Peyronie’s Disease, or PD, is an abnormal deformity of the penis that often presents as a bend or curve of the penis, but it may also present as narrowing, indentation, flopping, or ‘hourglassing’ of the penis. Peyronie’s disease or PD is common and affects up to 10% of men over the age of 40. It is often caused by micro-trauma or ‘wear and tear’ of the penis, but it can also be genetic. While not every bent penis needs treatment, it is important to recognize the physical and psychological impact of PD and learn whether your condition needs treatment. Determining whether treatment is needed can often be as much of a psychological question as a physical one. Why? Not all cases of Peyronie’s are painful, and not all instances inhibit a regular and enjoyable sex life.
You may have heard of a new erectile dysfunction therapy known as Eroxon (MED 3000) that the FDA recently approved for over-the-counter use. It is a topical gel marketed in Europe and the UK as a faster way to gain an erection versus Viagra or Cialis, and their generic forms sildenafil and tadalafil, respectively. However, while this sounds like a fantastic erectile dysfunction therapy, does it work?
Before determining whether this particular gel works, we should discuss the history of topical erectile dysfunction gels and formulations. This very short discussion centers around the fact that we have tried to create topical versions of several medical therapies, including, for example, trimix, which is otherwise used as an injection into the penis, without any success – the simple fact is that, to date, we do not have a reliable therapy that functions topically.
You may have heard of the term biohacking. It’s a colloquialism now used for a practice that is centuries, if not millennia, old – fine-tuning the body to extract the highest and best performance. A favorite therapy of Biohackers is known as platelet-rich plasma therapy, posited as a rejuvenation therapy, and is used in several applications. Orthopedic surgeons use it to help rejuvenate joints. Hair loss specialists claim it may assist with regrowth, especially in those with androgenic alopecia or male pattern baldness. Plastic surgeons use it for facial skin rejuvenation – the list goes on.
Before we get into the details about incontinence after prostatectomy, we must discuss Prostate Specific Antigen (PSA) and how we have modified our diagnostic process and, ultimately, treatment of prostate cancer over the years. You may have read elsewhere on our website that we once used to aggressively treat prostate cancer at the first signs of PSA rising above 4. As we have learned over the years, prostate cancer is often very slow-growing, and a single high PSA reading does not necessarily warrant a biopsy or treatment. Similarly, the presence of prostate cancer with a biopsy does not necessarily mean an immediate prostatectomy. The restraint we have shown with this newer knowledge of prostate cancer has reduced the number of prostatectomies we’ve had to perform and ultimately helped some patients avoid the consequences of such surgery, including incontinence and erectile dysfunction.
It may seem too simplistic and even ridiculous, but we’ve all been told that cranberries and their juice effectively prevent kidney stones. However, before you go out and drink liters of cranberry juice at a time, we must discuss some other ways to mitigate kidney stones and what you should do if you develop them.
Kidney stones are hardened crystals that develop within the kidneys for several potential reasons. Kidney stones do not cause pain for many as they are small enough to pass through the urinary system without us ever knowing. For some, however, kidney stones can develop to be quite large. While the stones remain in the kidneys themselves, they are usually asymptomatic. However, if they begin to migrate into the ureters – the tubes that carry urine from the kidneys to the bladder – they can cause significant pain and other complications. For some, kidney stones represent a harrowing circumstance, which may require passing the stone over a day or two or intervention from a urologist using shockwave therapy or lithotripsy. However, it’s important to remember that if you develop a fever or other signs of infection, this is an emergency that must be treated at the hospital. Kidney infections progress very rapidly and can be devastating if not treated early.
When discussing erectile dysfunction, or ED, most men are laser-focused on treatments to eliminate the embarrassment and lack of function. Because erectile function plays a significant psychological and physical role in our lives and lifestyles, we are often predisposed to trying almost everything to eliminate it, sometimes with little regard for the consequences. From supplements to pills and injections to implants, there is no lack of options when choosing how to treat ED.
Of course, each of the erectile dysfunction treatment options on the market today has side effects. Fortunately, due to the number of studies and funding put into these treatments, most options are relatively safe with minor side effects. However, a significant issue, considered an emergency, can arise from specific erectile dysfunction treatments. That concern, albeit rare, is priapism – an erection lasting more than four hours.
TESEs were first performed in the early 1990s and provided men with a fertility option even if semen analysis showed no sperm – known as azoospermia. This ushered in an era of male fertility options that allowed urologists to retrieve sperm in about 30% of men, ultimately resulting in about 25% of men being able to become fathers. With 1% or so of all American men not having usable sperm in their semen, this was a major step forward.
Around the same time, we began to understand the landscape of male versus female infertility, and we now know that about a third of all infertility issues can be attributed to the male patient, a third to the female patient, and a third to both. So, finding a way to improve male fertility has addressed a key concern of couples struggling to conceive.
The TESE and even micro-TESE is an invasive procedure used for sperm extraction from the testes. Both require cutting into the testicle, at which point the urologic surgeon tests areas of the testicle for sperm. If sperm are found, they are extracted for later insemination.
While there’s plenty we don’t know, we have learned a lot about male fertility and reproduction over the past few decades. One of the most exciting areas of research and advancement has been in the management of male fertility concerns. Nonobstructive azoospermia was at one time considered difficult or impossible to treat, yet now, many men with no detectable sperm in their semen have become fathers. Today, there are several sperm extraction techniques available to these men, but most are invasive. As such, there has been a need for minimally invasive diagnostics to see whether sperm can be found in the testes.
This is where testicular mapping or FNA mapping comes into play. Testicular mapping is a highly effective, mildly invasive diagnostic procedure in which the testicles are mapped using fine needle aspiration. During the procedure, testicular tissue samples are removed and then analyzed to see if sperm is present. This has been a game-changer for patients that once only had the more invasive micro-TESE as their only option. The following information on testicular mapping should be of interest to men suffering from Azoospermia.
- We expect to find sperm in about 50% of men with azoospermia
- Over 30% of men are eventually able to become fathers as a result
- It’s a Less-Invasive, similarly effective diagnostic option versus a Micro-TESE
- It doesn’t reduce testosterone levels appreciably
- Only a few physicians perform it around the US
Why a Second Procedure?
Knowing that testicular mapping is purely a diagnostic procedure, why wouldn’t we just use a micro-TESE that allows for both diagnosis and treatment? The answer is simple. About 50% of men with nonobstructive azoospermia do not have viable sperm in the testes. Both testicular mapping and micro-TESE are very good at identifying patients with viable sperm, but the micro-TESE does so in a much more invasive manner. That means that about 50% of our patients will have an unnecessarily invasive procedure that inhibits their lives and lifestyles and may even cause longer-term low testosterone.
Will It Hurt?
One of the best qualities of testicular mapping is how minimally invasive it is and how little the procedure hurts. To be sure, there will be some discomfort after the procedure as the anesthetic wears off. However, anesthesia is administered during the procedure, and patients do not feel appreciable discomfort. On the other hand, a micro-TESE can cause significant discomfort during the recovery period.
Is Micro-TESE a Bad Procedure?
While the above discusses the downsides of a micro-TESE versus testicular mapping, understand that these limitations are only in the diagnostic realm, and that is why Dr. Kapadia is one of the few urologic surgeons around the country to offer testicular mapping. However, as a sperm extraction procedure (something that testicular mapping cannot do), micro-TESE is the gold standard. If we know there is viable sperm in the testes, a micro-TESE is the most effective way to extract it and help our patients become fathers.
In short, working with Dr. Kapadia to optimize a diagnostic and sperm extraction plan can save time and discomfort in appropriate patients. Dr. Kapadia sees azoospermia patients from all over the southeast United States, and we look forward to scheduling a consultation with you to learn more about the diagnostic options that you may have.
Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for sexual satisfaction. It is a prevalent condition affecting up to 30 million men in the United States and 150 million worldwide. ED can significantly impact a man’s quality of life and intimate relationships. Luckily, numerous treatment options exist for ED, which range in invasiveness and cost. These include oral phosphodiesterase type 5 (PDE5) inhibitors (e.g., sildenafil, tadalafil), intraurethral alprostadil, penile injections, and vacuum devices. However, if these methods fail to provide satisfactory results or are contraindicated due to medical conditions, a penile implant may be worth considering. However, it can also be regarded as a first-line treatment through shared decision-making. This article explores the circumstances under which patients could contemplate a penile implant as a treatment option for ED, discussing the procedure, benefits, and potential risks involved.
Some situations that may warrant the consideration of a penile implant include:
- Non-Responsiveness to Medications: If oral medications or other ED treatments do not produce the desired results, a penile implant may be a viable alternative.
- Anatomical Abnormalities: Certain anatomical abnormalities, such as Peyronie’s disease (scar tissue formation in the penis) or severe congenital penile curvature, can coexist with refractory ED. In such cases, a penile implant can help overcome these physical limitations.
- Underlying Medical Conditions: Individuals with medical conditions like diabetes, spinal cord injuries, or prostate cancer treatments (e.g., radical prostatectomy) may experience persistent ED that does not respond well to conservative treatments. A penile implant can offer a solution in these cases.
There are two primary types of penile implants: inflatable and malleable.
- Inflatable Implants: This type consists of inflatable cylinders placed in the penis, a fluid-filled reservoir, and a pump. The cylinders fill with fluid by squeezing the pump in the scrotum, creating an erection. After intercourse, the liquid is transferred back to the reservoir, deflating the implant. The reservoir is typically placed within the pelvis through the same incision used to place the implant.
- Malleable Implants: Malleable implants, also known as semi-rigid implants, consist of bendable rods inserted into the penis. They allow the individual to position the penis for sexual activity manually. Unlike inflatable implants, malleable implants do not require a pump or reservoir. However, the same level of natural flaccidity is not achieved with a malleable.
Penile implants offer several benefits for individuals with persistent ED:
- Reliability: Penile implants provide a reliable and on-demand solution for achieving and maintaining erections.
- Spontaneity: Unlike other treatment options that may require planning or timing, penile implants allow for spontaneous sexual activity.
- Improved Satisfaction: Across multiple studies, penile implants have been shown to have up to a 90% patient and partner satisfaction rate. This high satisfaction rate makes sense as penile implants can restore sexual function and enhance overall well-being.
However, it is essential to consider the potential risks associated with penile implants, and discussing these factors with a physician is crucial before making a decision:
- Infection: While rare, the risk of developing an implant infection is between 1 and 3%. Infection risk is higher in the following situations: replacement or revision of penile implant, immunosuppression, poorly controlled diabetes, and pre-existing infection anywhere else in the body. In case of penile implant infection, the device must be removed, the cavity washed out, and new placement.
- Mechanical failure: As with any mechanical device, there is a chance of breakdown of the components over time, requiring reoperation. The risk of mechanical failure is 5% at five years after device placement.
- Intraoperative complications: Complications during the operation are exceptionally rare. However, one notable complication is an injury to the urethra, which requires abandoning the surgery and waiting to place the implant when the urethra has healed.
When traditional treatment options for ED prove ineffective or unsuitable, a penile implant can be considered a viable solution. It offers individuals a reliable and on-demand method to regain sexual function, improving quality of life and intimate relationships. However, the decision to pursue a penile implant should be made after carefully considering the individual’s unique circumstances in consultation with Dr. Kapadia.
Vasectomy is a safe, effective, and permanent method of male sterilization. Despite its widespread use, numerous misconceptions and myths surround this procedure. These misconceptions often deter men from considering a vasectomy. In this article, we aim to debunk some of the most common myths about vasectomies. By separating fact from fiction, we hope to clarify and enable men to make informed decisions about their reproductive health.
Myth 1: Vasectomy Is Immediately Effective
While vasectomy is an effective contraceptive method, it does not immediately render a man infertile. After undergoing a vasectomy, sperm will initially remain within the reproductive tract, which can potentially lead to pregnancy. It takes time and several ejaculations to fully clear the remaining sperm from the vas deferens and seminal vesicles. Men should continue using contraception until follow-up semen analysis in the office 8 to 16 weeks postoperatively demonstrates no sperm. Before this testing, men should perform at least 10 to 20 ejaculations.
Myth 2: Vasectomy Is Irreversible
Contrary to popular belief, vasectomy is not always irreversible. While the procedure is intended to be permanent, options are available for men who later decide to father children.
It is possible to restore fertility through a procedure called a vasectomy reversal, which is performed microscopically. Surveys suggest 2 to 6% of vasectomized men will ultimately seek reversal. It is important to know that this surgery is often expensive and not covered by insurance.
Myth 3: Vasectomy Is Painful
Many men avoid vasectomy for fear of pain and discomfort during the procedure. However, vasectomy is a relatively quick and straightforward surgical procedure. Most vasectomies are performed using local anesthesia, which numbs the area and significantly reduces pain. The process typically takes 15-30 minutes and involves making a small incision in the scrotum to access the vas deferens. Some men may experience mild discomfort or soreness post-surgery, but this can be managed with over-the-counter pain relievers and ice packs.
Myth 4: Vasectomy Increases the Risk of Prostate Cancer
In the past, men with vasectomies were believed to have a greater risk of developing prostate cancer. However, numerous studies have investigated this association, and the overall scientific evidence does not support a causal link between vasectomy and prostate cancer.
Myth 5: Sex Will Not Be as Pleasurable After a Vasectomy
Many men express concern that undergoing a vasectomy will reduce their sexual pleasure. However, it’s important to understand that vasectomy only interrupts the delivery of sperm during ejaculation. Vasectomy does not affect any of the nerves in the penis, so sensitivity or pleasure will remain unchanged. It also does not affect testosterone production, libido, or the ability to achieve and maintain an erection. Further, the freedom from worrying about unplanned pregnancies may make sex even more pleasurable for both partners.
Myth 6: Men Who Undergo Vasectomy Ejaculate Less
It is a common misconception that a vasectomy will reduce a man’s semen volume. However, the testicles contribute only about 5% of your semen volume. The remaining 95% is produced by the prostate and seminal vesicles, unaffected by a vasectomy.
Vasectomy remains a highly effective and reliable option for men seeking permanent sterilization. We hope to encourage men to make informed decisions about their reproductive health by dispelling common myths surrounding vasectomies. Men considering a vasectomy must consult a healthcare professional who can provide personalized information and address concerns.