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Cure Erectile Dysfunction with Chesapeake Urology and Dr. Marc Siegelbaum

Learn about treatment options for erectile dysfunction with Chesapeake Urology's Marc Siegelbaum, M.D. Find out how you can solve this problem and get the help you need.

Erectile Dysfunction

Erectile dysfunction (ED) is a common sexual problem for men. It is defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual activity. Approximately 30 million American men are affected by ED, according to the National Institutes of Health.

There are many possible causes of ED, including psychological, physical, and medical conditions. Common causes include:

  • Psychological conditions: Depression, anxiety, stress, or relationship problems can all interfere with sexual performance.
  • Physical conditions: Diabetes, high blood pressure, high cholesterol, or other medical conditions can lead to ED.
  • Medical conditions: Neurological disorders, such as multiple sclerosis or Parkinson’s disease, can cause ED.

In many cases, ED can be treated successfully. Treatment options include:

  • Medication: Oral medications, such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra), can be effective in treating ED.
  • Lifestyle changes: Quitting smoking, exercising regularly, and eating a healthy diet can improve sexual function.
  • Counseling: Therapy can help address psychological factors that may be contributing to ED.

ED can be a sign of a more serious underlying medical condition, such as cardiovascular disease. If you are experiencing ED, it is important to see your doctor to determine the cause and to discuss treatment options.

Learn about treatment options for erectile dysfunction with Marc Siegelbaum, M.D.

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Video transcription:

I just wanted to open up by telling you

that I didn’t always grow up, wanting to be a IDI specialist or a male and

continent specialist that wasn’t why

what necessarily went into medicine, but I went into urology and actually became

a cancer specialist. That’s really what I

do the most of in my surgical practice for about 13 years now, I’ve been doing a

lot of robotic surgery for prostate

cancer kidney cancers, do a lot of bladder cancer work and because I take

care of a lot of prostate cancer and

bladder cancer. A lot of the things we’re going to talk about tonight can result

from the treatment of those cancers

whether. It’s surgical treatment or radiation treatment, both of those can

have similar kind of consequences, in

terms of side effects from either of those treatments, so as I was becoming a

cancer surgeon and doing more and more

of. It I realized that men were suffering side effects from these kinds of things

potentially and I was sort of saddened

that I couldn’t take care of them. Myself and I made myself an expert actually

over time. I became interested in the treatment of IDI. I became interested in

the treatment of male incontinence. And

Really looked into training myself. To do these kinds of procedures in a more

in-depth way and actually over the years

became, an expert and I do go out on the circuit. If you will once in a while and

give these lectures, because I think a

lot of things we’re going to talk about tonight are sensitive issues, many

urologist I’m sure a lot of you probably see other urologist a lot of urologist

don’t, even talk about these things

necessarily they’re, not necessarily skilled, and how to treat a lot of these

things, so I think I prefer to go out on the circuit to at least educate people

and, hopefully through these tapings and

actually broadcasting on youtube, we’re going to educate a lot more people about

what’s out there what’s available to you

and I want to share with you tonight some of the things that are out there

for you we’re going to go through some

definitions of things first and then go into treatments. We’re gonna talk, about

erectile dysfunction, but as I go through

my talk, you’re gonna see, there’s many many medical conditions that can cause

edie. So let’s talk about that a little

bit. First of all, what is it? What is EDI mean we

think. We know what it is, but and we

probably do know what it is, but it’s the

inability to achieve or maintain an erection, persistent or significant

enough for intercourse

that’s. What IDI? Theoretically? Is you? Don’t necessarily have to have

intercourse to say that you have IDI but

that’s the strict definition for the thing about one in five Americans

actually have it men that are greater

than 20 years old, so that’s pretty prevalent there. That’s why all these

viagra’s and Cialis commercials that you

see they’re not just showing these commercials for their health

there’s a tremendous market out there

for the use of these drugs, because it’s a tremendous problem out there there are

many men that suffer from this even at

young ages, believe it or not, and more than half the men over the age of 40

have, some degree of VD, so once

you hit 40, it’s all over. So everybody in this room at least from

here up, we’re all screwed basically

based. On that statistic, I mean it’s all downhill, but it’s it’s actually true. The

Blood vessels that supply the penis or little tiny blood vessels that supply in

there and they’re vulnerable, just like

you get hardening of the arteries to the blood vessels in your heart. So – can you

get hardening of the arteries – the

blood vessels in your penis and they’re vulnerable

if. You don’t get enough blood flow in

there. It’s not gonna work properly, but

that’s a really interesting statistic to look at 40. You think they’re ear at your

prime and yet half of those men, have

difficulty -, and it approximately affects about 40 million American men so

it’s a pretty big number, pretty big

number. So how does this all happen? How does an erection happen? First of all

there has to be arousal and then the

nerves around the penis become activated, so it actually is initiated by nerve

inputs. That’s what does it? First, it’s an on a vascular thing. It’s really a nerve

stimulation thing and then, once the the

nerves are stimulated that actually causes the blood vessels to dilate there

are little tiny muscles around the arteries arteries. Are the vessels in the

body that actually bring blood flow? In

Veins are the things in the body that Brent carry the blood flow out but

there’s little muscles inside the walls

of, the arteries and those muscles are stimulated and cause the arteries to

stretch open. When the artery stretch more blood can flow in. If you look at

this cross-section of a penis, you know

we’re not trying to get too grotesque in here, but these are the central cavities

of. The penis called the corpora

cavernosa and there’s two of these chambers that sit side by side inside of

the, penis and inside of those chambers

it’s kind of loose spongy tissue in there and that loose spongy tissue fills

up with blood and once it does, the penis

then can get firm and long. So that’s how a proper erection happens, but while

that’s all happening so we’re getting

good blood flow in there. You also have to make sure that the veins don’t drain

out the blood flow too soon, so you might

have guys that come in and they say doc. I just can’t ever get an erection which

means. They clearly probably have a blood

flow in problem or you have other guys that say well doc, I get a pretty good

erection I, just can’t maintain the

erection. In those cases it’s usually they have an issue called venous leak

where. The veins dilate too soon in the

blood just leaks right back out. So it can be an inflow problem or an outflow

problem, but either way whether inflow or outflow. We kind of treat it the same way

and it’s nice to sort of talk about it

and, it’s nice to maybe come up with a diagnosis for why we think you might

have that issue, but we end up treating

it the same way because, interestingly enough, probably 15 years ago, we thought

we were geniuses. We figured out that if there’s an outflow problem, if there’s

too many veins and they’re leaking too

rapidly, what if we went in there and tied off all the all the veins in the

penis, you don’t really need all those

excess veins and we did. We used to do venous ligation surgery for that we’d

had great results for about six months. In these men, great results. It was like

be cure-all and then over time. The body is incredibly smart, but it ends up

building and renewing all these extra

veins. All these new veins would sprout up and they would start leaking -, so the

venous leak or the venous ligation surgery didn’t work beyond six months to

a year, so that that was not a viable

long-term option. So we abandon that procedure, while the arteries flowing in

the

vanes collapse that the blood cannot leak out too soon. Where do we see II D

what kind of patients? That’s what I was

talking about a few minutes ago. This is not just about cancer victims. It’s a lot

of kinds of many kinds of patients, come

in to see me that have all sorts of medical issues as the cause for their II

D. The most common, though, is vascular. We see a lot of guys as I said. The reason

why you have a D is because there’s

usually not enough blood flowing into these little vulnerable arteries. Just

Like. You have blockage of the little

arteries of the heart. So too, you can have of the blockage of the arteries of

the penis. Well, that’s a vascular

abnormality you’re not supposed to have blockage to those blood vessels, but you

do, because you have a buildup, of

atherosclerosis or plaque in these little blood vessels and the reason why

you have that is because your

cholesterol is high or because your

blood pressure is not well controlled or because you have diabetes or because

you’re a smoker. Those vessels become

vulnerable because of other underlying medical conditions that you have that

are, probably poorly controlled, but the

underlying underlying issue- is really vascular and, interestingly, enough

they’re really advocating now that if a

man comes in with Edie, that’s his primary complaint, you really should be

searching for cardiac anomalies. And

Though. In that person, you should work them up for cardiac dysfunction. Too

Because. If he’s got blockage to the

arteries down there. He probably has blockage to the arteries up here, too

they’re really advocating for Cardiology

consultation and those guys that their sole complaint really is Edie. The other

30% of men that come in are diabetics

and the reason why diabetics get this problem is because diabetics have issues

with their nerves. They get peripheral

neuropathies and, as I showed you in the beginning, those nerves are pretty

crucial to initiate the whole erection

process but, more importantly, diabetics have problems with the little blood

vessels. They get bleed blood vessels

that’s why they have problems, with

kidney failure, the little blood vessels to the kidneys shut down. They have

problems with diabetic retinopathy eye

problems, because the little blood vessels and the eyes are vulnerable. And

So, -, down there

so the little blood vessels in the penis are vulnerable to all of their blood

vessels. All throughout their

we are vulnerable for blood flow issues and Edie is just one sign or symptom of

diabetes, so we always screen for that

too should screen for it. Other things that caused Edie medications. You know

every single patient that I see is on

some kind of medication, probably at least one antihypertensives. And

Antihypertensives are probably the chief

reason why men might have Edie. Some antihypertensives are worse than others

that cause Edie, and we can’t change

those medications around with the help of your primary care doctor. We don’t

just do this stuff willy-nilly, but we

might suggest to your primary care. Could they switch them to a different category

of antihypertensives and that in and of

itself might help? So we look at their medications and see if that impacts

their also a sort of other assorted

other reasons why men might have Edie, pelvic surgery or trauma can cause Edie

neurological causes multiple sclerosis, Parkinson’s disease. Things like that can

cause Edie, back issues with slip, discs and nerve compression can cause Edie

different kinds of endocrine problems

can cause it. So there’s a lot of different kinds of things that can cause

Edie it’s, not just cancer patients

that’s. Not what we’re talking about. In fact, that’s the minority of the patients

that I deal with are actually cancer

victims, at least for their Edie, and just like I talked to you when we talked

about the stress incontinence. This is

the exact same slide. That I showed you about quality of life. You don’t have to

have sex to be alive right. It’s not

cancer, it’s not cancer, but you maybe do have to

have sex to preserve the quality of your life. It’s it’s not life and death but

for some men, it’s more important than

others for some women, it’s more important than others. For some men and

women, it’s not important at all. You know

when I have discussions with men about their cancers. For instance, the women

usually are, in the background, going I

don’t even want to talk about this. I just want to make sure my husband’s

alive ten years from now that’s what

they care about and the husband’s going. No, no, that’s not what I want to talk

about I want to make sure this thing’s

alive, so there’s very different perspectives in there and also the age

of, the patient, that I’m speaking with

you know. I have to counsel for it here, old’s about their prostate cancer, – I

also counsel, 70 year olds about their

prostate cancer. So it’s very different kind of conversation, you’re going to

have with a 40 year old than you might

have, with a 70 or 80 year old, about

these things. So you have to tailor your conversation to the particular person

that’s there, but all of these things

still apply again not life and death, but in some way a dysfunctional guy over

time is not happy. They’re not satisfied. Their partners may not be satisfied. It

May not be that obvious. It may not be that evident, but a general happy good

marriage, it’s clearly not dependent on sexual function, but it’s a component of

it. We try to support the men and women the couples on the basis of improving

the overall quality of their existence and in these cases, I’m jumping forward

just for a second, as far as insurance

covering, some of the procedures that we do, even though we get pretty damn good

coverage for these things sometimes they

balk at covering it because they say this, isn’t you don’t need to have proper

sex for life? This isn’t a life and death

issue. Why should we cover this and in some way, I understand the concept but I

don’t if they will cover prosthetic implants for women who have breast

cancer

why? Wouldn’t they cover this? So we’re big advocates for that. If we can prove

that it’s clearly a physical issue

we’re, big advocates for fighting on your behalf to try to get these things

covered. We will write letters to your

insurance companies with the proper medical data that they need to back, it

up and nine times out of ten. They will improve it. That’s today, I, don’t know

what’s gonna happen tomorrow, but that’s

today there’s still pretty good coverage for it. I can’t say you have the same

coverage for the viagra sin, the cialis

that’s a whole nother can of worms, but that’s usually the pharmacy

subcontractors that kind of end up doing

deals with your insurance companies. What are the options for people who have IDI

what? Can we do for them? First of all

sometimes. Family physicians will take care of these things. You a lot of guys

will have already been treated by the

time. They come to see me they’ve been on

a couple different drugs, you it’s it’s not it’s absolutely

appropriate for your primary care, doctor

to, try the viagra’s or the Sai Alice’s, or the Lavi choice of the stendra x’ or

the, a bunch of other drugs that

are out there. Now for this kind of thing they all work. They all work, similarly

they work a little bit different. Each

One of them has a slightly different mechanism, but as long as you’re, not on

nitric oxide or nitroglycerine for cardiac issues, you can really safely

take any of these drugs. Just about it’s nitroglycerin, that’s the absolute no-no

so! If those are those little pills, that

you put under your tongue or sometimes it could be a preparation that you take

every day, because your cardiologist put

you on nitroglycerin, you should not be taking any of those drugs in that case

that’s. The only exception, but anyway the

primary care physician might give it to you. Your urologist can treat it and then

the subset of urologist that that is

somebody, like myself as a prosthetic urologist, some of the treatments that

I’m going to talk about tonight, can only

be done by a prosthetic urologist who has experience with putting these types

of devices in and we’ll get to that in a

minute

so. What are all the options? The drugs injections, implants, vacu, erection

devices, urethral suppositories, and these the we actually use all of these things

in some form or fashion, so I’m gonna

talk about these things. Let what I think is good. What I think is not

so good, what’s practical, what’s not so

practical and see what you think, so the oral medications, I kind of jumped ahead

already a little bit and told you a

little bit about the oral meds. Listen when I first started off in practice, we

didn’t have one single drug available. To

Give to a man didn’t exist. There was something called trazadone which was

really a sedative sleeping pill that as

a side effect caused a little bit of erectile sort of arousal that was about

it there really weren’t any drugs at all

so. Imagine a practicing neurologist. They suddenly had this drug

called viagra, my god, if you didn’t buy

stock in that company, when, when viagra came out, you’re a knucklehead, it was an

incredible thing to actually offer a

drug to a patient that had reasonable side effects, pretty safe for anybody to

take and had pretty damn good results. So

From that came the drug explosion of all the other drugs again

all a little different, all work, a little

different all have some side effects that may not be as bad as some of the

other drugs. So sometimes it’s worth

trying more than one kind of drug to see. If the first one didn’t work so well, or

had a wicked side effect try. Another one

we are advocates for that, and we would help you through through that, but they

do work and basically the way they work

is they dilate the blood vessels, there’s a complicated sort of physical mechanism

for, how it works, but essentially it dilates the blood vessels and more blood

flows in that’s exactly how it works. And

They all work very. Similarly, it requires sexual stimulation. You can’t

just take the drug, and then you know

kind of wait around for 15 minutes and see what happens. You actually have to

engage in something you want to take it

about an hour before the anticipated blessed event. So you have to wait about

an hour. Some of the drugs may work a

little quicker than that, usually typically it’ll work up to four hours or

so, but with cialis it stays in your

system for about 36 hours or so so you know that’s that’s up to you. I

Don’t I, don’t like anything in my system

any longer than it needs to be in my system, because everything has some side

effects if you will, but if you’re

planning a weekend in Vegas that may come in handy, so you

can plan it depending on what your

lifestyle is like. You should definitely not take it more than once a day and

some of the oral medication, efficacy can

be affected by food, so some of the drugs you can take with food and some of the

drugs. You can’t take with food some of

the drugs you can take with fatty meals and some of the drugs you can most of

them. You can just take pretty much

willy-nilly, but some of them happen. You can’t- and your physician will tell you

about, that there are some little

restrictions about that and they’re pretty effective. Look, look at that

number 50 to 85 percent of

cases men are gonna, have some kind of positive result. The problem is, is that

it? Doesn’t it’s not sustained

necessarily? It doesn’t last for forever doesn’t work all the time, sometimes men

stop the medication, because it causes

side effects that are just too annoying to them, and it’s just not worth it so

although. That number sounds pretty good

it’s, not necessarily sustainable for the rest

your life or the rest of your sexual

life, but it’s certainly worth trying

that. Certainly is our first go-to thing when we have a patient coming in with

this problem, almost half a men with Edie

after prostate surgery. If they’ve had prostate surgery, what this little blurb

is trying to tell you about half of

those guys, ultimately stop taking the medicine just for what the reason I just

said they just don’t like the side

effects or the way it makes them feel or they feel it’s not natural or they just

have to plan too much their overall not

satisfied with doing that. But if you’re gonna have sex once a week, this

is just me sort of philosophizing it’s, why not I mean I I? Think you could

use this for forever. If it works for you and then men with diabetes are about one

and a half to two times more likely to

move on to other treatments eventually, because it just doesn’t work, that’s what

I meant by saying it’s not sustainable

it. Just stops working the drug, you sort of develop a tolerance or a resistance

to, the drugs, and you have to move on to

another kind of treatment. What we talked about most of these kind of things about

the oral. This is another slide about the

oral medication. Some of the side effects, I didn’t tell you

headache facial flushing, stuffy, nose

upset stomach. Those are the most common kinds of symptoms that you would see

side effects that you might see. I did

tell you about the nitrates, that’s very important and if you’ve ever had heart

problems, you should tell your physician that you’ve had heart problems not

necessarily, because you’re taking

nitroglycerin, but we have to make sure

you’re healthy enough to have sex I mean sex may be the most vigorous thing. That

You do in your life. If you’re not in

shape and you’re not running and you’re, not jogging and you’re, not in great

health, we have to make sure you’re

healthy enough to have sex. I’m sure

you’ve heard that statement on the commercials, but it’s actually quite true

so. If we feel that you may not be we

might, recommend that you get a cardiology workup before you go on some

of these medications and that just makes

sense it just makes sense. Doesn’t it let’s talk about the next treatment

option, it’s called a vacu erection

device. Essentially it’s a vacu tube. It’s a it’s a plastic hollow cylinder

that. The penis is put inside of and there’s either a manual pumping thing or

a battery pumping thing, but it by

pumping that pump so to speak. It draws blood into the penis

we use these vacu devices, all the time

in men who’ve had the prostate surgery. Radical prostatectomies for cancer and

this is how we rehabilitate them. So

Instead of sending them to the physical therapist. We make them buy one of these

they’re, pretty reasonably priced. We make

them buy one of these gizmos and we have them cycle the penis once or twice a day

we have them kind of draw the blood into

the penis. It gives you a very good erection, quite frankly, but you can’t

have sex with this cylinder on there. So

What you have to do is remove the cylinder and when the cylinder comes off

you’re putting this ring device at the

base of the penis to keep the blood in there. This has been around also forever

for forever and it’s quite effective and some men find it very

satisfactory. If you will, because it

doesn’t involve expensive medications or injections or implants and things like

that, but most other men don’t

necessarily want to fool with this stuff. It takes it’s a whole sort of ritual

that. You have to go through and by the

time you’re done your wife’s, probably asleep by the time to get back

in there. So it’s some men just

don’t want to mess around with all this, but we use it for rehabilitative

purposes all the time and when the men

are doing that and they’re used to using this a lot, they use it for sexual

function too, and they might be quite

satisfied with it. So it is an option and it’s a reasonably priced option that is

not covered by insurance. Medicare will

not pay for this thing, but it ain’t gonna break your bank at all. It’s pretty

reasonably priced. We talked about some

of these things, but a little bit of difficult mechanics, sometimes maybe a

lack spontaneity. You could get some

bruising. If you don’t quite, do it exactly right. Some people think the the

erections aren’t quite as rigid as they

know. They should be might cause a little penile discomfort. Some numbness coldness

you know what I have found that if

you’re motivated enough they’re, guys that are willing to do anything to make

sure. They have an erection, so those are

all the potential little side effects side effects that go with, but I don’t

rule out any of this for anybody, I try

to, take them down, give them all of these options and see what they’re willing to

try. This is my least favorite option for Eady. It’s the urethral suppository also

known as Meuse mus II this person, the animated picture here it shows this

little applique

that goes down the urethra, the urinary opening it is a teeny-tiny little

applicator. Quite honestly, it is tiny. And

It doesn’t hurt to put the applicator in the tip of the penis, like that. But

Inside of that applicator is this

teeny-weeny little pellet and once you put the applicator inside the urethra if

you squeeze that little ball or bulb at

the end, and you pop in this little teeny, tiny pellet in the urethra and that

pellet actually dissolves in there. And

That medication is called prostaglandin. Essentially it diffuses into the into

the substance of the penis and that

causes the blood vessels of the penis to dilate too. So that’s how it’s it’s sort

of delivered into the urethra, but it dissolves and spreads into the cavernous

spaces of the penis and it it actually

can cause erections. The reason why it’s not my favorite of all the different

options is because number one it doesn’t

work so well. It probably only works in about 40% of men that I find that are

using it and also they have more discomfort not from the applicator but

the. Medicine itself is annoying it

causes a lot of burning and discomfort and they end up discontinuing it a lot

so I’m. Just being honest, this is my

experience with these particular medications, but again some men who use

it love it if it works for them and they

don’t get irritation, maybe it’s worth at least a shot. We usually start at a

pretty medi to good dose and then I

bring them up to the highest dose. If need be. The next option, which we use a

lot in a lot of our patients, is intra calvinist. Injection therapy and what

that means is again there’s that

grotesque sort of cut section of the penis with the two chambers inside this

by. The way this chamber is where the

urine comes out. That’s the urethra again this space inside of these two chambers

is, this spongy tissue space, and you actually can take a needle with a

medication in there and inject directly

into the side of the shaft of the penis into that spongy space. The needles that

we use are little teeny, tiny, tuberculin syringes. They really are small and you

might. Think my god who would ever do

something like this, but it’s very doable I, actually teach the men how to do. It

Myself I show them how to do it. We actually use a Sam

of. The real medication in the office and

they stay there till they either get an

erection or don’t get an erection, but I can teach them to inject themselves. In

Five minutes, it’s not difficult to teach

someone. If they’re motivated to do this, there are other men that will

say there’s no way I’m sticking a needle

in, my penis and that’s that they’re. They then I, know I need to move on

to the next arena, but if you’ve heard

these advertisements on TV that we guarantee you an erection for a hundred

and, seventy nine dollars or your money

back

that’s, what it is and then they charge you about three thousand dollars for the

medication and it’s an incredible ripoff. What’s going on out there there’s a lot

of. These injection clinics that are

popping up no pun intended, but they are and what it is, is injection clinics and

you don’t need to be a urologist to do

it. Theoretically, there has to be at least a physician signed on to the

injection clinic somewhere probably

sitting in Denver, but he’s sending his physician assistant or his nurses to run

these clinics, and they basically will do

a sample injection in the office for a patient and then actually sell them the

medication a thousand times more than

what. It would cost you if you submitted it through your insurance. Company

Because insurance companies will usually

pay for this. So if they’ll pay for your Viagra or Cialis they’ll, usually pay for

this stuff too, but again you have to be

willing to do it. It’s pretty effective, it’s pretty effective in causing decent

erections. It’s not meant to be used five

times a week. That’s not what this is for it’s really at the most for once or

twice a week. It’s not really also

necessarily recommended for very young guys. It’s not what I like to go to for

younger guys that are using this because

long-term use of this medication can cause scar tissue inside the penis. And

That might preclude the ability, of

trying other types of options for you. If this thing stops working so sure, for

older, gentlemen I think it’s a great idea or for short term use, if we’re

using this as a bridge to some other therapy or thinking that you’re going to

recover more from the surgery. Why not

try this as an interim step very much an advocate for it and we do use this again

it’s a teeny, tiny little needle? It’s not very painful, despite what you might

think, but it can cause discomfort. The medication itself can cause a little

discomfort, so penile pain is one of the

side effects, but pretty rare penile fibrosis or scar tissue, I, talked

about, priapism or prolonged erection. I know: we’ve seen the commercials about

viagra. If you have a prolonged erection

that, lasts for more than four hours seek attention immediately. We’ve never had

I’ve, never seen one single case, of

viagra cialis or any of those drugs I’ll probably get hit. Tonight, though I’m

gonna call but I’ve never seen one case

of any of those drugs causing that this can this medication can and that’s why

we start with pretty low conservative doses and have the men inch up on the

dosage very slowly. They can do it at

home. They actually are doing it themselves. We show them what to do start

low and we work our way up and if you do

it in that way, we rarely will see the prolonged erection and the reason why a

prolonged erection is. It may be good for

for, a good time that night, but it’ll stop working for the rest of your life

if. You don’t get it down so prolonged

erections or priapism has to be corrected. You can’t leave it like that

but, it’s doable and I use. It a lot, and then we go on to the penile implants

this- is what I was talking about. That

The urologist that you go to has to have experience with putting in prosthetics

they have to be a prosthetic urologist

prosthetics to have been around for a long time. It’s been I’ve been

in practice for 25 26 years now, and I was trained to put these things in in my

residency before I went out into private

practice I put in ones different now than I put in then, but they’ve been

around for a long time too. So there are

some very clever urologist out there from years ago, that came up with these

very ingenious devices and even to this

day that the prosthetics have not changed all that much

again again better materials, a little

bit different release, valves and pump mechanisms, but pretty much the same

thing as it was years ago. Well how does

it work? Remember I told you about the two separate cavities that there are in

the penis. Well, the prosthesis actually

we put in a cylinder in the one cat cavity. We put another sill in there in

the other cavity. There actually is a

cylinder, that’s made out of silicone, but it’s filled with saline

so. One cylinder goes into one cavity

another cylinder goes in the other cavity all done through one single

incision, underneath the penis incisions

only about that big. We can put this entire device in through that, so the

cylinders go in each cavity. There is

then a pump mechanism in the scrot. It’s a little ball. It’s a little bit

bigger than the one I showed you for the

artificial sphincter and then just like the artificial sphincter, there’s a ball

reservoir that can that actually has the

fluid in it. That is put behind the pubic bone, where you’ll never see or feel or

touch it or know that it’s there it’s

imperceptible to you, as a matter of fact, just like with the artificial sphincter

you could walk around naked in the gym

no guy would say: hey you have one of those things in there. Don’t ya actually

you cannot you they cannot tell, and if

they can tell they’re looking way too close you ought to leave, but anyway, you

can’t tell you cannot tell it looks

completely, normal and natural, and the only thing that you will actually feel

is the ball or the pump because that’s

the control mechanism that actually gets this thing to work and when you actually

squeeze this ball, it’s sort of a steady

kind of squeezing unity about you need about five or six squeezes to transfer

fluid from the reservoir into these cylinders. So, instead of blood, filling up

that space, its saline or saltwater, that’s filling up the the cylinder the

cylinder, that’s inside of your cavernous channels and basically once it’s pumped

up, it can stay pumped up for forever. So we don’t worry in this case about

priapism. That’s not hurtful

that’s, not hurtful at all so you’re

pretty happy! Your partner is pretty happy and you can have it pumped up

within, five or six seconds. So the reason

why we like these devices, it really simulates spontaneous normal activity

just. Like the good old days. If you’re in

the mood within 10 seconds, you’re ready to go, you can be. You can be functional

as long as you want your partner can

have, multiple orgasms I mean my god, I’m helping you people greatly. You should be

thanking I’ve saved many a marriage, many a marriage

who needs sex, counselors I mean marriage

counselors when you can have one of

these, but anyway, in all seriousness, though it

is it is, it does sort of replicate the more natural spontaneous type of

erection. We put these things in as an

outpatient also takes about an hour to an hour and 15 minutes to do it

send men, home with a catheter in their

bladder and a little dream. They all come back. The next day we take the drain out

and the catheter out, and we check

everything they usually come back in a week. We do a second checkup and then

they come back in four weeks and we

actually demonstrate to them how to use this thing. That’s the sequence of events

of, what’s happening here from the

short-term, it is painful. You do have to take off about a week of work or five or

six days anyway, of a kind of laying it

low at home, because you basically want to take it easy. You want to use ice

packs for a couple of days. So there is a

recovery period associated with it, but usually within a week, they’re back to

work and they’re using the device within

four to five weeks. So that tells you about where you stand as far as the

recovery period is concerned, but some of

the things that can happen. It may cause post-operative pain, but that’s usually

short-term. There can be a mechanical

malfunction where these, since it is a hydraulic device, it can break but the

actual chance of this thing: breaking is

in the order of five percent over the course of your lifetime, I’m talking

about. So these things are incredibly

durable and if it breaks, we can replace it and actually the replacement surgery

is easier than putting in the implant

the first time around, not that you want to go through surgery again, but the the

it is possible to fix it or replace it

and. It’s a pretty low low incidence of that happening. The most important thing

that we worry about is infection. Because

It is in a prosthetic device. There is about a five percent chance of infection

although, that’s usually moreso in

diabetics than in non diabetics, and also the device itself is impregnated with

antibiotics and we’re very careful, about

giving antibiotics before during and after so the infection rate in my hands

is actually way less than five percent

as far as I’m concerned. So it’s pretty low risk but diabetics a little bit

higher risk. The benefits are pretty

obvious. We talked about it, it’s a permanent solution. It’s spontaneous it

can last as long as you desire it’s

entirely contained inside the body. It’s concealed the patient and partner

satisfactions

the order of 94% patients and partners. This is long term. This is long term, so

from a satisfaction score compared to all the other options that I talked

about tonight, including this Alison

viagra’s and Levite res. It’s it’s better than all of them. That’s why we promote

this to not as a first, not as a first

option. This this shouldn’t be a first option for anybody. It really shouldn’t

be unless they’ve tried multiple options

by the time they’ve come to see me and I get those kind of referrals, I have

patients that are referred to me

specifically for implants. Because

They’ve tried many of the other options, but in general, a guy coming in off the

street with Edie. You really should not

talk them into having an implant as their first option. It’s not ethically

appropriate, but having said that, it’s the one that men aren’t men and the

women partners are mostly satisfied, with

compared to all the others. This statistic is wrong: it’s really been

around for 60 years and nearly half a

million implants have been placed in this country. So it’s it’s a

very prevalent type of procedure, that’s

being done out there. I did allude to earlier about insurance coverage, I

already covered that and in general just

to refresh your memory. Almost all of them are covered most of the time and if

they’re not we will advocate for you, as I said. Sometimes we have to talk to the

insurance physicians. We have to write

letters on your behalf, but a lot of times we’ll get them to cover it

ultimately. If you think it your

insurance doesn’t cover it. You really should let us handle it and also let the

representatives from the company we

actually the company that makes these devices has a team of experts who will

help fight the insurance companies as well, and we have they have other

programs to financially assist men. Who

Absolutely can’t get the prosthetic covered and some of the risks are

similar to the risks that we talked

about a mechanical failure pain. We talked about all that so in summary, it’s

a, pretty common problem. Just like

incontinence –is, there’s a variety of

treatment options. You should talk to your partner. In fact, I really prefer to

speak to see the the man and the woman

it’s wonderful when they both come in and consult with me. It just makes it a

thousand times easier when they’re both

on the same page, and it’s really adorable to see when they both are on

the same

Paige. Those are some of my happiest

patients they’re, really there for a common sort of goal, and it works

out very well when they’re both there

and again, you have to make sure that your urologist is a prosthetic type of

urologist and if not go, seize won’t

someone. Who is it’s America? You can go anywhere, you want you.

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