An unusual request for a penile implant revision

 

  • January 18 2015

Dear Dr. Reed,

  • I Would like to have a 10 inch penile implant non-inflatable, concealable prostheses used in the treatment of erectile dysfunction rigid, but with flexibility to position the rods in an erect or concealed configuration. a model with a tapered silicone elastomer body for a natural shape, providing xcellent girth while maintaining a firm erection.
    In the past I had an inflatable prostheses placed in, but it has recently broken inside and needs to be replace. Could you perform this operation, taking one prosthesis out, and placing the non-inflatable in? Thank you for your attention, I will make an appointment as soon as I have your answer.

    Dustin from Houston, Texas.

    Good afternoon Dustin,

    Thank you for reviewing our web-site http://www.penisdoctor.com/prosthesis.htm

    Can it be done? Well possibly. Is it a good idea? Frankly no.

    Unilateral inflatable implants are performed in unusual situations such as a man who has had complete rebuilding of his penis (phalloplasty) or in a female to male transsexual with same. I have not heard nor would I recommend an inflatable on one side and a semi-rigid or malleable on the other. Either replace the inflatable with another inflatable or have malleables inserted on both sides. You say 10″ length. Only if what was put in is 10″ long. To insert an excessively large implant into a smaller space will only lead to tissue breakdown and extrusion. You’ll be back in the operating room again, more than once.

    If you would like to call the office, we can talk further.

    Cordially,
    Harold M. Reed, M.D. FICS
    305-865-2000

    Senior Member of the American Urological Association
    Member Society of Genito-Urinary Reconstructive Surgeons
    Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
    Founding Member Sexual Society of North America
    International Society for Sexual Medicine

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Persistent swelling after adult circumcision done elsewhere

January 18, 2015

Dear Dr. Reed,

I had an adult circumcision in February 2014 by urologist in Georgia.   I am having a persistent swelling problem that Dr. has offered to try to address with a revision, but I was wondering if you might be willing to share your opinion on the matter before I proceed with anything with him.

The circumcision preserved almost all of the mucosal layer of skin, and at my request, also left the frenulum in place. Most of the other aspects healed up well, but around three months, I noticed that the remaining inner skin seemed to remain full with lymphatic fluid.

At Dr’s advice, I wore a compression bandage for many months in the hopes of that physically preventing the fluid from collecting would eventually allow it to fully heal. However, each time I remove the compression bandage, a portion of the mucosal layer of skin fills with lymph. Despite months with this therapy, the pocket of lymphatic fluid seems to exist. it collects basically between the scar line and the fold that develops when flaccid. (The skin seems to fold in that location because of the relative looseness of the skin when flaccid, and because of the mild pulling pressure from the frenulum.)

The doctor believes that cutting out more of the mucosal layer of skin will resolve the issue, but I was really wondering if you might be able to tell my your opinion on the matter, and if you have experienced anything like this with a patient. I could also certainly share pictures if that would be helpful.

I thank you so much for your time. This has been a very difficult process, and any advice you can offer would be much appreciated.

Kent

January 18, 2015

Good morning Kent,

There is no shortage of good urologists in Georgia.

I agree that sometimes the lymphatics do no reconstitute, the reason being the under layer also needs to be approximated.  We think of a circumcision as about removing skin and skin only.

The more deep the incision, the more injury to the lymphatic drainage, and if deeper yet, possible neural injury.

The approach I would recommend for a cosmetic adult circumcision is two-fold.  One remove the bulk of the wet tissue to reduce the swelling right on the table and secondly re-approximate the incision deeply bringing together healthy lymphatics to reconstitute drainage.  In that this area has been the site of prior surgery, healing may proceed somewhat more slowly but eventually you should do well.  Been there, done that.

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America
International Society for Sexual Medicine

 

Hypospadias patient seeking cosmetic repair

January 15, 2015

Good afternoon Albert,

Hypospadias is the incomplete tubularization of the urethra.  Your case is distal
and the success rate of repair is reasonably high.  We like the Snodgrass technique for this
purpose.  Please see http://www.penisdoctor.com/hypospadias.html.  For more advanced
cases we can do a buccal graft, tissue taken from the inside lining of your check.  The incisions heal rapidly
and we have been pleased with the success rate as well.  The patient in the photo below (a fisherman)  had both hypospadias and Peyronie’s and came to Miami from Oregon.

He wanted to travel back by bus, but I paid for his flight back to be with his family during the weekend.

Sincerely,

Harold M. Reed, M.D.

Hypospadias

Hypospadias is a congenital condition or could occur with Prince Albert ring trauma in which the urinary opening is not on the tip of the head but rather below. Can be on the shaft or perineum. May be associated with incompletely formed urethra resulting in scarring or tethering on the underside and downward curvature. This patient had upward curvature (unrelated) and glanular hypospadias which we corrected simultaneously with plication and TIP (tubularized incised plate) or Snodgrass procedure.

Example #1: 1/1 – 1/4

1/1
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1/2
[]

1/3
[]

1/4
[]

Peyronie’s in Miami. Can it be fixed without surgery?

January 15, 2015

Dear Dr. Reed,

Have been diagnosed with Peyronie’s or “bent spike” syndrome.  Probably attributable to
female above trauma, heard a pop, then a bruise, sore, and now difficulty entering with loss of 2 inches in length.

Will never do that again. Saw your web-site http://www.penisdoctor.com/peyronies.htm.  Can we talk about
some of the newer non-operative ways of correcting this.  Live in Los Angeles, but will travel to Miami.

Jason K

Good afternoon Jason,

Yes, there are some newer methods on the horizon, but let’s review the stats first and also adverse reactions.  Traction under the aegis of a urologist is still a formidble performer for restoration, may not be 100% but you’ll be a “contender”
again.

Sincerely,

Harold M. Reed, M.D.
305-865-2000

Peyronie’s disease, named after the french surgeon to King Louis XV, is a restricting scar or plaque that exists in the lining of the erectile bodies resulting in a tethering of erections (“bent spike syndrome”). The cause of Peyronie’s disease is now thought to be repetitive trauma. An unappreciated example would be female above trauma which may occur after the penis momentarily slips out of the vagina. Autoimmune basis for plaque has also been ascribed. Peyronie’s disease may co-exist with Dupuytren’s flexion contractures of the hand.

Disorders unassociated with plaque, yet producing erectile deformity include “lateral penile curvature” seen occasionally in adolescents when unilateral enlargement of one erectile body (typically the right) causes the penis to deviate to the left and “chordee, without hypospadias”. In the latter, the erect penis angulates downwards secondary to a restrictive developmental anomaly of tissues surrounding the distal urethra. As with Peyronie’s disease, these deformities can be corrected by removing a wedge (s) of tunica albuginea (the lining tissue of the erectile bodies) on the opposite side. When the tunica is resewn, plication of the edges of resected wedge results in some shortening of the uninvolved side to counter the tether on the opposite side. You may anticipate that your erect length following surgery approximates your stretched penile length now. If this is not acceptable, some patients will opt for a simultaneous or staged lengthening procedure to be performed after surgery.

peyronies disease
pre-op, curves to the leftpeyronies disease
intra-op.Curved corrected and verified to be
straight before closing
peyronies disease
pre-op.  Curves downwardspeyronies disease
intra-op confirmation that penis is now perfectly straight
peyronies disease
subsequent post-op photo of same patient
peyronies disease
pre-op, marked dorsal (upwards angulation)peyronies disease
intra-op, neurovascular bundle lifted, plaque removed,
pericardial patch inserted, perfectly straight penis
peyronies disease peyronies disease
pre-op curvature views, unable to penetrate, also some degree of impotency
peyronies disease  peyronies disease
post-op with curvature corrected and penile prosthesis installed
[]  []
pre-op showing a 55 degree angulation, intraoperative correction with multiple parallel suture plication showing straightened result

Concealed penis, buried penis, hidden penis, whatever. Yearn to be a dangler again.

January 15, 2015

Dear Dr. Reed,

Visited your site http://www.penisdoctor.com/photo-concealed-hidden-penis.htm

I am terribly embarrassed and my wife never mentions this but my penis seems to be getting smaller and more retracted with each passing year.  Still have strong erections, but would like more dangling length.  We talked briefly on the phone.  I am somewhat overweight for 5’8″ at 230 pounds.

Dennis

Dear Dennis,

There are non-operative ways of restoring your length and even adding to that.  Please call Dr. Reed at 305-865-2000.

Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons
Founding Member Sexual Society of North America
International Society for Sexual Medicine

305-865-2000

Example #1: 1/1-1/3
Figures 1/1-3 show classic “hidden penis” often called buried or concealed penis. Often there are 2 factors, obesity and a loss of anchoring or looseness of penile shaft skin at the base which causes the penis to slip downwards below the body surface line. This patient had a third factor, perhaps an overzealous circumcision and preputial synechia. This is like a cartoon character with a broad brimmed hat pulling down and shrinking into a midget.

This synechia was released (raw area 1/2) and should re-epithelialize in about 6 to 8 weeks. Plenty of penile shaft was noted under the skin. Just needed to be exteriorized with loose skin properly secured at the base of the penis.

Also performed was pubic and upper scrotal liposuction, and removal of a large lower abdominal crescent of skin and over hanging fat. A recommendation or weight loss in heavy patients is always the first approach.

1/1
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1/2
[]

1/3
[]

Seeking vasectomy reversal, would like to be a poppy

January 15, 2015

Good afternoon Dr. Reed,

I am 35 years old, recently married and had a vasectomy when I was 30.  What is the likelihood I will have a successful vasectomy reversal.  I was directed to your web-site http://www.penisdoctor.com/reversevasectomy.htm

Jeremy D.

Good afternoon Jeremy,

There are 2 markers for success.  The first is the reappearance of sperm and the second is the take home baby rate.  Both these figures are listed below.  Equally important is that your wife is pronounced fertile and safe to conceive.

There is still time for more Jills and Jeremy’s.

Best wishes for 2015,

Harold M. Reed, M.D.

Vasectomy Reversal

 

Simply put: a vasectomy reversal or vasovasostomy is the urological procedure to re-establish fertility. Every year, there are nearly 500,000 men each year in the United States that have a vasectomy. Of those 500,000 males, there are between 2% and 6% that will want a reverse vasectomy. Of those individuals that want a vasectomy reversal, the most common reason given is that they want to have the ability to produce offspring after the remarriage to a younger female. The vasectomy reversal procedure will offer the most optimal degree of success when it is performed microscopically. This is because there is much less of a chance that the finer sutures will obstruct the internal channel at the reconnection site. It is recommended that local or regional anesthesia take place. Before the vasectomy reversal procedure takes place, it is highly recommended that the female be gynecologically evaluated. This will help determine whether she is fertile and able to carry a baby safely during the term. The reverse vasectomy operation usually is achieved by making upper scrotal incisions bilaterally. By identifying the site of the past vasectomy, the edges of vas above and below are freshened. A tight closure comes about when perfect right angle cuts are made. Proper anastomotic technique does incorporate accurate mucosa (the vas’ inner lining) to the approximation of the mucosa, leak proof anastomosis (connection) and tension free anastomosis. All of this will preserve a good blood supply for the atraumatic handling of tissue and high performance wound healing.In terms of success, the resurfacing of sperm in the ejaculate compared to pregnancy of couple that were followed up three years was 97%, while it was 76% had the vasectomy taken place three years or less prior. If vasectomy reversal takes place 3 to 8 years after the vasectomy, the success rate will diminish 88 percent and 53 percent. Between 9 to 14 years after, the percentages are 79% and 44%, and following 15 years or more it is 71% and 30%. Should a “blowout” in the epididymis occur, a vaso-epididymostomy will be indicated. One other consideration after a flawed vasovasotomy is to aspirate sperm directly from the testis and via in vitro techniques fertilize at one time many eggs produced hyperstimulation. An insertion of single sperm into the cytoplasm of a mature egg is defined as the intracytoplasmic sperm injection. According to the American Society for Reproductive Medicine, the “take home” baby rate is between 15% and 20% in regard to well-selected couples with implantation of 3 to 6 embryos/blastocysts at one time.Comprehensive vasectomy reversal fee at the Reed Centre is $6,200.00. Consultation is $250.

Question about silicone in the penis

Hi Doctor Reed,

For some time now I have been considering a penile girth enhancement.
I am trying to get as much info as possible online, and I keep getting
mixed stories about silicone injections.  I understand you do not offer
this at your facility but do you have any thoughts on this? Have you
worked with patients post silicone injection? Do you have any pictures
to support?
I would appreciate any information you could send over.

Thanks again,

Reggie

January 15, 2015

Good Morning Reggie,
I have included some information and photos regarding silicone injection
for penile girth enhancement.

Silicone injection to the male genitalia as well as other parts of the body
for enhancement is often done by non-medical personnel or doctors operating
in foreign countries. The fees seems affordable, but the results are often
disastrous. Silicone like injectable fat chooses paths of least resistance.
Once inserted, silicone takes a random walk and the ultimate result is often
unpredictable.

Although we are removing silicone as frequently as a few cases a month, there
are surgical pitfalls. Silicone destroys normal healthy vascularity, so there is a
propensity for poor wound healing, including separation and infection. Inevitably
some silicone must be left within few milliliters of the skin as removing all of that
will certainly result in skin necrosis. Silicone often will track into the lymphatic system.
Tissue bulking secondary to ligneous edema may result in periodic swelling depending
upon degree of physical activity.

Example #2 – 2/1 – 2/3

2/1 silicon

2/2 Same patient, lateral view. silicon

2/3 Same patient, following limited silicone removal and closure. silicon

[Top]

Self injected silicone like product. Example #3                                                – 3/1 – 3/4

3/1 surg

3/2surg

3/3 Status post revision. surg

3/4 Specimen all neatly laid out, prior to sending to pathology. surg

Vasectomy reversal success rates

Hello Dr. Reed,

I have recently remarried to a beautiful younger woman who has always
desired to have a family and I would love nothing more than to give it to her.
I am 4 years post vasectomy, is it too late to reverse? I am aware the alternative
methods to conception, in vitro for example, but I honeslty would like to try it the
old fashion way.

Could you possibly send me statistical information regarding success rates
this many years out?

Thanks in advance,

Michael

Good morning Michael,

I woud like to congratulate you on your recent marriage, and thank you for your
interest in what we do.

In terms of success, the resurfacing of sperm in the ejaculate compared to
pregnancy of couple that were followed up three years was 97%, while it was
76% had the vasectomy taken place three years or less prior. If vasectomy
reversal takes place 3 to 8 years after the vasectomy, the success rate will
diminish 88 percent and 53 percent. Between 9 to 14 years after, the percentages

are 79% and 44%, and following 15 years or more it is 71% and 30%. Should a
“blowout” in the epididymis occur, a vaso-epididymostomy will be indicated. One
other consideration after a flawed vasovasotomy is to aspirate sperm directly from
the testis and via in vitro techniques fertilize at one time many eggs produced
hyperstimulation. An insertion of single sperm into the cytoplasm of a mature egg is
defined as the intracytoplasmic sperm injection. According to the American Society
for Reproductive Medicine, the “take home” baby rate is between 15% and 20% in
regard to well-selected couples with implantation of 3 to 6 embryos/blastocysts at one
time.Comprehensive vasectomy reversal fee at the Reed Centre is $6,200.00.
Consultation is $250.

Enjoy the rest of your week,

Harold Reed, M.D.

Problem with my scrotal skin, please help

Hi Dr. Reed,

I have a problem in that my scrotal skin attaches too high to the shaft of my penis.
I am happy with my penis size, but the scrotal web makes it look smaller than it
actually is.  Is there any procedure you offer that could help me? Could you maybe
send some photos? It would be appreciated!

Hope to hear from you soon,

Dean
January 15, 2015

Good afternoon Dean.  The procedure you need would be a release of the penoscrotal
web.
Penile-scrotal web or “turkey neck” as said in the vernacular gives the illusion of shorter
penile length and often causes some irritation during penetration  especially with tugging
on hairs and drawing in of the scrotum into the vagina.

The remedy is resection of the peno-scrotal web.  Although some authors favor a Z plasty
we have seen these patients and for me it looks like the mark of Zoro on the penile shaft
and scrotum. I believe our approach is more cosmetic because the penile incision remains
in the midline as an extension of the raphe, and the scrotal incisions even on a fresh post
op are difficult to discern. Our fee is $250 for consultation. The charge for release of
peno-scrotal web and reconstruction including local anesthesia and use of the facility is
an additional $2500.

Here are some photos from out website www.penisdoctor.com to help you visualize:

Photos 1 and 2 show pre-op condition. Web goes half way up to shaft.
Photos 3, 4 and 5 show immediately post op status.  Incision lines should heal imperceptibly.

1/1

penoscrotal web

1/2

penoscrotal

1/3

penoscrotal

1/4

penoscrotal

1/5

penoscrotal

 

For further information please visit our website at www.penisdoctor.com

or contact our office at 305-865-2000

Cordially,

Harold Reed, M.D.

Gynecomastia, before and after photos

Jnauary 15, 2015

Dear Dr. Reed,

Any photos of your photos of your work?

With appreciation.

 

Reuben

Hi Reuben taken from our web-site http://penisdoctor.com

 

Harold M. Reed, M.D.

305-865-2000

Patient 1:
Moderate Gynecomastia, very noticeable in a tee shirt.
Example photographs 1/1 – 1/5.

1/1
gynecomastia
1/2
gynecomastia

Same patient immediately post surgery, contours are now masculine (right side).

1/3
gynecomastia
1/4
gynecomastia

His left side post op.

1/5
gynecomastia

Patient 2:
Young adult male with fibrous glandular Gynecomastia, which did not respond to liposuction.
Example photographs 2/1 – 2/2.

2/1
gynecomastia

Post op following removal of mass, via a limited
infraareolar incision which healed perfectly.

2/2