If your first attempt at treating Erectile Dysfunction does not give you the results you desire, know you have other options

Author: Dr. Lieberman

E.D. is very common in men today — in fact 53% of men over 40 have some form of it. Despite its widespread impact, however, there is no sense of fraternity among these men. In fact, most men still don’t want to openly talk about E.D., choosing to either ignore the problem and hope it will go away … or attempting to find a solution, but doing so half-heartedly — and very often unsuccessfully — because they are embarrassed about their situation.

It’s rather puzzling, really. If it were any other affliction, these men would not rest until they’d exhausted every reasonable option at a cure. But when it comes to trying to resolve their E.D. issue, they dabble a little and often give up. They try some pills they borrowed from a friend … a crème they bought off the Internet … or maybe even tried getting an injection from a medical practitioner. But if they didn’t see immediate results, they shrugged their shoulders, clammed up, and unnecessarily returned to their life with E.D.

As is the case with nearly all health issues, education is key. Men with E.D. must know that 85-90% of the time there is a physical condition causing their E.D. which needs to be addressed — such as uncontrolled diabetes … heart disease … or hypertension. And, most importantly, they must know that there are not one, but SEVERAL proven, medically-sound ways that can resolve your E.D. (should it not be resolved by treating the pre-existing physical condition).

Yes, there are medications. But if the little blue pill does not give you the results you want, don’t give up! Injectables — which have an 85% success rate, but are not the most convenient option — may be the solution for you. Or perhaps you should consider a penile implant that has a 95+% success rate with producing reliable erections when needed.

Only a urologist, like myself, who specializes in the treatment of male E.D. can offer you the options of oral and injectable E.D. treatments, as well as surgical implants.

Erectile Dysfunction can be a sign of a serious health condition that needs treatment

Author: Dr. Lieberman

In the United States, approximately 50 million men suffer from erectile dysfunction. As our population continues to grow and age, this number is expected to increase. In fact, the worldwide prevalence of erectile dysfunction was 152 million in 1995 — and is expected to increase to 322 million in 2025, according to the Web site edguidance.com. 

These numbers are alarming, no doubt. What’s perhaps more alarming, however, is the amount of misinformation that men have regarding this condition. When a man faces the inability to have an erection when he wants to, he will often dismisses this problem as being “in his head.” Now this can be true, but psychological issues such as stress and anxiety are usually not the only factors at work. Problems getting or keeping an erection can be a sign of a serious health condition that needs treatment, such as heart disease … poorly controlled diabetes … vascular disease …hypertension. By ignoring your E.D. you may be also ignoring a much larger threat to your overall health!

Treating an underlying health problem may be enough to reverse your erectile dysfunction. If treating an underlying condition doesn't help your erectile dysfunction, medications or other direct treatments may work. The key with treatment, however, is the credentials of the person providing it. Long story short — you should only consult trained medical doctors. Start with your primary care physician. Don’t be embarrassed and talk honestly and candidly about your situation. Usually, he or she will refer you to a board-certified urologist, like myself, who specializes male sexual dysfunction.

I cannot overemphasize the importance of seeing a urologist that specializes in male sexual dysfunction. He or she will be able to address your E.D. with all modalities of treatment, including both medical and surgical alternatives. And when it comes to surgical alternatives for E.D., make sure to evaluate the level of experience that your urologist has in this area. This is extremely critical. Choose someone like myself who has a record of successfully performing penile implant surgery for many, many years. In fact, I have the most widespread experience in penile implant surgery in the Lehigh Valley, performing implant surgery on a regular basis.

Erectile Dysfunction surgery and injectables often produce results when oral meds can't.

Does your doctor have experience with all of them?

Author: Dr. Lieberman

Long before there were commercials advertising oral medications for resolving erectile dysfunction … long before there were jokes about the side effect of a four-hour erection … and long before anyone was familiar with the phrase “the little blue pill” … I began practicing as a trained, board-certified urologist in the area of male sexual dysfunction. It was 27 years ago to be exact.

Now, some nearly three decades later, I can proudly state that I am still helping men come to grips with their erectile dysfunction issues — and, more importantly, — solve their E.D. In this time, the field of medicine has made great strides in identifying the causes of E.D. and its treatments. In fact, it probably surprises you that treatment options for E.D. are not merely limited to the heavily-advertised oral medications like Cialis and Viagra. Injectable treatments and penile implants are other available treatment options — and they have much higher success rates than their more well-known oral-medicine counterparts. Injectables typically have an 85% success rate with patients. A penile implant — a device that is surgically implanted in the patient that allows him to have a reliable erection whenever  he so desires — has an even more impressive success rate of greater than 95%.

Surprisingly some men are put off by the idea of having an operation to cure their E.D., despite its nearly 100% success rate with producing erections and despite the fact that in their current state, they cannot have the sex they want. To these patients I typically ask, “Which sounds better to you – a 95% chance that you can have an erection whenever you want one if you have the surgery … or a 0% of having an erection if you don’t have a penile implant?” (It’s actually more of a rhetorical question isn’t it?)

I speak from experience. I’m the only urologist in the Lehigh valley who performs penile surgery on a regular basis. In fact, I have the broadest experience in this area of any doctor in the Lehigh Valley. And many of my patients are specifically referred to me for the surgery by other urologists in the valley after oral and injectable options failed. The surgery takes less than an hour. And is performed on an outpatient or short-stay basis. Patients can return to sexual activity about eight weeks after the procedure. If you have E.D. and wish to talk about ways to address it such as a penile implant, talk to a trained urologist who specializes in the area of male sexual dysfunction such as myself, or at the very least, ask your primary care physician for his or her advice. 

Provenge is the first FDA-approved immunotherapy for prostate cancer. But … is it right for you?

Author: Dr. John Maggioncalda

The goal of every Urologist is to diagnose and treat prostate cancer early. The earlier the detection, the greater the chance a treatment will lead to long-term survival. Sadly, some patients progress even after their treatment and still others are diagnosed with advanced disease from the very beginning of our interaction with them. The next step for these patients is to ensure their testosterone level is very low. This is usually accomplished by using an agent, or a combination of agents, such as Lupron, Zometa, Eligard, or Casodex. These medicines will block the body’s production of testosterone and its attachment to receptors in cells preventing the growth of prostate cancer. Unfortunately, they work for a variable amount of time, in some cases only 2-4 years. What next?  Recently, a new immunotherapy called Provenge has been approved for patients with metastatic prostate cancer with rising PSA levels despite low, castrate levels of testosterone. 

Provenge is the first FDA approved form of immunotherapy for the treatment of metastatic prostate cancer.  Patients must have a rising PSA, despite castrate levels of testosterone, and some demonstrable form of metastatic disease by CT/MRI, ultrasound or bone scan.  Potential patients must also be healthy enough to receive Provenge with at least a 6-month life expectancy and no or limited pain from their metastases. 

Provenge is not a form of chemotherapy; it is considered immunotherapy.  The treatment uses the body’s own cancer fighting cells and energizes them to attack prostate cancer cells.  Once approved for treatment a patient will have blood drawn and the immune cells separated from the red cells.  These immune cells are then stimulated so that they will begin attacking the prostate cancer cells.  The immune cells are reintroduced into the body after stimulation and the process is repeated two more times.  These three treatments are all that is required and the total treatment takes 4-5 weeks.  The side effects of Provenge can include bruising from the needle sticks, fatigue, backache, and low-grade fevers. 

Once a patient receives Provenge the progress of their disease will continue to be monitored by their Urologist or Oncologist.  There is often no direct reduction in a patient’s PSA level after treatment but, studies have shown an improvement in overall survival compared to subjects that did not receive the treatment.  Patients are still able to receive other forms of chemotherapy once Provenge is administered. 

If you are a patient with metastatic, castrate-resistant prostate cancer, I encourage you to talk with your Oncologist or Urologist about Provenge to see if it is an option for you.  Remember, not every patient may be a good candidate for Provenge.

Spending too much time in the men's room?

Author: Dr. Murphy

You're probably heard the ads on TV —  Trouble going?  Always in the bathroom?  Take this medication and stop being bothered by your aging prostate!

Prostate enlargement, called "Benign Prostatic Hyperplasia," or BPH for short, affects a lot of us — up to a third of all men will be bothered by it at some point. As the prostate enlarges, it pinches off the flow of urine from the bladder. Slowing of the stream, difficulty starting, and poor bladder emptying are the most common signs. A strong urge to go right away, even leaking before making it to the bathroom can happen, as well as getting up more often at night. We're not really sure why some men get it and others don't. It isn't caused by the things we eat or drink, or anything we do — you could say it's just part of aging, like arthritis or getting cataracts.

Fortunately there are ways to treat it. Some men feel that herbal remedies such as saw palmetto help them (although medical studies that compared saw palmetto to a sugar pill do not seem to show much benefit).  There are a couple of different types of prescription meds that work well:  

• Flomax, now available as the generic drug Tamsulosin, is the most commonly used medication for BPH. It relaxes the muscle fibers where the bladder empties through the prostate to open up the urinary flow. This medication starts working in just a week or two.
• Avodart, and a similar generic called Finasteride, shrink the prostate to improve the urinary stream, although it can take a few months to notice any improvement.  

Side effects of both of these meds are usually temporary and aren't too bothersome.

For some men, medications don't help enough. They might need a procedure to open up the urinary channel. These treatments are done under a sedative or fully asleep so there isn't any pain:

• Microwave Hyperthermia heats the prostate tissue up, and over the next few weeks it shrinks to open the channel.
• Another type of treatment removes the enlarged prostate tissue through a scope in the urethral channel. Some people call this a "Roto-Rooter."  In one technique, a laser uses a beam of energy to vaporize the tissue. The other, called Transurethral Resection, or TURP, trims out the tissue. Most men are back to full activities within a week or two. 

So all those ads on TV do make a good point. Prostate enlargement can be really annoying, and there are lots of ways to treat it. Like they say, talk to your doctor and see what you can do to urinate normally again.

Why we do what we do

Author: Dr. Dan Silverberg

I want to tell you about Jack and Maryanne (names are changed to protect privacy). Jack died a few months ago at the age of 86 of cardiac disease.  

Twenty-three years ago I removed Jack’s urinary bladder for extensive bladder cancer. Without surgery, he would have died of bladder cancer within just a year or two. This surgery is one of the most complex operations we perform as urologists. The patient's body is changed forever. For the rest of his life, Jack wore a bag on his abdomen to collect his urine. A patient's decision to undergo this surgery is never an easy one, even when staring cancer in the face. Following the surgery, Jack made a successful recovery and lived for many years in good health.

I received a note from his widow recently. It reads, in part, as follows:

Dear Dr. Silverberg and Staff,

Thank you so much for your expression of sympathy.

I also want to thank you for the wonderful care you and your staff gave Jack.

Dr. Silverberg thanks to you, Jack and I had 23 additional years together. In 1989 you told us that without the surgery Jack would have a year or two at the most. If Jack would allow you to remove his bladder, he would live for many years and die from something else.  

You were so right. 

Fondly Maryanne

This note reminds us beautifully that we do not just take care of patients. We take care of real people. They have families who love them. They have hopes and dreams for the future. When we give them an additional 23 years of life, they have the time to see their children grow to adulthood. They have that time to enjoy their grandchildren. They have the time to pursue and realize their hopes and dreams.

After all of the time we spend in the office, after all the time spent in the hospital, after all the time that we spend being doctors and nurses and medical assistants and office staff, the success of our work is measured by the extra years of life that we give to our patients.

Kidney Stone Treatment

Author: John Maggioncalda MD

Once you have been diagnosed with a kidney stone the treatment options vary.  Your urologist must take into account your health, the size of the stone, its location in the kidney or ureter, and even your prior history of passing stones.

One of the easiest ways to treat a kidney stone is to let it pass.  In many cases a small stone (<4mm) will pass spontaneously with increased fluids and pain medication.  If you have a history of passing stones in the same kidney previously, you are more likely to pass another one.  This approach reduces the need for surgical intervention and any post-op pain associated with it.  The time to pass the stone can vary however, from a few days to a few weeks.  If the pain is too intense or the time to pass the stone becomes great (>4 weeks), or you have a solitary kidney or some form of obstruction to the ureter, then spontaneous passage may not be preferred.

If your stone is clearly visible on an x-ray and in the top part of the ureter, shockwave lithotripsy or ureteroscopy is a good option for treatment.  Shockwave lithotripsy involves sending focused sound waves on to the stone to break it to small pieces.  It is done under anesthesia in the operating room, and takes about 30 minutes.  It is generally greater than 80% successful in breaking up a stone.  There can be post-op discomfort but it is usually mild to moderate.  Keep in mind that the stone must be visible on x-ray for this technique to work.  Ureteroscopy involves passing a flexible fiber optic scope up the ureter to see the stone.  A laser fiber is then passed through the scope and breaks up the stone on contact.  This procedure is more invasive, takes about 30 minutes, and usually requires a stent for 5-7 days afterwards.  Post-op pain can be significant but, it is more often moderate at worst.  The benefit of ureteroscopy is that it can work on all stones, even those not visible on x-ray.  It is also >93% successful in eradicating the stone.

Large stones in the kidney (>2cm) are very challenging and often require more invasive techniques to treat.  Percutaneous nephrolithotomy involves the passage of larger instruments into the kidney through a patient’s back.  It is also done in the operating room under anesthesia with the patient face down or prone.  Larger instruments allow the urologist to fragment and remove larger stone pieces using this technique.  Unlike the other procedures mentioned, this technique requires a hospital stay of 1-2 days and can be quite painful.  The risk of bleeding as well as other complications is also higher with this procedure.  The benefit of percutaneous nephrolithotomy is that a larger stone can often be treated efficiently with one trip to the operating room.

It is important to make sure you discuss all your treatment options with your urologist prior to planning surgery for a stone.  Remember each stone episode may be different and the treatment will vary by stone and by patient.