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Some degree of penile curvature is not unusual but a significant, often painful onset of new curvature occurs this could signify the development of Peyronies Disease.  Peyronies Disease can occur in men of any age but most  frequently in men in their 50′s. The worst aspect of Peyronie’s is that it could result in significant sexual dysfunction making sexual intercourse impossible. Painful erections are also commonly associated with Peyronie’s.

The actual cause of Peyronie’s Disease is unknown and why some men get it and others don’t is a mystery. It can be associated with  penile trauma and a condition know as Dupytren’s Contracture where abnormal scar tissue forms on the hands and feet.

Peyronie’s Disease often follows a particular cycle which can last over a period of 18 months.  Progressive curvature with varying degrees of pain may occur in the first 6 months. The pain often resolves as does the curvature in a significant number of men. Unfortunately a good percentage of men are left with severe curvature requiring treatment in order to resume normal sexual function.

Treatment of PD depends on the severity of the curvature and a man’s overall ability to have an erection. If the curvature is mild and not interfering with sexual function no treatment is required. Severe curvature usually requires surgical correction which often results in significant improvement and a resumption of sexual activity. When ED is present along with Peyronie’s Disease the best treatment is placement of an Inflatable Penile Prosthesis.

There is no question that Viagra was ( and still is) a breakthrough medication. I remember hearing about Viagra before it was released and how doubtful I was that a PILL could actually work at causing  erections in men with ED.  The rest of course is history. Subsequently Cialis and Levitra became available with essentially the same effectiveness as Viagra.  As we have since learned, about 60% of men with ED respond to these medications and the remaining 40% do not.  There are also a number of men who  intitially respond and then stop responding.  That’s a lot of men!

Why does this happen? Do men become immune to the medication?  Are they getting a bad batch of pills? Are they taking it properly? Well there are several reasons why this happens and there are several points to be made about taking these medications properly.

The first thing to know is that these medications often do not work the first time taken. Many men require 2 to 4 occasions to use the medication before it works-why this occurs is not entirely understood. Second, it’s important to maximize the effectiveness of these medications with proper timing (Viagra requires taking the pill one hour prior to sexual activity and preferably on an empty stomach. Cialis and Levitra 30 minutes before sex).  The maximum dose must also be used if lower dosages are not working. And as I’ve mentioned in a previous blog, normalizing a low Testosterone level will also increase the effectiveness of these meds in many men so this should be addressed.

Now if all these factors are accounted for and the medications still aren’t working this likely represents a severe degree of ED. If the medications were working at first and are no longer effective this likely represents a worsening of the ED rather than the body “getting used to” the medications.  In order for the medications to work there has to be some normal functioning nerves and blood supply  present. So when a man stops responding to the medication it usually represents a worsening of the physical factors in the body rather than an immunity or the body becoming used to the medication.

The best way to maintain your current level of Erectile function, with or without medication is to maintain a healthy lifestyle. This includes diet, exercise, smoking cessation and stress reduction.

For advice on maintaining normal erectile function, lifestyle changes or treatment when medications do not help your ED call 215-563-1199 to arrange a consultation with me.

Penile Rehabilitation (PR)  refers to a set of treatments designed to restore a man’s ability to achieve an erection following Prostate Cancer Surgery (i.e., radical prostatectomy). PR was created to help men resume normal sexual function following treatment for Prostate Cancer. Since many men may not be able to obtain or maintain their erections after treatment, PR may contribute to a quicker recovery of normal sexual function.

What is PR ?

PR varies from doctor to doctor but almost always consists of a combination of an oral Erectile Dysfunction (ED) medication (Viagra, Cialis or Levitra), a Vacuum Erections Device and Penile Injections. The idea is to maintain the health of the penis by stimulating as much blood flow into the penis on a regular basis so that a normal erection can occur. There is no one method to perform PR, but most Urologists agree that a combination of these treatments should be performed shortly after Prostate Cancer treatment.

Does PR Work?

After PR treatment many men are able to obtain erections and engage in normal sexual activity.  Studies are inconclusive as to whether or not spontaneous erectile function will return sooner, or at all, with PR treatment.

It’s important to note that if you have ED prior to Prostate Cancer Surgery (or Radiation Therapy), PR will not restore your normal erectile function. However, there are many treatments for ED so that you can engage in normal and satisfying sexual activity. (See my blog post from December 21, 2o11.)

What’s a Man to Do?

Since there is little downside to PR it’s a good idea to provide stimulation and blood flow to the penis as soon as possible after Prostate Cancer Surgery.  The sooner men resume their normal routines (including work, exercising, hobbies, etc.) the better!  Resuming your daily routine plays an important part in regaining normal erectile function.

Most Urologists performing Prostate Cancer Surgery do place their patients on PR treatment after surgery.  Be sure to ask if PR will play a role in your recovery if you’re contemplating Prostate Cancer Surgery. If you would like a consultation with me regarding my PR program, call 215-563-1199 to schedule an appointment.

What is Low T? 

The issue of low T is the significant impact this has on important areas of men’s health.  This is a very HOT topic now as it should be. Testosterone (T), the male hormone or chemical in the bloodstream provides a lot of what makes us MEN in the physical and mental sense. (Women have testosterone too at a much lower level). A normal part of aging is a decline in Testosterone levels starting  at around age 50 so it’s worth discussing.

 Testosterone is a vital element in men’s health that is associated with the following facts:

• Contributes to normal sex drive and erectile function
• Help maintain normal muscle size and strength
• Contribute to normal bone growth and strength
• Is associated with a sense of well being and mood
• Is necessary for Sperm Production

When T levels decline, all of these areas can be affected. So how do you know if you have low T? Common symptoms of Low T are ED, decreased sex drive, fatigue, feeling unmotivated, memory changes, loss of muscle mass and increased belly fat (spare tire) and an increased risk of mortality due to heart disease.

Treating Low T:

Low T is quite treatable and correctable through treatments commonly referred to as “T Replacement Therapy“.   There a number of ways to accomplish this: topical medication, injections, implantable pellets.  Unfortunately there are no oral Testosterone medications as they have been found to be toxic to the liver. All of these are good options and should be discussed with a doctor who is experienced in diagnosing and treating low T. The biggest mistakes I find are not interpreting the Testosterone levels correctly and not increasing the levels sufficiently with medication to correct the symptoms of Low T.

Once T levels are back in the normal range there is an obvious improvement in the way men feel. Sex drive  and energy levels are increased, erections improve, muscle mass increases. There  are also the benefits of improving bone health, metabolic functions (such as improved diabetic control, adiposity or fat levels), improved cardiovascular health and a reduction in the risk of Dementia.

Are there Risks of  T Replacement?

T replacement has been shown to be quite safe but close monitoring by a physician is essential. While  T replacement will not cause Prostate Cancer it could stimulate hidden cancer by raising PSA levels. PSA is the blood used to help detect prostate cancer in men. If this rises to an abnormal level while on T replacement a prostate biopsy should be performed. This happens to a a small number of men on T replacement.   A small number of men may experience hair loss, breast enlargement, leg swelling or a  rise in Red Blood Cell count, all of which are treatable and reversible.

To find out if you have Low T ask your doctor to obtain a simple blood measuring your Free and Total Testosterone levels. For more information, counseling or treatment of Low T you can schedule a consultation with me by calling 215-563-1199.

At the risk of sounding like a cliche, one size DOESN”T fit all when it comes to ED treatment. Fortunately, there are many good treatment options for men  with ED. A man’s response to ED treatment depends of many factors such as the cause of ED, the length of time ED has been present, severity of the ED to name a few. The BEST ED treatment is the one that works for you.

Treatment options for ED include over the counter preparations, Testosterone Replacement Therapy, oral prescription medications (ie Viagra, Levitra, Cialis and now Staxyn), Vacuum Erection Devices, Penile Injection Therapy and Penile Implants. My philosophy: whatever works for you that is safe and effective. So if an over the counter herbal works (and they might in men with mild cases of ED) then go for it. What is important is to have the appropriate evaluation of your ED and have realistic expectations. You’re probably not going to respond to an over the counter oral medication if you had a non nerve sparing Radical Prostatectomy for prostate cancer,  but you might if you have no risk factors such as smoking, Diabetes and you’re in decent physical condition.
It’s essential to have your Testosterone (T) level checked as part of the evaluation. If your T is low your ED may be successfully treated with T replacement alone. Many many who did not respond to oral medications such as Viagra or Cialis will respond if their low T is treated appropriately. (More on Testosterone Replacement Therapy in a future post).

The best way to treat your ED is to start simple and move to different treatments if one doesn’t work.  I will treat low T first and frequently combine this with an oral medication in men with moderate to severe ED (ie Diabetic or men who underwent treatment for  prostate cancer ). If this fails I will recommend penile injection therapy or a Vacuum Erection Device. When a man has tried all of the above options without success the best option is an Inflatable Penile Implant. Without question this is THE best option when a man has tried everything else without success. (See my post on Demember 1).
I would be very happy to discuss the evaluation and best treatment options for your ED. You can call 215-563-1199 to schedule a consultation with me.

ED (erectile dysfunction) or Impotence is defined as the inability to achieve an erection sufficient for sexual intercourse. This a very common condition which affects over 18 million men worldwide!  Although ED can affect men in their 20′s, it most commonly occurs in men over 40 years old. If we exclude psychological causes of ED (which absolutely exist), the most common causes of ED are Diabetes (#1 on the list), Hypertension, High Cholesterol, Smoking, Obesity, Vascular Disease (including Heart Disease and PAD) and treatment for Prostate Cancer (both Surgery and Radiation).
As you know, lifestyle components such as diet, activity and smoking have a great impact on ones overall health. In fact, most of the conditions noted above, including ED, are greatly impacted if not caused by lifestyle factors making them potentially preventable in many men. Since normal Erectile function is largely about NORMAL BLOOD FLOW getting to the PENIS, maintaing healthy blood vessels is essential for normal erectile function. A healthy diet, regular exercise and avoiding smoking are THE best ways to maintain healthy blood vessels in your body. In fact, several studies have shown significant improvement in erectile function though lifestyle changes alone.  And this doesn’t necessarily mean becoming a vegetarian or a marathon runner!  Your body wants to move and have good nutrients added to it to stay healthy so even small changes in your diet and exercise will have a positive impact on your health: doing SOMETHING is always better than  doing nothing.
Of course, you can be doing all the right things and still develop ED. This is especially true of healthy men undergoing treatment for Prostate Cancer where ED may be an unavoidable side effect requiring treatment.
For the most up to date treatment for ED you need to see a professional, and the best person for this is a Urologist. For a consultation with me to discuss successful ways to treat your ED please call 215-563-1199.

This is a question I am asked everyday by the men who seek my professional advice in regards to their erectile dysfunction, but only after they have tried every other “treatment” (dietary supplements, vacuum pumps and even prescription medication) all of which failed.   There are situations that simply cannot be effectively treated with the most common methods. For those men for whom nothing else seemed to have worked, their best alternative is to consider a Penile Implant. It simply is the only treatment that fully restores a man’s ability to achieve an erection for complete sexual activity and satisfaction. We’re talking normal sensation and orgasm every time!

What is a penile implant?

It’s a medical device(like a heart valve, knee or hip replacement) that is implanted into the penis through a small opening in the scrotum. Once implanted it cannot be seen and nobody except you knows that it’s there.  Penile implants are one of the most reliable medical devices that are made. The two companies who manufacture Penile Implants are American Medical  Systems and Coloplast.

Is a Penile Implant safe?

As a Urologist who has implanted many of these I have no hesitation recommending a Penile Implant for many of my patients. I always encourage men to get into the best physical condition that’s possible for them before proceeding with an implant. This means obtaining a medical clearance from your doctor stating that you’re fit for the procedure. If you’re Diabetic this must be under control. If you have heart disease this must be stable. If you’re  on any blood thinners they must be able to safetly stop these for 7-10 days prior to placing the implant.

Is a Penile Implant Penile Enlargement Surgery?

NO. Penile enlargement surgery has nothing to do with restoring a man’s sexual function.  A penile implant, however, will prevent a man’s penis from shrinking as often happens after prostate cancer surgery or from simply aging.

How do I know if a Penile Implant is for me?

Having a discussion with a Urologist who is experienced in Penile Implant Surgery is the best way to make an informed decision to proceed with this. This is something I am very experienced in and would be glad to have an in depth conversation with you about. Please call 215-563-1199 to schedule a consultation with me.