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Straight Up with Dr. Cornell – Talking Points

Erectile Dysfunction

  • 30 M American men with ED, 10 M will fail pills and are candidates for an implant
  • 50% of men over 50 have some degree of ED
  • Huge underserved population, with <20K IPP done annually WORLDWIDE

Penile Implants

  • 45 year-old technology, developed at Baylor
  • 93% patient satisfaction rate; done in 30 minute, single-incision procedure done under GA
    • Not noticeable, no scar, no change in penile sensation or orgasm, stays hard even after climax, negligible loss of shaft length which is minimized by ventral phalloplasty, can be used as often as like
    • 1-3% annual mechanical failure rate
    • Infection rate under 2% for diabetics, less for healthy patients—85% are salvageable without loss of device
    • Covered by Medicare, most insurance plans with auth. obtained before surgery
    • 1-2 weeks of scrotal swelling, minimized by jock strap.
    • Back to work <= 1 week
    • Back in the saddle with device activated in 1 month

Non-Surgical ED Treatment Options

  • Pills
    • All work same, with difference in side effect profile and length action
    • Fail one, likely to fail all
  • Penile Injections
    • Not painful, but inconvenient
    • More potent than pills, cannot be used more than once daily
    • Usually a bridge between pills and surgery

Prostate Cancer

  • Approx 220K US men dx’d with CaP last year – no symptoms associated with early CaP
  • 98% 10 year survival, but only if treated
  • 10% of cases will die, 40% of CaP deaths are among African-American men (despite representing only 13% of US population)
  • No one should die of prostate cancer in this country! Death from Cap only occurs if screening is neglected – both PSA and DRE required.
  • All African-American men should be screened with BOTH PSA and DRE annually at 40
  • Usual age of CaP dx is 66 years of age
  • 60% of prostate cancer surgery patients will develop ED post op
  • 50% of CaP XRT patients develop ED after 5 years
  • 20-30% of prostate cancer surgery patients will develop persistent urinary leakage
  • With approx. 100K prostate cancer surgery patients/ year in the US, and given the incidence of ED in men over 50, approx. 75K new ED patients and 25K new male urinary incontinence pts each year in the US alone resulting just from CaP treatment.

ED / Incontinence

  • PPED occurs in 80% men 5 yrs out from RRP (Scandanavian study)
  • PPI occurs in nearly 50% men 5 years out from RRP (typically quoted at only 5%)
  • Anxiety and reduced QOL from PPED and PPI is considerable, 30-40% 7 years out from RRP
  • With 100K annual RRP in US, TENS of THOUSANDS of new US men each year deserve discussion about IPP/AUS.
  • Both IPP/AUS can be done in single procedure thru single incision in 90 minutes with no visible scar.
  • Overnight hospital stay for IV abx, home next morning w/o tubes, drains or catheters
  • Both devices completely unnoticeable and internalized.
  • Activated 1 month postoperatively. No metal components, able to have MRI or pass airport security.
  • No change in sensitivity during intercourse, No change in when bladder feels full or how you urinate.
  • Loss of penile shaft length is negligible and able to remain erect even after ejaculation, which is unchanged by the IPP.
  • Length of the IPP is determined by intraoperative measurements, given the largest possible implant.
  • Mechanical failure rate of these devices is 1-3%/year and are expected to last a lifetime.
  • Infection rate for IPP is under 2% for diabetics, less for non-diabetics – 85% of the rare infections can be salvaged without losing the device.
  • Infection rate for AUS is almost unheard of.
  • Back to work usually in under one week, with scrotal swelling for 1-2 weeks – minimized by day and night use of jock strap.
  • Both devices are covered by CMS and nearly all private insurance, AUTH is obtained before surgery, so no surprise OOP $$.
  • Satisfaction rate 93% for both IPP and AUS, restoring potency and urinary control to preop level of function.

BPH

  • Non-cancerous prostate enlargement.
  • Higher risk among African American men – genetics, hormonal causes
  • Risk worsens with age, as prostate continues to grow throughout life – bigger usually means worse urinary symptoms of nocturia, weak stream, urgent need to go, possibly leakage
  • 2 or more trips to bathroom/night warrants GU evaluation for obstruction
  • Treatment options include pills, office thermotherapy, incisionless endoscopic surgery
  • Treatment improves stream, reduces bathroom trips at night, and allows low-pressure, complete bladder emptying and discontinuation of pills postoperatively.
  • Failure to treat risks UTI, bladder stones, urinary retention with catheter dependence.

Low T

  • Testosterone is the male hormone, made by the testicles
  • Responsible for sex drive (libido), necessary for quality erections, lean muscle mass, mental sharpness and bone health
  • After age 40, we make 1% less Testosterone each year
  • Low T cause of belly fat, tired/sluggish feeling and muscle atrophy as we age
  • Testosterone can be replaced by topical creams, gels, patches or injectable/depot preparations that can last weeks or months
  • Low T in women following menopause or long-term birth control use can lead to vaginal dryness and pain during intercourse. Low T can and should be replaced in women too!