Rated one of the nation’s top physicians for patient satisfaction in 2015, Gregory Lowe, MD, urologic surgeon and sexual medicine specialist at OhioHealth Urology Physicians, merges high-level expertise with state-of-the-art devices and techniques to treat erectile dysfunction (ED) and male urinary incontinence (UI).
ED affects as many as 30 million men in the U.S., according to the Urology Care Foundation.
“Older men typically develop ED due to complications from diabetes, heart disease, and past prostate surgery or prostate cancer treatment,” Dr. Lowe says. “For younger men who develop ED, some of it relates to stress and some to anxiety. For others, their hormone panel might be a bit off.”
In more than 80 percent of cases, ED is related to physiological rather than psychological conditions, Dr. Lowe explains. However, a mental component often develops following the onset of ED, as it can have a profound impact on self-esteem and personal relationships.
“Furthermore, ED won’t resolve ‘with time,’” he adds. “Left untreated, it typically worsens.”
UI affects up to a third of older men, according to the National Institute of Diabetes and Digestive and Kidney Diseases. The chief causes are similar to those of ED, with the exception of heart disease. Like ED, UI markedly diminishes quality of life, and the conditions have considerable overlap.
“The No. 1 cause of both is diabetes,” Dr. Lowe notes. “And as ED worsens, men are more likely to develop incontinence.”
Assessing ED Treatments
Oral medications such as sildenafil citrate are effective ED treatments for about 70 percent of men who are otherwise healthy, according to Harvard Medical School. However, efficacy is limited among men in whom cardiovascular disease, prostate surgery or diabetes has damaged arteries or nerves, and for some, oral medications are not effective at all. They also cannot be taken by men who take nitrates. Intracavernosal injection yields only about a 40 percent patient satisfaction rate, according to a study published in Andrology, and Dr. Lowe points out that another treatment, intraurethral suppositories, is not frequently chosen because of high cost and an aching sensation many men experience when they use the suppositories. A vacuum erection device frequently reduces sexual sensation and partner satisfaction, he adds.
In contrast, Dr. Lowe finds his patients have high success rates with penile prosthetics, the gold standard for treating ED for the past 40 years. These implants have a patient and partner satisfaction rate greater than 90 percent.
“The procedure takes less than an hour,” he says. “Patients return home the same day or early the next morning and can begin using the prosthesis four to six weeks following surgery.”
About 95 percent of penile prosthetics used in the U.S. are inflatable; the remainder are semi-rigid and simply bend into position, Dr. Lowe adds. He most often 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 prosthetic — 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.”
Some patients with UI benefit from use of a catheter or a suprapubic tube, a catheter 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 efficacy 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 satisfaction 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 cuff 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. Lowe encourages primary care providers to have an open conversation with patients who have ED or UI. Many men go years before seeking help, due to embarrassment or lack of awareness about effective treatments.
“Patients with ED should be referred to a urologist if they’ve tried oral medication therapy and haven’t had success,” Dr. Lowe says. “However, if a patient has significant ED as well as comorbidities — or if a provider thinks a patient’s problem will worsen over the course of the next five years — it’s important to refer him to a sexual medicine specialist who has experience in performing penile prosthetic placements and other genitourinary procedures. These treatments can greatly enhance quality of life.”
If you would like to receive ED/UI patient education materials for your office or speak further with Dr. Lowe, please contact Alex Horn at 614-349-6316.