Advanced Urology
Centers of New York -
Garden City East

A Division of Integrated Medical Professionals, PLLC

Address

585 Stewart Ave. Suite L14
Garden City, NY 11530
(P) 516.873.5353
(F) 516.873.8850
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Insurance companies

www.imppllc.com

www.aucofny.com

Health Topics

Erectile Dysfunction

Erectile dysfunction (ED) is a common, chronic condition. Based on prior studies including the landmark Massachusetts Male Aging Study, it has been estimated that up to 50% of men aged 40 to 70 years suffer from some degree of ED. ED is most often a vascular disease and most men who have ED also have medical conditions which lead to vascular problems, such as diabetes mellitus, hypertension, elevated lipids and cholesterol and smoking. Evidence is accumulating that ED may predict future cardiovascular events such as heart attack or stroke. It has been shown that ED is an independent predictor of future cardiovascular events comparable to cigarette smoking, elevated lipids and cholesterol, and a family history of heart attack. Men with known medical conditions who present with ED should have a thorough cardiovascular evaluation if they have not already had one. Men without known medical conditions who present with ED should also be evaluated as this may represent impending cardiovascular disease.

It has been over 10 years since the blockbuster ED drug Viagra was first released and many men and their partners have benefitted tremendously from this medication. There are now three oral medications available for men suffering from ED, each with similar side effects and effectiveness. Cialis differs from Viagra and Levitra because it remains in the blood stream 18 to 36 hours allowing couples more spontaneous sexual activity. It is important that men who take these medications are instructed properly to improve the effectiveness of the medication. Additionally, if a man finds one medication not effective his physician should try the others because some patients may find one medication more effective than another.

Although up to 2/3 of men with ED will respond to these medications, men with certain medical conditions have a lesser chance of responding. Men with diabetes mellitus or who have been treated for prostate cancer respond less to these medications. For men who don't respond, a variety of other treatments are available and effective if the patient is motivated to pursue these treatments. Men who fail to respond to the "magic pill" should be referred to a urologist for consideration of other effective treatments.

Peyronie's Disease

Peyronie's disease is a benign disease of the penis of unknown cause and is named after Fancois Gigot de la Peyronie who described the condition in a paper written in 1743. This condition is present in 1 to 3% of the male population and may be higher based on some reports. The condition most often affects middle aged men but has been reported in men as young as 18 years.

The disease often presents with a lump on the penis and may cause considerable anxiety as the patient may think it represents a tumor or cancer. Patients may also experience penile curvature and deformities. Sometimes early in the course of the disease, painful erections may be experienced. Peyronie's disease is also associated with ED although some men will experience psychological ED in response to the penile curvature and deformity.

Although the cause of Peyronie's disease is not entirely clear, experimental research suggests this condition develops as an exaggerated healing response to a minor injury to the penis. Surrounding the penile cylinders which become engorged with blood during erection, called the corpus cavernosa, is a sheath of strong tissue called the tunica albuginea, or the white tunic. It is hypothesized that during sexual intercourse, a minor injury or tear occurs in this sheath and the body overreacts in the healing process and excessive scar tissue is laid down. This scar tissue is called a plaque and sometimes calcium is found in the plaque. Penile curvature and deformity may arise because the plaque does not expand or stretch when the erection develops.

Men with Peyronie's disease should be evaluated because the treatment will be determined by several factors, such as duration of the condition, the degree of penile curvature, the presence or absence of ED, physical or psychological, and whether calcium has been deposited in the plaque. Therefore it is important that men with this condition see a urologist, the specialist best able to evaluate and treat this disease.

Many treatments are available to treat Peyronie's disease but unfortunately, many have not been shown to be very effective. Oral therapies such as Vitamin E or an enzyme called POTABA have not been shown to be very effective. Topical therapy consisting of a medication called verapamil in a cream form applied to the penis demonstrated improvement in only one published paper and some urologists have found this therapy to be unsuccessful. However, several studies have demonstrated that verapamil injections do offer many patients improvement in their condition. Verapamil is a class of drugs called calcium channel blockers. It is theorized that when this medication is injected directly into the plaque it prevents the cells called fibroblasts from functioning normally thus preventing or reducing the production of the scar tissue. For those patients who are not candidates for this treatment or who fail, surgery is often very successful.

Male hypogonadism or low testosterone

Testosterone is the main male sex hormone. Most of the testosterone in men is produced by the testes with additional small amounts secreted by the adrenal gland. In the brain, the hypothalamus stimulates the pituitary gland which in turn stimulates the testes to produce testosterone. Low testosterone is characterized as either primary, testicular, or secondary, pituitary. Low testosterone affects nearly 14 million men in the US. Nearly 38% of men greater than 45 years have low testosterone levels. Low testosterone is frequently found in men with certain medical conditions. 50% of men with obesity, diabetes or AIDS will have low testosterone. 40% of men with high blood pressure and elevated lipids will also have low testosterone and almost 20% of men with ED will be diagnosed with hypogonadism. Low testosterone is often found in men with metabolic syndrome which is characterized by high blood pressure, elevated lipids, type 2 diabetes and central adiposity (increased waist girth).

Emerging evidence from clinical studies strongly suggests that men with low testosterone may not live as long as men with normal testosterone. One study examined male veterans over an 8 year period. Men with normal testosterone demonstrated a survival rate of 79.9% compared to 65.1% for men with low testosterone.

The signs of low testosterone include: increased body fat and body mass index (BMI); reduced muscle bulk and strength; low bone mineral density (osteopenia or osteoporosis); and loss of body hair. The symptoms of low testosterone include: decreased energy; depressed mood; decreased sex drive and ED; diminished work performance; poor concentration and memory; and sleep disturbance.

The diagnosis is determined by assessing symptoms, physical examination and measurement of testosterone levels. Levels below 300 ng/dl are considered abnormally low. Further hormone testing often confirms the diagnosis. Additional testing, such as bone density studies may be advised.

There are several options for treating low testosterone. Testosterone pills are discouraged because of potential liver damage and uneven blood levels. Testosterone injections are effective but should be given weekly. Topical patches and gels are preferred by many patients and provide a steady state blood level. Testosterone pellets have been available for many years but are underused. The pellets are inserted under the skin and last up to six months. A new testosterone injection is not yet approved by the FDA, but consists of two injections in the buttocks and normal blood levels last almost 3 months.

Testosterone replacement therapy (TRT) has been available for decades and numerous studies have shown this to be an effective and safe therapy. There has been concern that TRT may stimulate undetected prostate cancer, however, this has never been demonstrated in any clinical study. Patients who are on TRT need to be monitored. TRT may stimulate prostate growth and increase the red blood cell production. Patients are monitored periodically with a blood count and PSA test.