Akash Kapadia, MD Home
Benign prostatic hyperplasia, or BPH, is the noncancerous enlargement of the prostate due to the proliferation of cells within the prostate. BPH is as normal as aging, and this is why approximately 90% of men will have an enlarged prostate by the time they reach the age of 80.
Continue reading “Retrograde Ejaculation After BPH Treatment”
While the end of summer may be filled with enjoying friends and family, barbecues, and getting some last-minute hot weather, it also represents the time we are most at risk for kidney stones. And if you live in or around Atlanta, you have the dubious distinction of being part of the Stone Belt – an area encompassing the Southeast United States where patients are particularly prone to develop kidney stones. Why is that? The combination of outdoor activity, hot weather, and many of us being chronically dehydrated can increase stone development during these hot months.
Continue reading “Kidney Stones This Summer & Fall – What You Need to Know”
If you’ve been considering a penile prosthesis for erectile dysfunction that has not responded to medication like Viagra/Sildenafil or Cialis/Tadalafil, or Trimix injections, you have likely come across the three-piece inflatable penile prosthesis. This is, after all, the gold standard in penile plants and by far the most employed implant to restore erectile function in qualifying patients. However, it’s important that patients understand the full breadth of severe ED treatment options before they choose, even if one option is dominant.
In this case, patients looking for a penile implant may have the option of a malleable implant versus the three-piece inflatable type. In this article, we will talk about the benefits of each, and which may be best for you.
A malleable penile prosthesis is simply a semi-rigid metal core rod that is placed within the penis, replacing the corpora cavernosa that are no longer receiving enough blood to create or sustain an erection. The surgery is straightforward, with the surgeon hollowing part of the penile shaft, sizing the rod, and ultimately implanting it. To achieve an erection, patients lift the penis upward. To eliminate the erection, they put it back down. Everything is performed by hand and on demand.
The Benefits of the Malleable Penile Prosthesis Include
An inflatable penile prosthesis is a three-part medical device that includes two pencil-shaped balloon structures that replace the corpora cavernosa in the penis, a pump and release valve implanted in the scrotum, and a reservoir placed deep within the pelvis. All three of these components are hidden, and after some adjustment time, the patient will barely realize they’re there. The inflatable penile prosthesis is the most common penile implant in use today. To create an erection, the patient pumps the scrotal device 10 to 15 times. This forces liquid from the reservoir into the implant. A small button on the pump allows water to drain out and back into the reservoir.
The Benefits of the Inflatable Penile Prosthesis Are Severalfold:
Note: There are differences between the two major inflatable penile implant devices, which are discussed in a separate blog.
As you can see, both malleable and inflatable penile prostheses can make a big difference in a man’s sex life, especially if they have not been able to enjoy their sex life for some time. There is a reason, however, why the inflatable penile implant is so popular, and that is because the nature of the implant mimics normal erectile function very closely. Erections feel very natural, as does the flaccid penis.
Ultimately, the most important takeaway from this article is that any man who is not able to achieve an erection after having tried medications and injections should know that they do have an option in the form of a penile implant.
Secondly, Dr. Kapadia is one of the region’s leaders in penile implant procedures and is a Center of Excellence for both the Coloplast Titan and the Boston Scientific AMS 700 devices. Schedule an appointment with Dr. Kapadia to learn more and take the next steps towards restoring the erectile function you want.
It’s hard enough to decide to get a penile implant to treat severe erectile dysfunction, even knowing that the alternative may be an inability ever to achieve an erection again. After all, the idea of removing the natural corpora from your penis and replacing them with an implant seems, well, drastic. However, while it may be a difficult decision for you, there is also a consideration about your partner and how to break it to them, if at all.
Before getting into a discussion about this very delicate topic, you must understand a few things.
First, if you are in a committed, long-term relationship, you will most likely want your partner to participate in the decision-making process. It’s unlikely that you can sweep significant surgery under the rug. Not only is there the surgery itself but also the recovery, during which time you will not have any sexual interaction. Secondly, having a partner to support you during recovery and even in the initial decision-making process is very important for your physical and emotional well-being.
Older patients who are not in committed relationships and who are dating older partners may find the conversation to be slightly more straightforward as well. After all, as we get older, we usually understand the physical limitations that come with age. Whether it’s taking erectile function pills like Viagra or Cialis, needing injections, or even a penile implant, the concerns become less concerning. Most importantly, the function is there.
So, in the end, this discussion primarily concerns younger and middle-aged patients whose partners would not expect them to have or need a penile implant.
Many patients, especially those on the dating scene, choose to hide the fact that they have a penile implant. It is a decision that every patient must make individually. However, there is some degree of fear and trepidation that comes with keeping this kind of secret that can preclude a patient from enjoying their sex life. Also, no matter how discreet the penile implant may be, and it most certainly is, being entirely contained within the body, it remains somewhat difficult, especially when a man is having regular sexual relations with the same person, to hide the motions needed to inflate and deflate the prosthesis.
So, let’s get into what you can say or do to alleviate concerns associated with a penile implant and reduce the possibility of misunderstandings by a partner.
Explain what a penile implant is and isn’t. When someone discusses a penile implant, the first thought is toward male enhancement. However, these implants are purely functional and have nothing to do with increasing a man’s length or girth. This must be explained clearly to avoid confusion or thoughts that the implant may be for aesthetic purposes.
When discussing the penile implant, it may also be helpful to explain the need for it. Whether it was a traumatic event or vascular issues that caused the inability to achieve an erection, having your partner understand that it was a medical issue that necessitated the penile implant can take some of the shock from the announcement.
There may also be some concern on the part of the partner that sex will somehow feel different. This is another misconception that should be discussed, and you have the equipment to prove it. This is especially true with the AMS 700 implant, which feels natural when the penis is flaccid and erect. This part of the discussion must, of course, be approached very carefully and tactfully.
If you have an upcoming visit on the books with Dr. Kapadia or your local penile implant specialist, it may be good to invite your partner along to hear directly from the surgeon about the device. Your partner can even understand the composition of the implant by looking at and feeling a demo device.
Lastly is understanding the problematic truth that can occur in some relationships. While we would all hope that our personalities and other attributes would be enough to enjoy a committed relationship, some people fixate on a problem that, in this case, has no bearing on sexual function.
While we praise the virtues of modern three-piece penile implants (and they are technological marvels) and how discreet and natural they are, most patients will want to tell their partner about their implant to be fully candid with someone they care about. This conversation can go one of two ways…but hopefully very well, with an understanding partner. Most importantly, be sure to do and say what you feel is best for your needs and the needs of your budding or mature relationship.
The sex life of a middle-aged man is under threat from any number of urological conditions. One of the most psychologically and physically debilitating is erectile dysfunction. And while we have excellent first-line options in the form of medications like Viagra and Cialis or their generic versions, Sildenafil and Tadalafil, as well as penile injections, eventually, patients with erectile dysfunction, will not be able to achieve the erection they want, even with these arrows in their quiver.
Unrelated in cause but certainly related in function is a curvature or deformity of the penis known as Peyronie’s disease. There are several possible causes of Peyronie’s curvature, many of which we don’t understand fully. However, the general consensus, or at least a going theory, is that micro-traumas to the penis over time can cause the buildup of penile plaque that ultimately underlies the curvature of the penis. Penile plaque can accumulate anywhere around the penis, and therefore the curvature is not necessarily upward but can also be downward or even to the sides.
Peyronie’s disease has several potential treatments and options. About 5-10% of cases will improve independently. This leaves most patients needing some intervention for relief. The only FDA approved medical treatment for Peyronie’s is a medication known as Xiaflex that can be injected into the penile plaque and, along with manual traction, can soften the plaque and help remodel the penis to a more normal state. Xiaflex can be effective in nearly 75% of patients that undergo treatments, leaving some needing more invasive intervention. Penile plication to straighten the penis with a counter-suture or plaque removal and grafting, which allows the surgeon to remove the penile plaque mechanically, are a couple of options for more significant diseases.
However, if patients are suffering from severe erectile dysfunction as well that does not respond to medications, then they must consider a penile implant. A penile implant can be used to straighten Peyronie’s curvature. Call it a 2-for-1 curative option. This surgical option is, of course, a very personal decision that must be made in consultation with an expert in both conditions, like Dr. Kapadia.
It is worth understanding that a penile implant may not be performed on patients who are responding to ED medications. On the other hand, patients with severe erectile dysfunction need not have severe Peyronie’s to benefit from an implant to address both conditions. In other words, erectile dysfunction is the primary diagnosis and justification for an implant.
In the case of both Peyronie’s Disease and Erectile Dysfunction, the most significant limiting factor in men finding the proper treatment is fear and embarrassment. However, it’s essential to know that Dr. Kapadia works with men of all ages and all severity levels to treat both disorders. So, the first step is making an appointment with Dr. Kapadia to learn more about this and other potential treatment options.
When men reach middle age, they are often struck by the number of tests needed to prevent disease and keep them healthy. One such test that used to be controversial simply because it was misinterpreted but is now very useful is the prostate-specific antigen or PSA test. Let’s briefly touch on the idea of this incredible comeback – PSA was widely used in the 80s and 90s as a measure of prostate and guidance for a biopsy. At the time, we didn’t know much, certainly not as much as we do now, about prostate cancer. Often, these PSA readings were misinterpreted, and the following occurred:
As you might imagine, this treat-everything approach led to over-treatment of a cancer that can be alternately slow-growing or very aggressive. When it was recognized that many patients were over-treated, PSA screening became controversial
We now use PSA as a screening test in conjunction with many additional tests including urine and blood genomic markers for prostate cancer as well as a multiparametric prostate MRI to determine which patients need a biopsy. Furthermore, we are also more selective about which patients need treatment if prostate cancer is diagnosed after a biopsy.
Embarking on a vasectomy reversal journey is no small decision. For one, vasectomy reversals are costly and typically not covered by insurance (unlike the original vasectomy); second, the microsurgical surgical process is intricate and takes quite some time – three to four hours. Lastly, there are no guarantees that a vasectomy reversal will work, though over 90% of vasectomy reversals within ten years of the original vasectomy produce sperm in the ejaculate. This, of course, doesn’t guarantee pregnancy. With all that said, when a man decides to have the vasectomy reversal, he is typically very motivated. One of the top-of-mind questions is “When can we start to try for a pregnancy,” and “How long will it take to get pregnant?”
Of course, these two questions are quite different in that the former relies on the recovery time from surgery while the latter is based on good timing, a bit of luck, and the couple’s fertility status. Let’s dive in.
Continue reading “How Long After a Vasectomy Reversal Can You Expect to Get Pregnant?”
In middle age, most men begin to battle lower urinary tract symptoms or LUTS, most of which are precipitated by a very usual and benign issue known as benign prostatic hyperplasia or BPH. This is what we call the proliferation of cells within the prostate that cause it to enlarge and, ultimately, restrict the outflow of urine. This happens because as the prostate grows, it clamps down on the urethra and narrows its diameter. It is estimated that about 50% of men over the age of 50 and 80% of men over the age of 80 experience BPH. Hence, the likelihood of frequent or incomplete urination, dribbling, or waking up to pee at night is a genuine possibility starting when we hit our 40s.
Continue reading “Can More Than One Enlarged Prostate Procedure Be Performed?”
With all the novel medical and surgical therapies developed over the past few decades to address Erectile Dysfunction or ED, two remain stalwarts in the front-line fight to improve erectile function. These, of course, are Viagra and Cialis, generically known as Sildenafil and Tadalafil, respectively. Both drugs are PDE 5 inhibitors, which essentially relax the muscles in the lining of the arteries, allowing them to expand and delivering more blood as a result. Being that ED is a primarily vascular concern, this increased blood flow is exceptionally important for continued erectile function and sexual health.
Continue reading “Are Viagra (Sildenafil) and Cialis (Tadalafil) Interchangeable?”
When patients find that they need erectile dysfunction/ED medication, their mind often goes straight to which medication is best. This decision can be challenging with all of the marketing swirling around ED treatment. Ultimately, however, the two most commonly known medications on the market are Sildenafil, the generic version of Viagra, and Tadalafil, the generic version of Cialis. Other than the dosages – 100 mg maximum for sildenafil and 20 mg maximum for Tadalafil, the two drugs have similarities and differences that every patient should know and understand.
For one, both are PDE5 inhibitors, which relax and widen blood vessels to allow for increased blood flow. This is the primary mechanism of their effectiveness, and it’s why they are so good for mild to moderate ED.
Continue reading “Comparing Viagra/Sildenafil to Cialis/Tadalafil”