Archive for the ‘Phalloplasty’ Category

Status post circumcision with sloppy look and peno-scrotal web

Thursday, January 21st, 2010

Dr. Reed:

About a year ago I was circumcised by my urologist.   He did not respect my request to leave as much inner foreskin as possible. Nor did he respect my request to remain awake and aware during the procedure. The outcome is a low and sloppy look with suture marks all around.  He also pulled scrotum skin up the shaft leaving a turkey neck web.  The result is that my penis looks much shorter and I cannot penetrate as deeply. 

The frenulum was left.  It is very sensitive and pleasurable upon initial penetration but after thrusting and becoming more erect it becomes painful.

I’d like to have a recirc if possible and have the turkey neck trimmed back and the frenulum removed.

Would photos help in evaluating if this is doable?   Can you give me some idea of fee?…healing time?

I’m 65, gay, and love sex.  But due to what I’ve described, find myself not having it as often as my partner wants.

Oh yes, I want to be as aware as possible and see as much of procedure as possible.

Thanks,
M.  O’Day

January 21, 2010

Good morning Mr. O’Day,
Thank you for your continued interest in what we do.

For most patients we recommend you stay here overnight following your revision procedure, and you can throw in a safety factor of an extra day.  Your sutures should be removed 12 days fter revision by a health care professional.

You can be seen in consultation and done the same day.

Yes of course, we wish to see you before you take off.

Taking your other thoughtful questions…

2.Can the frenulum be removed without total loss of sensation that it offers?We remove the frenulum on most patients, and of the 10 % or less that request it not be removed, 80% return and say, “now Doctor, please remove it.”   Truly doubt there will be any difference in sensation, but if there is any concern then don’t have it removed.,

 

3. When I am erect, turkey neck is barely visible but my balls are pulled up the shaft.  Is this the usual situation?  I very much want my balls lower for penetration again!If you have hyper-retractile testes or so called “yo-yo” testes, there is a procedure to correct for this.

 

How much scaring is left by scrotal cuts? Usually a fine white line that lays out like an inverted “Y” with limbs about 3/4″ at most in each direction.

 

How long is healing?Healing continues over 6 weeks for maximal tensile strength but cosmetically certain refinements such as fading of all redness an take up to 13 months.

 

How many weeks before sex is possible?You could resume sex typically in 6 weeks. 

 

4. Could lengthening be doen simultaneously? No for this reason.  Successful lengthening depends upon use of traction within a day or 2 after surgery to maintain what was accomplished in the operating room and build upon that.  If you have a circumcision revision, your penis will be much too tender for traction and also you will rip you suture line apart. 

 

How much would that cost in addition to other surgery?If you have orchidopexy (to prevent rising in your scrotum), that fee is an added $2,500.  Lengthening as a procedure unto it self is $4,500 and this is posted on our web-site.

 

Michael, have a serene weekend, and again many thanks for considering our facility,

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

Testes hung up in mid scrotum after testicular enhancement

Sunday, January 17th, 2010

I am interested in penis lengthening and possible eventual girth enhancement. I had testicle implants with a west coast doctor and have been ’stretching’ with some results, however I’d like to make my testicles hang lower. I also have somewhat of a ‘turkey neck’. I would like to know if you can relax the chords on my testicles to make them hang lower and would also like to know what you can do for the ‘turkey neck’. I’d like to know if I can do either of these in conjunction with penis lengthening. Thanks.  Parmuth

Hi Parmuth,

Thank you for your interest in what we do and your excellent clinical presentation.

Several thoughts come to mind.

If the doctor has entered the membrane that surrounds your testicles, this type of surgery frequently results unfortunately in adhesions that bind and fixate the testes  in one position.

That is why our implants are placed in front and below the testes.  We have also noted degradation of testicular function if entry is made into the testicular membrane, the tunica vaginalis.

Peno-scrotal webs are fairly easy to correct.  Please avoid the Z-plasty incision, as this looks like the “mark of Zorro” when it heals

Please review the attached letter and do visit our web-site.  Look at all the documents and photos.  If you feel I am the doctor for you or my level of expertise could provide the best advice that you are seeking, then please initiate a consultation over the phone with our office.

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

Saturday, January 16th, 2010

I believe I have some infertility problems associated with a varicose vein on my scrotum. I was also interested in lengthening at the same time. Do you perform this operation?  Can you do both at the same time? And what are the prices and payment options?   Thank you.

Donald

Good afternoon Donald,

A varicose vein on your scrotum would not produce infertility but a varicocele, (similar to many varicose veins) surrounding your spermatic cord could.

Please review the attached on phalloplasty and penile enlargement, length and girth.

In that a well performed varicocelectomy may result in some discomfort after surgery and lead you to procrastinate on early use of traction, I would suggest you have the more important operation for you done first.

Best wishes,

Harold M. Reed, M.D.

Penile Extender (stretching) in Peyronie’s

Thursday, December 31st, 2009

by Dr. M Culha and group from Turkey   Traction was applied from 3 to 8 hours a day for 6 months.  Results 93% (27 patients) noted curvature reduction (from 10 to 30 degrees), length increased from 1/4″ to 3/8″   In another group, comprised of patients who refused to use the penile extender device, a small portion noted penile shortening. 

Harold M. Reed, M.D.

 

Effectiveness of intralesional Verapamil on Peyronie’s

Tuesday, December 29th, 2009

As reported by J. Chen  (J. of Sexual Medicine).  45 men were treated and only one patient reported improvement.  Each patient was treated with 8 weekly injections.  Conclusion: Verapamil is not effective in correcting curvature or facilitating vaginal penetration.

Harold M. Reed, M.D,.

The incidence of spontanous resoltuion of Peyronie’s (without any medical intervention) is about 15%.  This give credence to many medications and non-operative treatments.

 

Penile Implant, not what I asked for

Saturday, October 31st, 2009

 I asked for the Ultimate AMS I was given the step down with out my conscent. Ilost 2′ and some Dimension. The Pump leaks and partially fills when its deflated. Can I get back my inches and a better girth?    Rudy

Good morning Rudy,

Thank you for your interest in what we do.  Hope you can relate to our gallery of “ups and downs.”   Have been doing implants since 1975, and probably have done over 2000.

Fortunately your AMS product has a life-time warranty applicable to any treating physician.

We have been known to perform some magic in situations such as yours, but you do need to be seen at the office so I can best advise you.

Please understand it may be as simple as revising some technical errors during your previous installation, but you do need to have this reversed ASAP as scar contracture will make it more difficult to regain the length loss.

Also bear in mind any operation is associated with risk.  The experience of your urologist and his focus to the problems at hand will help minimize this.

You may wish to initiate a consultation over the phone by sending us your name, address, and phone number in an envelope along with a check for 250.

All the best,

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

Penile Augmentation, long shopping list

Friday, August 28th, 2009

as im going to be flying in from the UK. im going to be limited on how long i can stay in america for i was just wondering how long do you thing i should wait between having the two stages of surgery ie 4 weeks 6 weeks or longer? im eager to get as much done in one sitting as im going to be traveling a long way to have the procedures im intrested in…. and then  if the wait is only 4 weeks between surgerys…i could stay in the states in stead of flying home and then back???????
 
scrotal altreation (turkey neck pushed back?)
left testical enlargement
head glans enlargement
lengthening
and widening
and may be some pubic fat removal?
 
i know these can not all be perforemed at the one sitting (surgery) so i just wanted to know how much you think we could do at one go  and then how long before i can have the otheres completed??
 
ie stage 1 = glans enlargement,lengthening,widening and scrotol pushing back under the shaft?             then       stage 2 = fat pad lipo,testicular enlargemnt
 
im not looking for monster girth only a very modest increase of say 1″ all over,thanks again good doctor  Brian

Good morning Brian,

Lengthening, insertion of left testicular implant, and perhaps release of penile scrotal web, could be done at the same time.  Girth enhancement and glans enhancement need to be done separately as insertion of AlloDerm  works like a fixative to reduce length gains produced by traction.

Pubic liposuction could be done with either of these procedures, but is not advised as the transient lymphatic injury impacts on wound healing of the penis and scrotum. To do a proper job think of the pubic fat pad as an inverted U which extends down into the scrotum along side the penis.   This needs to go also. Tenderness for a few weeks in  that area, may cause you to procrastinate on use of traction,  which ideally should be done within a few days after surgery to maintain exteriorization of the penis.

Please understand the results in length are 35% me (with surgery) and 65% you (with traction).  To gain  an inch in erect length you would need to apply traction for am minimum of 6 months. 

Don’t rush to have the second stage done as you will obviate the potential gains with length enhancement.

You are spending a lot of hard earned money and we wish to have  as many assurances in place you will have a gratifying result.

Cheers,

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

 

 

Peyronie’s, Simultaneous insertion of penile implant and modeling

Sunday, May 10th, 2009

Looking back at 9 patients who had Peyronie’s and underwent installation of an inflatable penile implant and simultaneous modeling to correct penile curvature, that is to say, bending of the inflated or erect penis in the opposite direction to correct for angulation, the incidence of mechanical malfunction that followed was 33.3%. Admittedly a small group for a study, but in the control group, the incidence of mechanical malfunction was 4.3%, after a mean followup of about 19.6 months. Reported by Dr. Christopher DiBlasio and group from Memphis, TN. at the April 2009 AUA meeting.

Harold M. Reed, M.D.
Penile Implant and Phalloplasty Surgeon

Can Peyronies be caused by Transurethral Resection of the Prostate (TURP)

Saturday, February 21st, 2009

 

Developed Peyronie’s Disease after the 3rd of 3 failed Transurethral Resections in 4 months in 2006. Is this common? What help short of surgery? Use a VED device already–thanks GWJ
 
Good morning George,
This is not common, but certainly I have seen this on a few occasions.  With Peyronie’s there may be also associated loss of length, plaque, waist banding of the circumference, erectile dysfunction and pain.   The treatment options are many and with every one there are some responders.
We have also seen erectile dysfunction following TURP, and of course urinary incontinence.
The vacuum erection device (VED) is a 2 edged sword as pooling of blood in the penis without adequate oxygenation may cause atrophy and injury to your delicate spongy erectile tissue.
I would be pleased to discuss in depth the any options available to you after you initiate a consultation with our office.     
                                                                            
With kindest regards,
Harold M. Reed, M.D.
305-865-2000

Silicone Disasters and Aesthetic Revision

Sunday, February 15th, 2009
 Please see our web-site  http://www.penisdoctor.com/silicone.htm        

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.

We have seen many transsexual females with butts that look like car tires. Way too much material is often unfortunately a feature of silicone practitioners and the results are very grotesque.

Here are some examples including one case of a female breast representative of so many we have seen, with hard lumpy contours.

Lastly 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.

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