I visit several threads on HealingWell, and they have been very helpful to me in my journey with prostate cancer, so I thought I'd post to try and help others. I also tried pills, injections, and pump after surgery to little avail. I decided on implant surgery, and did so after only 1 year. I believe many men wait too long. Doctors tell men that they could get return of function 18 months to 2 years after surgery...I had a positive margin and opted for radiation. Radiation kills nerve cells over roughly the same time frame. My odds of getting any return of nerve function was slim, so I made the decision for implant after only one year. I decided to use the Cleveland Clinic, as they have the top urologic center in the country. I went with the chief of urology, Drogo Montague, for my surgeon. I am happy with that decision.
First day in the hospital was not nearly as bad as I'd envisioned. With pain meds and very close and courteous attention, I was in no discomfort. At home, I stayed on pain meds for a couple of weeks but the little pain I had was very manageable. Just used Tylenol after that. There was some swelling, but it didn't hurt much, so I wasn't sure how much was swelling and how much was what I should expect as far as size.
What I have learned is that most men lose about an inch to 1 1/2 inches in the prostatectomy. This is because the prostate is about that size, and a section of urethra runs through it. Once they remove it, the re-attach the urethra to the bladder behind it. I asked why they can't come up with a spacer, and my surgeon said that tissue will only regrow to tissue, and not artificial spacers. I wondered why they can't try something like a bovine or porcine section of urethra, but I suppose they are more concerned with saving your life than maintaining penis size. If they understood the impact of that loss, coupled with the additional loss of sixe that comes with loss of tissue through diminished blood flow, they may rethink that effort, but that's just my thoughts on it. Men get nightly erections that deliver oxygenated blood to the penile tissue..when that doesn't happen, tissue loss ensues. That's why I say that most men wait too long..you can't regain that size loss. In addition, a lot of size comes with the engorgement of the head (glans) and with loss of blood flow, the glans no longer becomes enlarged. All in all, I experienced about a 40% length loss from pre-surgery to post-implant. I am told that with the AMS700 LGX (the implant my surgeon used), I will gain about an inch back with expansion over 12-18 months. That's would put me at overall loss of about 28%. As far as girth, I am not sure of my loss but can say that I am definitely smaller post-implant. The AMS700 is supposed to expand in girth as well, so we will see how that goes. At just under 3 months post-implant I have not noticed any real size increase, but they don't even let you start pumping the device up until six weeks after surgery, so that's not surprising.
Back to the surgery. After getting home, my biggest discomfort was the scrotum. The pump was larger than I expected, though its placed in such a way its not noticeable to the casual observer, if you will. They place it in a sort of pouch area, centered, and higher than the testicles. This keeps it from moving too much and interfering with the testicles. I had to research this, because I kept thinking that it was very close to the surface and wasn't really moving down into the scrotum much, while at the same time fearing it would because I am quite sensitive in that area anyway. They tell you to work it down periodically, but that is working it down within that scrotal pouch. Being just under such a thin layer of skin, it was uncomfortable, and hard to sleep at times. The pump felt like to was too big and the skin was stretched too tight around it. Sitting upright was hard because the pump has to angle one way or the other, and this was somewhat painful too.They also tell you to keep the penis angled up so it can heal properly...I did that as much as possible, mostly when I slept and sat, but when active this was harder to do. It seems to have healed fine though. Anyway, what happens with healing is that your body encapsulates the hardware. The scrotal skin seems to have thickened up over time. I have no trouble sitting now, three months in...and sometimes there is a little discomfort with the scrotal skin after pumping, but very little.
One of the best things about the implant, is that because of the earlier urethra /size loss issue I mentioned, after surgery I was constantly battling the tendency for the penis to shrink into the body. I was embarrassed to by reaching in to adjust this, sometimes in public, when running or jogging, etc...but it was quite annoying and bothersome. After surgery, this no longer happens. The implant keeps me at a constant length, and it looks quite natural. I have noticed a tendency for it to lean a little right, and have a very very slight turn to it when pumped up, but this is usually due to one tube maybe healing a tiny bit shorter than the other, and it can be manipulated by hand. This is barely noticeable though.
At around three weeks I experimented with manual stimulation and found that I could still have orgasm, That worried me quite a bit so this was a relief. At 6 weeks I returned to my surgeon for activation. They show you how to pump it up. I noted at first, and still occasionally, a little discomfort when/after inflation in the glans. As the tube ends seat into the glans and the tubes expand, I would have expected this. I believe as the body encapsulates the implant, tissue builds around it. I imagine it will do so around the glans too. At three months everything feels pretty natural. Quite frankly, I have not tried sex yet, but I believe that would not be a problem physically, except I was told shorter strokes are in order, as length is shorter. I do not have as much sensitivity, though it is not bad at this point and I can reach orgasm...my surgeon said that sensitivity would eventually return to almost normal levels.
I continue to inflate the device at least daily if possible, for as long as I have time to maintain it. I can get a little discomfort when pumping to maximum capacity and maintaining it for long periods..30-60 minutes. But I rarely maintain it to that level. I do try to pump as much as I can, wait some time, pump again, etc, etc. This is critical to expansion. Doctor says it will not hurt the device to pump it as much as I am capable of doing.
I like the device. It is much better than pumps or injections. Injections caused me a lot of pain and vacuum didn't maintain an erection enough for sex. For me, there are still some mental issues to deal with, intimacy issues, etc. But that's more personal and VERY different for each guy. As far as the physical side of it all, I would definitely recommend the implant. I find that doctors really skew the hopes of men who get prostatectomies...most end up impotent. The satisfaction ratings from men with implants are very high. I recommend it, and I recommend not waiting too long to so it.