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Erectile Dysfunction Treatments in San Antonio, TX

If you're struggling with erectile dysfunction, know that you're not alone. There are treatments available that can help you regain your confidence and enjoy a healthy sex life. Learn more about your options and find a solution that's right for you.

Erectile Dysfunction Treatments

Erectile Dysfunction (ED) is a sexual disorder that affects men of all ages, but is more common in older men. ED is defined as the inability to get or keep an erection long enough for sexual intercourse. While occasional ED is not a cause for concern, persistent ED can be a sign of an underlying health condition. There are many potential causes of ED, including:

  • Aging
  • High blood pressure
  • High cholesterol
  • Diabetes
  • Obesity
  • Metabolic syndrome
  • Parkinson’s disease
  • Multiple sclerosis
  • Alcoholism
  • Drug abuse
  • Sleep disorders
  • Depression
  • Anxiety

ED can also be a side effect of certain medications, such as antidepressants, blood pressure medications, and ulcer medications. If you think you may have ED, the first step is to see your doctor. He or she will ask about your medical history and do a physical exam. Your doctor may also order blood tests to check for underlying health conditions. Once a diagnosis is made, your doctor will discuss treatment options with you.

Treatment Options

There are a number of treatment options for ED, including:

  • Oral medications: These include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). These medications work by relaxing the muscles in the penis and increasing blood flow to the area. They are taken 30-60 minutes before sexual activity and should not be used more than once a day.
  • Penile injections: These injections are alprostadil (Caverject, Edex, Muse) and trimix. They are injected into the side of the penis 5-20 minutes before sexual activity. These injections should not be used more than three times a week.
  • Penile suppositories: These are alprostadil (Muse) and bimix. They are inserted into the tip of the penis 5-20 minutes before sexual activity. These injections should not be used more than three times a week.
  • Vacuum devices: These devices are <a href=https://www.healthline.com/health/
Urologist, Dr. LeRoy A. Jones, explains all of the treatment options for erectile dysfunction (ED).

More Info: urologysanantonio.com | edtreatmentsanantonio.com

This lecture was given in three parts. This video is Part 1

View Part 2 – Treatments for Male Incontinence here: youtu.be/JhfBgkTsFfo

View Part 3 – Richard’s Story here: youtu.be/tfVLS-JYNSs

Dr. Jones reviews pros and cons of each treatment, their effectiveness and the treatments’ cost. Dr. Jones first discusses how oral medications (Viagra, Cilias, etc.) work. Next, he explains the vacu erection device followed by penile injection therapy, and intraurethral suppositories (MUSE). Finally, he details the surgical placement of an inflatable penile prosthesis or penile implant.

A penile implant is a medical device that is implanted in the man’s body. The surgery is performed as an outpatient procedure. Penile implants have been in clinical use since the 1970s and provide an option for men who have tried other impotence treatments without success.

View an animation sequence showing how the penile prosthesis works here: youtu.be/QGSC6q_q6K4

The penile implant is entirely contained in the body. Unlike pills, injections and vacu erection devices (VED), with the penile implant a man does not need to plan to take an ED medication or have the VED on hand when the mood strikes; he can be spontaneous. The penile implant does not interfere with ejaculation, orgasm or sensation. In published studies, 92% of patients reported sexual activity with the implant to be excellent or satisfactory. 96% of their partners reported sexual activity with the implant to be excellent or satisfactory.

A penile implant is not recommended for men who respond to noninvasive ED treatments. Once a penile implant has been placed, a man cannot go back to taking ED medications or using penile injections or the vacu erection device. The penile implant is recommended for men who no longer respond to other treatment options or who have tried other treatment options and would prefer a penile implant.

The speaker at this community lecture, LeRoy A. Jones, MD, is a board-certified urologist in private practice with Urology San Antonio. He sees patients at the Urology San Antonio Center for Men’s Center for Health & Wellness. Dr. Jones is one of the less than 1 percent of urologist who perform more than 80 prosthetic urologic procedures (penile implant and artificial urinary sphincter) each year. In fact, Dr. Jones typically performs 200 prosthetic procedures a year, making him one of the two most experienced prosthetic urologists in the world.

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Video transcription:

Alright, well welcome. Thanks for ,, ah being here, spending some
time to come, learn about erectile dysfunction and about the different treatment options
that are… that are available. So,, we’ll kinda run through the slide. Deck,

What is ED?
So ED, this is…. This definition, ah, was
first, came from the National Institutes of Health and basically it’s the inability to
keep and maintain an erection. That’s normal for sexual intercourse. So for the patient to be satisfied, having
intercourse. ,! It’s something that is very, very common.. It’s estimated that about 30 million American
men have some type of ED. And, it’s a spectrum,, it’s not all or none. Meaning,. You can have mild, moderate to severe. And. So it’s a spectr of a condition., , and I think that that’s important to understand. When. We look at reasons for problems. With
Erectile dysfunction,. There are lots of reasons, but the bottom line, sort of the take home
message is that,. Typically there’s a disease state, or what we call organic, as opposed
to, in the mind. A lot of guys, wanna think that,, okay, gosh
it’s, my mind,, that is the problem, that I can’t get erections. But. Generally, it’s a reason. It’s, a physical cause. And. So you can see on here,, vascular…, … Getting, an erection is normal blood flow,
so. Anything! That’s going to cause vascular, disease,, heart, disease,, ah…, high blood
pressure,. That kind of stuff, can affect it. Ah diabetes… Diabetes is very common here in San Antonio. And diabetes is a disease of both blood vessels
and nerves. And, so that can cause trouble. And. Then medicines and obviously medicines
can influence it. A little bit. But I always tell patients… a lot of patients are… they say,
well, I was fine,, and then they put me on some medicine for my high blood pressure
and, then I started to have trouble with erections. Ah,. It’s important to be treated for high
blood, pressure, ’cause as I tell patients,, I mean if you have a stroke, and it doesn’t
matter. If you have an erection or not. And, so I think it’s important to take the
medicines that your,, your regular doctor has given you to treat the condition. And. So that’s important. So. We look at restoration or return of erectile
function… Ah,. There are a lot of different options: for
patients that are out there. And, so I think everybody is familiar. With
The pills or oral therapy. Viagra came out in 1998,, and so it’s amazing
what, it’s done. And. It’s also amazing what their lawyers have
done, because the patent is still protected,. So there is no generic Viagra.. None of these medicines are generic, and so
they’re. Expensive. I disagree with this slide a little bit. Ah, the oral medicines work in about 65% of
patients as opposed to what they say on here, 70,, 80%. And, really a lot of it just depends on how
bad the blood vessel disease, is. So. If somebody has diabetes and high blood
pressure, heart disease, treated for high cholesterol,, the chances of the medicine,
falls off. Maybe, it only works about 20 or 30%. If. Someone has been treated for prostate cancer,
maybe that…, you know, again. That number is less. And, so it depends. There’s, not sort of one, uniform percentage
of patients that respond to the medicines. A lot of it just depends on, on what medical
condition that they have. So. The way that these medicines work, is that
the. Patient takes them. There are some instructions and also some
precautions. Ah,. The patient needs to have stimulation. So. You can’t take it and then just sort of
wait around and hope that an erection comes up. You actually have to be stimulated. Ah. You take it typically an hour or two before
anticipated sexual activity. And. Then there’s a window where the medicines
work. So you have to plan. Ah Cialis,. That window is a little bit longer. ,, but in general, you have to plan when
you want to use it. Never take more than once a day. And again,. Some of the medicines can be affected
by, by food, and so,, particularly Viagra and Levitra,. Food can affect it.. What are the side effects of the medicines? Well they’re, all fairly common,, but they’re
short-lived. And. So you can have some headache, facial
flushing,. Ah, maybe a stuffy nose,, a little nasal congestion,, that kind of stuff. The only contraindication, meaning,, who can’t
take this medicines? If the individual is on nitrates. And. So nitrates is a heart medicine and so… Really, it’s safe for any other medicine. Blood pressure, medicines, beta blockers,, diabetes
medicines,, all that stuff and so the medicines… And. It’s been studied, because Viagra’s been
out since 1998,, it’s really been studied in every group and with all sorts of medicines. Some precautions, alpha blockers, those are
medicines used to help guys urinate a little bit. Better. So patients want to be on stable, prostate
medicine., , and then again,. If there is some question
about, the heart condition of the patient and the patient needs to talks to their… their cardiologist and just sort of see, if
they’re okay to be sexually active.. And. It’s just like,, you know,! Are they okay
to exercise? So, it’s the same type of question. And. So these are the things, and that’s why
it’s important that the individual, , ah, ah see their physician, to get prescribed
the medicine. So they can be counseled on how to take it. Correctly. And then also given the proper instructions,
and. So that’s important. So,. What else is out there? , and then let me say, the pills, average
$20, $25 for one pill. , and so,, just as your baseline. So. What else is out? There? Well, the other. Some other options are the
vacu erection, device. Ah,, one of my patients,. His wife refers to
this as the mood killer. It’s, a very cumbersome, bulky, ah, device. And. You can see on here, ,, there’s a vacuum,
it’s, a cylinder that goes over the penis. And. Then the vacu draws blood into the penis,
and. Then, when the penis is full,, there’s a little constrictive band, that’s placed around
the penis. And, so, ,. It does take some time to kinda
set up and you…. You can see the side effects listed. Here. It can cause some bruising,, maybe some discomfort. ,, the erection also isn’t warm. And. So some of the women don’t like that. And
So… Ah,, but nonetheless, it’s out there, and… I, put all these things on here, not
to tell you which one is better. But just so there are choices. So, for some people,, the vacu erection device
is…. They like it. Well, that’s great. I mean it doesn’t matter to me. And some people, the pills work and they like
it. Well. That’s great too., But I think it’s important to know. What’s
Out there. And ,, just so you’re educated., Another, ah, treatment option is a, is
a,, a suppository. And. Basically, what that is,? It’s a little
pellet,! It’s about the size of a grain of rice that goes inside the urine, channel. And MUSE stands for ,. This Medicated Urethral
Suppository for Erection. But, another patient… I learn all these things from patients.. Muse doesn’t work that well and he says: that
MUSE stands: for,
Maybe we’ll see an erection.
,. It only works in about 40% of patients. And. It’s expensive,! It’s about $30 for one
little pellet,, one treatment. So! No needles are needed.. You get an erection in 10-15, minutes. You got to refrigerate it. But again, ,, it’s expensive and doesn’t
have. A great efficacy, rate, ,. Only in about 30 or 40% of patients. These are some of the side. Effects. But, really the big one is probably urethral
burning and irritation. So just like. If you’ve gotten soap, inside
your urethra, the urine channel,, that’s, maybe that’s what it feels: like., Ah and so ah… Nonetheless,. So for some people, MUSE is what
they. Prefer. Ah,. We don’t write a lot of prescriptions
for MUSE, to be quite honest.. There are some patients that have tried it
and like it. And, so I’ll refill, it. But. As far as you know,, starting out with
therapy, ,. It’s really not a great option for patients. Also. We have here, injection therapy,, and…
and ,, so Caverject as listed on here, is a widely used. Agent. There’s other types of injection therapy, that
we use,, ah there’s stuff that we get from a compounding pharmacy that we teach patients. And so,, you know,. When you see some of the
advertisements in the newspaper,, the Men’s Solution and that kind of stuff, they guarantee
an erection,. They pretty much put everybody on injection therapy., So they’re not going to try different treatment
options. They’re, not going to try… okay,, let’s try
the pills. And. If that doesn’t work, then, you know,
we can try injections. And. If that doesn’t work,, then we can try
something else. There, there’s just basically one answer. And so…, because they can sell that stuff
to you. And, so they actually… I’ve heard that it’s actually pretty expensive
for a vial. The injection therapy has been out…. The
Concept has been out since 1982 or so. And. We have lots of patients on injection
therapy. And. There are patients that fail oral medicine,
and, we’ll go ahead and put them on injection therapy., And so,. We do the teaching in our office. It’s, actually very cost. Effective. Now we get our injection medicine made generally
at one of the local compounding pharmacies,. So it’s really only about 2-$3 per erection. So. It’s just getting over the hurdle of putting
a needle into the penis. Guys have to get over. But , the efficacy, effectiveness of injection,
may be about 80%. Remember, where I said pills were about. 65%. MUSE is about 40%. So. That kind of gives you an idea. Of… of…
of, where everything kinda fits in. But you can see on here, I mean you got to
put a needle in. You’ve got to inject it right into the erectile
tissue.. You get an erection. It’s about 10 minutes to get an erection.. These are some of the side. Effects, you can
get, some scar, tissue, ah,, it can be painful.. If, guys have been treated for prostate cancer,
they, always complain of some discomfort when they use injection therapy. So ah,. So there are some issues with it. But: all treatments are going to have some
side effects. I mean that’s just the way it is. So. Now penile implants. So,. What are penile implants?, And , I have a great slide. That’s kind of
pokes fun at it,, but we’re not allowed to use it. Anymore. So anyway, penile implants have actually been
out for a long time,. So since 1972. And ah,, it was actually invented at Baylor,
one of my professors, Brantley Scott, was the guy that came up with this.. Which is really pretty amazing.. He also came up with the artificial sphincter,
um. And. He was originally from San Antonio, I
mean, there’s a lot of Texas roots to this. So,, so the device has been out for over 40
years,, which is amazing., And, ah and ,. So this slide needs to updated. ,. It is an operation, ah,, but it’s… the
surgery has evolved. So. When I was a resident and learned how to
do the surgery, it was a 2-3 hour operation. for a first time, patient, patients
were in the hospital for 4, 5 days. And, it was a big deal.. Complications were greater. Now,, it’s an outpatient, operation. So. Today I did one artificial urinary sphincter
and. Then three penile implants and so… On, the virgin patients, meaning,, who have
not had surgery before,, it’s 30 minutes,. They go home the same day. And, so big difference. From… from years ago., Excellent, patient,, partner, satisfaction…, Lots of studies, we’ve done,, a bunch of studies
ourselves, and ,. It does demonstrate, ah, that. These are ah,. When you look at ah, patient
satisfaction ah,. Now this is actually a two-piece device,, but again, at the end of the day,
it’s. The same concept., Patients and partners are happy with this
and. You know,, there’s a lot of positives to it.. Mr. King will get up here and kind of give
you his feeling about it. But, the spontaneity of it. , and again, they’re fairly durable, devices. Now. Some people think that there’s something
hanging out the body. That people can tell you have an implant inside
you. That’s, quite the contrary. I mean nobody knows, ,. You can’t tell. I mean,, even looking at somebody,, even when
it’s deflated, with the type of device I tend to put in. If. The individual has good use of their hands,
called, the inflatable device. And. So that’s a device where there’s a pump
in, the scrotum. And on here,, you know,, just kind of backing
up,. Let me just go over the diagram. There’s a little reservoir here that holds
sterile saline. , inside the penis,, the erection, chamber,
or, the cylinder, and then down in the scrotum, between the testicles is the pump. So. Everything is underneath the skin. There’s a little incision,, maybe about an
inch or so,, and everything is put in through that. So, the device is, think of hydraulics, it’s
filled with water, and that’s essentially how it works,, ah with the device. And. So as long as the individual has good
use of their hands, they’re able to get the inflatable device. And when they want to use it,, they inflate
it, it provides good rigidity.. They can leave it up as long as they want. When they’re done they let it down.. You can use it, you know, five times a day. And, there’s no limit,. Once the patient has
healed up for this. And, then again, as I said,, when it’s deflated,
the cylinders are soft,. It looks soft and you can hardly tell that anybody has anything
inside of them. And, there’s different types of cylinders,
and. Everyone, asks, well,, you know,. How do you measure? And this and that… Well? Everyone has a different sized, penis
of course,, and so we measure and put in what’s appropriate for the individual. And ,. So that’s how that… that works. We keep all this stuff in the hospital. So
We have plenty of,, ah, choices for patients. So. This is a long-term solution. So. These devices,, as I, tell patients, they’re
meant to last 15-20 years, when we put them in. ,. Ah the companies that make them they do
provide the patient, with a warranty, generally for the lifetime of the patient. And I, always joke that it’s just for parts,
it’s, not for labor, so… ,, but you can use it anytime. You want. Spontaneous,, ah,, again…, , and good patient satisfaction. It doesn’t affect ejaculation or orgasm, really
has no…, no role with that. That’s separate. So, risks. Again,. Everything has risks. Just, like the shots, have risks, the pills
have risks,. Everything has risks. ,. So it’s important thing to understand. Probably the biggest thing that people are
afraid of, infection. And, so you know, I, think now days, some of
the enhancements with the device they’re coated with antibiotics. I, think that was probably the best thing. That’s been, I guess about 10 years.. And! That’s really deceased the infection rate. So in a non-diabetic,, the infection rate is
less than 1%,, which is I think, amazing. I mean that’s less than hips and knees. That
The orthopedic physicians, put in. So I think that right there, is fairly amazing. ,. It does,, as it says, on here,, will make
natural and spontaneous erections impossible. But patients. Always they always question,
well. If it doesn’t, work, can I go back to what I had? And I tell them, I mean what did you have
before? I mean the guys that are getting implants
have, ED. Alright,, so we’re not putting implants in
patients that, they take Viagra and it works great or they’re happy on shots. I mean,. They have erectile dysfunction, and
generally. They don’t respond to any other treatment. So they’re looking to be treated. And. So that’s why we put it in. ,! You can get some shortening with the device. A lot of it just depends. On… again, everyone’s
penis is different. How elastic or stretchable the penis is. Ah. Some patients will complain of some loss
of length,, some don’t. And. All that stuff is determined by physical
exam. And. There are things that we do before. Surgery,
To help stretch up the penis, , if that’s a big concern of patients. And again,. This is where seeing somebody with
some experience in this , ah process can help you to get good satisfaction, . Mechanical failures. We talked about, and then
pain. But again. This goes back. To…, , and the
risks have to be put on here. I. Think it’s important. If. You look at patient satisfaction, in excess
of, 90, 95% and that’s been over the years. And. So that’s not anything. That’s new that
just kind of popped, up., And, that’s…, various studies all over the
U.S. and outside of the country, , that patients like it. So. Certainly if something had all these horrible
risks,, we wouldn’t still be putting in the implants. And, so ah,, that’s a possible thing,, ah. Is it covered by insurance or Medicare? It. Actually, is. Medicare covers it., At least for now, I joke. And ah,. It is covered by Medicare, TriCare,
really. Most insurances cover it. It’s rare that insurances don’t. , for those that are self-pay,. It’s expensive
so,, you know, fifteen,, eighteen thousand, dollars. And I do have some patients that… pay. ,, but in general, most of the patients,
the majority,. The overwhelming majority of patients,, their insurance, covers it. Their Medicare and what have you, cover it. So. It is covered by insurance, and if here
is a problem with the device, , again, , insurance will cover for it to be fixed, and
corrected, and this and that. Ah,. Obviously, the company doesn’t guarantee
insurance coverage and that’s something that the practice does. We have people,. That’s all they do,. They figure
out authorization and everything else. And, counsel, the patient, on what their piece, if
they decide to get an implant, is gonna be., You know,. What their component is. So, not every urologist is a prosthetic urologist., , ah, and you know,, as we said, I mean,
you, know, I’ve been doing prosthetic, urology, really, since I got out of training, so, now
we’re coming up on 20 years,, which is sort of a scary, number. But, ah, I’ve been fortunate enough to do
it. I, really like it. And, because I really like it and I’ve done
a lot, I’ve, gotten pretty accomplished at it and so… And I. Think it’s important to get good outcomes,
to see somebody that’s experienced in it. Because, you know,. There are little nuances,
just with any surgery. , I. Don’t do cancer robotic, surgery. We have people here that do that stuff, and…
and ah. Or. We have people that take out. Kidneys. I mean again,. Fortunately, in our group we
have all these specialists that can concentrate and focus. And, so today,, like I said, I, mean I, did four
prosthetic cases. That’ a lot of cases,. When you ask the AMS
people…, I mean that’s,, and that happens. Every week. , Tuesday is my day. And. So we stay fairly busy. And. So it’s important to seek somebody with
some experience in this and ah, to get a good result, I. Think that that’s key., So, again, erectile dysfunction is very common.. A lot of great treatment. Options. Penile implant is a solution and especially
if you’re nonresponsive to the other therapies. But get the partner involved, no question
about, it. And, and feel free… We just opened up our men’s health and wellness
clinic. It’s. Just at the end of the parking lot, so
I’m very excited about that. So,, it’s an environment for men,, … Obviously. The wives can come with their husband. But ah… But the way that the décor is set
up and once the patients get in the back,. There are just guys taking care of them, so…
it’s, a sensitive subject,, no question about it,, and so we try and make the environment,
geared towards guys where they can feel comfortable. Talking to us. The people, I work with,, my team, , they’ve
been, with me… Chris now, a number of years and so ah…
does a great job and so, I. Think that that’s really part of it as well. I mean the feedback we get from patients.

What users commented:

I really wish that there was a view of the slides as the physician was discussing the procedures and devices.