Causes, Symptoms and Treatments for Erectile Dysfunction (ED) and Male Urinary Incontinence

thanks for coming to one of our many educational seminars we have through Chesapeake urology I'm dr. Tom Houston I'll be speaking tonight first on erectile dysfunction we will also have a talk from dr. Chang following this on urinary incontinence and treatment there up I'll give you a little information on myself first I was raised in the San Diego area I went to the United States Naval Academy undergrad and then the Navy was kind enough to put me through med school so I went to med school at Georgetown University and then did my residency and internship at the Naval Medical Center in San Diego and after that I did 20 years in the Navy was head of the major teaching program at Balboa in San Diego where we taught residents a lot of the surgical techniques that were going to be talking about tonight after I retired in 97 I came out here in join dr. Cara Monta and dr. Zoran and we were in practice for a number of years and then we joined Chesapeake urology and we've had the opportunity to give these educational seminars we now have access to a lot of the more recent and up-to-date techniques and it's exciting to be able to talk to you tonight about some of the things that we're doing to treat both IDI and urinary incontinence first we're going to talk about erectile dysfunction we're going to cover a lot of things a lot of which is is already pretty common knowledge but I'm going to touch on some of the reasons people develop your wrecked-tile dysfunction some of the conservative and then some of the more advanced treatments that we have over and above just pills to treat this problem we define it as the persistent inability to attain and maintain an erection that allows you to have satisfactory intercourse so that can include someone who gets an erection and then has the erection go down too soon it can count patients who just can't get an erection at all with or without stimulation it includes also premature ejaculation and things like that which we may touch upon it's a very common problem one in five American men over the age of 20 has erectile dysfunction or has experienced some sort of erectile dysfunction episode in their lifetime and more than half of men over the age of 40 have some degree of erectile dysfunction fortunately I guess because of that attention is getting on TV men aren't suffering in silence anymore they're coming up and asking their primary care physician and then coming to see us when need be a little about the erectile process it's a combination of neurological and vascular things going on when the brain sends the signal with pleasurable arousal sensation to the penis what happens is the blood vessels in the penis engorge and cause the two erectile bodies which these are them in cross-section but there are two cylinders in the penis that normally engorge with blood to allow for a firm erection the blood vessels that supply the penis are two very delicate blood vessels that run alongside the prostate and so those blood vessels can be affected before any other blood vessels in the body by things like atherosclerosis diabetes hypertension things like that so you may have no other manifestations and then suddenly start manifesting the fact that you can't maintain an erection it's also intuitively as you would guess related to overall health sometimes we find that erectile dysfunction is the first symptom of something more serious going on diabetes vascular disease etc etcetera so when I see someone for erectile dysfunction I'm thinking not only about the IDI but I'm thinking about are there other things that may be going on that may have precipitated this problem and so we kind of it's it's kind of our job as overall clinicians to say okay we're gonna treat that but we're I'm gonna make sure you don't have something else going on so we it many times we may do screening tests for diabetes prostate cancer heart disease things like that erectile dysfunction affects patients in a lot of different ways it can affect your overall quality of life and it just has a major impact across all of the spectrum diabetes is the number one cause of erectile dysfunction in men and it happens because of the small vessel disease diabetes is notorious for causing the blood vessels in the body to develop plaques and to interfere with blood flow that's also a reason why many men who have diabetes can develop phimosis if they're uncircumcised the foreskin gets tight and becomes harder to retract and that also can lead to erectile dysfunction in many instances so many times what I'll do as a urologist when I examine a patient is we'll look at a urine to make sure they're not spilling sugar into the urine we'll check labs to make sure that they're not running high blood sugars and if they have diabetes we'll look to make sure the diabetes is under control check your hemoglobin a1c check your fasting blood Sugar's etc etc once more and more about diabetes talking about the vascular disease patients who have diabetes it's pretty important that number one we're going to treat the edy but it's it's very important that you get the diabetes under control and keep it under control we do that also for prevention of cardiovascular problems etc etc the longer you have diabetes the further it can progress and the more likelihood there is a developing erectile dysfunction it's also very common in patients who have heart disease a lot of patients who have either hypertension or heart disease are on a lot of medications and so it it always happens that a patient will come in to see me and they'll have started a new medication and they'll have erectile dysfunction and many times a lot of medications that are specifically used to treat the heart and blood pressure can it adversely affect erect erections the problem is you got to be on these medicines because you have to get these other problems under control so we have to work around them it's not simply a matter of stopping these medications so we have to keep them going we also screen patients for vascular disease Claude occation just because the blood vessels to the penis are involved doesn't mean other blood vessels can't be involved too and so patients may have problems with peripheral vascular disease trouble walking distances without getting cramps in their legs things like that so these are all things that are important to get under control now a lot of patients will ask me well the first thing you'll say is well well we need to check my testosterone because I'm not getting good erections testosterone plays an important part in the erectile syndrome but testosterone isn't the gasoline that drives the engine for erections okay getting erections like we talked about is a vascular phenomenon you have to have the blood flow you have to have the flow through the pipes to get the penis heart and keep it heart testosterone is more a function of general well-being sex drive muscle mass libido things like that so many times erectile dysfunction and low testosterone go hand in hand but just because you have a low testosterone if I replace that and fix it that doesn't necessarily mean we're gonna fix the erectile dysfunction but we many times will check that as a problem it's a very common coexistent problem and four and ten men over the age of 45 can have problems with testosterone levels so we will undoubtedly check that and if it is a problem we can discuss replacing it and these are the basic symptoms of hypogonadism or low testosterone men will experience a easy fatigue low sex drive low energy levels there may be loss of muscle mass so there are a lot of advantages to replacing testosterone when and if a patient needs it and we will certainly not hesitate to do that when and if a patient has a low testosterone you can't take a pill for it the only way we can really safely replenish testosterone is through the use of patches or gels that are put on daily or more recently we have new testosterone pellets that can be inserted that will give off normal doses of testosterone and keep you at a normal level for 3 to 4 months at a time we're watching you very carefully to make sure you don't have side effects from it we always check with your primary care physician before we consider doing that but there are a lot of benefits to replacing testosterone and men who have low testosterone levels so we talked a little bit about the vascular supply to the penis and how vascular genic erectile dysfunction can happen the vast majority of patients that I see develop your wrecked-tile dysfunction because the blood vessels just are not carrying the load anymore another very important cause of erectile dysfunction is neurogenic or a neurological erectile dysfunction and this can happen in patients who've had major surgery or radiation therapy the nerves that cause these blood vessels to dilate run in very close proximity to the prostate so many men who've had prostate surgery radical prostatectomy robotic prostatectomy sometimes radiation therapy sometimes brachytherapy these can affect the nerves now it doesn't usually happen immediately with radiation therapy that may happen over years as the nerves deteriorate with surgery it's more dramatic many times when I do prostatectomy on patients we have to go through a pretty extensive penile rehabilitation program to kind of get those nerves working again we will work on that but sometimes despite our best efforts if there's a neurological problem the erections don't come back as easily this is a graph that shows the percentage of patients that can have erectile dysfunction associated with prostate cancer treatment and it can be anywhere from 25 to 75 percent of men disease is another not so commonly known cause of your erectile dysfunction but certainly a cause of discomfort and consternation and men Peyronie's disease is not really a disease that's I call it a condition but it's a condition where scar tissue is laid down in the wall of the penis and it happens inexorably kind of over years and we don't really know what causes it but the thought is perhaps micro trauma from intercourse or whatever can do it you develop plaques in the wall you remember the anatomy of the penis before where you had those erectile bodies that normally fill with blood well they're encased in a tight envelope that holds the blood and that's called the corpus or the corpus cavernosum the the corpora can develop scar tissue and so over years you may develop a gradual curvature of the penis it may be painless at first or it may be painful but in some patients can have a dramatic curvature can be up to 45 or 90 degrees and that can cause pain both with that patient himself and with his partner with intercourse as you can imagine so we always examine the patient to make sure there aren't any puranas plaques and we'll ask you you know if you get an erection is it straight or is it bent and if it's bent there are treatments we have that are very successful in reducing the curvature and getting rid of this plaque sometimes they coexist a patient will have both the erectile dysfunction and Peyronie's disease you can't really address one without addressing the other and this just talks a little bit about the ideology of Peyronie's disease but you can literally see that in some instances it can curve any way it can come dorsally straight back towards the head it can go left port or starboard as we used to say in a good old days either way you can see some significant curvature and if that happens we can treat that that's not going to be the main focus of my talk tonight but we can talk a little bit about some of the treatments we have for that and that's symptoms of payro knees disease many times patient we'll start off with pain with erections the curvature may progress over time the pain is usually a sign that the plaque formation is ongoing so when I'm going to treat Peyronie's disease I may wait until the acute painful phase is gone so that you no longer get pain all you have s this is a curvature that tells me there's no more plaque being laid down and I can go ahead and treat it you with conservative treatments or injection treatments or any of a number of things and this talks about some of the treatments that we have for Peyronie's disease we can operate to remove the plaque or straighten the penis or a new treatment that we have is called Ziya flex they've been advertising it on TV it shows the guy walking around the corner sideways stuff like that we actually inject a collagen reducing medicine directly into the plaque and it's very effective at reducing and fixing the Peyronie's disease you start by talking with your primary care physician and you let him know what's going on and a lot of them are very good about educating patients and talking to you about some of the earlier and successful treatments by the time I see a patient usually he's been through the gamut of at least a number of different pills and possibly some other treatment options so at that point we we go as you can see across the bottom there is a wide spectrum of treatments that we have for erectile dysfunction starting conservatively and working our way up to the medicines that you've all heard about that have been around for about 25 years the viagra the levitra the cialis stendra these are all medicines that were originally designed as heart medicines they they thought they could give it to patients to improve blood flow through the body and reduce the risk of heart disease so they gave these medicines or samples they're up to a bunch of guys in a study and they found that these medicines don't have any effect on the heart but nobody in the study wanted to give the medicine back and so will they figure it out that what it was doing is it was selectively dilating those two little arteries that we talked about down there that that can cause erection they all belong to a class of medications called pde5 inhibitor inhibitors phosphodiesterase v is a is a chemical that improves blood flow we usually start with a pill viagra is the classic one you take a pill about an hour before you want to have intercourse it doesn't magically give you an erection but it improves the blood flow enough so that you can attain and maintain the erection better they're very effective as a first-line treatment most of them have minimal side effects the only patients that I see that can't cannot take these are patients who have heart disease who carry nitroglycerin because if you pop a Viagra and a nitroglycerin at the same time you will hit the deck and have some serious problems it's too much of a good thing because of the the vasodilation but I have patients who have had heart transplants that don't have significant coronary heart disease that that can take the medication there are some side effects usually very minimal but some patients with Viagra have reported a Bluegreen kind of haze or colorblindness noted fortunately since most the time it's nighttime this doesn't matter some patients can experience a mild headache some people experience some reflux type symptoms or back pain with the cialis there have been some some other notes that have come out about perhaps the association of sudden blindness with patients who've taken viagra that's a condition called nai o N and it's a vascular phenomena where suddenly the blood flow to the I can get messed up I've been practiced in 30 years and I and I haven't seen it but it's something to be aware of and so that's why they say if you take any if you take a Viagra and you have any visual disturbances there's also some new data that came out that says viagra could conceivably be associated with melanoma in patients who take viagra a lot and then go out in the Sun well once again these studies were all based on millions of patients and some of whom who developed these symptoms or had these problems developed had a history of taking viagra so that there's not a one-to-one causation then this has not really stopped me from from prescribing the medication we talked about the side effects we talked about when to talk to your doctor or if you if you have visual disturbances or any of that stuff that's good vacuum directing devices these are a very non-invasive way of restoring erections and and in this case it's a it's a cylinder that can either be a hand pump tour vac a battery operated where you place the cylinder over the penis it creates a seal with the base of the penis and when you pump it it literally pulls the blood down into the penis then there's usually a band that can be applied from the base around the base of the penis that holds the blood there these have been around in multiple different models for literally decades you may see them on the internet I don't think you even need a prescription to get them they're useful they work they're non-invasive and they don't cause complications but they're kind of a pain and they're bulky and not a lot of guys stick with them for very long but they sometimes can be used with other treatments like there's no reason you can't take a Viagra and if you're not quite getting as much of an erection as you want you can supplement it with this once again about the vacuum erection device no real complications sometimes there can be some bruising from it the vast majority on my patient most of the time it's covered by Medicare the vast majority of my patients will use it for a while and then it'll go by the wayside urethral suppositories these were exciting for a couple of years it's a medication in its pure form called prostaglandin prostaglandin is a substance that's present normally in the body and when it's when it's in the circulation it increases blood flow it says get blood down here now so one way we have of delivering that is to take a tiny suppository that's inserted through the urethra at the tip of the urethra and then you push the little plunger and it allows the suppository to drop off in the urethra and it's absorbed through the urethral wall and it gives you an erection in that way it's useful but it's it's once again it's a little uncomfortable and not a lot of guys that I've treated it with stick with it there is another more effective way to deliver the medication to the erectile bodies and that's to deliver the prostaglandin directly in there with a needle this is the treatment penile injection therapy is the treatment that you hear about on the radio the Boston Medical Group the men's health clinic the patients where they say we guarantee results okay well they're pretty darn right that's that's what usually happens the way we do it is we take a tiny needle an insulin syringe for those of you who are familiar with it and we inject it through the base of the penis near the abdomen so there are very few pain receptors there every single one of my patients that I talked to this about says there is no way I'm sticking a needle in my penis and virtually every single one of them when I do it they're like I don't even really feel that you know it's not a big deal so once you get over the stigma of doing it it can be done it's literally an amazing effectiveness within we usually do test doses here in the office within usually about five minutes of giving a very very tiny amount you'll get a very efficient erection and it usually lasts about an hour the side effects of this treatment are minimal there can be slight bruising at the injection site so even in patients who are on blood thinners it's not usually a problem I have you hold pressure to the injection site for about a minute and then you massage the penis to distribute the medication and within five to ten minutes there is a very very impressive erection useful it can be done no more than once in a day usually two or three times a week if necessary and it's very effective a lot of the places that market this that's their only niche if you will their main Bala wicks so they'll charge a lot of money you'll go in there you'll walk out of there with a smile on your face after they do the test injection and then they'll sell you a vial of medicine for a thousand bucks you know we have our own pharmacy that makes it up in the Baltimore area we don't make money from doing this and they usually mix up the vials and send the syringes and the instrument and the alcohol wipes as a packet and it usually ends up being about eighty two hundred bucks for a vial of ten doses so it's it's a very effective treatment and I have a lot of patients who are on it and it works very well the ultimate treatment that we have is for patients who've tried you know it's I've tried a I've tried B I've tried C and they're all very good about going through the progression and they and for whatever the reason the injection is no longer work they can't take the pills because the side effects or because of expense the treatment that we offer that's got the highest satisfaction rate is a penile implant or a penile prosthesis in this case with a penile prosthesis we are replacing those corporal bodies that we talked about so that you no longer have to fill that with your own blood we replace it with two cylinders which can fill with saline and to make the penis hard and then there is a pump that we can seal down in the scrotum that allows you to activate the device so you can see that these actually date back to the days of the early 1800s in the whaling days they actually implanted whale bones into these cylinders or under the skin of the penis to make the penis hard probably around the 60s or the 70s urologists developed what we call the semi rigid prosthesis which was a braided wire or solid silicone device that could be implanted in the to corporal bodies side by side that would virtually give you a permanent erection but because they were braided wire and cased in silicone they could be malleable so you could bend it so you're not walking around with wood all day but you can at least bend it down and and and things like that then as time evolved we became more advanced in our ability to conceal the device so that now the main device that I'm implanting is a three piece device so it has the two cylinders in the penis it has the pump down in the scrotum that you can't see but it's kind of down between the testicles and then there's a reservoir that we implant up behind the bladder that holds the fluid and it holds a substantial amount of fluid so that when you pump the pump it transfers fluid from the reservoir and into these cylinders and gives you an excellent erection with increase in both length and girth which is is a new thing that's happening with these prosthesis so I've put in hundreds of these and I will tell you that it's a big step it's not for everybody but it's for those patients who've been pretty religious about trying all the other things and it's just not working anymore once we put a prosthesis in there's not any other way to get an erection it's not like you can say well I'll have the prosthesis but if I don't like it I'll take it out and go back to my injections you can't do that because when we put the prosthesis in we're replacing those corporal bodies the spongy tissue in there with these cylinders so that getting kind of gets squished aside so a prosthesis is forever if you're going to use it but those patients who get it the satisfaction rate is better than eighty-five percent at seven years more than 85 percent of patients who've had a prosthesis would do it again or would recommend it to their friends so so it's it's a very effective way once the devices is started and this just shows what the device looks like there are variations of it we use the AMS device or the Boston Scientific here's the reservoir here here's the cylinders and then here's the pump 97% of patients would recommend the penile implant to others ninety-eight percent of patients reported their erections were excellent or satisfactory and 96 percent of partners associated this with better sex life and were and were happy with it one thing I caution my patients about is no one's gonna give you what God gave you okay a prosthesis is not perfect one difference is when you implant a prosthesis the head of the penis that used to engorge doesn't engorge anymore it's not getting that blood flow down there but the penile prosthesis itself goes down to about the middle of the glans so the entire length of the shaft of the penis is rigid and it works very well benefits of the penile implants we talked about this a little bit the the operation takes about an hour to an hour and a half we're doing them right here in our surgery center it's an outpatient procedure the way dr. Chang and I implant them as we make a tiny incision at the base of the penis kind of where the penis and the scrotum meet and we can implant all three of the components through that incision we dilate the penis to get the maximum size cylinders in to make sure it's the most lifelike erection we can have so there's inevitably some bruising and some swelling associated with it for a week or so after the procedure so you're pretty sore but the stitches that we put in the scrotum just dissolve usually a patient can urinate without any problem after that and within a week or two the tenderness and swelling starts to go down usually at about three weeks post-op I'll have a patient come back and we'll cycle the device and make sure it's worked and seating properly and then I have the patient cycle the device every day pump it up keep it up for about 10 minutes and then deflate it and then usually a couple weeks after that they can start using it for intercourse again most insurances cover this before we recommend it we always make sure that your insurance will cover it and work very closely with our with our office staff here it's a very common procedure it's a very successful procedure but it's a procedure and ain't like getting your hair cut there are complications that can happen with any surgery the main risks that we worry about with a prosthesis is infection if the prosthesis gets infected it's an artificial device it doesn't have its own blood supply so all the antibiotics in the world may not get in there to cure it so it's a dreaded complication we make darn sure if you have diabetes that before we put you through surgery your diabetes is under good control we give you antibiotics before and after the procedure we use meticulous sterile technique so overall the infection rate is much less than 2% with one of these okay if it does get infected usually do a salvage procedure take it out and replace it at a later time there is a slight risk of malfunction these devices have been literally used since the early 80s and they are constantly making revisions to them to make them better they're now implanted they're embedded with antibiotics so the risk of infection is lower there's usually only one connection that we have to make so we don't have leaks from the connectors anymore the reliability of these devices is amazing and it and more than 90% of them are still functional after seven years the beauty of most of these companies is if there is a malfunction they'll replace it for free there's a lifetime guarantee you got to have an operation to fix it but the AMS people and the Boston Scientific people stand by their product very well so that's the gist of it we offer the full gamut of erectile-dysfunction treatments here including which we may talk about later the new gains wave you may have heard of you know the the shock wave treatments that there that we use for stones we can use now for erectile dysfunction and I may briefly mention that at the end of the evening which we have - it's still experimental it's not FDA approved so most insurances won't pay for it but we offer it through our main office up in Baltimore and I'd be happy to talk to that should the need arise thank you it's been my pleasure I will come back and I promise we'll answer any and all questions that you have I'd now like to introduce my partner dr. Chang who's our resident expert on female and male incontinence reconstruction and penile reconstruction and Peyronie's thank you for coming everybody I'm dr. Chang I work out of this office with dr. Hughes Minh I went to medical school in Philadelphia at Temple University and then I trained out in Midwest after residency at the University of Missouri I did a further training in reconstructive urology which involves things like trauma and pross prosthetics and male and continence surgery so I'm going to talk about male and continence surgery specifically we're going to talk about male stress urinary incontinence what is male stress urinary incontinence and who has it and what causes it so typically it's not normal for a guy to be leaking urine unless you've had surgery to remove your prostate or you've had some sort of instrumentation or some sort of trauma or a pelvic fracture which led to a disturbance in your urinary tract a guy shouldn't have any urine leaks what is stress urinary incontinence so after your bladder fills your bladder has a mechanism to keep you dry and that's the sphincter guys who undergo prostate surgery the prostate sits right next to that sphincter muscle so once it gets removed whether it's the nerve damage or the the direct damage to the sphincter at least two a week or muscle at the base of the bladder before it was able to provide enough pressure to hold urine in this space it's become weak so you start leaking urine and that's what stress urinary incontinence is and if you cough sneeze lift something heavy and you realize that there's some wetness that's stress urinary incontinence but that's not something that you should be having unless you've had some sort of pelvic trauma or you've had your prostate removed but if you have urine leaks as a man and you've not had any prostate surgery or you've not had any other instrumentations then it's probably another form of urine leak that's beyond the scope of this talk today it's roughly about 50% of men who have undergone prostate surgery it's it's roughly half guys who have undergone prostate surgery immediately sometimes we'll know whether or not they're leaking and if it's a mild form of urine leak oftentimes over a period of time it'll correct itself but after 12 months or so if you continue to have urine leaks that's not going to get any better this is what your bladder looks like it's stores urine here's your prostate and right at the base is the muscle that I was talking to you about this the sphincter muscle which co-op's and does this to keep this intact so that nothing leaks out neurologic disorders enlarged prostate radiation therapy and then trauma your leaks is it's not something that's gonna kill you it's not like having cancer but it's it's a result of surgery to remove cancer it's quality of life issue but you know if you're leaking so much urine that you you know that you have this smell you have this border it's very restricting to men because oftentimes they get depressed they know that they have this problem and they don't want to go out and socialize when they can be socializing because they're more worried about am I gonna have an accident get wet so it's it's a it's a it's a big problem it affects all parts of your life so these are just numbers of how many people get diagnosed with cancer in just data if you have stress urinary incontinence you're gonna know it right after your prostate surgery often times if you have mild form of incontinence your function to restore dryness you typically comes back within the first year but not everybody is fortunate to to gain that continence back depending on how much urine leaks that you have there there are different ways to treat this problem stress urinary incontinence is a mechanical problem so it's not something that can be treated with medicine it usually requires some sort of bulking or some sort of surgical intervention to treat this problem urologists are urgence who treat this problem and particularly doctors who do prosthetic surgery are the ones who typically deal with this issue let's say you just had your prostate surgery and you're starting to notice that you have some urine leak there's there's some behavioral modifications that we could we could do reduce fluid intake you plan out your bathroom breaks but that's really not very satisfying for most men and there's also other interventions like pellet pelvic physical therapy to strengthen your your muscle and all that is typically done within that first year despite those maneuvers you could still be leaking urine ways that you can get around that with this as often times either wearing diapers or there's catheters or there's clamps that you can put on the penis but it's again it's not very satisfactory those are the methods that people have used in the past if I see a patient and they're worried about this urine leak some of the information that I typically ask or how many pads are you using do you leak urine at night so based on that it's it's either your candidate for a male sling or artificial urinary sphincter they're both implantation surgery so male sling is is analogous to surgery that we do on female patients with stress urinary incontinence it's a it's basically a mesh device it's like a hammock that goes inside your urethra and it gives you support so it basically augments that muscle where it just doesn't have enough support so it gives it a lift and that usually provides good enough support to give men who had mild stress urinary incontinence relief and it's not a mechanical device it's just a hammock and it goes in there to support the idea is to stop it but it also gives you the ability to urinate on your own so so when your bladder becomes full it still is able to generate some pressure but it's not so we don't put it in there so that your bladder can't overcome that pressure but it has to be somewhat less than the pressure that your bladder is going to generate to push urine out but in men who have just you leak like a sieve you're wearing like three four five six pads a day then we play something called an artificial urinary sphincter and basically this is a mechanical device but basically what it does is it's basically a band that's filled with fluid goes around your urine tube and it gives it compression so that it provides pressure so that you don't leak urine out that way and it's it's a three-piece device just like the the penile prosthesis it's a little bit smaller but you have a pump that sits inside your scrotum basically when your brain senses that your bladder is full you just give this device a few pushes and then it opens up the device it allows you to urinate you don't have to do anything after that it gets its self time so that it refills itself after three to five minutes and it's it's very convenient you don't have to deal with external appliances everything's inside this device has also been around since the 80s it's very durable it could last potentially more than a decade patients who've had had this done are very happy with the overall result this is Trading the uplift support of a male sling this is called an advanced sling the sling is placed through your operator canal which is the the pelvic bone and it provides basically support in your pelvis like this it's uh it's minimally invasive your incision is only about this big the procedure takes about an hour to hour and fifteen minutes to do it's done here at our surgery center and you get to go home the same day usually I don't leave a catheter in afterwards but sometimes I may leave a Catherine for like a day this is the artificial sphincter I was telling you about this is for for the guy who leaves a lot of urine leaking like three four five six pads a day this is the cuff that goes around that urine tube the urethra and at rest it stays compressed like that and when you're ready to urinate or evacuate your bladder you just give this pump that sits inside your scrotum a few squeezes this opens up and you're allowed to empty your bladder once that's done there's mechanical forces here so that this device will close back up again after three to five minutes so you'll be dry again it's a surgery that takes a minimal amount of time it could be life-changing and it and even though we're not saving any lives here by making you dry it could really potentially you know change the quality of life the thing that we worry about the most is infection the infection rates are low with this both type of surgeries that it's less than 1% but if you do get an infection these devices have to be removed but there is always also risk of injury to the urethra because we're operating near the urine tube and then there's a post-operative urinary retention where you may not be able to urinate afterwards but it's typically due to swelling and that typically resolves after a short period of time and it is another device that we're placing it's not as traumatic as placing a penile prosthesis because we're not putting in a huge device but it is something foreign so you're gonna have some post-operative pain after a period of time like decade or so you can have malfunction or with the artificer in your sphincter because you're compressing a healthy tissue with this device the area where it gets compressed it astrophys or it shrinks so sometimes we have to go back in there and replace that band to a smaller size and then another thing is if you go in there and put it in a device that's too small for your your urethra it could potentially erode into your urinary tract which causes an infection then it has to be removed it's a very convenient device to use it's it's very safe I've not had anybody who had major pain after the surgery after you know the expected course if anybody has issues with urinary incontinence dr. huesemann and I are here and we could provide service

Channel: Chesapeake Urology

Views: 1,229,138

Keywords: Erectile Dysfunction, ED, Male Urinary Incontinence, Male Incontinence, Men who are incontinence, Urinary male leakage, men leak urine, man leak urine, guy can't hold my pee, pee leakage in guys, guy incontinence, Chesapeake Urology, Chesapeake Urology treatment for ED, Minimally invasive treatment for ED, pills for erectile dysfunction, what causes ED

Id: QGm4JSa3l28

Length: 36min 37sec (2197 seconds)

Published: Mon Jul 02 2018