By: Alexander Rozanski, MD, is a fellowship-trained urologist specializing in male genitourinary reconstruction and men's health.
September is Prostate Cancer Awareness Month. With over 10% of men being diagnosed with prostate cancer at some point in their lifetime, it is the most common cancer for men in the United States. Fortunately, we have many good treatment options for prostate cancer and the overall 5-year survival rate exceeds 95%.
Erectile dysfunction (ED) is present in more than half of men over the age of 40 and often associated with health conditions such as diabetes, heart disease, low testosterone, prostate cancer treatment and Peyronie's disease (penile curvature). ED is defined as the inability to achieve or maintain an erection firm enough for sexual intercourse.
Prostate cancer and ED are related because certain treatment options for prostate cancer can increase the risk of ED. Up to 46% of men report ED symptoms one year following radical prostatectomy surgery. Up to 50% of men report sexual dysfunction symptoms following pelvic radiation therapy.
Stress urinary incontinence (SUI) is another potential side effect of prostate cancer treatment. SUI is defined as bladder leakage, particularly while coughing, sneezing, laughing, lifting heavy objects, walking, jogging, etc. About 9-16% of men will develop persistent SUI one year after their prostate cancer surgery. It is also seen in a small percent of men who undergo pelvic radiation therapy for prostate cancer.
Modern treatment options for ED
Treatment options for ED include oral medications, injections, penile implants, vacuum erection devices and urethral suppositories. The side effects, success rates and satisfaction rates vary with each of these treatments.
ED is an exceedingly common problem; fortunately, several treatment options are available to help men who experience it. A popular and effective solution I offer my patients is a penile implant, which provides a permanent solution with very high patient and partner satisfaction rates. However, it is important that men thoroughly talk with their doctors and partners about all treatment options and find what best fits their lifestyle.
The effectiveness of the penile implant is substantial. An impressive 98% of patients report erections to be excellent or satisfactory. Even after seven years of surgery, 94% of implants are still in use and free of revision. The device is entirely contained internally within the body and nicely replicates both a natural erection when inflated and a flaccid state upon deflation. Better than other ED treatments, the penile implant allows couples to preserve spontaneity in their intimate sexual relationships.
Modern treatment options for SUI
There are both short-term and long-term treatment options for SUI. However, many patients report that short-term coping strategies, such as urinary pads/diapers or penile incontinence clamps, become burdensome and problematic over time. Alternatively, there are dependable long-term treatment options that provide patients a range of lasting benefits.
Short-term options can become expensive in the long run and are often uncomfortable. Therefore, permanent solutions for male incontinence, including the male sling and artificial urinary sphincter, are regularly chosen as a man's best option for managing incontinence.
The male sling is placed during a minimally-invasive procedure. It is designed to support the urethra to control urinary leakage for men with mild to moderate incontinence. Its positive impact is immediate and regular activities can often be resumed within 1-2 weeks after the procedure. Unlike short-term options, there is no patient interaction with the male sling once it is inserted. Instead, it works on its own to help restore urinary continence.
An artificial urinary sphincter mimics a man's own healthy urinary sphincter muscle, allowing him to control his urine until urination is desired or needed. It offers most men with a weakened sphincter muscle the ability to achieve urinary continence. It can be used for all severities of incontinence and represents the "gold standard" treatment option for this condition. The device is placed entirely inside the body and is undetectable from the outside.
If you are bothered by your leakage, take action to regain confidence and improve your quality of life. We're here to help patients understand all of their options and answer their questions about the short-term and long-term treatments available to them.
Appointments and education
Men who are experiencing the negative effects of ED and/or SUI are encouraged to speak with a doctor. There are many effective treatment options available including medications, devices and surgery.
New patient appointments are available at UT Health Physicians. Call now to make an appointment (210-450-9600).