Is the Penile Implant the “last resort” or “best option” for ED?

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Every day in clinic I meet men who complain that their erection is weaker. I repeat: every single day.  Erectile dysfunction is very common and occurs to approximately 40% of guys above 40 years old.  These men often come in to see me after they‘ve done their research online to know what their options are.  They find many alternatives which include oral medications, injections, urethral gels, vacuum therapy, shockwaves, PRP, stem cells and the penile implant. Unfortunately, some of these are experimental and have not been proven to work. Without knowing the pros and cons of each treatment option, it is hard to know what is the best option for each individual.

I first wish to clarify that ED is NOT an “on and off switch”.  What I mean by this is that many people think that men either have a VERY STRONG ERECTION or NO ERECTION at all.  However, those who suffer from it know that it is a spectrum. Think of it as a scale or grading system.  The erection can be anywhere between 0% (completely flaccid) and 100% (hard as a rock).

That said, every man who notices that he is having problems with either gaining or maintaining an erection should consider going to see his primary care doctor.  They should first make sure that there is no medical condition that could be contributing to his sexual impotence.  If you are diagnosed with Diabetes, heart disease, high blood pressure, thyroid problems, low testosterone, etc : these medical conditions could be the cause of your weak erections.  The second thing they should do is:  visit a specialist!  Visit someone who knows all the treatment options and can help guide you to what is best for you.

What is the best treatment for ED?

This is a difficult question to answer because there are different causes of erectile dysfunction.  For example, men with “hormonal ED” will benefit from Testosterone Replacement Therapy. Men with psychogenic ED benefit from behavioral sexual therapy. However, men with vascular erectile dysfunction, that is problems with blood flow in the penis will not necessarily respond to Testosterone or behavioral therapy.  This is why it is important you go visit a SPECIALIST who can help guide you towards the best treatment specifically for you.

“My doctor told me the penile implant is the last resort”

Another thing we need to clarify is that the penile implant is probably the MOST EFFECTIVE therapy for ED, no matter the degree or severity of erectile dysfunction.   Multiple research studies have shown that men with penile implants are more satisfied with their sexual function than those taking pills, injections or vacuum therapy.  If you wonder, treatment satisfaction rate after the implant is more than 95% for BOTH patients AND partners.  That is more than 30% more than pills, injections and vacuum therapy!

So… why do some consider it the “last resort”?

Most of the time we offer the penile prosthesis for men with severe ED that do not respond to medications or other therapies. The inflatable penile implant is a device that is placed inside the penis. It will occupy the space and disrupt that space within the erectile tissue.  If the implant needs to get removed; then, other therapies (like Sildenafil, Tadalafil or injections) will not work. This is the reason some doctors consider it as the last resort. “….because once you have the implant there is no going back”.  However, I do not think this way and I will explain why…

Does the Penile Implant need to be replaced regularly?

There is a big misconception regarding penile implants.  Many men think that it needs to be replaced regularly, but the fact is that it does not.  In 5 years, 95% of implants still work.  Research studies have gone up to 15 years, and 70% of penile prostheses were still working!  I have seen men 18 to 20 years after their original surgery who still have a functional implant that helps them gain and maintain the erection they want.

Is the penile implant the best option for me?

As previously mentioned, the inflatable penile prosthesis has been scientifically proven to be the BEST treatment option for ED and the therapy with the highest satisfaction rate. Even though it is mostly reserved for men who do not respond to medications or other therapies, there are men that get the procedure done for other reasons.  Here are some examples:

1. Some men do not want to go through EVERY… SINGLE.. THERAPY before they find a solution.
2. Some men do not want to take medications even though they work.  Oral medications like Sildenafil or Tadalafil are known to have side effects like headaches, back pain, flushing of the face, etc.  To be honest…. Men don’t have to “settle” for a treatment that is causing them side effects.
3. Other men find injections and vacuum therapies are not good for their lifestyle.  Injections require timing and preparation.   Most of these injectable medications, like Trimix, need to be refrigerated and can cause long-lasting painful erections, scar tissue, among other side effects.  Vacuum therapies need lubrication and a rubber band to “keep the blood trapped” inside the penis which can cause pain and discomfort.  These inconveniences can decrease the spontaneity of the sexual encounter and be a “turn-off” for most couples.
4. Some men have already failed everything. They still fear the penile implant because someone told them “there is no going back”.  I usually answer them with..   “you’ve already failed everything. What is it you ‘would be going back to, injections or pills that you already know don’t work?’.  Immediately, they understand that it is time to take the next step if they wish to recover their sexual life back.

So… is the penile implant the best option for guys with ED? In most cases, it actually is! Think about it.  The inflatable penile implant is inside your body, completely concealed. It will be there on demand, every.. single.. time you need it.  After you recover from the surgery, it is unlikely you will have pain or discomfort.   It will take you 30 seconds to achieve an erection and it will remain erect until YOU make it go down.

In Summary…

Although erectile dysfunction is very common, there are many causes and severities that make treatments to be different for each individual.  Goals are very different for every man and every couple.  My goal as a specialist in Urological Sexual Medicine is to help you reach your goals.  If you think a penile implant is an option for you, come visit us.  You do not have to FAIL everything and all other treatment options to be a “candidate”.   If you have erectile dysfunction, I have great news for you:  You ARE A CANDIDATE for the penile implant. It is not the last resort. In most cases, it is the best resort and solution for ED.   We can help you reach your goals!   Call us!  I would be honored to help you.   Remember we are….  GatekeepersofMen!

El implante de pene: la última opción para la Disfunción Eréctil, o la mejor opción?

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Todos los días veo a hombres que presentan a mi clínica con la preocupación de que su erección está “más débil”. Repito:  TODOS LOS DIAS.  La disfunción eréctil, o impotencia sexual, es bien común y ocurre en 40% de los hombres mayores de 40 años.  Muchos hombres que sufren de impotencia sexual llegan a mi clínica luego de haber investigado en el internet acerca de sus opciones de tratamiento.  Estas opciones incluyen: medicamentos orales, inyecciones, terapia de vacío (Vacuum), terapia de shock, inyecciones de plasma, células madres y el implante de pene.  Desafortunadamente, algunas de estas alternativas aún se consideran experimentales y no son recomendadas por la academia de Urología Americana o la Sociedad de Medicina Sexual.  Por lo tanto, es difícil saber cual es la mejor opción para cada individuo si no conocemos los beneficios y riesgos de cada terapia.

Antes que todo, quisiera clarificar una cosa:  La Disfunción Eréctil no es un encendedor que prende y apaga.   Muchas personas (hombres y mujeres) piensan que solo dos cosas ocurren en los hombres en cuanto a sus erecciones:  UNA ERECCIÓN BIEN FUERTE o CERO ERECCIÓN.  Sin embargo, aquellos hombres que sufren de impotencia sexual saben que es un espectro.

Ahora bien, todo hombre que haya notado que tiene problemas con obtener o mantener una erección debe visitar a su médico primario. Usted debe de asegurarse de que una condición médica esté contribuyendo a su impotencia sexual.  Si usted tiene diabetes, la presión arterial alta, problemas de su tiroide, colesterol, baja testosterona, etc.: estas condiciones pueden ser la causa principal de sus erecciones débiles.  Lo segundo que esos hombres deben de hacer es: ¡visitar a un especialista!  Visite a alguien que conozca a fondo las opciones de tratamiento y que pueda guiarlo y proveer una solución para usted.

¿Cuál es el mejor tratamiento para la disfunción eréctil?

Esta pregunta es difícil de contestar porque hay diferentes causas para la disfunción eréctil.  Por ejemplo, los hombres con “disfunción hormonal” responden a terapia de Testosterona.  Los hombres con “disfunción psicogénica” se benefician de terapias de comportamiento sexual.  Sin embargo, los hombres con disfunción eréctil VASCULAR, eso es problemas con el flujo sanguíneo sanguíneo hacia el pene no necesariamente responderán a la Testosterona o terapias de comportamiento. Por eso es que es bien importante que visite a un ESPECIALISTA que pueda guiarlo a usted hacia el mejor tratamiento específicamente para usted como individuo.

“Mi doctor me dijo que el implante peneano es la última opción.”

Otro argumento que debemos de clarificar es que el tratamiento más eficaz para la disfunción eréctil es el implante de pene. La prótesis hidráulica de pene es el mejor tratamiento para la impotencia sexual sin importar la severidad de la disfunción.  Múltiples estudios investigativos han demostrado que los hombres con implantes de pene están más satisfechos con su función sexual que aquellos hombres que son tratados con pastillas, inyecciones y/o la terapia de bomba de vacío.  Para ser más específico, la taza de satisfacción para los pacientes con implantes peneanos y sus parejas excede un 95%.   Esto es 30% más que las pastillas, inyecciones y la bomba de vacío!

Entonces… ¿por qué algunos lo consideran el último recurso?

La mayoría de las veces nosotros ofrecemos el implante peneano a los hombres que sufren de disfunción eréctil SEVERA. Eso es, aquellos que ya no responden a otras terapias o tratamientos.  La prótesis hidráulica, conocida como “la bombita”, es un dispositivo que se inserta dentro del pene. El implante ocupa y destruye el espacio dentro del téjido eréctil del pene.  Por lo tanto, si el implante se remueve, otras terapias como las pastillas o las inyecciones intracavernosas NO van a funcionar. Por esa razón muchos doctores consideran el implante peneano como la última opción.  Muchos dicen “…una vez te pongan el implante, no hay vuelta atrás.”  Sin embargo, te explicaré porque yo no pienso de esa manera…

¿El implante de pene tiene que re-emplazarse regularmente?

El concepto más equivocado que escucho en cuanto a los implantes peneanos es el siguiente:  Muchos hombres piensan que el implante tiene que cambiarse regularmente, cuando realmente esto no es cierto.  En 5 años, 95% de los implantes aún funcionan.   Los estudios investigativos demuestran que 70% de los implantes funcionan más de 15 años!  Yo he visto hombres 20 años luego de su cirugía que aún tienen su bombita funcionando.

¿La mejor opción para mi sería el implante de pene?

Como mencioné anteriormente, los estudios científicos han demostrado que el implante hidráulico de pene es la MEJOR opción de tratamiento para la disfunción eréctil y la terapia con la mayor taza de satisfacción.  Aunque se ofrece mayormente a hombres que han fallado otros tratamientos, hay hombres que se hacen la cirugía por otras razones. Aquí algunos ejemplos:

1. Algunos hombres no quieren intentar TODAS… LAS.. TERAPIAS antes de encontrar una solución permanente.
2. Algunos hombres no quieren tomar medicinas aún si éstas funcionan.  Las pastillas como Sildenafil y Tadalafil tienen efectos secundarios como dolores de cabeza, dolores de espalda, palpitaciones en el pecho, enrojecimiento de la cara, etc. Para serte honesto….  Los hombres no tienen que conformarse con un tratamiento que le esté causando efectos secundarios.
3. Otros hombres encuentran que las inyecciones y la bomba de vacío no son la solución debido a su estilo de vida.  Las inyecciones funcionan en un tiempo específico y toman preparación.  La mayoría de las inyecciones tienen que mantenerse refrigeradas y pueden causar erecciones dolorosas, tejido de cicatriz, entre otros efectos secundarios. La bomba de vacío  necesitan lubricación y un anillo de constricción para “atrapar la sangre” dentro del pene que puede causar dolor e incomodidad.  Estas inconveniencias pueden disminuir la espontaneidad del acto sexual y le “quita las ganas” a muchas parejas.
4. Algunos hombres ya han intentado y fallado todo.  Aún así temen el implante de pene porque alguien les dijo “no hay vuelta atrás”.  Sin embargo, mi contestación a ellos es la siguiente “ya has fallado todo.  ¿A qué irías de regreso? ¿Inyecciones y pastillas que ya sabes que no funcionan?”.  Inmediatamente ellos entienden que es tiempo de tomar el próximo paso hacia la recuperación de su vida sexual.

Por lo tanto, la contestación a la pregunta “el implante peneano será la mejor opción para mi?” En la mayoría de las ocasiones, sí lo es! Piénsalo.  La prótesis hidráulica de pene está escondida dentro de su cuerpo. Va estar listo para uso en… todo… momento y SIEMPRE que usted lo necesite. Luego que usted se recupere de su cirugía, es poco probable que usted tenga dolor o incomodidad.

En Resúmen…

Aunque la disfunción eréctil es bien común, hay muchas causas y severidades que hace que los tratamientos sean diferentes para cada individuo. Tanto cada hombre como cada pareja tienen metas distintas.  Mi meta como especialista en Medicina Sexual Urológica es ayudarlo a usted llegar a sus metas.  Si usted cree que el implante de pene es una opción para usted, visítenos! Usted no tiene que fallar todos los otros tratamientos para ser un “buen candidato” para el implante.   Si usted tiene disfunción eréctil, tengo excelentes noticias para usted: Usted ES CANDIDATO para el implante de pene. La bombita no es el último recurso.  En la mayoría de los casos, es el mejor recurso. ¡Nosotros podemos ayudarlo a llegar a su meta! ¡Llámenos! Sería un honor poder ayudarlo.  Recuerde que somos… GatekeepersofMen!

Congenital Penile Curvature

Are all curves the same?

Curved or bent penis. This is the ONE condition in Men’s Health that generally NO ONE talks about.  Some men even wonder “can that really happen?” and, those who suffer from it think “Am I the only one with this?”.  Many years ago, men with penile curvature suffered in silence and, fortunately, now we even see it in commercials and realize we are not alone.

Penile curvatures are very common.  The penis can bend upward, downward or to the sides.  In most occasions, the curvature is mild and does not cause any problems. However, some men have more complex curves that make them more self-conscious.  Most often, a penile curvature is due to normal differences in penis anatomy, but sometimes scar tissue or another problem causes a bent penis and painful erections.

The 3 R’s of Men’s Health

People often ask me what I do as a urologist who specializes in Men’s Sexual Health.   It is simple. I sum it up in 3 words. I refer to them as the 3 R’s of Men’s Health:

1.     Rehabilitate

2.     Reconstruct

3.     Restore

Helping men live LONGER and BETTER…

A male’s life expectancy 

Every day I see men of all ages who come into our office concerned about their erections.   These range from men in their early 20s to those in their late 80s.  But what they do not know is that in many occasions, their sexual or reproductive concerns can be the effect or aftermath of something far more serious.   In our last post we discussed the relationship between erectile dysfunction and heart disease.  Today, we will dive in deeper and discuss how a we, as a men’s health specialist, can help men live longer.

June is the official month for Men’s Health!

This week the European Urology Focus journal published a scientific article that immediately caught my attention.  The title was “Male Sexual and Reproductive Health – Does the urologist have a role in addressing inequality in life expectancy?”. [1]  We all know life expectancy for men is less (70.5 years) when compared with women (75.6 years).   This study aimed to evaluate the association between male sexual and reproductive health-related diseases and life expectancy.  In other words, if there is a correlation between these two, then a urologist (the physician who focuses in male sexual and reproductive health) can play a vital role to improve life expectancy for men. So… if you are wondering what research has shown are the leading causes of death in men, here you go:

Main contributors of Death in Men

1. Cardiovascular disease (CVD)
2. Cancer
3. Diabetes
4. Respiratory disease
5. Injuries (Trauma)

Studies indicate men have higher premature death rates from CVD because they tend to have higher rates of all major risk factors.  These risk factors include high blood pressure, obesity, diabetes, high cholesterol and smoking.   The number one cause of respiratory disease in men is smoking.  Research has shown that men start to smoke earlier than women and smoke more cigarettes per day than women. [2] Smoking can also lead to CVD, cancer and erectile dysfunction.

Think about it.   All these can be prevented!

If you exercise regularly, eat a healthy diet and control your blood pressure and cholesterol levels, you can prevent or at least delay heart disease and diabetes.

How can we screen for CVD?

A urologist regularly evaluates men with erectile dysfunction and, as discussed in our previous post, erectile dysfunction can be a sign of CVD.  Simple screening tools for CVD include measuring your blood pressure and obtaining blood work. Important labs are a lipid profile to check your cholesterol and triglyceride levels,  and a hemoglobin A1c to screen for diabetes.

Low Testosterone: Helping men live longer

There is a strong connection between testosterone deficiency and diabetes. The American Diabetes Standards of Care recommend to check testosterone levels in every man with diabetes and decreased sexual drive (libido) or erectile dysfunction. Even more, research shows that testosterone can improve overall health and hence, help men live a longer healthier life.  Testosterone, when used appropriately, can offer MAJOR health benefits for men.    Even though there is still a controversy between testosterone replacement therapy and cardiovascular safety, most research studies and experts believe that testosterone treatment is SAFE when managed adequately.

Prostate Cancer and Survivorship

The most common cancer in men (second to skin cancer) is prostate cancer.  Given African-American and Hispanic men are more likely to not only be diagnosed with prostate cancer, but die from it, we strongly encourage prostate cancer screening.  Also, even though there is no conclusive evidence that any single diet will protect men from acquiring prostate cancer, a study published in the World Journal of Urology in 2017 reported that physical activity, controlled body weight and a diet rich in vegetables can reduce the risk of prostate cancer progression.  Therefore, we encourage men diagnosed with prostate cancer to aim to improve their diet and increased their physical activity.

We need to remember that prostate cancer therapies have increased cure rates and overall survival. When detected early, prostate cancer is CURABLE! Surgery and radiation can cure early stages of prostate cancer.   If you survived prostate cancer and now suffer from erectile dysfunction, low testosterone symptoms, urinary incontinence or changes in orgasm, an urologist specialized in sexual health is primed to help you.

In Conclusion…

Many men who come to see me haven’t even seen their primary care doctors in years.  As a urologist and Gatekeeper of Men  I pledge to help screen men to improve not only their sexual and reproductive lives but their OVERALL health. I encourage EVERYONE reading this to visit their primary care doctors and visit your local urologist. We can help and are here to serve you!