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Reattaching the PSL after surgery?

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Reattaching the PSL after surgery?

I had the lengthening surgery done in 1996 by a surgeon in Ontario.The penile suspensory ligaments were identified then divided.We didn’t have access to much information other than what was offered by the surgeon.As this was a fairly new procedure,there wasn’t a lot of information from medical boards or databases regarding the safety and the lack of success with this procedure.My over zealousness had gotten the best of me,although I did put off the surgery for 2 months when he told me he was at patient#30 and was not using any type of weight or traction exercises yet!
I never realized at the time,the importance of the psl for anchorage and stability during sex! Arghh I guess hindsight is 20/20
So I present myself with frustration,depressing regrets and anxiety on a regular basis.Especially lately being involved with a girl I love for the last 9 months.
It was a V-Y plasty with a forward advancement flap.Weights were used as indicated, but I still feel as if I experienced some degree of re-contraction in spite of my 0.5” length gain :rolleyes: :mad:
I have less prominence of the superficial dorsal vein and my erections have not been the greatest since the surgery.I dont think the SDV was compromised or any other emisary veins.Flow voids have been demonstrated to be normal when performed through my urologist.
PE has kept me relatively in good function and has maintained my sanity for the most part.
My medical chart can and will be obtained for medical and legal purposes,as there are a few actions against this retired surgeon.

There is a palpable gap between the penis and pubic symphysis.Would there be a way for surgeons to re-attach the suspensory ligaments? or if not,would there be ligament type of material with similar elasticity they can use to attach from buck’s fascia to the pubic symphysis coupled with proper reconstructive plasty to give stability in that area once again? I wonder what the most efficient solution would be at this point in order to give me more stability and continual PE gains?
Thanks to all in advance for any and all information and advice :D

Hope I’m in the right forum area Mods? thanks

I dont either Thunder but any knowledge that you or the other members are aware of or come across would greatly be appreciated. I dont know if my suspensory ligaments can be saved.They might have been severed from the surface of the penis and that is where unfortunately the blood supply comes from.Especially the fact that it’s been 14 years.An MRI or ultrasound? is warranted. Thanks.

Here is something that I found that sounds promising.

Hope it helps and let us know what you find out!

8Works

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Source URL: http://www.medicalnewstoday.com/articles/62355.php

The Penile Suspensory Ligament: Abnormalities And Repair
Main Category: Urology / Nephrology
Also Included In: Erectile Dysfunction / Premature Ejaculation; Men’s health
Article Date: 05 Feb 2007 - 8:00 PST

Visitor Ratings:
Healthcare Professional:
General Public:

The penile suspensory ligament (PSL) supports and maintains the erect penis in an upright position during sexual intercourse. The suspensory apparatus of the penis consists of the fundiform ligament, the suspensory ligament proper and the arcuate subpubic ligament. The fundiform ligament is superficial and not adherent to the tunica albuginea, whilst the suspensory ligament proper bridges between the symphysis pubis and the tunica albuginea of the corpus cavernosum and circumscribes the dorsal vein of the penis. The arcuate subpubic ligament runs a similar course to the suspensory ligament proper; it is a slightly denser structure and lies further posterior. Functionally, the PSL maintains the base of the penis in front of the pubis and acts as a major point of support for the erect penis during intercourse.

A group from St. Peter’s Hospital in London, UK led by Chi-Ying Li report on a group of 35 men with abnormalities of the PSL who subsequently underwent repair. The report is published in the January 2007 issue of BJU International.

Fifteen of the 35 men presented with PSL abnormalities after sexual trauma from forced downwards pressure of the erect penis. They complained of penile instability, deformity and variable degrees of erectile dysfunction (ED). The other men had similar complaints but no distinct history of a traumatic injury. All men underwent a detailed medical history and had the physical exam finding of a palpable gap between the pubis and the penis which was more evident when the men were given a pharmacologically induced erection.

The surgical technique of repair included identifying the PSL via a transverse suprapubic incision. Once identified, the PSL was reinforced or repaired using nonabsorbable no. 1 Nylon sutures placed from the midline of the tunica to the pubic symphysis, until the optimal functional penile position was achieved as documented by an artificial erection test. The mean number of sutures required was 4. When there was also penile curvature present (21 men), the curvature was corrected at the same time using a variety of techniques such as Nesbit’s procedure or plaque incision and grafting. After surgery, men were asked to delay sexual intercourse for 6 weeks.

Analysis of results revealed that thirty-two of 35 men (91%) had a straight penis; two men had a residual curvature < 15 degrees and one had 25 degrees of residual curvature. Two men (6%) developed de novo ED, which was successfully treated with sildenafil. Both of these men had repair of the PSL and a Nesbit procedure for penile curvature. Two men who presented with venogenic ED were cured as were all of the men who presented with penile pain. There were no postoperative complications although three men had a repeat procedure for inadequate results including one who had penile dysmorphic disorder. The overall satisfaction rate was 86% (30 of 35 men).

This report describes the often overlooked problem of an abnormality of the penile suspensory ligament. The diagnosis is largely clinical and can be elicited by physical exam findings. This problem can be induced iatrogenically after the penile suspensory ligament is divided in penile lengthening surgery and the technique for repair described here can be useful in that clinical condition and those that are described in this report.

BJU Int. 2007 Jan.; 99(1): 117-20

Reviewed by UroToday.com Contributing Editor Michael J. Metro, M.D

How in the world would you find a urologist who is an expert in that procedure in the US or Canada, since the study was done in the UK just a year ago is probably the next good question. Hopefully someone here has a clue on that. I guess price would also be a great question too! That likely won’t be cheap :( but well worth it!

OK, hold on buddy! I kinda feel like I’m talking to myself, but I found out some more info. That info was reviewed by UroToday.com Contributing Editor Michael J. Metro, M.D. Who it looks like happens to practice in the US, and if he is not practicing I bet he can tell you who is the best to handle your case!

Did a quick search and came up with this:

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Source URL: http://www.urotoday.com/component/o…ewUser/uid,127/

Michael J. Metro, MD

Michael J. Metro, MD serves as Clinical Assistant Professor of Urology at Albert Einstein Medical Center, Philadelphia, an affiliate of Thomas Jefferson Health System and has done so since 2001. He also serves in a similar capacity at Temple University Medical Center.

Dr. Metro received his undergraduate degree in Biology and received his medical degree from the University of Pittsburgh in 1992 and 1996. He completed his surgical training and urologic residency at the Hospital of the University of Pennsylvania in 2001. He went on to complete a fellowship in Traumatic and Reconstructive urology at the University of California, San Francisco under the direction of Dr. Jack W. McAninch in 2002. He also served as clinical instructor at San Francisco General Hospital during this time.

He has authored several peer-reviewed journal articles and book chapters and is a co-editor of an upcoming book on Urologic emergencies. He has presented at regional, national and international meetings on such topics as erectile dysfunction, urethral reconstruction and urologic trauma.

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I didn’t try to dig up the Dr. Contact Info, yet, :) but here is UroToday’s info:

UroToday, 1802 Fifth Street, Berkeley CA 94710
510.540.0930 (fax), info@urotoday.com

I’m sure they would refer you to him if it is possible.

Good Luck

8Works

OK, sorry for the multiple posts. It is probably getting old. Anyway, here is the Doctors info, or I’m pretty sure it is his:

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Source URL: http://www.healthgrades.com/consume…TV_LID=BTN_Appt

Contact Information for Dr. Michael Metro

A.5401 Old York Road Klein Building Suite 500
Philadelphia, PA 19141
(215) 456-1177

B.9880 Bustleton Avenue
Philadelphia, PA 19115
(215) 677-0667

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I’m hoping your sleeping and you’ll wake up in the morning and find this and be the happiest guy in the world filled with hope!

Let us know how things go. K, bye. Last post I swear!

8Works

Thank you so much! I really appreciate it 8 Works :) I have that article but not the contact info.Great work done ! and I owe you big time. I just pray to god that the surgeon didn’t cut right to the bone,so that there is some ligament tissue to suture to.

I think this also might be helpful to anyone who has had the lengthening surgery and is considering correction………

ORIGINAL RESEARCH—SURGERY
Minimizing the Losses in Penile Lengthening: “V-Y Half-Skin Half-Fat Advancement Flap” and “T-Closure” Combined with Severing the Suspensory Ligament

* Osama Shaeer, MD**Department of Andrology, Faculty of Medicine, Cairo University, Egypt

Introduction. The technique most commonly used for penile lengthening is the release of the suspensory ligament in combination with an inverted V-Y skin plasty. This technique has drawbacks such as the possibility of reattachment of the penis to the pubis, a hump that forms at the base of the penis, in addition to alteration in the angle of erection.

Aim. In this work, we describe a new technique that overrides these drawbacks and minimize the loss of gained length.

Methods. The suspensory ligament was released through a penopubic incision. The caudal flap of the resected ligaments was reflected caudally and sutured to the Buck’s fascia. The V flap was incised. The caudal half of the V was deskinned, leaving a cranial skin-covered V flap, and a caudal, rectangular fat flap. The fat flap was pulled into the gap between the base of the penis and the pubis and secured in position by suturing its deep surface and lower edge to the pubis. This maneuver filled up the gap. The V incision was closed as a Y. The penopubic incision was closed as a T shape, to avoid pulling the penis back at skin closure. A stay suture stretched from the glans to the thigh, maintaining the penis in the stretched position. A urinary catheter was inserted.

Results. Six months after surgery, there was no loss in the length gained. The angle of erection (as reported by the patient) was similar to that prior to the procedure. The skin incisions left no hump and a faint scar that was not troublesome to the patient.

Conclusion. “V-Y half-skin half-fat advancement flap” and “T-closure” may improve the results of suspensory ligament release for penile lengthening. The reported techniques minimize the losses compromising length gain, whether in-surgery or following it.

My mistake, sorry. I believe it’s just a better technique for those considering the surgery..but do NOT consider the surgery! stick to hard work-huge reward from PE. :up:

Originally Posted by Snakecharmer
Thank you so much! I really appreciate it 8 Works :) I have that article but not the contact info.Great work done ! And I owe you big time. I just pray to god that the surgeon didn’t cut right to the bone,so that there is some ligament tissue to suture to.

Your welcome! I’m glad I could help.

I’m in a rather similar situation to yours. I also had the lengthening surgery in 1996, but in California. I was 19. Basically I was young, stupid, low self-esteem, you name it and armed with a credit card. Hopefully guys who are considering this will hear us saying: I WOULD NOT RECOMMEND!! So far as I can tell I got nothing as far as gains, and honestly even if I did, I still would not be happy with the functionality issues of a cut PSL. Thankfully, I wasn’t mutilated or anything like that, but your absolutely right about the value of the PSL. Many sexual positions are impossible without it. Having a girl or guy (what ever your taste is) on top I find to be pretty much next to impossible. I’ve only been with 2 chicks who have been able to work with it in this position, which was awesome, but I wasn’t exactly at ease. Every other time, it simply doesn’t work and usual results in a lost erection and some feelings of frustration and regret on my part. Missionary and such are ok (not certainly as good as it could be), cause I know how to work with it. I also feel, like it may have effected my erection quality to. Perhaps screwed with my blood supply or something, but I have not had a doctor check it out as of yet.

Anyway, what I’m trying to say, is I feel your pain, bro! I’m considering surgical means for repair, but I haven’t researched it extensively and I’m probably going to wait for a while before I go that route. However, I think it is inevitably something that I will do if it can be done with a high degree of certainty that it won’t make matters any worse. So, PLEASE keep me, and the rest of us on Thunders up to date with what you find out! I’m certain there are a lot more men who are in the same situation as us. One is never alone!

I wish you the best,

8Works


My PE Statistics are here

Did the surgeon use the old V-Y forward advancement flap? Reversing the V-Y advancement usually gives more stability. Yes girl on top is next to impossible and the fear/anxiety of buckling causes loss of erection.

You should have an ultrasound doppler done through your urologist to make sure that you have normal venous integrity and occlusion in your dick. Is the top vein still there or does it fade off closer to the base?

Who was your surgeon if you dont mind me asking? It’s just a huge effort now to get things fixed properly but I’m sure huge improvement can be obtained, so stay focus and positive. Are you looking into legal action?

Originally Posted by Snakecharmer
Did the surgeon use the old V-Y forward advancement flap? Reversing the V-Y advancement usually gives more stability. Yes girl on top is next to impossible and the fear/anxiety of buckling causes loss of erection.

You should have an ultrasound doppler done through your urologist to make sure that you have normal venous integrity and occlusion in your dick. Is the top vein still there or does it fade off closer to the base?

Who was your surgeon if you don’t mind me asking? It’s just a huge effort now to get things fixed properly but I’m sure huge improvement can be obtained, so stay focus and positive. Are you looking into legal action?

No. I believe my incision was at that time the “newer” transverse incision (that is the straight line one, right) and is less than 2” long hidden under my pubes. The scar really isn’t noticeable unless I trim my pubes too far, and I think it would have healed even better, but stretching post surgery in the downward angle didn’t help in the healing process. So, it is a little wider and more noticeable than I’m sure it could have been.

I’m trying to remember the Doctor’s last name, but off the top of my head all I can remember is that it started with an R. Looking online is seems that it would either be Dr. Melvyn Rosenstein or Dr. Gary Rheinschild. I want to say it was the later, but I’d have to search for some record of that to be sure. I know that I stayed in Anaheim, CA when I had the surgery done in ‘96 and it was close to where the clinic was.

As far as legal action. I haven’t though about it. I kinda figured that all the paperwork that I signed released the Dr of pretty much all Liability. Plus I think that there are some guys out there who got pretty screwed up so they would probably look at me and my situation and think nothing of it. Additionally it has been so long, and I’m not sure what the statue of limitations is on a lawsuit like that. Honestly I just wouldn’t know where to start on legal action and I don’t have a lot of cash to make it happen. That is if cash is necessary to do it. In the end, though if there were a means to sue and I had a good case I’d do it. Justice and some cash to pay for fixing things up!

As far as an ultrasound doppler and checking normal venous integrity and occlusion in my dick. I’d have to say I’m not so sure what your talking about exactly, but I’m assuming this is to see if it might be causing some sort of ED. :) Possible. I’ll have to check into that. If there is an issue what can be done though? And, I’m not sure about the top vein now, or what it was like before, for that matter. I’ll have to pay closer attention next time I jack off. Hmm, sounds like a good excuse! :)

I hear you on the buckling thing. It’s like my dick is hard enough to go in, but unless I have the right angle or stabilize it will not penetrate further, instead it will buckle, bent or arc like a bow. Not cool. One way around it, which I haven’t tried with anyone because I’d feel stupid, is to have sex with your underwear on, but the waistband in the front pulled down to just under the base of your shaft. This provides the proper leverage or anchoring that is necessary. But, who wants to have sex in their underwear, right! “Ah, yeah, take off all your close so I can fuck the crap out of you, but I’m gonna go ahead and keep on my underwear. OK?” No go!

I must say, it is good to discuss this with someone and figure out some of the details and possible avenues towards recovery. Well, best of luck to you, and do keep me posted and let me know if I can help ya in any way. I’ll do what I can.

8Works

I also had the lengthening done back in 1996 but haven’t experienced any of the negatives you guys did. My erection angle remained the same as did my erection stability. I’m not necessarily against the surgery but I think natural PE should be exhausted before the surgical route is tried. If you can gain an inch naturally than why have surgery?

Did either of you have girth enhancement done as well?

Originally Posted by Big Dipper
I also had the lengthening done back in 1996 but haven’t experienced any of the negatives you guys did. My erection angle remained the same as did my erection stability. I’m not necessarily against the surgery but I think natural PE should be exhausted before the surgical route is tried. If you can gain an inch naturally than why have surgery?

Did either of you have girth enhancement done as well?


No, I just had the lengthening done. Did you? Who was your Dr and what kind of results did you see?

It is certainly good to hear that you haven’t suffered any negative effects. You are apparently in the minority, congratulations! I wish it worked out that way for the rest of us. Did they perhaps sever the PSL and then reattach it in a more forward position so as to add length and maintain penile stability and erection angle? I know that procedure was around for at least a while. Another possibility is that your PSL reattached itself, at least partially if not fully. Oddly ligaments are quite good at doing that if given the opportunity. I believe mine or some of mine were attempting to reattach after my surgery, but as I was told to do, I just kept stretching to prevent it from happening. I kinda feel like there is still some support from the ligaments that remain, but not adequate to compete with normal by my measure.

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