First Doctor Visit

I finally got to see the doctor who will perform my implant. He is the head of the urology department at a university in northern New York, and lists penile implants as a special interest. I needed more information than that to decide if he was qualified to do this surgery.

When I got to his office I was greeted and signed in efficiently. Then I got moved to a treatment room within 10 minutes of the time of the appointment. There I was greeted by a woman who admitted to being a trainee, who took my medical and medication history.

Then a young man entered the room who obviously is a resident. He performed a cursory inspection of my genitals, and discussed the dangers and opportunities of the surgery. I told him my preference for a Coloplast Titan OTR implant. I also said that I had a list of questions for the urologist. He asked me to ask him the questions, and he would answer them for me, saving the urologist's time. The long and short of it is that I asked him the questions, and then also asked the urologist the questions when he later entered the room. The resident’s answers were uniformly wrong. Do not trust a resident for anything. If you deal with an educational setting for your surgery, you are paying for the services of the fully qualified attending urologist. I realize that residents need to be trained. I just don’t want them to be trained on me. I’m sorry, because I realize that this is an unreasonable position, but that is my position, and this experience bears out the reasoning for it.

Finally, the attending specialist entered the room, and, after some pleasantries, I asked him the questions, which follow:

Will you be doing the surgery and visiting me in the hospital? He answered, “Yes” to both questions.

What is your infection rate? He answered, “Less than 2%”

I asked him how many penile implant surgeries he had performed, and how many he performs per year. He said, “I do about 30 per year, and I have been doing that for about 15 years.” That sounded like a reasonable level of experience to me.

What is your revision rate? How often have you had to repair or redo an implant surgery? “Less than 2%. I had one patient who was 82, who managed to break his implant! I also get a lot of revisions to do from implants which were installed by other physicians. I didn’t count them in the 2%”.

I use Fortesta, which is a testosterone supplement. It has the effect of increasing my age lowered sex drive. (This is a common problem. If you, or your wife have it, get to an endocrinologist. It is easily fixed.) It works well, but it didn’t make much sense for me to be using it immediately after my surgery, when I couldn’t have intercourse. He said I could do whatever I wanted about the Fortesta. I will not use it until I am physically ready to resume intercourse.

I asked which implant he would be using. He said that he would be using the Coloplast Titan OTR.

I asked him what type of anesthetic he would be using. He said he would use general anesthesia. I said that was great, because I had problems with local anesthesia. It doesn’t work well for me, and I had a very painful vasectomy many years ago.

I asked where he would do the incision. He said that recent research has said that there were fewer problems for incisions just above the pubic bone, and that was where he would do mine. That made me very happy, since that agreed with my research on the web, which stated that there were fewer infections for incisions there. If you think about it, it makes sense that an incision on your lower abdomen would be drier, and more exposed to the air, than an incision on your scrotum, therefore there would be less chance for infection. For more info on this, see the video by Dr. Eid in the video section fo this blog.

I also was told that I would be given a stool softener before the surgery. The anesthetic can make you very constipated, which is the last thing you need after abdominal surgery.

I also discussed the catheter with him. I told him that I had to use a catheter after a prostate biopsy, and that after I was discharged from the hospital, my urine flow had stopped and I had to rush back across town to be recatheterized. I also told him that the catheter was VERY uncomfortable while I had it in in the hospital. He said that he could either remove the catheter immediately after the surgery, or not use one at all. I said, “GREAT”!

Finally, I pointed out that I was living about 70 miles from the hospital, and was concerned about my wife driving me home immediately after I am discharged from the hospital. He advised that I should stay in a hotel for one more day afterI am discharged, before I go home. That made sense to me, especially since there is still some possibility that I might have some problem urinating immediately after the surgery.

In short, he answered all of my questions exactly as I wanted the doctor performing this surgery to do. Something like this is always a crap shoot. All you can do in life is the best you can do. In this case I feel that I have taken reasonable precautions, done reasonable research, and asked reasonable questions. We’ll see. My surgery is scheduled for July 15, 2013.