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Expert Care GREGORY LOW E, MD, urologic surgeon and sexual health specialist with OhioHealth Urologic Physicians, combines specialty training and extensive clinical experience to optimize treatment of ED and UI. + Education: Graduated from Medical College of Ohio at Toledo + Residency: Trained in urology at Ohio State University Wexner Medical Center, where he has more recently served as an Assistant Professor of Urology. He received the Humanitarianism Award during his residency for embodying the qualities of empathy, compassion and kindness. + Fellowship: Completed a fellowship in andrology and male infertility at the University of Virginia Health System, with a focus on sexual dysfunction and male urinary incontinence employs a prosthetic consisting of two cylinders, each entering into the two channels where blood enters the penis, and a pump, which inflates and deflates the cylinders and rests between the testicles. A saline-filled fluid reservoir is placed under the abdominal muscles. "Most men I treat who opt for the pros- thetic — often after trying other methods without much success — report wishing they had done this years ago," Dr. Lowe says. "It provides a rigid erection, and at 10 years post-implantation, it continues functioning well for 92 percent of patients." ADDRESSING UI Some patients with UI benefit from use of a catheter or a suprapubic tube, a cath- eter that enters the bladder via the belly. However, these treatments involve multiple trips to the bathroom to empty the drainage bag, as well as close monitoring of the bag to prevent it from getting too full. Penile clamps are a less popular treatment option. In addition, injections of bulking agents to boost urethral resistance to urinary flow show comparatively lower e¢cacy than options such as male slings or artificial urinary sphincters, according to Dr. Lowe. Male sling procedures traditionally have been performed on men who have mild to moderate UI. For those who experience near-total incontinence, however, artificial sphincters are more effective, Dr. Lowe notes. For example, they yielded a 90 percent satisfac- tion rate among patients who had severe incontinence related to prostatectomy, according to research published in The Journal of Urology. Artificial sphincters are placed under the skin and consist of three primary parts: a balloon, a cu• and a pump — all of which are connected via flexible, kink- resistant tubing. The device simulates a healthy sphincter and enables the patient to regulate urination by squeezing and releasing a pump located in the scrotum. Incisions are usually no longer than six centimeters, according to Dr. Lowe, and patients may begin using the device within six weeks after the procedure. "The artificial sphincter is the best option if a patient wants to be completely dry," Dr. Lowe says. "Some men with this condition are self-conscious and even avoid going out. This procedure restores their ability to lead the life they want to lead." LIFE-LIMITING TO LIFE-ENHANCING Dr. L owe encou ra ges pr i ma r y ca re providers to have an open conversation with patients who have ED or UI. Ma ny men go yea rs before seeking help, due to emba rrassment or lack of awa reness about effective treatments. "Patients with ED should be referred to a urologist if they 've tried ora l medi- cation therapy and haven't had success," Dr. Lowe says. "However, if a patient has sig nif ica nt ED a s wel l a s comorbidi- ties — or if a provider thinks a patient 's problem will worsen over the course of the nex t f ive yea rs — it 's impor ta nt to refer him to a sexua l medicine specia list who has experience in performing penile prosthetic placements and other genito- urina r y procedures. These treatments ca n g reatly enha nce qua lit y of life." If you would like to receive ED/UI patient education materials for your oce or speak further with Dr. Lowe, please contact Alex Horn at 614-349-6316. ■ M D N E W S .C O M /// M D N E W S C E N T R A L O H I O S P E C I A L E D I T I O N ■ W I N T E R 2 016 / 2 017 0 5

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