Video: Treatments for Erectile Dysfunction

THE STAGING GUIDE VIDEO SERIES | TRANSCRIPTION:

Hi, I'm Dr. Scholz. Let's talk about prostate cancer.

This video's going to cover the common treatments for the correction of erectile dysfunction, otherwise known as impotence. Prostate cancer therapy is commonly associated with difficulties getting erections, and a number of methods and treatments have been developed to try and counteract that problem. Everyone's heard of Viagra and Cialis, and there are other products on the market too, such as Stendra. These pill are almost miraculous in their beneficial effects, and typically without much in the way of side effects, they can help re-establish normal erectile function.

Unfortunately, they don't work in everybody after treatment, so there are certainly no guarantees. There's also a possibility for side effects from these pills, though side effects are not terribly common. Some men can develop some stuffy nose or some headaches, see blue hue in their vision, or even get low blood pressure, especially if these medicines are taken with common products like Flomax. But for the most part, these medicines have worked well to re-establish sexual function in a lot of men who would otherwise be completely incapacitated.

Since pills don't work in everyone, what is usually the next step to try and recover erectile function? There are a variety of different things that are tried. Let's cover first the idea of a vacuum pump. These devices, a cylindrical tube is placed over the penis and blood is drawn into the penis to establish an erection with the placement of a elastic band around the base of the penis. This can cause a functional and serviceable erection in probably most men. In my experience however, this approach, being rather cumbersome, and also a little difficult to implement and execute, only proves to be popular in maybe about 15-20% of men. In men who pills aren't working and pumps aren't working, the next level of intervention is to consider an injection. When I was first exposed to the thought of injection therapy, I was rather horrified because we are talking about a shot in the base of the penis. A very tiny needle thankfully, but a needle nevertheless. I discovered over time however, that patients readily accept this type of intervention because it's very predictable and very effective and very convenient. I myself am not trained in the administration of dosing and how to actually do this therapy, I refer to specialists. And I've found over the years that the average urologists typically are not very skilled in teaching patients how to do injection therapy. They just don't seem to be that engaged. It's important to seek out a urologist that spends a significant amount of time working in this area and has experience in training patients. When people are properly instructed, practically everyone will have the restoration of erections that are serviceable for intercourse.

When speaking of injections, there is a product on the market where a small pellet is placed in the urethra; the urinary passage that comes out the end of the penis. This product, called MUSE, is effective also in a relatively small minority of patients, in my experience. Perhaps 10-20% of men swear by the product and are very happy with the results. So while MUSE is not a big success in most people, a minority of men will benefit, and of course, they're attracted to the fact that there are no needles involved. So MUSE is worth a try. Some experts have said that men that are getting semi-serviceable erections with Cialis or Viagra, but that aren't quite adequate, may be the best candidates to try MUSE to try and re-establish an adequate erection for maintaining good results for intercourse.

Lastly, we should talk about the placement of a prosthetic device surgically in the penis. This is a big step; a major operation to put a plastic device inside the penis surgically. This is also very effective, and satisfaction rates with this type of product are about 80-85% of men. So there's a percentage of men that will go through a major operation and not get satisfactory results. Fortunately, this is only a minority. Men certainly have to be motivated to undergo this type of surgery. The men who have undergone this treatment have, for the most part, been very pleased with the results. This type of surgery requires special expertise. Urologists that specialize exclusively in putting in penile prostheses are necessary to get the best chance for a good outcome.

So in summary, to treat erectile dysfunction, doctors typically use a stepwise approach, starting with pills, moving on to vacuum pumps, and then perhaps to shots. And then lastly, if all these other measures are ineffective, surgical intervention with the placement of prosthesis is then considered.

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