Impotence/Erectile Dysfunction (cont.)
IN THIS ARTICLE
Surgical Treatment
- Penile implants: In the past, the placement of prosthetic devices within the penis was the only effective therapy for men with organic ED. Now, this is the last option considered. Nevertheless, this remains a reliable form of therapy. Before selecting this form of management, your doctor will discuss the benefits and risks of this procedure with you and your partner. Nearly 100% of the men with implants express satisfaction. Part of this enthusiasm is related to the failure of other therapies and a highly motivated user. Two types of devices are available, a semirigid and a multi-component inflatable system.
- With the semirigid device, 2 matching cylinders are implanted into the penis. These devices provide enough rigidity for penetration and rarely break. The major drawbacks are the cosmetic appearance of the penis, the need for a surgery, and the destruction of the natural erectile mechanism when the device is implanted.
- The inflatable devices consist of 2 cylinders inserted into the penis, a pump placed in the scrotum to inflate the cylinders, and a reservoir that is contained either within the cylinders or in a separate reservoir placed beneath the tissue of the lower abdomen. The inflatable prosthesis generally remains functional for 7-10 years before a replacement may be necessary. Complications include infections in 2% of users, device malfunction in 4%, erosion of the device through the urethra or skin in 2%, and painful erections in 1%.
- With the semirigid device, 2 matching cylinders are implanted into the penis. These devices provide enough rigidity for penetration and rarely break. The major drawbacks are the cosmetic appearance of the penis, the need for a surgery, and the destruction of the natural erectile mechanism when the device is implanted.
Types of Surgical Therapies for Erectile Dysfunction
| Treatment | Advantages | Disadvantages |
|---|---|---|
| Semi-rigid or malleable rod implants | Simple surgery
Relatively few complications No moving parts Least expensive implant 70-80% success rate Highly effective |
Constant erection at all times
May be difficult to conceal Does not increase width of penis Risk of infection Permanently alters or may injure erection bodies Most likely implant to cause pain or erode through skin If unsuccessful, interferes with other treatments |
| Fully inflatable implants | Mimics natural process of rigidity-flaccidity
User controls state of erection Natural appearance No concealment problems Increases width of penis when activated 70-80% success rate Highly effective |
Relatively high rate of mechanical failure
Risk of infection Most expensive implant Permanently alters or may injure erection bodies If unsuccessful, interferes with other treatments |
| Self-contained inflatable unitary implants | Mimics natural process of rigidity-flaccidity
User controls state of erection Natural appearance No concealment problems Simpler surgery than fully inflatable prosthesis 70-80% success rate Highly effective |
Sometimes difficult to activate the inflatable device
Does not increase width of penis Mechanical breakdowns possible Long-term results not available Risk of infection Relatively expensive Permanently alters or may injure erection bodies If unsuccessful, interferes with other treatments |
| Vascular reconstructive surgery | Restores natural erections when successful
Natural appearance No implant required If unsuccessful, does not interfere with other treatments 40-50% overall success rate Moderately effective |
Most technically difficult surgery
Only 50% of men are potential candidates Extensive testing required Risk of infection, scar tissue formation with distortion of the penis, and painful erections May cause shortening or numbness of the penis Long-term results not available Relatively high relapse rate Very expensive |
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Indication
Uroxatral® (alfuzosin HCl 10 mg extended-release tablets) is an alpha1-blocker for the treatment of the signs and symptoms of BPH.
Important Safety Information
Do not take UROXATRAL if you have liver problems or if you are taking antifungal drugs like ketoconazole or itraconazole, or HIV drugs like ritonavir.
UROXATRAL can cause a sudden drop in blood pressure, especially when starting treatment. This may lead to fainting, dizziness, and lightheadedness. Do not drive, operate machinery, or do any dangerous activity until you know how UROXATRAL will affect you. This is especially important if you already have a problem with low blood pressure or take medicines to treat high blood pressure. There may be an increased risk of low blood pressure and fainting when taking UROXATRAL in combination with blood pressure medication or nitrates, or erectile dysfunction medication.
If considering cataract surgery (clouding of the eyes), tell your eye surgeon that you are currently taking UROXATRAL or have previously been treated with an alpha-blocker.
Before taking UROXATRAL, tell your doctor if you have kidney problems.
Also, tell your doctor if you or any family member(s) have or take medications for a rare heart condition known as congenital prolongation of the QT interval.
BPH and prostate cancer can cause the same symptoms. However, UROXATRAL is not a treatment for prostate cancer.
The most common side effects with UROXATRAL are dizziness, upper respiratory tract infection, headache, and tiredness.
Please see UROXATRAL full prescribing information.
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