a lot cheaper than Edex, and it works great!  Takes about 15 -20 minutes to reach peak hardness, lasts 60 - 90 minutes.  The Little Woman and I are gettin' older so she doesn't want to have more than one go-round in any one session, but I've gotten into the shower after a bout of lovemaking and within the above time-period found I was easily stimulated back to full attention, so I'm thinking you could get at least a couple of good rodgerings with each dose if you and your partner are up for it.  The only drawback is that I seem to require a bigger dose than when I started....   The Doc said that if I eventually need a really big dose then I should switch to Tri-Mix, which is the two drugs listed above plus the drug that's in Edex, so it would be back to having an aching Willy.  Woohoo!  The things we do for love....  

Bathmate: A Different Kind of Penis Pump

The Bathmate is a different animal from the others, in that it is supposedly a male enhancement device and is not really meant for intercourse.  You generally need to be in the bath or shower to use it (hence the name), so unless you're gonna do the deed there it's not practical for sex, more's the pity since it is about the most effective Vacuum Erectile Device I've tried so far.

It's a big bullet-shaped device with a domed top and an "alligator" flexible rubber-like gasket at the bottom.  You fill it with water and then push it back against your body, which forces water out a one-way valve in the dome, creating suction.  You wait a minute until the suction draws blood into the penis (and thus the suction lessens), then you push it back again to force more water out and increase the suction, repeating the cycle every so often until you can't increase the suction any more.  You're supposed to leave the device on for a maximum of 15 minutes (making for a danged long shower, sometimes) in three sessions of five minutes each.  The result was that it made my weenie about as big as it's ever been since I developed Peyronie's, and almost hard enough for penetration, despite my severe ED.  Did it increase my size? Hard to say:  as I continued to use it over several months, the graduated measurements marked on the side of the cylinder did increase by about 2.5 centimeters, but I don't know if that was a real increase or just my becoming more adept at applying the suction, thus collapsing the seal tighter and forcing the head farther into the cylinder.  My wife, however, remarked that when I use Edex to get a real, full erection,  my little man seems thicker, for some reason, so....

Still, whether or not it really increased my size and/or helped partially cure my Peyronie's disease, it gave me a great sense of fullness that lasted for quite a while when I also used a cock ring to keep it engorged after removing the pump.  If felt so good that I more often than not, um, pleasured myself, which made the shower even LONGER!  Dang....  After about 8 months of use, however, it appears the seal is failing, so I can't get the suction to work very well, even with gel lubricant as a seal, so I'll have to buy a new or different one to continue.  Hmph! (Update:  I bought another one and after a while it developed the same problem.  Cleaning the valve helped the problem some, but did not cure it. *sigh*