Dr. Richard Alexander of Baystate Medical Practices - Greenfield Urology, appeared on last night's Medical Rounds - a collaboration between Baystate Health and Western Mass News. The weekly Medical Rounds is broadcast in the 5:30 p.m. portion of the Tuesday night news and focuses on family health and wellness and breakthrough technology. Each session is followed by an interactive live chat. Last night's session focused on erectile dysfunction and other male urological problems.
Q: Not being able to achieve an erection can be quite an emotional issue for men. Why is it so common today?
A: It is common. I believe what is actually happening is that it has been common all along, but men were not coming to the forefront about it because it is an embarrassing subject. Now erectile dysfunction is in the public eye, people see commercials on television about it every day, and men are now encouraged to seek help because there are new therapies that are effective and safe.
Q: What are your thoughts on the first penis transplant which was performed recently in Boston?
A: It is an amazing technological feat, but whether it becomes a mainstream therapy remains to be determined. The long-term outcome of this transplant will be the most important thing. The question remains whether or not the patient will have good urinary function, the cosmetic outcome, and the sexual function of this transplanted organ, perhaps one of the most important reasons for the transplant, for which a lot of things must happen for it to work. Also, transplants involve patients being on immuno-suppression drugs, which come with their own side effects.
Q: We hear so much about pills like Viagra and Cialis today, are they the best options and are they right for everyone? What other treatments do urologists bring to the table when discussing treatments with patients?
A: There are many therapies besides just taking medications. They are the first step, but not everyone is a candidate because of other medications they may be taking, such as nitrates, which are dangerous when taken together. You also have to take the medications properly, and I find that many patients I see were not properly counseled in their use. You just don’t take a pill and expect to get an immediate erection. What these drugs do is to increase your response to arousal. Other therapies include vacuum erection devices, self-injection therapy, which is a very effective way to induce an erection, and a penile prostheses, which is a surgical procedure to implant a device inside the penis.
Q: About prostate surgery for men who have cancer, can’t this very surgery designed to rid men of their prostate cancer also leave them impotent and suffering from urinary incontinence? Have there been any advances as of late in minimizing these troubling side effects?
A: First of all, patients have to be selected for invasive surgery, it is not appropriate therapy for everyone. The risks for the devastating consequences of impotence and incontinence are low, but drastic for those affected. Newer techniques have drastically improved the frequency of those consequences. However, robotic surgery, thought to be a possible answer to them, hasn’t diminished the frequency of these side effects. However, robotic surgery is less invasive and there is less blood loss in the operation.