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23, September 2011 • USa today

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erectile dysfunction restoring confidence with treatment

overactive bladder Learn to fight the urge

urological health

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on raising awareness for urological healTh

t

Photo: Getty ImaGes

Stepping Up to the plate Baseball legend Joe Torre raises awareness for prostate cancer

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challenges

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We recommend eye on the prize Anne Abernathy has not allowed incontinence to slow her down

Do Your Y hoMeworK pAge 5

“i realized nobody was talking about this. When i retired from the sport and discovered one in four women has this problem, i felt i had to come forward.”

open up speak candidly with your doctor about your symptoms. Photo: istockPhoto.com

Urologic conditions, while humiliating and disruptive to everyday life, are quite common and, in most cases, treatable. Far too many people are not seeking the help that they deserve. It is time for America to break the silence about these silent conditions.

Yourology: Know your symptoms

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rologic conditions— r a n g i n g from conditions such as congenital anomalies and enuresis (bedwetting) in children, to infertility and cancer in adults—affect millions of Americans each and every day. It is my hope that the articles and inspirational stories in this publication will serve as a reminder not only that treatment is available, but that no one is alone in dealing with these sometimes embarrassing and debilitating conditions. We’re all in this together— whether you’re a patient, a physician, or a researcher working toward advancements in diagnosis, treatment and cures.

looking forward Research plays a critical role in how we advance in developing new diagnostics, treatments and cures. Although health-related

biomedical research in the United States has been adversely affected by declines in funding, urology—a historically underfunded field in comparison to others—has been particularly hard-hit. This may sound like bad news, but there’s a silver lining: because some urologic conditions are harbingers of more serious conditions (erectile dysfunction, for instance, has been linked to heart disease), there are opportunities for multidisciplinary study and research. The AUA Foundation has released a National Urology Research Agenda (NURA) that identifies areas of scientific priority and opportunity, but also emphasizes the importance of multi-disciplinary activities and defines areas of multidisciplinary potential. Working smarter now will help save lives – and healthcare dollars – later.

stay informed For more than 35 years, the AUA Foundation has worked not only

sushil s. lacy, MD, facs president, American Urological Association

“…no one is alone in dealing with these sometimes embarrassing and debilitating conditions. We’re all in this together – whether you’re a patient, a physician, or a researcher working toward advancements in diagnosis, treatment and cures.”

In 1999,Torre,who has a history of heart disease in his family, reported for an annual stress test. During this routine check-up, Torre’s cardiologist detected an elevated PSA level. PSA (or prostate specific antigen) is a protein that is produced by the cells of the prostate gland

and is often an indicator of the presence of prostate cancer. At his cardiologist’s urging,Torre had his PSA score checked a few weeks later,when he reported to spring training in Florida. The results revealed that the PSAlevel had risen and this spurred a series of tests to determine ifTorre did,in fact,have cancer. “I think this is when, even for a positive person like I try to be, it was tough to think positively, especially when you have no control of the situation,” reflects Torre. “The biopsies, followed by the waiting, and then the results came back that I did indeed have prostate cancer. After that the ball started rolling quickly. It scared me, there’s no question. It scared me because the word ‘cancer’ you asso-

ciate with this big, black hole that nobody comes out of.” Having been diagnosed with an aggressive form of prostate cancer, Torre was faced with a difficult decision. “Prostate cancer is, at first, a little complicated because you have to choose your course of action,” explains Torre. “And it just changes your life. In fact, you realize that it’s something that really, for a time, takes over your life.’” Torre’s wife, Ali, who was his rock throughout the ordeal, was also proactive in researching the treatment options. With this information and the advice of his doctors,Torre elected to have surgery — a nerve-sparing prostatectomy — which was a suc-

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a doctor without borders

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Cranberries could be the key to a healthier urinary tract

to support urological research, but also to provide patients with much needed information on urologic diseases.This summer, the Foundation unveiled its newly redesigned web site, UrologyHealth.org, which contains an abundance of patient information on a wide variety of conditions, in addition to information about the National Urology Research Agenda and other public awareness initiatives and campaigns. I invite you to visit the site to gain valuable insight into urologic diseases, share information with friends and family, and find out what you can do to support research as we move forward with treatments and cures. Urology touches everyone. If you or someone you know is dealing with a urologic condition, let them know they aren’t alone.

SuShil S. lacy, MD, FacS [email protected]

a victory off the field for Joe torre Known as the fearless manager of the new York Yankees, who led the team out of an 18-year hiatus to win 4 titles in 5 years, Joe Torre is no stranger to overcoming the odds and coming out on top. But perhaps his hardest-fought victory is one that occurred off of the baseball field.

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cess. Two months after defeating cancer, Torre was back in the dugout, leading the NewYorkYankees to their 3rdWorld Series under his management. Now, twelveyears later, he is still healthy,cancer-free, and as MLB’s Vice President of Operations, has no intentions of retiring any time soon. “I guess the more information you get,the more you realize,it’s not necessarily a death sentence,” says Torre.“By paying attention to your health, you can continue living a very productive, normal life — even if you’ve had, or are living with prostate cancer.” Maven Browning [email protected]

dr. Abu-Sitta brings life-changing treatment and technology to the gaza Strip

uroloGIcal health, 4th edItIon, sePtemeber 2011 publisher: megan brunhofer [email protected] Business Developer: sara Quigley [email protected] Designer: ariela anelli [email protected] Managing Director: eric alexander [email protected] editorial Manager: luciana colapinto [email protected] contributors: american urology association, dr. moeen abu-sitta, analyte health, anne abernathy, Kidney and urology Foundation of america, dr. sushil lacy, national association for continence, cindy riley, Joe torre, Wake Forest baptist medical center Distributed within: usa today, september 2011 this section was created by mediaplanet and did not involve usa today or its editorial departments.

FolloW us on FacebooK & tWItter! facebook.com/Mediaplanetusa twitter.com/Mediaplanetusa Mediaplanet’s business is to create new customers for our advertisers by providing readers with high-quality editorial content that motivates them to act.

Urinary tract infections are responsible for nearly 10 million doctor visits each year. Cranberries have been shown to be effective in numerous laboratory studies to aid in the prevention of UTIs For more information visit www.uscranberries.com/UTIhealth Sobota AE. Inhibition of bacterial adherence by cranberry juice: potential use for the treatment of urinary tract infection. J Urol. 1984;131(5):1013-6. Avorn J, Monane M, Gurwitz JH, Glynn RJ, Choodnovskiy Lipsitz LA. Reduction of bacteriuria and pyuria after ingestion of cranberry juice. JAMA. 1994;271(10):751-754. Guay DR. Cranberry and urinary tract infections. Drugs. 2009;69(7):775-807. Schmidt DR, Sobota AE. An examination of the anti-adherence activity of cranberry juice on urinary and nonurinary bacterial isolates. Microbios. 1988;55(224-225):173-81. Zafriri D, Ofek I, Adar R, Pocino M, Sharon N. Inhibitory activity of cranberry juice on adherence of type 1 and type P fimbriated Escherichia coli to eucaryotic cells. Antimicrob Agents Chemother.1989;33(1):92-8. Ofek I, Goldhar J, Sharon N. Anti-Escherichia coli adhesion activity of cranberry and blueberry juices. Adv Exp Med Biol. 1996;408:179-83.

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inspiration

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spreaD The KnowleDge

full of ideas: Tips for a healthy bladder Of the 25 million adult Americans affected by urinary incontinence, an estimated 75-80 percent are female.Many of these women have suffered needlessly for far too long.

coming to terms “The average person waits seven years before seeking treatment, because they think if they leak they’ll need surgery,” explains Jill Rabin, M.D., head of Urogynecology, at Long Island Jewish Medical Center.“They need to realize it’s not a shameful condition and it’s treatable in most cases.” “There are medications available to quiet an overactive bladder,” Rabin points out.“Physical therapy and estrogen replacement can also be helpful, along with minimally invasive surgery.” Women are four to five times more likely than men to have urinary incontinence problems, in large part because of the trauma the body experiences during pregnancy and vaginal deliveries. Up to 70 percent of women first experience stress urinary incontinence – leakage when coughing, laughing,or lifting – during pregnancy or post-partum. For the large majority, the symptoms disappear after the body recovers from childbirth; however, the underlying damage remains. Consequently, as women age and lose muscle, gain weight, stop exercising, and encounter additional risk factors, the symptoms resurface. “People don’t bring it up to their doctors because they think they are an oddity, not realizing how widely prevalent it is,” says Nancy Muller, Executive Director of the National Association for Continence. “Or they misdiagnose their own symptoms and fear a fatal disease,which they don’t want to hear. Our greatest challenge is to help get people educated about the symptoms, the causes, the different types of bladder and bowel control problems, the treatment options,etc.We want to enable individuals to be their own health advocate.”

regaining control Of the 15-16 million women with SUI, about one-third have symptoms severe enough to be considered strong candidates for surgery. As procedures become less invasive and recovery times faster, it’s reasonable for a higher percentage to seriously consider surgery. But every woman should evaluate the non-surgical alternatives and spend at least three months in a serious effort to strengthen the pelvic floor muscles. “Physical therapy including biofeedback may help,as do vaginal support devices,urethral injection therapy and the use of thermal energy for remodeling the urethra.” As women age they become more likely to experience urgency and frequency, or overactive bladder (OAB). When most severe, loss of urine occurs before the toilet can be reached (this is referred to as urge incontinence). When SUI and urge incontinence occur together, it is referred to as mixed urinary incontinence. Women who have mixed incontinence should explore nonsurgical and surgical options for both and combine treatments.Treatment for OAB,includes bladder retraining, medications,and nerve stimulation. Adds Rabin, “Incontinent women tend to have a poor body image and become depressed, reducing their quality of life.” Once they’re able to reclaim control of their bladders,they will be able to reclaim control of their lives. cinDy riley [email protected]

unDer The TuTelage Dr. abu-sitta teaches doctors how to perform urological procedures. Photo: dr. moeen abu-sitta

no boundaries: a doctor’s quest to bring treatment to medically isolated gaza ■ Question: How does a palestinian gynecologist in the U.S. help women suffering thousands of miles away? ■ answer:: by volunteering to train physicians in the Middle east who can provide desperately needed medical services. Although he maintains a successful practice in Buffalo, New York, Moeen Abu-Sitta, M.D. has never forgotten the region he left behind as a teenager to study in Kuwait. “Gaza is where my family is and where I was born,” explains Abu-Sitta,a private practitioner who serves as Clinical Associate Professor at the University of Buffalo and Director of the Division of Urogynecology and Reconstructive Pelvic Surgery. “Gaza is one of the poorest, most medically isolated areas of the world,where 1.5 million people live in prison. It’s where pain and suffering are inflicted on the entire population simply because of political differences.”

Boundless love Known for treating women with pelvic organ prolapse and urinary incontinence, a specialty field not commonly found in third-world countries,Dr.Abu-Sitta wanted to give

“even if what i’m doing is just a drop in the bucket, it’s by far the most rewarding thing i’ve ever done in my medical career.” back to his homeland, making his first medical mission to Gaza in 2006. There, armed with thousands of dollars worth of donated materials and devices, he trained a team of urologists and gynecologists through lectures and operating room techniques, as part of his mission to help females regain their dignity and self-respect.

inspiring hope “Women with urinary incontinence live in shame and isolation.This condition is more common in women with a high rate of vaginal births and with less than adequate obstetric care. Pelvic organ prolapse is also common. It’s a very painful condition when the uterus, bladder, and rectum fall out of the vagina as a result of damage and trauma from childbirth.What results is a large mass or organs hanging between their legs, making it impossible for these poor women to lead

normal lives. It’s a serious problem that can be corrected through surgery very successfully. But, untreated, these women are embarrassed, ostracized and waiting to die.”

a grim reality Half the battle in assisting patients, Abu-Sitta explains, is gaining access. Abu-Sitta recalls lengthy airplane flights and being forced to spend most of his arrival date at the border, waiting for his turn to cross over. Closed borders, in fact, prevented a second medical mission until 2010,when he managed to enter through Egypt. Overwhelmed by the poverty and the deplorable conditions at the Jabaliya Refugee Camp, Abu-Sitta managed to perform almost a dozen procedures during his visit to Al Awda Hospital. “My colleagues from 2006 had run ads letting everyone know when I’d

be coming to meet with patients. They were lined up, waiting to be seen. I assembled a team of doctors who wanted to learn how to do the procedures, and we started operating the next day. It was worth it,of course, because the patients and their families were so filled with gratitude in the end.” Abu-Sitta adds somberly,“I remember looking out from the hospital, which is on the border with Israel, and viewing the modern town right next door. It was painful to recognize the dichotomy of this third-world country side by side with modern civilization on the other side of the fence.” Despite having to pay for each costly trip out of his own pocket,AbuSitta is determined to return to the area, although the political climates in Egypt and Isreal make it impossible in the near future. “I have no idea when I’ll be able to go back.Although it’s emotionally and physically draining, I want to help these women change their lives for the better. Even if what I’m doing is just a drop in the bucket,it’s by far the most rewarding thing I’ve ever done in my medical career.” cinDy riley [email protected]

on the right tract: preventing and treating uti one of nature’s tiniest fruits can play a major role in maintaining proper urinary health. “It’s not a myth—cranberry juice really does contain an ingredient that prevents urinary tract infections,” explains Sophie Fletcher, M.D., an assistant professor and Director of Research at Houston’s Center for Restorative Pelvic Medicine. “Those agents are called proanthocyanidins, or PACs.” The PACs attach to bacteria, inhibiting it from sticking to the inside of the bladder. Research has shown that 36 mg of cranberry PACs can keep the urinary tract healthy and free of E.coli, which commonly cause infections. “You can get 36 mg of PACs if you drink an 11-ounce glass of cranberry juice every day.Look for a supplement with that 36 mg PAC,” says Fletcher. “For my patients who have recurrent infections, cranberry can be a great natural alternative to low-dose antibiotics.” Amy Howell, Ph.D., an Associate

Research Scientist at Rutgers University points out, “Cranberry can be termed a ‘super fruit’ because it has a wide range of health benefits, not only for the urinary tract, but also for the prevention of ulcers and gum disease.It’s also been shown to reduce certain risk factors for heart disease and cancer. What makes cranberry stand apart from other super foods is that there are positive human clinical trials to back up the benefits. “Here at Rutgers, we isolated the compounds in cranberry that prevent the bacteria from attaching to the bladder wall. If the bacteria can’t bind to the wall, they won’t grow and are washed harmlessly out of the body in the urine stream. Different forms of cranberry prevent this adhesion, including commercial juices, capsules,fresh and dried cranberries,and even sauces.” For overall urinary tract health, Howell suggests using unscented soaps for bathing and staying away from douching, which can upset the natural flora in the urinary tract. Dr. Fletcher recommends drinking

chew on This. More and more research is pointing to the health-inducing benefits of Photo: istockPhoto.com cranberries.

six to eight 8-ounce glasses of water each day, and clearing the bladder as soon as there’s an urge to urinate. “Women should dry well after emptying the bladder, and should empty the bladder completely after intercourse,” says Fletcher. “Avoid wearing moist, wet, or sweaty clothing for

long periods of time.Postmenopausal women should also use some type of vaginal moisturizer.”

cinDy riley [email protected]



5 Tip

inspiration Question: Why would an accomplished former Olympian go public with her struggle with incontinence? answer: Because Anne Abernathy believes no one should suffer in silence.

3 Be vocal

life without limits: anne abernathy speaks out about incontinence for anne abernathy, dealing with a weak bladder was more than just an inconvenience—it threatened her career as an olympic lugist. “In my sport you have to be very focused and relaxed on the sled,” explains Abernathy, 58. “When you’re going down a track at 90 miles per hour, the G forces have a tendency to play havoc with your body. I started having some issues with my bladder as far as leaks, and it kept me from concentrating on what I was doing.” It was shortly before the 2002 winter games in Salt Lake City when Abernathy realized she had a problem with urine leakage. Having suffered a serious head injury in a crash just a year earlier, she felt everything was hitting at once. “I think I was more upset about the bladder problem than the brain injury,” she confesses, “because I didn’t know where to turn for help with a problem I didn’t want people on the racing circuit to know about.”

getting back on track Known affectionately as “Grandma

anne abernathy olympic athlete and motivational speaker.

“When i retired from the sport and discovered one in four women has this problem, i felt i had to come forward. people need to know if an olympic athlete can deal with this, they can too.”

Luge” because of her desire to compete in a youth-driven sport, Abernathy is admired by fans across the globe. In 2006, she became the first woman to participate in six Winter Olympic Games. She also secured a place in the Guinness Book of World Records as the oldest female to compete at the Winter Olympics. But her biggest victory may be her decision to take control of what had become an embarrassing health concern. “When you’re competing, you’re changing in front of men and women, and there are times when there are television cameras around. It’s a terrible feeling when you don’t know what’s happening with your body. I was trying different liners and such, because I didn’t know they made something designed just for my problem.”

spreading the word By accident, Abernathy stumbled upon a product that worked for her, leading her to become a spokeswoman for Tena. She felt it was important to share her struggles with others who were quietly battling bladder control issues. “I realized nobody was talking

golDen girl. with her sights set on the olympic gold medal, anne abernathy Photo: melita glanville refused to allow incontinence to stand in her way.

about this. When I retired from the sport and discovered one in four women has this problem, I felt I had to come forward. People need to know if an Olympic athlete can deal with this, they can too.” Extremely busy on the speaking circuit, Abernathy, a cancer survivor, has little time to spend at her home in the U.S. Virgin Islands. She’s currently working on a book, and is in talks to develop a television show.

“I want people to know having a weak bladder isn’t something that should hold them back. Women should have the opportunity to do what they enjoy, whether it’s sliding down an icy track, or watching their kids slide into home plate. You don’t have to crawl into a hole. You just have to take charge.”



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news don’t mIss

could it be low T? In the U.S.,the number of men suffering from low testosterone has been estimated at nearly 14 million, with less than 10 percent receiving treatment. “For many males,low testosterone is a problem that sneaks up on them,” says Tobias Kohler,M.D.,an assistant professor at Southern Illinois University School of Medicine. “They think falling asleep after dinner in front of theTV or having a low sex drive is just a normal part of aging, when that’s not the case.” Testosterone is responsible for erections, energy level, libido and overall feeling of well-being. Hypogonadism, or low testosterone, occurs when the testes fail to make adequate amounts of this important hormone. Sexual symptoms may include erectile dysfunction, delayed/absent orgasm, or reduced ejaculate volume.Non-sexual symptoms include depression, decreased muscle mass, and excessive fatigue. There are several options for treatment,the most common being in the form of transdermal gel. “When addressed properly, patients will think more clearly, be more motivated to exercise,and will generally see a return in their sexual desire,” Kohler explains. They just have to get the courage to make that appointment with their doctor.” “This is an important issue to discuss with one’s physician,since a prior study has shown low testosterone is associatedwith increased mortality,” Ryan Terlecki,M.D.,an Assistant Professor of Urology at Wake Forest University School of Medicine, explains.“Testosterone replacement has been shown to help men live longer and better.” cinDy riley [email protected]

the state of your prostate as prostate cancer continues to dominate headlines, debate is growing over the need to be screened. according to K.c. Balaji, M.D., professor of urology at wake forest Baptist Medical center, having a candid talk with your physician is key. “It’s a challenge, because if diagnosed with prostate cancer, only one or two men out of ten will die from it. It’s generally considered a slow-growing tumor. But close to 30,000 men die from prostate cancer each year, so it’s still a lethal disease. ” Treatment, which can include radiation or surgical removal of the prostate, often leads to inconti-

nence and erectile dysfunction. Dr. Balaji says the decision to get tested shouldn’t be made lightly. “Choosing to have a PSA test can be like opening Pandora’s box, because deciding where to go from there can be complicated for the patient.” Robert Waldbaum, M.D., Chairman Emeritus of the Department of Urology at North Shore University Hospital, adds,“Prostate cancer produces no symptoms until it’s advanced. A man’s age and health is very important in deciding treatment, as many side effects can cause more trouble than the treatment for the cancer itself.” Another health concern, enlarged prostate, is common in middle-aged men. Significant enlargement, however, if left untreated, can result in

considerable health consequences. “The need to urinate frequently both in the day and at night, a weak stream, straining with urination, a prolonged time to start urinating, and incomplete emptying of the bladder are all symptoms of BPH (benign prostatic hyperplasia),” explains Ryan Terlecki, M.D., Assistant Professor of Urology at Wake Forest Baptist Medical Center. “BPH is not synonymous with cancer,nor is it a precursor. But untreated, obstruction can lead to complete urinary retention, bladder dysfunction, infection, bladder stones and even kidney failure.” The mainstay of enlarged prostate therapy, according to Terlecki, has been alpha blockers such as tamsulosin and terazosin, and 5-alpha-reduc-

tase inhibitors, such as finasteride and dutasteride; however, there have been many noteworthy advancements in treatment for BPH. “Newer technology has allowed us to use laser energy to vaporize the prostate through an endoscope,” Terlecki explains. “Office based therapies exist that may use microwave energy or needle ablation to reach the desired outcome.” Newer research is also being done with Botox injections into the prostate, as well as using medications similar to Viagra. BPH can also be treated surgically.


Men: how to cope with incontinence it’s estimated roughly four to five million men experience the discomfort of urinary incontinence. at least half have symptoms as a side effect of surgery for the removal of the prostate gland.

options, such as home delivery, that allow them to discreetly manage their condition. Their next step should be a discussion with their physician to determine the best options that will allow them to return to their everyday life.”

Taking charge The others are typically older men with urge incontinence or younger men with spinal cord injury.Treatments options vary. “One of the biggest challenges that still exists is that incontinence can be embarrassing and difficult for people to discuss with friends, family and their physician,” says Michael Petras, CEO of Edgepark. “Incontinence sufferers should know they are not alone and that they have treatment and supply

“For mild leakage, there are behavioral interventions,” explains Nancy Muller, Executive Director of the National Association for Continence. “There are a variety of external catheters which serve as collection devices that men with milder leakage may find useful.” “For moderate leakage, there is a male sling, a surgical procedure to help compress the urethra to control the unwanted urine leakage. For more severe cases, the artificial

urinary sphincter has proven to be highly effective.” Brian Christine, M.D., Director of Prosthetic Urology and Erectile Restoration at Urology Centers of Alabama, says “Both procedures are very effective and safe, take under an hour and can be done on an outpatient basis. The sling acts as a means of support, while the sphincter is a compressive device. Choosing an experienced surgeon is crucial if you want the best outcome.”

restoring confidence Stress urinary incontinence (SUI) refers to urine leakage that occurs during activities that exert pressure on the bladder such as sneezing or coughing. SUI in men most commonly results from prostate cancer surgery.

According to Gerard Henry, M.D. of Regional Urology in Shreveport, Louisiana, “The top two side effects of prostate cancer, in a small percentage of men, can be ED and male urinary incontinence. Patients need to know that ED and male urinary incontinence are not a normal part of the treatment of prostate cancer and they do not have to live with those side effects.The good news is a prosthetic urologist can easily help with both.” Dr. Henry adds, “Men who suffer from urinary incontinence and ED should go to urologist for treatment. This will lead to better quality of life.”


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news speak comfortably about an uncomfortable situation a significant men’s health issue may not be getting the attention it deserves, even with an abundance of flashy ads and late-night television punch lines. “Despite the prevalence of TV commercials for Viagra and NASCAR driver sponsorships, most men underestimate the magnitude of erectile dysfunction,”says David Sobel, M.D., Director of the Denver Center of Men’s Health at Urology Associates. “It’s estimated that over 40 million American men experience erectile dysfunction (ED). Incidence increases with age and it affects all men from every race, culture and socio-economic status.” Dr. Sobel, who specializes in sexual medicine and is a contributor at SexualHealth.com., feels the biggest misconception regarding ED is that it isn’t a disease. “Every day men come to me complaining of erectile issues and then somehow think it’s because they aren’t trying hard enough. I hear about partners who conclude that the erectile dysfunction is because the

men are no longer attracted to them, or because the man is having an affair outside the relationship. ED is most certainly a disease – sometimes preventable and almost always treatable.” There also continues to be significant research into erectile and sexual dysfunction. “The PDE5 inhibitors continue to be very popular. Cialis now comes in a once a day dosing regimen that offers great spontaneity. The makers of Levitra recently came out with a tablet called Staxyn that melts on the tongue, rather than a pill that needs to be swallowed. Viagra has come out with a chewing gum which is now available in Europe. “Researchers have also focused energy on a topical form of PDE5 inhibitor that would be a cream applied to the penis. The makers of the penile implants have continued to make improvements, making them easier for the surgeon to place, more durable, and easier for the patient to use and live with. Recently, there has been a focus on gene therapy, as well as stem cell therapy as a treatment option for erectile dysfunction.”

Be Your own healTh aDvocaTe. have a meaningful conversation with your Photo: istockPhoto.com physician about your options.

According to Sobel, approximately 30 percent of males don’t respond strongly enough to PDE5 inhibitors. For these men, there are other options, including vacuum devices, urethral suppositories, penile injections, as well as penile implants. Placement of a penile implant is a surgical procedure that takes approximately 30-60 minutes. Patients can go home the same day and, within

a month, return to sexual function. Studies have shown the satisfaction rate regarding penile implant at approximately 90 percent. “Erectile dysfunction is often associated with vascular disease,” Sobel adds. “Patients who have poorly controlled high blood pressure, cholesterol, or diabetes can cause injury to their blood vessels that presents as erectile dysfunction. Many now

believe ED may be an early indicator, the ‘canary in the coal mine’, of heart disease. For this reason, often times the evaluation for erectile dysfunction includes a lipid panel, blood pressure check, and measuring blood glucose.” According to Gerard Henry, M.D. of Shreveport, Louisiana’s Regional Urology, “Prevention is the same as for heart disease. Exercise, appropriate weight, sugar control, keeping blood pressure and cholesterol within normal limits,medical health checks, and smoking cessation are all good ways to prevent ED.” The important thing to remember is that consulting your physician is always the first step. “I still find patients who delay mentioning issues regarding erections until the doctor’s hand is on the door knob of the exam room as they’re winding up the visit,” adds Sobel.“What I want men to understand is that physicians have become very comfortable, and often times very proactive, about discussing sexual health issues.” cinDy riley [email protected]

peyronie’s disease: cure for the curve

“Peyronie’s Disease (PD) is a condition – not really a disease – but a situation where there’s loss of the normal elastic fibers that surround the blood-filled parts of the penis,” explains Gerald Brock, M.D., Profes-

sor of Surgery and Urology Program Director at the University of Western Ontario. “Normally,when an erection occurs, the penis is pretty straight for most men. In cases where Peyronie’s has developed,the loss of elastic fibers and the ensuing scar results in a bend or curvature that can be 90 degrees or more,limiting sexual intercourse and causing pain.” It’s believed, in most cases, PD is the result of an injury or trauma. Although PD was once thought to be a rare disorder, studies indicate that

it is quite prevalent,affecting three to nine percent of adult men.The actual rate may be even higher, because many males are embarrassed to talk about it. “Typically,the sufferer is unaware of when or how it happened,” says Brock. “There have been a large number of recent developments in terms of treatment options apart from surgery. Use of a traction or stretching device has some limited evidence of success in some men. A drug called collagenase, which literally destroys

the collagen based scar and which has been recently approved for a similar condition involving the palm, is undergoing clinical trials.” Ege Can Serefoglu, M.D., with the Department of Urology at Tulane University School of Medicine, says standards for evaluating or reporting treatment outcomes are unclear, and therefore,research on effective therapies has been limited. “The benefits of non-surgical treatment options are conflicting,and further controlled studies are required

before any therapy can be fully recommended,” Dr. Serefoglu points out. “The success of surgery has been well documented; however, surgery is invasive, costly, and carries potential side effects. Patients who report stable disease that has been present for longer than 12 months, and who experience penile deformity preventing satisfactory sexual intercourse are best suited for surgery.” cinDy riley [email protected]

Do you or your partner suffer from

Peyronie’s disease? *

Peyronie’s disease affects as many as 5 million men in the United States. Visit menshealthpd.com/peyronies to learn more. Cook Medical believes in transparency. Therefore, it will be clearly indicated when information or commentary is being provided by Cook. *Estimate based on 2011 U.S. Census data for men aged 40 and above and occurrence of Peyronie’s by age group as reported in Mulhall JP, Creech SD, Boorjian SA, et al. Subjective and objective analysis of the prevalence of Peyronie’s disease in a population of men presenting for prostate cancer screening. J Urol. 2004;(6, pt 1):2350-2353.

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its exact cause remains unknown, but for men suffering from peyronie’s Disease, the discomfort and sexual dysfunction associated with it can be extremely frustrating.

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