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Author: Akash Kapadia, MD

Penile Implant as A Fix for Both Peyronie’s Disease and Erectile Dysfunction

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Older couple smiling and laughing, woman laughing into older man with beard shoulder

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.

When a Penile Implant Is Indicated

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.

The Bottom Line

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.

Do All PSA Rises Spell Cancer?

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Purple glove holding PSA test tube by the cap over diagnostic paper

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:

  • PSA levels found to be above four, immediately biopsy
  • If the biopsy shows any cancer, go straight to the prostatectomy
  • Manage post-prostatectomy side effects, including incontinence and erectile dysfunction

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.

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How Long After a Vasectomy Reversal Can You Expect to Get Pregnant?

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Man placing hands on pregnant partner’s pregnant stomach

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.

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Can More Than One Enlarged Prostate Procedure Be Performed?

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Man and doctor on doctors table in doctors office, doctor holding clipboard while male patients hands are in lap

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.

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Are Viagra (Sildenafil) and Cialis (Tadalafil) Interchangeable?

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Man popping blue pills out of packaging next to glass of water

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.

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Comparing Viagra/Sildenafil to Cialis/Tadalafil

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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.

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Choosing Between In-Office and Surgical BPH Treatment

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Benign prostatic hyperplasia, or BPH, is a common concern as men age and represents a significant cause of lower urinary tract symptoms ranging from mild to severe. Due to the prevalence of this condition, there are plenty of treatment options, from medication to office therapies and surgery. With all the available options, it can be confusing for patients to make the best choice for their circumstances. This article will discuss office versus surgical treatment options and when they make the most sense for your circumstances.

When patients first begin to experience lower urinary tract symptoms, many believe that they may have prostate cancer. However, prostate cancer rarely presents with urinary symptoms in its earlier stages. Most patients are relieved to find out that their symptoms are caused by benign prostatic enlargement, and they often, at this point, may or may not pursue therapy. Unfortunately, BPH is a progressive condition and tends to get worse. The gradual worsening, however, is often managed through lifestyle changes, including not going out to events or dinner or limiting fluid intake. These slowly creep up on a man, and their life can be severely limited before they know it. Many patients do not understand the breadth of minimally invasive options, including in-office ones, and consequently wait too long for treatment.

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Bent Penis? How Peyronie’s Disease Affects Your Physical and Mental Health

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Man in distress putting hands over face

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.

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Eroxon Topical Erectile Gel

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Man squeezing gel out of tube into hand

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.

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P-Shots for Erectile Health. Legit?

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Doctor with gloves filling injection

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.
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