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.

Penile Implants: A Brief Preliminary Comparison of Types

Since I don't have them yet, there isn't much I could tell you that you can't Google for yourself, but here's my take on them, anyway:  There are two basic types of implants: semi-rigid and inflatable. The rigid ones are malleable rods that keep your penis pretty much extended all the time-- you bend it up or down depending on whether you're ready to party or want the little guy to remain out of sight.  I don't find this very appealing, but one specialist pointed out that the rods generally last longer than the inflatables without having to be replaced.  For younger guys this might be important because since they are likely to be more sexually active, the repeated use of an inflatable might make them not last the 10 year average life they advertise, since the average implant patient tends to be older and less active.  

The inflatables have a more natural feel and appearance, I'm told, especially in the flaccid state, and they give the patient a great degree of control over the rigidity of one's member.  The bothersome thing about implants generally are that the length of the erect penis with implants is like 7 to 10% shorter than it used to be.  The dick doc said it would probably be about the length that you could stretch your flaccid penis with your hand. What the actual HELL?!  Even with the shortening caused by my Peyronie's I'm bigger'n that when in full bloom, so that prospect is very concerning.  If you look for implant videos on Youtube, you'll find one where the guy's johnson is freakin' HUGE, so he must have been an absolute HORSE before the surgery.  Geez, if only I could have what I once had....  Sigh.

There are two types of inflatables, too:  2 piece and 3 piece, which is kind of misleading.  The 3 piece has a fluid reservoir which is placed behind the abdominal wall, a pump in the scrotum, and the two cavernosal bladders, whereas the 2 piece has a combination pump and reservoir plus the bladders.  I couldn't find much information about pros and cons of either, though the docs seem to recommend the 3 piece.  The diagrams of the 2 piece make it seem like the ole' sac might be a little crowded with that combo.  ANYWAY, I'll let you know if I find out anything....

Peyronie's Hope & Despair: Penis Implants Now, or Hope for Something Better Down the Road?

I'm in a quandary.  I can't seem to commit to the idea of getting penis implants.  I got over the fear of the surgery (although it is done under general anesthesia, which has its own problems), since all the work is done through a small incision in the bottom of the scrotum.  The idea of being able to have an erection whenever I want one is alluring, too, and once the surgery is paid for there might not be the constant expense of ED drugs.  But once made, it's a permanent decision to always have implants, which, since the current inflatable models last only ten to fifteen years, might mean additional surgeries to replace them (although the manufacturer supposedly warrants them for life, so replacements wouldn't cost anything).

On the other hand, I read a .pdf download from Medispec.com, the manufacturer of the ED1000 (see post).  It was a digest of all the testing & research regarding Low Intensity Shock Wave Therapy (which is what the ED1000 is) and it also included some research regarding High Intensity Therapy for Peyronie's using a lithotripsy device to try to break up the scar tissue that causes it, the results of which have been mixed but look rather promising.  If I get implants now,  the ED1000 won't be available to me when it finally gets approved for use in the USA, so it seems to make sense to wait, for a while, at least.

It's frustrating, though, because my wife and I have only had actual intercourse twice in the last two months I've had Peyronie's, and it has been extremely awkward, although we did have some success with a doggie-style arrangement where she kneeled on the bed while I stood up on the floor, but it certainly isn't like it used to be.  Sigh.....  (Years later I have tried shock-wave therapy and finally had the implant surgery.  See later posts.)