Andrew Siegel MD 9/12/2020
SEPTEMBER: PROSTATE CANCER AWARENESS MONTH
Twenty-five years ago, Cal Ripken Jr., the Baltimore Orioles shortstop, played in his 2,131st game in a row, breaking Lou Gehrig’s record. In 2020, Ripken, now 60-years-old, had a routine health exam with a lab test showing a slightly elevated level of PSA (prostate-specific antigen) and thereafter underwent prostate biopsy that revealed early-stage cancer. He was successfully treated with surgical removal of the prostate.
As quoted in the NY Times, Ripken stated: “As baseball players, we have it all done for us when we play. As we retire, we’ve got to make our own appointments and sometimes you get a little lax. Men in particular, like me, can stick our heads in the sand and say everything’s going to be all right. Well, it might not be all right. But if you’re proactive and they do find it, you have options.”
And there you have it…be proactive by being screened annually with a digital rectal exam and a PSA blood test to detect prostate cancer in its earliest and most treatable forms. Remember that this is a cancer that causes NO symptoms until later in its course and therein lies the importance of screening.
ALTERNATIVES TO PILLS & PROCEDURES
A practical and sensible approach to ED begins with simple solutions and only if necessary proceeds with more complex strategies. Last week’s entry reviewed the “first line” healthy lifestyle approach to improving sexual issues. Today’s entry reviews “second line” approaches, an introduction to mechanical treatments. Future entries will review each of the aforementioned devices and approaches individually and in greater detail.
Second line ED treatments include mechanical devices, the topic of today’s entry, and pills, next week’s topic. The mechanical, non-pharmacological, non-surgical devices include: vacuum suction devices, venous constriction devices, vibration devices and penile traction devices. Low-intensity penile shockwave therapy is also included within this category.
VACUUM SUCTION DEVICES, A.K.A. PENIS PUMPS
Available at Urology Health Store
Vacuum suction devices are mechanical means of producing an erection in which the penis is placed within a plastic cylinder connected to a manual or battery-powered vacuum. Negative pressure draws in blood and engorges the penis and a constriction band is placed around the base of the penis to maintain the erection. It can be an effective means of treating ED and is also helpful in the penile rehabilitative process after prostatectomy to maintain penile blood flow and keep the erectile tissues supple and elastic. It also can be helpful to optimize penile length prior to penile implant surgery. The downside is that the device is a bit clunky to use, there may be some discomfort with subjecting the penis to vacuum pressures and the need for the constriction device to maintain the erection after the removal of the vacuum.
VENOUS CONSTRICTION DEVICES
Available at Urology Health Store
Venous constriction devices are used to help trap blood in the penis to maintain an established erection. Men who find these beneficial are usually able to obtain a reasonable quality rigid erection but tend to lose it prematurely, often due to failure of the blood trapping mechanism (veno-occlusive disease).
VIBERECT
Available at Urology Health Store
Male vibration devices were initially used to enable men with spinal cord injuries to be able to father children. When the vibration device is placed in contact with the penis, after a certain time period of stimulation it will induce ejaculation of semen, which is then used for assisted reproduction. Nowadays, vibration devices are used not only to induce ejaculation in men incapable of doing so, but on a broader basis for any man with ED to facilitate obtaining an erection (and ejaculation). The Viberect device has dual upper and lower arm so that the top and bottom of the penis can be simultaneously stimulated.
PENILE TRACTION DEVICES, A.K.A. STRETCHING DEVICES
Available at Urology Health Store
Penile traction is a minimally invasive, relatively new option for managing conditions associated with penile shortening. Traction can help improve the penile curvature and shortening associated with Peyronie’s disease, particularly when initiated early during the course of the disease, as well as following surgery or injection therapy for Peyronies. It may also be helpful to optimize penile length prior to penile implant surgery and for the management of any condition causing penile shortening. It does require a dedicated and compliant user willing to wear the traction device for extended periods of time in order to achieve satisfactory lengthening.
SHOCK WAVE THERAPY
Thank you Storz Medical and Robert Remington (RemingtonMedical.com) for above image of a shock wave unit used for the treatment of ED; note treatment of both the outer (left side of image) and inner aspects of the penis (right side of image)
Low energy penile shockwave therapy is a treatment option for men with ED in which low intensity shocks are applied to various sites of the penis. The mechanical stress and trauma to erectile tissues stimulates the growth of new blood vessels and nerve fibers and potentially enables penile tissue to regain the ability for spontaneous erection. It uniquely modifies the disease, unlike most traditional treatments that function as “Band-Aids.” It works best for men with mild ED that has responded to the oral ED medications. It is painless, safe and well tolerated. Ongoing clinical investigation will determine optimal treatment protocols. It is still not yet FDA approved and therefore is considered “investigational” and not covered by insurance, but it is likely that it will ultimately be approved by the FDA for the treatment of ED.
Wishing you the best of health,
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Dr. Andrew Siegel is a physician and urological surgeon who is board-certified in urology as well as in female pelvic medicine and reconstructive surgery. He is an Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community. He is a urologist at New Jersey Urology, the largest urology practice in the United States. Today’s entry is excerpted from his latest book, Prostate Cancer 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families.
Video trailer for Prostate Cancer 20/20
Preview of Prostate Cancer 20/20
Andrew Siegel MD Amazon author page
Prostate Cancer 20/20 on Apple iBooks
PROSTATE CANCER 20/20: A Practical Guide to Understanding Management Options for Patients and Their Families is now on sale at Audible, iTunes and Amazon as an audiobook read by the author (just over 6 hours).
Dr. Siegel’s other books:
PROMISCUOUS EATING— Understanding and Ending Our Self-Destructive Relationship with Food
MALE PELVIC FITNESS: Optimizing Sexual and Urinary Health
THE KEGEL FIX: Recharging Female Pelvic, Sexual, and Urinary Health
Our Greatest Wealth Is Health 