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A self-contained inflatable prosthesis is similar but has fewer parts. It consists of a pair of inflatable tubes in the penis with a pump attached directly to the end of the implant. The reservoir is also located in the shaft of the penis. Its compact design allows for simpler implantation, but because it takes up more space in the penis, there is less room for expansion.
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All of these conditions or lifestyle factors contribute to erectile difficulties in three major ways: By reducing blood flow, causing nerve damage, or changing the hormonal environment.
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The PSA blood test, originally intended only to monitor men after treatment for prostate cancer, should never have been promoted as a screening tool for men without symptoms. It has a high rate of false alarms (two out of every three) and misses cancer 25% of the time. Its dangers are so well recognized that no medical organization recommends PSA screening. Yet the test became popular because of prostate awareness campaigns funded by the pharmaceutical and medical device industries. The latter produces the biopsy guns which are in demand thanks to mass screening.
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The researchers at the Chinese University of Hong Kong believe that the root cause of both the erectile problems and the heart disease could be down to blood vessel damage caused by high blood sugar levels. They advise men who have impotency problems to see their doctor, as this appears to be a reliable warning sign of future health problems.
The study is published in the Nov. 11 online edition of Human Reproduction.
Discussion Policy
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Originally, alprostadil was used to treat neonates with congenital heart defects. In order to treat this condition, alprostadil has to be directly injected into the heart region. (4) This is the same drug that is used to treat ED, and until very recently the delivery method was the same principle! In other words, brand name products such as Caverject® were injected into the penis with fast-acting results. Having spoken to some who have practiced this method, it is apparently quite painless, but the thought of having to place a needle into one’s vital member is undoubtedly a “bridge too far” for most men! When one considers that this is meant to take place prior to love making, the two concepts/ thoughts just don’t seem to go together!
During the period following the licensing of sildenafil for use in ED, an increase in the number of patients seeking treatment for heretofore-untreated ED was widely anticipated. This institution did not find an increase in the number of men referred with ED in the year following 14 September 1998, compared to the year preceding this date. It is not clear though, if this anticipated increase in the number of men with ED have been dealt with in the primary care. Considering that the referral pattern from primary to secondary care has not changed in this institution, we do not feel that this has happened.
Safety concerns and adverse effects have been studied carefully. The most common adverse effects are headaches and upper GI distress. These are not usually severe and are self-limited when the drug is stopped. Sildenafil is a mild inhibitor of phosphodiesterase type 6, which is found in the retina. This inhibition is manifested by a blue haze at the periphery of the field of vision but is not dangerous. Very few patients have stopped taking sildenafil because of this effect.
Mild-to-moderate hepatic impairment: Not to exceed 10 mg PO qd prn
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Tadalafil should not be used with alpha-blockers (except Flomax), medicines used to treat high blood pressure and benign prostate hypertrophy (BPH), because the combination of tadalafil and an alpha-blocker may lower the blood pressure greatly and lead to dizziness and fainting. Examples of alpha-blockers include tamsulosin (Flomax), terazosin (Hytrin), doxazosin (Cardura), alfuzosin (Uroxatrol), and prazosin (Minipress). The only alpha-blocker that can be used safely with tadalafil is tamsulosin (Flomax). When tadalafil (20 mg) was given to healthy men taking 0.4 mg of Flomax daily, there was no significant decrease in blood pressure and so patients on this dose of tamsulosin (Flomax) can be prescribed tadalafil. The only alpha blocker that has not been tested with tadalafil is alfuzosin (Uroxatrol) and no recommendations can be made regarding the interaction between the two.
Table 4. Patient demographics. Ranges and percentages are provided in parentheses.
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Numerous factors can disrupt the normal physiologic mechanisms involved in erection (Table 1). Most cases of erectile dysfunction were thought to be psychologically based, but it is now understood that most have an organic cause, especially in older patients. In about 40% of men over 50 years old, the primary cause of erectile dysfunction is related to atherosclerotic disease.20 In this respect, risk factors are similar to those of cardiovascular disease. However, erectile dysfunction may also be related to psychological, neurological, hormonal, pharmacological and end-organ (penile) factors.
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