In this episode, Dr. Rena Malik, MD welcomes guest Dr. Jonathan Clavell to discuss the intricacies of penile implants. They delve ...

why-penile-implants-are-safe-and-effective-dr-clavell

Why Penile Implants ARE Safe and Effective | Dr. Clavell

in terms of length I think this is a very big misconception that people think that they're getting this bionic penis that they can now make longer or grossier than what they already have so in terms of of length that's probably like the you know the the question that everybody gets you right and it's like do like will I be can you make it bigger like I always ask him every morning when I when I go in to do the surgery I ask like do you have any more questions and every single patient asks me the same thing like Doc make sure you get the biggest um it's like please please if you can add an extra inch or two uh but again there's no way we can do that I we we provide them with whatever their penis provides that day so I had a friend from Puerto Rico who jokingly told his patients he's like well like well if you bring me a Prius I'll p in a Prius if you bring me an 18-wheeler I'll p in an 18-wheeler so again we can only size you to fit right um we cannot oversize you otherwise imagine you're going to have excruciating pain you're going to have an implant that's trying to find a space inside your body which eventually it will and what can happen is that implant can end up eroding through the penis um so again we only size of fit can it increase length very unlikely best you're probably going to get close to what you were before when it comes to length um and when it comes to girth sometimes there are implants that are so strong that there are some guys that they say that they can get a little bit thicker so girth can sometimes improve I never promise it but it can sometimes improve but length teely will not improve yeah and I tell people sometimes they feel like it's a little shorter because if the gland is not engorged which again is a blood flow phenomenon then it will look shorter because the gland is not engorged 100% agree I always tell people the worst thing you could do whenever you take the dressing office try to try to measure your penis all you're looking at even if it's partially inflated or even if they left it fully inflated all you're looking at is your flaccid penis with an implant again there are multiple things that happen when we get aroused the head of the penis engorges and also the urethra on the bottom side of the penis will also engorge and when they pump up that implant the the penis even looks a little bit flat and it's not until they get in gorch that everything now starts looking a more cylindrical and they're able to get close to what they were before yeah yeah absolutely so in terms of increasing length prior to an implant there's some studies that have shown using vacuum erection devices or doing different Maneuvers prior to surgery can help is there something that you recommend yes I mean I believe that the best thing that a guy can do in order for them to prepare themselves for surgery is to get an erection be it with taking medications if you're still using injection continue using the injections even if they partially work because sometimes they can get you know they can help expand the tissue in order for us to be able to get an implant in and the vacuum pump does more less the same thing again if you haven't had an Direction in 25 years don't expect for you to be what you were when you were 18 years old but I mean if you're still having partial erections and and now you're worried you're waiting to get your implant one good maneuver one one good thing that a guy can do is over like start stretching it with a vacuum Direction device and so is there a certain number of minutes you tell people to do daily or if if say that like I'm really aggressive I want to to it as long as possible let's take that guy what tell them I I start laughing because there's many guys who just start using that vacuum pump every single day all you all day every single day and they're like Doc I used to you know for a 3 hour sit it's like don't do that I mean you're going to get bruised um and and what I try to tell people is imagine that you're having sex right you know when you're having sex usually you're having sex for what 5 10 15 maybe 20 minutes at a time you're not having sex for 3 hours at a time or at least you could have you could be having sex for three hours but you're not having a fool erection for three hours right so I tell I try to tell them so what we try to do is we're trying to replicate like if you're having a really aggressive sex life and usually what you have is again maybe two erections in a day and prob doing it for 10 15 minutes is more than enough yeah yeah I think that's reason why I told people start with 5 minutes twice a day at most and if they feel like they drink a little more that's fine but I think 5 minutes twice a day it's probably sufficient to be honest yeah I usually what I tell them is you me you get the vacuum in you start suctioning it you suction until it starts hurting once it starts hurting you stop the suctioning you hold it there for about 10 15 seconds you do that 10 times the 10th time do it keep it there for about 2 minutes which will probably round up to like four or five minutes right that's more than enough more than enough I agree I agree so in terms of cycling you mentioned cycling what is it right for patients who don't know and what is your protocol that you recommend for patients so cycling is a process of inflating and deflating your implant it's as easy as that it's just getting it up and getting it down so the the science behind the cycling process is the following when the when we get a penal implant inside the inside the body specifically when we get an inflatable implant because you cannot cycle a malleable implant but when you get an inflatable implant inside the body we want to expand those tissues in within the actual penis as much as possible why because every time we put in a foreign body inside a person's body the body will start creating this surg surgical capsule or the pseudo capsule and it's this this sheath that will start forming around it and that's the way that the body will protect the rest of your organs from that foreign body so what we try to do is we we put in that implant we want that capsule to be as expanded as possible so that cycling process will hopefully start stretching out that capsule so that whenever that capsule ends up forming it forms on a fully expandable State how long will it take there are some uh experts that suggests me that it could take up to about 3 months for that to form uh there are some experts that that say that it starts forming as as soon as they won I'm not a big believer in that but usually in general it takes 3 to 6 months or sometimes even up to a year for that calal to form yeah um so what we try to do with cycling again just trying to expand that capsule so when do they start so usually I tell them it all depends on the surgeon um every surgeon has a specific protocols again there are some surge that start them as soon as day three day four um I'm not a believer in super early cycling and the main reason I'm not I'm not a Believer is because I I believe that super early cycling leads to two things which is pain because again you're there a very sensitive area that you're that just underwent surgery and also anxiety why you're not able to figure it out you're still in pain again you have to fully pump that thing up it will take 20 30 squeezes on a on an area that's super sensitive and also deflating it and you're going to get anxious frustrated and all you're going to be thinking is like am I doing it right and they're going to start freaking out right so what I tell them is you know hold off probably for about at least three to four weeks um so I tell them do not do do it sooner than 3 weeks I'm I feel better when they start doing it around four four to five weeks and then by the six week Mark they should definitely start doing it yeah I would say the majority of patients are still SW at 3 weeks I see them all at 3 weeks post up and I'd say the majority are still a little swollen and so it's still a little uncomfortable for them to feel for the pump and so the pump because we didn't actually describe it is actually just a little balloon that's in the scrotum that you pump up um and it does take like 20 to 30 pumps are there Maneuvers outside of ice packs that you tell people to help reduce the swelling early on H there's multiple things that we can do um I'm a Believer in in supplements like arnica um I'm a Believer in in tight underwear initially so the the worst thing that a guy can do is kind of like start going like completely nude commando commando that's the word I was looking for so yeah so that's the worst thing that they could probably do uh so usual I try to tell them it's like try to get an underwear that will help support your testicles while you're still having your penis sticking out I try to encourage them not to kind of let it hang let it do its own thing but for swelling that sometimes if they're if they have a lot of Edema I I try diuretics I'm a little bit like closer to the plastic surgery world or the Sur your philosophy uh so sometimes I can I can add steroids you know you know of course I would do it with antibiotics um that hasn't been studied that I know of at least it hasn't been studied with uh with P impant so again I'm not going research base here but sometimes I do rounds of steroids to start to help reduce swelling so there's multiple things that we can do but in general time time will usually take care of it yeah so is there do you put everyone I mean so tight underwear ice pads probably for do you have everyone's start arica so not everybody so I tell them that these are just things that you can that you can try the one thing that I do for my patients I always keep a dressing that stays there for 48 hours because after every surgery our body will start processing fluids in a different way um that happens with every surgery everybody gets swollen in a different spot right so I try to tell tell guys like I I'm going to try to keep your testicles and your scroll them as tight as possible while you are process reprocessing all these fluids and you pee everything out yeah so and then 48 hours later they remove the dressing if they're on blood thinners I usually keep them for 3 Days the the so that usually whenever they take those dressings out usually most of the swings already pretty much gone so in general what can people expect during their recovery um recovery is so unpredictable I can do the exact same surgery a 100 ways and I can have probably 50 different outcomes uh there are some guys that in terms of pain is a very common concern it's like dog how much pain will I have in pain subjective there's people who tolerate pain a lot better than others there I have some guys that are able to take maybe two tiol you know few first few days and that's it and then there are others that require pay medications for the full six weeks so everybody is different so when it comes to pain pain is unpredictable of course if you do have pain you know let your surgeon know it's most important thing if you are doing well and all of a sudden now so the say you're two three weeks out everything's going well and all of a sudden the third fourth week now you start noticing some swelling more pain more like Burning Sensations let your surgery know right away right we want to make sure that there's no infection but in general yeah Ian it's going to be a process that will take 6 weeks there's going to be swelling there going to be bruising there's going to be you know some tender bruises around the head of the P that's where we perforate you through to get the the needle through and it's just a matter of just stay in the course if you have any questions ask your surgeon and that's you know we try to provide them with as much education as possible through YouTube May through written material and that way they can we can put them at ease a little bit Yeah if you're already here you're ahead of the game right um but in terms of you know uh things to look out for so you mentioned burning you mentioned pain that's not getting better you mentioned redness drainage that sort of stuff what other things should people worry about I mean the the feverous chills if you're having like excruciate like you're having vomiting and you're not able to tolerate anything by mouth I mean that's something that to look out for right we place a reservoir that's placed in the abdomen and most of the time we're placing that blindly I mean I've never had any patient having any issues with with bowel obstruction but it can definitely happen um but the most important things is you know fevers chills having a redness around the incision that wasn't there before again new onset of swelling and most importantly the in if the incision opens up and starts trining that is not normal so you should contact your surgey right away so so we can make whatever remedies need to needs to make yeah if you see any part of the reservoir come in immediately oh of course any part any part of the any part of the implant that's fine any if you see any part of the implant that is not normal you should go see your surgery right away absolutely in terms of lifespan of the device right how many how long does the average implant last so usually implants last anywhere from 8 to 15 years that's on average but again this look a little bit like a car I like the the the car an allergies all the time and I tell them if you get a lemon it might last you two years that's super rare in general it's 8 to 15 years there's uh there's been several studies looking at this and one research study basically showed that at 5 years 95% of implants were still working at 10 years about 80 to 85% of implants were still working and then at 15 years 70% of implants were still working I am not a big believer of that study again that's just me so that's just me as Jonathan cell speaking so what I tell them is okay this is a medical device and medical devices stale the same way that a knee replacement is not going to last you forever a shoulder replac replacement is not going to last you forever a breast implant doesn't last forever this will eventually fail you might have Wonder like why are you don't believe in that study saying that 70% lasted over 15 years and the reason is I mean they there are many patients that get lost to followup and if a p if I'm doing a study and I do an implant on your husband for example and I don't see him ever again I cannot assume that his input is working cuz he probably went to somebody else and then then the but it's not working anymore so again these studies I mean we these are mostly single surgeon um there are some that have been multi-institutional there's one study in Spain that showed that 50% of implants were were working at 20 years I don't believe that either a long it's a long so if you ask me what's the longest implant that I've seen that that I've seen working 22 years and I actually saw it two two weeks ago I saw 20 I saw 20 here um yeah I was still working and and he was great he was doing great but that was one out of you know exactly and the cool thing about it is that this is something that usually it's implanted into older men I mean there those they tend to be the ones getting implants just in case if if somebody was listening to us and they are young and that doesn't mean that they're not candidates for an implant I mean there's not uh you checked the 50-year mark now I can get an implant doesn't work that way you know it's so funny I had a patient who came to me and and he was told he couldn't get one cuz he was too young yeah I mean you you get those often and it's frustrating right and you're like yeah I mean if you've tried you know medical therapy and you have a reason we we don't have to wait but in general again these are these tend to be older men so if you're implanting a guy who's 83 84 years old is very un likely they going to live above 100 years old so again an implant that's you know 10t under ground on a grave it's not an implant that works so I cannot count that as oh that impant is still working

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