penisdoctor.com

Peyronies, penile curvature affects 3% of sexually active men, and perhaps more who could care less.

Some are very creative with sexual positioning and can work around some very mind-boggling angulations.  Peyronie’s curvature which is caused by a deposition of scar tissue or plaque is also associated with erectile impairment, but not always.  For most patients there are many ways to approach Peyronie’s including medication, traction, suture plication of the larger curvature side, and insertion of a graft on the lesser involved side.

In severe cases where Peyronie’s results in severe loss of length, then many urologists would certainly consider the option of an inflatable implant, with or without insertion of graft.  As a rule of thumb, if over a 35% lysis in circumference is required to relax the tension and straighten the penis, then a graft such as Tutoplast should be employed.  Otherwise leaving an open defect may not provide enough integrity to the casing or tunica albuginea to provide sufficient axial rigidity.

Releasing plaque of course restores the lesser curvature back to the length of the uninvolved greater curvature.  For men who insist on a closer approximation of their length of yesteryear, the LGX cylinder of AMS (American Medical Systems) may be considered.  The LGX, different from its Ultrex predecessor, expands more uniformly and is not considered as prone to aneurysm formation.  Using a table top model as a demonstrator, easily a 3/8″ increase in length is obtained, but the manufacturer says could be at least twice that in some applications.

Grafting as the sole remedy for Peyronie’s has yielded a disappointing successful length restoration result rate.  Only 30% of patients, despite correction of angulation have some restoration. .  Perhaps for Peyronie’s patients, we should be thinking more of implants.  For a patient to opt for an implant is an important decision, because he will forsake forever being able to have a natural erection.  Although some tumescence does occur with implants, it is never enough should the implant be removed to provide sufficient intromission.  The patient must also accept occasional replacement as part of the deal and the 2 to 8% incidence of infection (all comers having implant surgery).  However, for most with implants, happiness is being able to never have to say “I’m sorry.”

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

A penile implant should be considered is a last resort for men with erectile impairment.  It may occur every time, or frequently enough that the uncertainty of a good performance becomes an anxiety provoking experience with down moderation of what needs to be done.

Sure, a penile implant is a mechanical device and while inflatables are the most commonly chosen by patients, still it is a mechanical device and as such, is not guaranteed to last forever.  The two major manufacturers, AMS and Mentor, both have warrantees that cover the implant for life.  They last on average 6 to 8 years, and just like a set of Michelin tires, could last 40,000 miles or you could have an unexpected problem a lot sooner.

That is why the implants alone today are so costly, about $8,000 plus dollars.  For a 45 to 50 year old man, conceivably 4 replacements may be needed in a lifetime.   The warrantees do not provide for surgical services, just the implant.  However, most surgeons would charge a nominal fee for an early redo.  Hospitals are usually not so inclined for self-pays.  In that we own the Reed Centre facility outright, we are perhaps the most affordable.

The satisfaction rate of patients and their partners approaches 90% and in the event of a breakdown, most rush to be up and running again.   Some of the closest and most social relationships I have had with patients has centered around their satisfaction with the implant.  As one wife stated, if I knew sex was going to be so much fun, I wouldn’t have said “no” so often.

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

Hardly a week goes by that we do not receive an inquiry from someone with “get-there-itis”.  Wants length and girth simultaneously. Please understand while some doctors do offer this, many of their practices have been bought out by businessmen who dictate their mode of operations.  Of course, this is a popular sell, but does it work as well as staged surgery?  I think not.  Most patients complain of inadequate length gains, and also some wound healing problems.  The penis does not appreciate too much simultaneous surgery.  If you have simultaneous surgery, you will not be able to apply traction for a good 6 weeks, lest you tear your incision line apart. Better to have lengthening done, if that’s what you require, use traction immediately afterwards to maintain what was accomplished in the operating room, and build upon that until you are satisfied.    Then, go on to  widening with appropriately longer strips of AlloDerm.

If you are result oriented, believe me, this is the proper way.  I have been a phalloplasty surgeon since 1986 with close to 3000 case experience since then.
 

Harold M. Reed, M.D.

Phimosis, or inability to retract the foreskin for daily hygiene is a problem many men co-exist with, sometimes for an entire adult life.  What’s underneath is not so pretty.  The skin may be denuded from chrinic inflmmation.  Yes, there are carcinogens, agents that predispose to cancer both of the glans (or head of the penis) as well as female genitalia.   When the foreskin does not retract over an erect head, that is a relative phimosis and of course, we can live with that.

Although some do recommend use of steroids, the lack of success and skin atrophy that may result, cause many such patients to ultimately seek adult circumcision.

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

Dr. Reed– A twenty-seven-year-old friend of mine– attending
university in Tucson– is suffering a painfully tight foreskin; one
which precludes the full exposure of the glans of his penis. He is in
search of means to alleviate and find a solution to the problem. I
understand there is a less severe solution than full circumcision,
and would like information on such methods. Thank you. Carl

Good morning Carl,

Thank you for your interest in what we do.

Yes, there is a simpler way and that is to make a dorsal
slit, but the foreskin will hang down below the head,
like a waddle. Most patients would not want to settle
for this on a permanent basis. My recommendation is
proceed to full circumcision unless some emergency
is present that requires temporization.

All the best to you and your friend.

Happy Holidays,

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

(courtesy of Joshua, unashamedly procirc)

Am J Obstet Gynecol. 2008 Oct 29.

The effects of male circumcision on female partners’ genital tract
symptoms and vaginal
infections in a randomized trial in Rakai, Uganda.

Gray RH, Kigozi G, Serwadda D, Makumbi F, Nalugoda F, Watya S,
Moulton L, Chen MZ,
Sewankambo NK, Kiwanuka N, Sempijja V, Lutalo T, Kagayii J, Wabwire-
Mangen F, Ridzon
R, Bacon M, Wawer MJ.

Departments of Population, Family, and Reproductive Health, Bloomberg
School of Public
Health, Johns Hopkins University, Baltimore, MD.

OBJECTIVE: The objective of the study was to assess effects of male
circumcision on female
genital symptoms and vaginal infections.

STUDY DESIGN: Human immunodeficiency virus (HIV)-negative men
enrolled in a trial
were randomized to immediate or delayed circumcision (control arm).
Genital symptoms,
bacterial vaginosis (BV), and trichomonas were assessed in HIV-
negative wives of married
participants. Adjusted prevalence risk ratios (adjPRR) and 95%
confidence intervals (CIs)
were assessed by multivariable log-binomial regression, intent-to-
treat analyses.

RESULTS: A total of 783 wives of control and 825 wives of
intervention arm men were
comparable at enrollment. BV at enrollment was higher in control
(38.3%) than
intervention arm spouses (30.5%, P = .001). At 1 year follow-up,
intervention arm wives
reported lower rates of genital ulceration (adjPRR, 0.78; 95% CI,
0.63-0.97), but there
were no differences in vaginal discharge or dysuria. The risk of
trichomonas was reduced
in intervention arm wives (adjPRR, 0.52; 95% CI, 0.05-0.98), as were
the risks of any BV
(adjPRR, 0.60; 95% CI, 0.38-0.94) and severe BV (prevalence risk
ratios, 0.39; 95% CI,
0.24-0.64).

CONCLUSION: Male circumcision reduces the risk of ulceration,
trichomonas, and BV in
female partners.