Issue link: https://viewer.e-digitaledition.com/i/1091761
TREATMENT OPTIONS FOR ERECTILE DYSFUNCTION Dr. Mosta fa repor ts a sig nif ica nt number of his patients see some improvement of ED symptoms with medication. "Probably 35 to 50 percent of patients will have some improvement," Dr. Mostafa says. "A little less than that will improve to the point where they don't require further treatment." Dr. Murtagh also urges referring physicians to suggest lifestyle changes to patients to help improve ED, as well as ensure none of the patient's medications are causing the condition. Other treatment options may include penile implants, which can be inserted on an outpatient basis using robotic surgery. "[Robotics are] a great tool to use for pelvic surgery," Dr. Murtagh says. "The pelvis is a deep structure and has a lot of organs, [and] all of these can be accessed with robotics." Dr. Murtagh says that robotic surgery allows the surgeon to have better visualization during the procedure and offers numerous benefits for the patient. "It gives us better outcomes and reduces recovery times," Dr. Murtagh says. "For a lot of the procedures we perform, patients recover much better." If you would like patient education materials for your office or would like to discuss this topic further, please contact The Toledo Clinic at 419-725-6850. ■ Treating Male Incontinence In addition to being a cause for ED, a radical prostatectomy or other prostate procedures can cause urinary incontinence. The Urology Care Foundation states that up to a third of American men and women suffer from urinary incontinence, including overactive bladder (OAB), stress urinary incontinence (SUI), mixed incontinence (OAB and SUI) and overflow incontinence. "OAB incontinence is very common in men," says Hesham Mostafa, MD, urologist at The Toledo Clinic. "It's usually caused by chronic bladder obstruction due to prostate enlargement ... SUI is not very common unless [the patient] has had some sort of surgery." The surgery Dr. Mostafa refers to is, usually, a radical prostatectomy as a treatment for cancer. SUI typically resolves within one year following surgery; if a patient still experiences SUI within six months after a radical prostatectomy, the patient can consult a urologist to discuss further treatment options. Treatments may include absorbent products, external collection devices or penile clamps. If these do not yield results, surgical options are available, such as the male sling and artificial urinary sphincter. "The male sling is a simple mesh that we put underneath the bladder," says Daniel Murtagh Jr., MD, MSDS, urologist at The Toledo Clinic. "[This] recreates the proper anatomy and helps men with leakage after a prostatectomy." Dr. Mostafa also uses the male sling, recommending it for patients with mild to moderate symptoms or patients with limited hand function. "[For] patients who have severe incontinence and good hand function, we suggest the artificial sphincter," Dr. Mostafa says. "It's a pressure balloon that goes around the urinary channel. It keeps its tone on the urethra, and a pump is placed on the scrotum." The sphincter closes the urethra to prevent leakage. By squeezing the pump in the scrotum, the sphincter opens the urethra to allow the flow of urine. "There's a very high satisfaction rate [in both options,]" Dr. Murtagh says. "It's well over 90 percent." " These are sensitive topics for patients. Men are now more aware of ED and know it's not uncommon or something they have to live with. Men need to have open and honest conversations with their urologists and primary care physicians." — DANIEL MURTAGH JR., MD, MSDS, UROLOGIST AT THE TOLEDO CLINIC M D N E W S . C O M /// M D N E W S N O R T H W E S T O H I O ■ 2 019 0 5