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Erectile dysfunction or as it used to be called, impotence, afflicts 30 to 40 million men in the United States. It takes on many forms and varieties. Some men have difficulty developing an erection; other men have difficulty maintaining an erection. The National Institute of Health has recognized this problem for years and research is progressing on the causes and treatments of erectile dysfunction. This disorder afflicts men primarily between the ages of 40 and 70 years of age. Several studies have shown that about 40% of men over 70 have this problem. Some of the factors that make one more likely to develop erectile dysfunction are diabetes, high blood pressure, cardiovascular disease, certain medications, a history of certain operations or surgical procedures, hormonal imbalances and psychological disorders such as depression. To evaluate men with this problem takes a simple history, physical, a blood test and rarely, other testing techniques. The treatment of impotence has changed dramatically since the advent of Viagra. This drug is effective in about 70% of men. If Viagra is not effective, then other therapies must be sought. Injection therapy, which involves the use of a very fine needle through which active medication is injected directly into the penis, has been the standard mode of therapy prior to Viagra. This method is still used successfully. It does not produce pain; it is predictable, reproducible and relatively inexpensive. Another treatment for erectile dysfunction is the use of a vacuum device. This is a simple mechanical medical device that patients are instructed on. It can be used quite readily by most men and has no major side effects. Surgery with implantation of penile prosthesis has been around since the late sixties. This operation is usually done as an outpatient or an overnight stay. Its results are predictable and reproducible. Most patients and partners are quite happy with the results of the operative procedure. There are several types of penile prosthesis. The inflatable type is one in which the patient has the capacity to produce an erection when desired and produce the flaccid position when desired. There are other types in which the inserted device produces the necessary rigidity by simply moving the prosthesis. The pharmaceutical industry has many exciting products in the pipeline. These drugs are designed to correct erectile dysfunction. There are several medications currently being evaluated and they are in various stages of development. Our practice is fortunate in that we are involved in the testing of these products. This testing is done according to FDA mandates. All testing is confidential and performed in our office. The medication is provided free of charge and all services surrounding these studies are paid for by the sponsoring pharmaceutical organizations.
Urinary Incontinence
Urinary incontinence affects 13 million ambulatory people in the U.S. and as many as 7 million homebound and extended care facility patients. Since the estimated annual cost of treating this disorder exceeds 27 billion dollars, it is obviously a major health issue. There are a variety of treatment options available to those who suffer from this embarrassing condition. Since there are different types and severities of incontinence, the therapeutic strategy that is employed may change from patient to patient. Incontinence specialists deal with several types of urinary leakage disorders. One common type is called "urge" incontinence. Patients so afflicted complain of an uncontrollable urge to void and as a result leak before they reach the toilet. This problem is usually associated with inflammatory conditions of the bladder, such as infections. On many occasions a short dose of antispasmodics will restore continence. For those people who have persistent leakage, biofeedback can help. This technique involves training patients to effectively contract their pelvic muscles, which in turn causes uncontrollable bladder contractions to stop.
The form of leakage that is most familiar to women is referred to as "stress" of increased intra-abdominal pressure from sneezing, coughing, lifting, etc., which causes the bladder to descend from its normal position and leak. Women who have experienced childbirth are at risk for developing this type of incontinence. Aging is also a factor. While this problem is the one most commonly treated by surgery, many patients respond to multiple alternatives that are available. These include biofeedback, which strengthens the pelvic muscles or medications that increase the tone of the sphincter or valve mechanism of the bladder. The surgical approaches generally comprise some form of bladder suspension procedure. A third kind of incontinence that mainly affects men, is the "overflow" variety. Bladder outlet obstruction caused by an enlarged prostate result in inefficient voiding such that the bladder retains increasing amounts of urine. Eventually the bladder cannot hold any more and leakage results. Once the obstruction is addressed continence should be restored. Additionally, both men and women can develop a condition known as intrinsic sphincter deficiency (ISD). In this setting their valve mechanism is incompetent. Sphincter active medications, biofeedback and surgery can be offered. Also, a collagen implant procedure (performed in the office) is a relatively new treatment for this type of leakage. Collagen is a viscous protein that is injected underneath the inner lining of the voiding passage.
Some patients with neurological disorders, such as Parkinson's disease, multiple sclerosis or spinal cord injury can also lose bladder control. They have a condition called "reflex" incontinence. In this condition their bladders contract inappropriately and without warning. They are treated with medications that decrease bladder spasticity. Finally, a "transient" form of incontinence has been recognized. This occurs in the group of people with cognitive disabilities that can result from diseases such as Alzheimer's. These individuals have normally functioning urinary tracts, but, for example, they may forget where their bathroom is located. Behavioral modification and medications are useful treatments. Treatments that can be considered include pharmacologic, behavioral modification with biofeedback training, dietary and fluid management, intra-urethral and intravaginal devices, and surgery.
In general, there are two classes of medications that are used to help restore continence - those that decrease bladder over-activity and those that increase the tone of the urethral sphincter. The FDA has recently approved new drugs for the over-active bladder: Ditropan XL and Detrol. These medications were developed through extensive research. Parts of those studies were conducted here in Waterbury at the Connecticut Center for Continence. In addition to these medications, some post-menopausal women can benefit from estrogen therapy, which helps to improve bladder support. Finally, antibiotics are commonly used to treat those infections that cause incontinence. Bladder control can also be restored in some instances through biofeedback training. This technique teaches patients how to perform effective pelvic floor contractions, or the so-called "Kegel" maneuvers. Most women know what these exercises are, but very few know how to perform them properly. A biofeedback monitor is used as an instructional tool to demonstrate the effectiveness of the patient's efforts. Some patients are plagued by increased urinary production, which can aggravate bladder control. Modifications in their diet, fluid intake and physical activity can help these individuals.
Lastly, surgical procedures might be the most appropriate therapy for selected individuals. For some, collagen implants, which can be performed in the office, are an attractive choice. For others, who may have more severe urinary leakage, formal operations may prove to be the better decision. Bladder suspension operations and those geared towards the restoration of better sphincteric function, i.e. "sling" procedures, are the most common surgical approaches. Artificial sphincters are also becoming popular for men with post-prostatectomy incontinence. All of the previously discussed treatments are not appropriate for every patient. Therapy is individualized to each person's specific problem, so that maximum benefit can be achieved. While not all incontinence is curable, virtually all incontinent patients can be improved. Please feel free to contact us at 800.757.8361 to receive information regarding incontinence or the Connecticut Center for Continence.
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Urology Specialists, P.C. Main office:
10 Main St., South
Midstate Hospital Connecticut Clinical Research Center Connecticut Center for Continence |
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