Erectile Dysfunction: A Sign of Heart Disease

“The penis is the gate way to the heart”

This week I had a patient who was scheduled to undergo a surgery for enlarged prostate.  I was excited to finally be back in the operating room after weeks without being able to perform elective procedures due to the Covid-19 pandemic.  As soon as I step into the surgery center’s building, I received a call from the anesthesiologist who suggested postponing the surgery.  We found that the patient’s blood pressure was very high and not well controlled. Upon questioning, the patient mentioned he decided to stop his blood pressure medications several weeks prior without consulting with his primary care physician.  After listening to the story, one of the nurses then told me:  “My husband does the same.  They notice that medications cause erectile dysfunction and he would rather continue with elevated blood pressure than lose his erections.”  This remark drove me to write today’s article.

June is the official month for Men’s Health!

Therefore, today I wish to focus on a very important topic.   Erectile dysfunction (ED) can be an indication of a man’s risk for heart disease and early death.   Yes, you read that correctly.   Erectile dysfunction is not only a problem that can affect the intimacy between you and your partner but can also be a symptom of something far more serious.

Remember there are 4 types of Erectile Dysfunction

(Do not worry, we will soon discuss and describe each and every one of these in the near future!)

1. Psychogenic
2. Neurogenic
3. Hormonal (low testosterone)
4. Vascular

However, the most common type is vascular erectile dysfunction.   Vascular ED occurs when there is not enough blood flow getting to the penis (arterial insufficiency) or the penis is unable to “trap” the blood inside (corporo-venous occlusion, also known as ‘venous leak’).  In order to understand how this works we have to remember that the blood vessel that brings blood flow to the penis (penile artery) is extremely small and much smaller than the vessels feeding the heart.  A clogged artery will impede the blood flow necessary to create an erection. Therefore, if a man has heart disease (also known as coronary artery disease), it is very likely that the penile artery will get clogged before the coronary arteries in the heart.

That is why erectile dysfunction can indicate if a man is at risk for heart disease and early death.  The phrase “The penis is the gateway to the heart” stems from this concept.  Men with atherosclerosis, or build-up of plaque in the arteries that cause blockage of blood flow, will have problems with blood flow in the penile artery before the coronary artery.  As we celebrate Men’s Health Month, I feel obliged to let all men know:

Erectile dysfunction can be both prevented and treated by practicing a healthy lifestyle. 

If we treat risk factors for heart disease, which include smoking, high blood pressure, high cholesterol, diabetes, obesity, among others, you will not only be able to perform in the bedroom, but also live a longer life.   It is very important that men discuss sexual symptoms with their doctors to help us identify cardiovascular or other risk factors that might be affecting your overall health.

In Conclusion…

So… please, follow your doctor’s orders.  Take those blood pressure medications. Control your cholesterol levels. Try to quit smoking. Do not let the diabetes to get out of control.  We (doctors) are only here to help you.  If you have problems with your erections, we have all the tools to help you.  If you are searching for an urologist, Come visit us!   It will be an honor to help you get back in the game and continue playing the game for a loooooooong time!

Men’s Health during the Coronavirus Pandemic

First of all, I want to disclose that I am NOT an infectious disease expert and just like you, I am learning about this new Coronavirus every day. We all know that the human race as a whole is going through a difficult time that will impact our lives, if it hasn’t already. This can be physically, socially and financially. However, when you listen to the experts, there is one great thing about it…  WE HAVE THE POWER TO CONTROL IT.  We can ALL contribute to avoid spreading this disease.

A good friend of mine, and sexual health expert, recently said “Today, Men’s Health has a different meaning”.  He is correct!  We have to focus on what we have in front of us.  This motivated me to write a blog post describing the different things we, as men,  can do at home while we try to #FlattenTheCurve by practicing social distancing.  These practices should be continued even after the pandemic is controlled. The goal of this post is to appease our minds. There is no need to panic, we will get through this.

I was recently diagnosed with prostate cancer and my treatment has been delayed, what should I do?

This is probably one of the most common concerns and a very important one for men.  First of all, remember that prostate cancer is curable. Most prostate cancers are considered “slow-growing”, meaning:  they do not progress as fast as other cancers do.  Some research studies found that certain prostate cancers DO NOT become more aggressive in up to 6 months without treatment. In other words, if you were recently diagnosed with prostate cancer of low or intermediate risk, the probability of it becoming more aggressive while you wait to get treated is low.  However, if you were diagnosed with prostate cancer make sure you contact your urologist to ensure that he or she discusses the severity of your diagnosis and the plan of care.

I have Peyronie’s disease, what can I do at home?      

Traction therapy is one of the least invasive therapies for Peyronie’s Disease and its success has been shown to be dependent on one thing: TIME.  Fortunately for us, the coronavirus has given us more TIME to be at home.   Men who have penile curvature, can go ahead and use their traction devices to help improve their curvature.

Xiaflex is the only FDA approved medication for the treatment of Peyronie’s Disease. These are injections administered in cycles. Each cycle involves 2 injections delivered into the Peyronie’s plaque 2 days apart.  Your doctor will then wait 6 weeks to start the next cycle. What are patients supposed to do in between each cycle? MODELING exercises which can be achieved with or without Traction Therapy.

If the coronavirus interrupted your injections, do not worry.  Peyronie’s disease should not get worse if injections are being delayed.  Take advantage of the time you have at home and exercise the penis through modeling and traction therapy!

I have Low Testosterone, will I need to stop my therapy?

Many men who come to our office with low testosterone are boosting their T levels with Bio-available testosterone pellets.  These pellets are slowly absorbed and usually last in our bodies  3 to 6 months.  If you were getting testosterone pellets and fear to be exposed to the coronavirus or cannot get to your doctor’s office, hope is not lost. You should consider injectable (intramuscular or subcutaneous) testosterone shots while you wait for your next testosterone pellet administration.  These are injections that you or your partner can administer in the commodity of your home once or twice a week.   Moreover, if you are getting weekly injections at a “Men’s T-clinic”,  there is no need for you to do that anymore.  You can give yourself those injections at home! Lastly, for those wondering if pharmacies will run out of testosterone injections, we do not anticipate this happening.

I have ED and my penile implant surgery was cancelled, what should I do?

Recently, the Surgeon General of the United States, World Health Organization and CDC recommended hospitals to cancel all elective surgeries.  Hospitals are trying to preserve beds and ventilators for those who will need it.  We understand penile implant surgery is considered outpatient and will not require a long hospitalization.  For those men who were scheduled for surgery, we have your best interest at heart.  We do not want you to be exposed to the virus and want you to stay healthy.

Rest assured, your surgery will be re-scheduled as soon as we feel it is safe for you to undergo the procedure. 

That being said, if you are wondering what you can do while you wait for your surgery…

Penile Injections

If you haven’t tried Trimix injectable therapy: now is the time to consider using it!  Penile injections work similar to oral medications. They expand the blood vessels that bring blood into your penis to help you gain an erection.  Trimix injections should be first administered by your doctor to ensure what’s the best dose for you. Our goal is for you to have a strong erection for intercourse that will last how long YOU want it while limiting side effects. Call our office and I will be glad to prescribe you the medication.

Vacuum device

If you have already tried and failed injectable therapy and can’t wait for your penile implant, the best thing you could do while you wait is vacuum therapy.   Imagine you are going to run a marathon. The only way you will finish that race successfully is with TRAINING.  Your penis is about to go through a marathon (surgery), and we want your penis to be ready for that “marathon”.  Vacuum therapy can help “train” your penis for surgery and keep its tissues strong and elastic by preventing scar formation, also known as fibrosis. Vacuum therapy will also stretch your penis and allow your surgeon to put in the biggest implant possible.

I was planning on visiting the office, and now I am unsure if I should go.

I have GREAT NEWS for you.  Our office is equipped to provide TeleMedicine visits.  TeleMedicine allows for you to “visit” us and talk to me, your doctor, from the comfort of your home. Call us for more information! 

One last thing, take advantage of the extra time and give your body some love: rest, hydrate, EXERCISE! Also, remember to continue washing your hands, practice social distancing and follow the CDC and World Health Organization recommendations.  This too shall pass and hopefully, soon we will get you back in the game!

Why you should choose Rezum Therapy to treat your Enlarged Prostate

Gatekeepers of Men is BACK!  It’s been several months since my last post and I am certainly excited to bring #GatekeepersofMen back into action. I want to start out this post with a fun fact: 50% of men above 50 years old suffer from symptoms of an enlarged prostate (BPH). Do you understand those numbers?  In other words, if you are above 50 years old and you are reading this, either you or just best friend (assuming he is also your age) have some type of obstructive urinary symptom secondary to BPH.

Men tend to suffer with these symptoms without knowing that there are minimally invasive procedures that can help restore urination patterns. Therefore, today we will talk about the major advantages of REZUM Water Vapor Therapy.  After being designated as one of the few Centers of Excellence in the United States for Rezum Prostate Therapy, I felt the obligation to describe these advantages for everyone to know.

1. Opportunity to discontinue medications

We all know that men want to stay away from anything related to medicine.  We do not like going to the doctor and we certainly do not like taking medications.  Prostate medications include alpha blockers (e.g Tamsulosin or Flomax), 5-alpha reductase inhibitors (e.g. Finasteride or Dutasteride), and PDE5 inhibitors (e.g. Cialis or Tadalafil).  All these medications have side effects, some of which can be detrimental to your health.   Rezum Therapy is a minimally invasive procedure that gives you the opportunity to have a strong steady stream WITHOUT having to take your prostate medications.  After you recover from your Rezum therapy, you have a very high likelihood that your doctor will take you off those medications.

2. No general anesthesia required. Rezum is an in-office procedure.      

Rezum is NOT a surgery.  It is a minimally invasive procedure that can be safely done in the office. 

Therefore, you do not have to wait long hours in the hospital or need to go to the operating room.   You do not have to undergo the risks of general anesthesia. And, most importantly, you will be able to go home right after the procedure.  There is no need to stay in the hospital.   The procedure can be done successfully under local anesthesia and light sedation with minimal discomfort.

3. Preserves Sexual Function (Erections and Ejaculation)

The goal of every procedure in medicine is to provide the best possible outcome while minimizing adverse effects.  Most surgeries that are available for enlarged prostate, like the Transurethral Resection of the Prostate, commonly referred to as the TURP or “Roto-Rooter”, carry potential adverse effects.  In most occasions, men who undergo the TURP find themselves exchanging their ability to ejaculate for a better urinary stream.  The TURP and other prostate procedures can also increase the risk of erectile dysfunction.

Now we have a solution that can help preserve your ejaculation and erections! Research studies show that Rezum is able to successfully treat obstructing prostate tissue while preserving sexual function.  In the initial clinical trial, there were no patients developing ED after 4 years and ejaculation seemed to improve over time.

4. Duration of the procedure is less than 5 minutes

Most prostate procedures done in the operating room take anywhere between 30 minutes to up to 2 to 3 hours.  I have vast experience utilizing the Rezum technology and the procedure has never surpassed 4 minutes (even for bigger prostates).  Rezum is a quick procedure that most of the time takes no more than 2 minutes for it to be completed.  It is both quick (therefore minimizing discomfort) and efficient.

Click here to Watch the Rezum Therapy

5. Rezum provides long lasting results

Research shows re-treatment rates similar to the TURP surgery after 5 years.  Now, remember that Rezum is a fairly new technology that’s only been available to patients for less than 6 years.  The available research studies reveal that after 4 years, only 4.4% of men required another procedure to help them urinate and only 5.2% of men had to restart their medications. These numbers are very similar to the TURP that has shown up to 14 % of patients requiring surgical re-treatment after 5 years.

In Conclusion…

We believe Rezum is a great solution for the treatment of urinary symptoms secondary to an enlarged prostate. At the time of the publication of this post, our office is one of the few Rezum Center of Excellence offices in the United States, and one out of three in the state of Texas.  If you suffer from obstructive urinary symptoms, are tired of taking medications, or are having complications from an enlarged prostate, call us!  We would be honored to help improve your quality of life.

Why Choose Dr. Clavell?

Dr. Clavell is considered an expert in BPH and Rezūm therapy. He has extensive training and experience using Rezūm and is the first Rezūm center of excellence in the state of Texas. Dr. Clavell’s protocol is well-known to minimize discomfort, optimize patient outcomes and is currently being adopted by many urologists in the community. Dr. Clavell will sit down and explain in detail what to expect before, during and after your procedure. Call our urology clinic in Houston, TX at (713) 652-5011 today to schedule an appointment.

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Prostate Cancer Treatment Options

The purpose of the Movember movement is to create awareness among MEN and women regarding prostate cancer. I want to emphasize how important it is for men to go to their urologist and get their prostates checked.  We all know women tend to be more responsible than their male counterparts when it comes to their medical care and health.   Why?   Us Men feel we are invincible, strong, machos, heroes, the main character in the movie, and silverback gorillas. Moreover, it isn’t until we start feeling very sick or have multiple problems, that we decide to go to the doctor.

Continue reading “Treatment Options for Prostate Cancer”

Movember

Time to create Awareness of Men’s Health Issues!

Movember (from the Australian-English diminutive word for mustache , “mo”, and “November”) is an annual movement involving growing of moustaches during the month of November to create awareness of men’s health related issues including Prostate Cancer, Testicular Cancer, Men’s Health and suicide prevention.

Therefore, I have decided to dedicate this month’s #GatekeepersofMen series to the Movember movement.  Let’s start off with Prostate Cancer.

How common is prostate cancer?

Prostate cancer is the second most common cancer in men (skin cancer being the most common).  The American Cancer Society estimates that about 1 out of 9 men will be diagnosed with the disease during his lifetime.   That number is staggering!  Think about it, if you are in a get-together event with 8 of your male friends, one of you will be diagnosed with prostate cancer!

Moreover, older men and African-American men have a higher risk of developing cancer in their prostate.  60% of cases are diagnosed in men older than 65 years old, and it is extremely rare for men under 40 to be diagnosed.  Regarding race: 1 of every 6 African-American men develop prostate cancer.

Who is at risk?

1. Age: The risk of developing prostate cancer increases with age.  This is why we encourage men older than 50 years old to ask their doctors about screening.
2. Family History: If someone in your family (brother, father or son) was diagnosed with prostate cancer you have a 2 to 3 times higher risk of developing the disease.
3. Race: Studies show that African American are at higher risk of developing prostate cancer.
4. Smoking: Just as with other cancers, smoking increases your risk of developing prostate cancer.

What are the symptoms of prostate cancer?

Unfortunately, not everyone experiences symptoms. Many of the “signs and symptoms”  coincide with BPH and these include:

• Urinary frequency, especially during the night
• Difficulty starting urination
• Difficulty holding the urge to urinate
• Weak stream
• Blood in the urine or semen

One symptom: frequent pain of the lower back, hips or upper thighs, could be an indication that the cancer is already spreading. Therefore, it is crucial that us men start the screening process when indicated.

What does Prostate Cancer Screening involve?

1. PSA test:  PSA stands for prostate specific antigen. PSA is a chemical that ONLY the prostate produces into the bloodstream.  When PSA is found elevated in a blood test, it indicates that there is increased activity of the prostate. In some occasions, that increased activity may indicate that there is uncontrolled cell growth which means, cancer is growing.
2. DRE:  DRE stands for digital rectal exam.  Yes. It is a necessary tool that urologists use to help detect the presence and aggressiveness of prostate cancer even though nobody likes this test.  Why?  Not all prostate cancers show an elevated PSA. Therefore, we don’t want to miss a cancer that may be growing even when the PSA is within normal limits.

When should I start screening?

The most common question that I receive from friends, family, and patients is: when do I need to start screening for prostate cancer? Basically, if you are a MALE above 50, talk to your doctor about screening.  Most importantly, if you are African American or have family history of men with cancer in their prostate, you should consider screening starting at 45 years old.

In Conclusion…

If you are a male above 50 years old, are African-American or have a family member with history of prostate cancer, you should visit a urologist.  Early detection is key!  Studies show that more than 98% of prostate cancers are curable if detected and treated early.   If it is detected late, the chance of survival beyond 5 years can be as low as 26%.

In our next post I will be talking about how prostate cancer can be treated. If you are looking for a urologist, come visit us.  We are eager to meet you and help you retake the reigns of your life.  You are in control!

Considering Surgery for your Enlarged Prostate?

Over the past decade, urologists and men with obstructing urinary symptoms secondary to BPH have been introduced to a number of surgical alternatives for managing this condition.

Continue reading “What to know when considering surgery for BPH”