09 Oct Beyond the Blue Pill: Innovation and Advancements in the Treatment of Erectile Dysfunction
Erectile Dysfunction (ED), or impotence, is a surprisingly common condition experienced by nearly 40 million American men. And contrary to popular belief, medical causes are found in 80 to 90% of the cases. Despite these statistics, the average urologist does not routinely complete a comprehensive evaluation or treatment of ED due to a lack of training and/or comfort with the topic of human sexuality. Uniquely, as an ED Specialist, I am very comfortable and well trained in the subject matter. This allows me to establish a strong relationship with my patients and to address the specific details of their condition.
In the years following the advent of medications like Viagra, millions of men have tried these medications in an attempt to improve their erectile function and regain intimacy in their lives. Unfortunately, these meds have failed in 30-40% of the patients. Under these circumstances, patients require a detailed history-physical and a panel of blood tests that may reveal reversible causes of ED. Additionally, patients can benefit from the Color Doppler Ultrasound (PCDU), a specialized test that I perform to evaluate the penile arteries and veins. Besides identifying a reason for a pt’s ED, the CDU can be used to assess the risk of heart disease and the need for further cardiac assessment. ED is now being recognized as one of the earliest signs of coronary artery disease (CAD), presenting about 3 years before a heart attack or stroke. Ultimately, ED may be a warning sign for silent vascular disease, suggesting that all men with ED should see a doctor to be screened for underlying heart disease.
Based on my diagnostic evaluations, I always advocate a specific treatment option that will work with a patient’s unique value system and goals. When medications like Viagra fail, I offer several treatment options: injection therapy, urethral suppositories, vacuum erectile devices (VEDs) or the implantation of an inflatable penile prosthesis (IPP). Due to lack of reliability, spontaneity, and cost, the first 3 options fail in 70% of patients at the end of one year of follow-up. However, for some men and their significant others, a small internal pump or Inflatable Penile Prosthesis (IPP) may provide the best option. An IPP continues to demonstrate the highest levels of patient and partner satisfaction (94-98% satisfaction rates). While this treatment option is often the best solution for men who have failed other conservative therapies, it still remains a relative secret to the community at-large due to a lack of education and marketing.
An IPP is a water-filled device that is placed within a small incision in a 30 to 45-minute procedure. By squeezing the pump (which is entirely contained in the scrotum), fluid is transferred to the penis, resulting in an erection. In order to return the penis to its non-erect state, a button on the pump is simply depressed. After the device is placed, patients do not need medications to perform sex, and the device is free of maintenance. Patients can engage in sexual relations spontaneously and with confidence. They continue to experience normal sensations, including orgasms and ejaculations. With enhancements to these devices, infection rates are less than 1%, and mechanical failures are rare. Medicare and many commercial plans cover the procedure. As a simple minimally invasive treatment, an IPP is a life-changing event that restores the “manhood” to the men that receive them.
By Dr. Shawn Blick, MD