Dr. Bryan Kansas on Erectile Dysfunction
Dr. Bryan Kansas: Hi, I'm Dr. Bryan Kansas and I'm here to talk to you about erectile dysfunction today. It's a very common issue we see here in the office and it can effect anyone in their 20's all the way up to their 90's. Sometimes people are a little embarrassed to talk about it but it's what we do for a living so it's something that we like to help people out with. In general, an erection is very simple. More blood flow out than blood flow out equals an erection. It's a fairly simple formula.
There are some nerves that release chemicals that make this happen and we'll get more intricate with those chemicals in just a little bit. The structure of the penis has the corpora on the sides. There are two of them. These are what fill with blood and create the erection. The urethra is in the middle and this is what someone voids through. The head or glands on the top is for cushioning and sensitivity. There are a lot of reasons for erectile dysfunction. People who smoke tend to have erectile dysfunction. People who drink too much alcohol tend to have erectile dysfunction. People who are overweight and don't exercise and some anti-depressants and blood pressure medications cause this, there can be psychological reasons and then of course pelvic surgery including radical prostitecthamy and certain colon procedures.
There are many options for erectile dysfunction. I like to start low and move up the chain. We typically start with trying to figure out what's going on and rule out a psychological issue then we go onto oral agents like Viagra or Levitra or Cialis. These certainly don't work for everyone but it's not the end of the line. Try them first if the patient fails on those we move forward. The mechanism by which these work is they inhibit a compound called phosphodiasperase 5. This compound actually breaks down nitric oxide which is released by the nerves in order to help the flow into the penis. If someone fails oral agents the next step would be something like a vacuum erection device. This is an external device that the patient puts over the penis, manually pumps the blood into the penis, and then drops a ring to the base of the penis in order to prevent the blood from flowing out. When the patient is done with intercourse they remove the ring and the erection goes away. But if the vacuum erection device doesn't work for them the next step would be muse which is an insert able tablet that goes down the urethra and is directly absorbed into the penis.
After this we can use injectable agents such as prostate gland e1 or a trimix solution. Sometimes it's a little difficult to convince someone to stick a needle in their own penis but they work reasonably well. The next step would be surgical. There are three different types of penile prosthesis. A malleable prosthesis which is essentially two semi stiff rods placed into the corpora. The patient puts the penis up when they want to use it and the simply just fold it away when they don't want to use it. These are reasonable. They work well. They are slightly less expensive alternative.
After this there's a two piece penile prosthesis. This has the two cylinders that go into the corpora. The pump that goes into the scream. All the fluid is maintained within these single units. The downside to these is they don't deflate all the way so a patient has a semi erect penis from time to time. One that I use most frequently is a 3 piece penile prosthesis. It actually has 4 components. 2 cylinders for the penis, that's 1. A pump and the scrotum, and the reservoir that holds 2 to 3 ounces of sterile saline solution which goes into the groin. There's a very high satisfaction rate with these devices. About 90 or so % of people would tell their friends they would have it done again. The mechanical reliability is good. They typically last between 8 and 12 years. They can be replaced if need be. The approach I like to use is an infrapubic approach. I like to come above the penis and make an inch or an inch and a half long incision. I put the cylinders into the penis. The pump goes down into the scrotum, the reservoir goes down into the groin all through that single incision. I typically do these as an outpatient. They take between 30 and 40 minutes on average. I send the patient home with a drain. The drain comes out in the office the next day. This is up inflating the penis and there's the finishing product there. This is the approach that most surgeons use. It's between the penis and scrotum. I'm personally not a big fan of this because I believe it leads to a higher infection rate by coming across the scrotum.
In general I just want people to know their intimacy can be re achieved. You are not the only one. I like to take a stepwise systematic approach to this. I like to go non-surgical first and surgery if needed only.
Thanks.