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Erectile Dysfunction After Treatment Erectile Dysfunction After Treatment Prostatepedia_September 2016 Volume 2 No. 1 September 2016 Volume 2 No. 1 P1 In this issue.... This month, we’re talking about Hormonal therapy can cause severe While there are a range of other erectile dysfunction (ED) in men ED. As a result, the Viagra drug family treatment options for men who have with prostate cancer. The three major often does not pose sufficient activity been on hormonal therapy and for prostate cancer treatment tools— to facilitate vaginal penetration. whom Viagra is not sufficient, I have surgery, radiation, and hormonal Fortunately, two drugs have been shown seen the most success with penile therapy—all result in serious sexual in randomized trials to significantly injections and penile implants. dysfunction in a majority of men. improve the effectiveness of Viagra. Both approaches have a high success And ED treatment options each The first drug is losartan, a blood rate in our patients, but many men pose serious issues with side pressure drug that blocks angiotensin, are reluctant to inject their penises effects, effectiveness, and cost. a hormone that causes blood vessels and even fewer have elected to get to contract. By blocking the action a penile implant. However, those Viagra and related drugs can be helpful of angiotensin, losartan causes blood patients who have elected to get penile for many men. There is extensive vessels to relax. As erections require implants have been very satisfied with medical literature that supports using relaxation of the arteries to the penis, the result. As one patient said, “I push these drugs after surgery or radiation. the benefit of losartan is obvious. a bulb in my scrotum and I get an Most medical oncologists do not erection. It stays up until I push focus on sexual function. I think this Cabergoline is the second drug that has a second time. I wasn’t that good may, in part, explain why we do not been shown to improve the effectiveness at 17!” have well-established programs of Viagra. Cabergoline is a long-acting, to counter sexual dysfunction in men very potent dopamine agonist that has The bottom line? Talk to your on hormonal therapy. With that in mind, been shown to act as an aphrodisiac in doctor about erectile dysfunction I thought it might be worthwhile both men and women. A randomized trial after treatment. to mention what has worked in comparing Viagra alone to Viagra in my clinic. addition to cabergoline showed improved Charles E. Myers, Jr., MD sexual performance in the cabergoline arm. P2 September 2016 Volume 2 No. 1 Jean-Francois Eid, MD The Penile Implant After Prostate Cancer Dr. Jean-Francois Eid, of New York procedures that needed fine, When a man has erectile dysfunction, City’s Advanced Urological Care, precise work, rather than extirpative he thinks about it all the time. It’s not is a urologist who specializes in procedures to remove a big tumor. something that affects him only in the treating advanced erectile dysfunction. I found extirpative procedures bedroom. After a while, it fatigues, to be less technically challenging. occupies, and depresses the brain. Prostatepedia spoke with him Every time he sees a love scene recently about penile prostheses My work continues to fascinate me. in a movie theater or he goes out to after prostate cancer. The patient evaluation requires thorough have drinks with friends or somebody history-taking and some psychological makes a joke or he sees an attractive How did you come to focus on erectile insight, which is something I enjoy person, he is reminded that he has dysfunction? doing. At the same time, you want erectile dysfunction. It depresses men tremendously. Dr. Eid: I became interested in erectile dysfunction as a medical student. The first thing a patient will say Back in the early 1980s, I heard after he gets a penile implant is, a urologist lecture about penile implants. “When a man has “I’m a new man. I feel so free. During my residency at NewYork- erectile dysfunction, You gave me a new life.” It’s sort Presbyterian Hospital, we had an of bizarre, because you would think ultrasound machine in the department he thinks about it all that somebody would say that if you of urology. Nobody was using it, the time.” saved them from cancer or from so another Urology Fellow and I started a heart attack and not from erectile using the machine to do blood flow dysfunction. studies on patients with erectile dysfunction. to make the patient feel comfortable; How does a penile prosthesis work? erectile dysfunction is a somewhat I became interested in using penile personal and delicate issue. There Dr. Eid: There are two types of penile injections to provide patients with is a little art and empathy involved implants. One type of penile implant, erections. I went from being interested in communicating with someone is always firm and is called a semi- in the diagnosis of erectile dysfunction suffering from erectile dysfunction. malleable implant. The other is to being interested in treating patients a saline-filled inflatable implant. with penile injections. Back in the I find it extremely gratifying to make 1980s, we didn’t have pills like Viagra somebody potent again without The inflatable implant was invented and Cialis. We didn’t really have any leaving any traces of the surgery. in 1973 and FDA-approved in 1975. options that worked. My goal is to conceal and hide It consists of two cylindrical plastic the implant so the patient feels tubes that are placed inside the shaft Throughout my training, I always completely normal. of the penis and are connected to preferred delicate reconstructive a pump that is concealed inside the P14 September 2016 Volume 2 No. 1 scrotal sac. The pump is connected half inch either on the right or the How long does a penile implant last? to a small reservoir the size of a ping- left side of the lower abdomen. pong ball that stores the saline when The reservoir is then placed from Dr. Eid: Penile implants will last an erection is not needed. The saline above, underneath the abdominal anywhere from 15 to 20 years. fluid is transferred into the cylinders muscles, and the tubing is tunneled But when they break, they are by activating the pump when the into the scrotal sac to connect easily replaced. patient is interested in being sexually with the pump tubing. A separate active. It’s a hydraulic device that incision is unnecessary for patients Infection of the device is the most is manually activated. It mimics following radiation therapy and is only dreaded complication and occurs a physiological erection, while also needed for patients following robotic because of bacterial contamination allowing the penis to become flaccid prostatectomy. of the implant during the surgical when an erection isn’t needed. procedure. The rate of infection Are there any other considerations varies according to surgeon’s talent, There are two manufacturers, for prostate cancer patients? experience, and surgical volume. both in the state of Minnesota. This can be as high as 15% or as low Boston Scientific is in Minnetonka. Dr. Eid: The data on potency after as 2%. Our infection rate is 0.47% Coloplast is in Minneapolis. prostate cancer surgery varies based on 3,028 consecutive implants tremendously. If you look at the since January 2006. We update our In which patients is the inflatable European data published by independent data on a regular basis. pump used? third parties, post-surgery erections returned to normal in fewer than Specialists will have a much Dr. Eid: This is a great treatment for 10% of men. Another 20% responded lower infection rate. It’s important advanced ED that does not respond to pills like Viagra or Cialis. Seventy for patients to seek out the most to medications such as Viagra or Cialis. percent of men after robotic experienced doctor. Think of a penile In order to optimize the outcome, prostatectomy do not respond implant as one would a root canal we have every possible device size to oral medication. procedure. You want to see a root available in the operating room; canal specialist, rather than a general the penis is measured during the Patients need to know that if they dentist for it. procedure, and the correct cylinder wait for more than two years after size placed in order to maximize surgery and recovery of erections Seeing a specialist is very important, the size and quality of the erection. hasn’t occurred, then it’s appropriate because it minimizes the risk of It’s difficult to tell which implant is to consider a penile implant. infection, maximizes the size of the appropriate for which patient until penis, and optimizes the placement then. The choice of device brand Some patients do use penile self- of the pump and concealment of tubing depends on the patient’s anatomy, injections. There are two types of and incision. Specialists also make his age, his partner’s age, his manual penile injection medication. Caverject smaller incisions, which reduce areas dexterity, whether he has scar tissue, and Edex are FDA-approved and of skin numbness, preserving sensation his body habitus, etc. can be purchased in drug stores. and ability to achieve orgasm. These injections are safe for long- There are some special considerations term use. Do you advise patients to specifically for prostate cancer patients regarding ask about infection rates when reservoir placement (the little ping- There are other types of medications, evaluating doctors? pong-ball-like structure that stores such as Trimix (mixture of papaverine, the saline fluid).
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