At 10:54 PM 1/10/2009, you wrote:

Dr. Reed,

I have phimosis, i went to jackson memorial hospital, but they had me use this cream, but it didn’t work, and they kept stalling saying i should wait and wait,until i decided not to go anymore, so i decided to look for different doctors, and i found your page, so i would like to know the cost of the surgery including any fees or anesthesia or anything. and is there financial aid or some king of monthly payment.

Chris

Good morning Chris,

Thank you for your interest in what at we do.

Sadly this has been our experience as well.
I have been a board certified urologist since 1975.

Additionally steroid creams may even cause atrophy of penile
skin and this is irreversible.

Please schedule in for a proper circumcision.

All my best to you this Sunday,

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

 

Received a call last week from a patient who was unhappy with the contour of his penis post AlloDerm and also started to noted some hardness and some discomort, and wanted it removed.  Yesterday, call updated, leakage of fluid noted.  Patient will be seen ASAP this Monday and hopefully will have drainage of abscess and possible removal of an infected graft.  Every so often we see the occasional very affluent patient who says, “money is no object, put is as many AlloDerm pieces as you can.”

Please keep in mind overpacking the penis can lead to vascular compression and without blood flow, the patient is more likely to have an infection.   Moderation is always a good idea with elective surgery.

Avoid too much surgery on the penis at one time.  Can interfere with vascularization, so important for wound healing and lymphatic drainage.

Harold Reed, M.D.

Harold M. Reed, M.D.

Dr. Reed, 

 i need to get some answers for my husband. he is, obviously, uncircumcised. the problem is, the foreskin around the tip of his penis frequently gets large cracks, for the lack of a better word. these cracks bleed, and are very sore. it totally interferes with his life. he and i are a very sexually active couple, but this has totally put a damper on sexual activity for a week at a time. how do i convince him that circumcision is probably needed. also, my mother had cervical cancer, i am told uncircumcised men can cause cervical cancer in women. i am terrorfied at the thought of this. but most importantly is the pain that he endures from the tissue of the foreskin. please, any information would help greatly. thanking you in advance. charlotte

Good morning Charlotte,

I certainly agree with your concerns and sooner
or later your husband will realize that a properly
performed circumcision with sexual downtime of
about 6 to 7 weeks is the best recommendation.

There are conservative measures that could be
employed, but trust me after 36 years of practice and being
a senior member of the AUA I can advise you,
he’ll just be deferring the inevitable.

More importantly, I think he’ll be happier once he has
healed and confess, perhaps to you, he should have
had this done sooner.

All my best and happy New Year to you both,

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

 

A very nice gentlemen in  his 50′s presented with a history of gradual erectile impairment and was now on pharmacologic injection, shots to the penis with medications usually containing prostaglandin E-1 to produce erection.

On erection his penis was not bent, but there was a small crease in the distal shaft.  The size of his penis was about 3 times volumetrically of average.   He had injected that area on occasion but could not correlate loss of contour with any particular injection.

Thoughts and advice…    Injections into the penis have to be compressed just like ideally a vena-puncture in an arm vein for 5 minutes or so.  The leakage of blood outside the vascular system is a great stimulus for fibrosis and of course loss of spongy tissue.  In this case, spongy tissue of the corpora cavernosa.  Injection techniques were reviewed with the patient.

While I do not believe medications for Peyronie’s will help, perhaps in the future stem cell research may be able to replace lost corporal tissue or impaired corporal tissue.  Some urologists believe
men with large penises may experience erectile impairment earlier because there is a larger demand for rapid filling.

Harold M. Reed, M.D.

Jill Stein
November 01, 2007
AMS 700 Series devices elicit high degree of patient satisfaction 

PARIS ?Early results suggest that patients like the newly modified AMS 700 series inflatable pump penis prosthesis. 

The findings are based on a six-month follow-up of 32 men diagnosed with organic erectile dysfunction who underwent implantation of an AMS 700 series penile prosthesis with the new Momentary Squeeze Pump. Findings were presented here at the Soci?t? Internationale d’Urologie 29^th Congress. 

Overall, there was a high degree of satisfaction with respect to ease of inflation and deflation of the device as documented by patient questionnaires, said principal investigator Ajay Nehra, MD, professor of urology at Mayo Clinic College of Medicine in Rochester, Minn. ?Developments in the field of biosynthetic materials have allowed physicians the use of artificial/mechanical devices to replace malfunctioning or damaged body parts and organs,? Dr. Nehra pointed out in a poster presentation. ?These devices, or prostheses, are not compatible with long-term error-free function and are limited to minimal local tissue reaction. They have replaced earlier attempts at using tissue from donor areas and even xenografts in substituting damaged organs.? 

Historically, penile prosthetic surgery did not become popular until the early ’70s with the introduction of the first inflatable penile prosthesis and paired semirigid intercorporeal sponge-filled silicone implants followed by the flexirod prosthesis.   

As for the hydraulic devices that are used today, modifications have resulted in significant improvements in overall mechanical failure rates. Recently, the FDA approved additional modifications in the AMS 700 series. Specifically, changes were made to the scrotal pump to ease deflation. In addition, angulation changes were made in the exit tubing of the penile cylinders to ease proximal and distal positioning. A new feature was added to the pump’s fluid to resist flow into the deflated cylinders caused by pressure on the fluid-filled reservoir with auto-inflation. 

Of the study participants, 29 had primary placement of the device, and three underwent explant of malfunctioning penile prosthesis and immediate re-implant of an AMS 700 MS prosthesis. There have been no cases of infection.      

Fifteen of 19 patients who completed the questionnaire six months after surgery said that they were very satisfied with the device, two re-ported being moderately satisfied, and two described themselves as somewhat dissatisfied. 

All 19 respondents agreed that it was easy to find the device for inflation of the cylinders. Eighteen patients agreed or tended to agree that it was easy to hold the pump while inflating, and 18 reported that there was a reasonable amount of force required to inflate the device. Sixteen reported that they could inflate the device with relative ease. 

Eighteen respondents felt that the force required to initiate deflation was reasonable. Nineteen reported that the amount of time required to hold the deflation button to deflate the device was reasonable, and all of them stated that the amount of time required to actually deflate the device was reasonable. Seventeen stated that the overall ease of deflating the prosthesis was either very easy or easy.

New Penile Prostheses Found Easier to Use

The fluid transfer pump is necessary for inflatable prosthesis function.   Whereas previous deflate mechanisms have used a sustained squeeze bar, the MS release systems stands for Momentary Squeeze.  Push down on a 3/16″ raise dot for 3 seconds and then the device deflates automatically.  Whereas sustained squeezing could be painful, this (momentary squeeze) is usually well accepted.        

Harold M. Reed, M.D.