Post-Prostatectomy Rehabilitation Improves Men's Natural Sexual Function

Men's Natural Sexual Function
This year doctors will diagnose nearly 219,000 men with prostate cancer. Many will undergo radical prostatectomy surgery. While radical prostatectomy provides an excellent cure, impotence (erectile dysfunction) is a common side effect. However early, postoperative penile rehabilitation can speed prostatectomy patients' healing, achieve natural erectile function and improve their quality of life.
Studies show that even 24 months after prostate cancer treatment sexual dysfunction was the most important quality of life issue. "Increasingly doctors are finding quality of life issues important in the overall treatment of any disease, including erectile dysfunction," said Dr. Skip Freedman, executive medical director for AllMed Healthcare Management.
Treating erectile dysfunction has changed over the last several years, and can offer men a confusing number of treatment choices. Today treatments can range from vacuum erectile devices, oral drugs and injection therapies to penile prostheses.
Working with postoperative patients, a doctor may choose either single or combined therapies based on a patient's rehabilitation need and lifestyle. "Starting penile rehabilitation early after a prostatectomy prevents tissue damage, or fibrosis, by oxygenating the cavernosa or erectile tissue," said Dr. Freedman.
Doctors commonly prescribe single oral therapies such as 5PDEI, or sildenafil (trade name Viagra). Studies of these drugs show early treatment with 50 to 100 milligrams a day (or every other day) improves sexual function and that higher doses produce better results. There's also a health benefit. Using sildenafil early preserves the smooth muscles in the penis. At 100 milligrams a day, 5PDEI increases the smooth muscle content of the cavernosa. With oral therapies, patients often will accept a lower degree of sexual satisfaction.
After post-radical prostatectomy, vacuum erectile devices (VEDs) or vacuum constriction devices (VCDs) aid earlier recurring erections while preserving the penile length and girth that heightens sexual satisfaction for men and their spouses.
Injecting vaso-active substances, such as alprostadil (Prostaglandin E1, or PGE1), increases blood flow and expands blood tissue vessels. Studies on intracavernous injections of PGE1 show it can prevent long-term postoperative damage by periodically increasing oxygenation of the spongy cavernosa tissue. Intraurethral PGE1 (MUSE, or Medicated Urethral Suppository for Erections) can promote the earlier return of spontaneous erections and sexual activity.
Intracavernous PGE1 or VCDs are best used during the first postoperative months, because they allow sexual activity to begin earlier and facilitate long-term healing. However, because of the postoperative nerve damage (neuropraxia), 5PDE1 medications are rarely successful in producing erections. In time, their efficacy improves, however.

No-Scalpel Vasectomies By Skilled Surgeons May Speed Recovery

Vasectomies

Although no-scalpel vasectomies are becoming more popular among physicians and patients, there are no definitive statistics to confirm the superiority of this choice, and a new review's main conclusion is to underline the importance of training.
Yet training is not always available or sought, said lead reviewer Dr. Lynley Cook, a public health physician and clinical senior lecturer at the University of Otago in Christchurch, New Zealand.
She said, "Training may not be available in all places in the world and surgeons who learned how to do vasectomies using the standard incision method may not be interested in learning a new technique."
Vasectomy, a surgical form of birth control in which a duct known as the vas is cut or tied, has traditionally been performed by making an incision in the skin of the scrotum. Cutting or tying the vas, which carries sperm from the testicles, leaves a man infertile.
Instead of making an incision, the no-scalpel technique uses a sharp instrument to puncture the skin. Advantages of puncturing rather than cutting the skin of the scrotum include less bleeding, bruising, infection and pain. Also, the puncture is usually so small that it does not require stitches.
The review looked at two studies that compared the no-scalpel method of vasectomy to the traditional method. The studies arrived at conflicting results.
The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.
The larger study, conducted in 1999, included 1,429 men in five countries: Brazil, Guatemala, Indonesia, Sri Lanka and Thailand. All eight physicians � � " general surgeons and urologists � � " had experience with the standard vasectomy technique and three had experience with the no-scalpel method. Inexperienced surgeons received training in the no-scalpel technique.
In this study, men who received no-scalpel vasectomies had less bleeding, bruising, infection and pain during surgery and follow-up. Doctors using the no-scalpel method had more surgical difficulties than those who used the incision method � � " primarily locating the vas. Even so, the no-scalpel method resulted in a shorter operation. The patients also had a shorter recovery with a quicker resumption of postoperative sexual activity.
The smaller trial included 100 participants treated at a single site in Denmark. None of the eight doctors had substantial experience in the no-scalpel technique. Training was limited to an instructional video and one supervised procedure. Only one surgeon performed more than 10 no-scalpel vasectomies in the trial.
The smaller study showed no difference in postoperative results between the two techniques, but this, review authors say, could have been due to the small numbers of participants. Another important factor was the lack of experience that participating doctors had in the no-scalpel technique.
Both studies found the two techniques to be equally effective in terms of providing permanent fertility control. Although the larger study seemed to demonstrate many advantages to the no-scalpel method, the reviewers found the results inconclusive, largely because results from the studies could not be pooled for analysis.
"From the results of the review, we would agree that the no-scalpel methodology is the preferable method to use, as it has lower rate of adverse events," Cook said. "But the no-scalpel technique requires more training and a higher level of skill. One of the most important issues for men seeking a vasectomy is the experience of the surgeon with that particular method."
"The no-scalpel vasectomy is much more difficult to learn than the conventional one and requires more hands-on training," said Dr. Marc Goldstein, executive director of the Men's Service Center, Cornell University, Weill Medical College. "Adequate training is key." Goldstein was not involved with the review.
Despite the lack of documented evidence, men are increasingly asking their doctors about this method. Goldstein said that one-third of the vasectomies now done in the United States use the no-scalpel method.
Goldstein recommends that a patient considering a no-scalpel vasectomy ask his doctor where he received his training and how many of these surgeries he has done. More studies would help: "Informed patients will benefit from data showing that it is a technique associated with less pain and fewer complications."

Erectile Dysfunction Common, Link with Severity of Heart Disease

Erectile Dysfunction and Heart

Sexual condition also associated with other chronic diseases and their risk factors
Erectile dysfunction (ED) affects approximately one in five American men, appears to be associated with cardiovascular and other chronic diseases and may predict severity and a poor prognosis among those with heart disease, according to three studies in the January 23 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
New medications for erectile dysfunction, introduced in 1998, prompted a 50 percent increase in physician visits related to the condition from 1996 to 2000, according to background information in one of the articles. Most previous estimates of the impact of erectile dysfunction have either excluded some men based on age, ethnicity or profession or were compiled before these medications became available. This led the National Institutes of Health Consensus Development Panel on Impotence to call for national epidemiological data to provide information about prevalence and risk factors for erectile dysfunction, the authors write.
Christopher S. Saigal, M.D., M.P.H., The David Geffen School of Medicine at UCLA, Los Angeles, and colleagues at the Urologic Diseases in America Project analyzed data from the 2001-2002 National Health and Nutrition Examinational Survey (NHANES). A total of 2,126 men age 20 years and older responded to the survey, answered questions about sexual function and underwent a physical examination. Men who said they were sometimes or never able to maintain an erection adequate for sexual intercourse were defined as having erectile dysfunction.

Healthy Solution For Men Suffering From Erectile Dysfunction

For men tired of taking drugs for the common, and often devastating, medical condition of erectile dysfunction, The Penis Diet offers an informative how-to solution encompassing a safe, natural wellness plan and positive lifestyle changes to enhance performance for the long term.
For men who are not quite convinced that drugs like VIAGRA are the best way to achieve an erection, The Penis Diet offers something they can really sink their teeth into. This informative how-to book offers a natural, safe wellness plan and positive lifestyle changes as an alternative to erectile dysfunction (ED) drugs.
Co-authored by Damon Z. Cozamanis, D.C. and Marc D. Grobman, D.O., F.A.C.P., The Penis Diet, offers solutions that, unlike ED drugs, target the actual cause of problem and promote long-term health of the penis.
"Drugs only address the symptoms of erectile dysfunction, and come with a host of unwanted side-effects," said Grobman, a board-certified internist. "In the Penis Diet, we offer a comprehensive plan that addressed one of the main problems associated with ED-lack of adequate blood flow to the penis.
"Instead of taking a pill for a quick fix, we provide answers that do more than just improve sexual performance for a few hours. What we present in this book can also bring about positive changes in other aspects of life, such as self image, relationships and job performance — in and out of the bedroom."
After just a few months following the recommendations in The Penis Diet, men will start to notice longer and firmer erections and enjoy more powerful orgasms. Beyond being a safe, natural approach for preventing or reversing ED, the book is advised for men of all ages who are concerned about the health of their penis and want to prolong their physical enjoyment.
The approach Drs. Cozamanis and Grobman took in writing The Penis Diet reinforces the lifestyle-change component that is critical for long-term results. Although the book does contain dietary suggestions and plans, it also educates the reader on other physical and emotional conditions that may contribute to the problem, gives insights into the "how and why" of treatment options that really work, and guides the reader on how to integrate the best changes into his sexual relationships.
"ED is such a sensitive subject, and many patients go for the quickest and least conspicuous solution … which is not necessarily the best," said Cozamanis. "While we respect the sensitivity and the serious nature of ED, we also took an upbeat tone in presenting medical facts and recommendations. By lightening the mood, we help the reader to relax with the subject matter and become open to the choices he has to improve the situation."
At less than 75 pages, The Penis Diet is sufficiently informative, yet doesn’t lead the reader through a confusing maze of medical terminology. It offers clear and encouraging steps and considerations ranging from the causes of ED, cures and prevention, to "how to feed your penis," exercises, myths and facts.

Erectile Dysfunction Often Sign of a Cardiovascular Problem

Erectile Dysfunction and Cardiovascular Health

"Erectile dysfunction is not just a quality of life issue, but needs to be considered a significant public health concern associated with preventive cardiovascular medicine," states lead researcher and author of the article, Kevin Billups, MD. "The earlier a man is evaluated for Erectile Dysfunction, the better the outcome for maintaining good erectile function and good cardiovascular health."
Research suggests that medical evaluation for� � Erectile Dysfunction in patients needs to be integrated into an evaluation for cardiovascular risk as well. The study stresses that early recognition of ED, "particularly in high-risk and underserved minority populations" like African Americans and Hispanics, can lead to early diagnosis of previously undetected cardiovascular risk factors and subclinical vascular disease. African American men are 20% more likely to have ED than Caucasians, according the National Health and Social Life Survey.
While� � Erectile Dysfunction has traditionally been seen as a secondary complication to heart disease, diabetes, and other vascular illnesses, key findings in various clinical research studies have shown that ED was often present prior to the diagnosis of these other medical conditions. Because of this strong association, ED is now being considered an important barometer of a man's overall cardiovascular health and an early symptom of a more generalized vascular problem.
Adopting the ideas presented in this paper could have a significant impact on preventive cardiovascular health strategies," adds Dr. Billups.
The MHI recommends that all men aged 25 years and older should be asked about ED. Any signs of the problem should prompt physicians to aggressively assess whether or not the patient is at risk for cardiovascular disease.