Blick Options beyond PDE-5

Treatment Options Beyond PDE-5 Inhibitors--Dr. Shawn Blick, MD

Shawn Blick, M.D.

Valley Urologic Associates ? 13555 W. McDowell Road, Suite 304, Goodyear, AZ ? 18699 N. 67th Avenue, Suite 230, Glendale, AZ ? 3815 E. Bell Road, Suite 3600, Phoenix, AZ

Education ? Medical School: Mt. Sinai ? Residency--Beth Israel in NYC ? Oncology (Cancer) Training: Memorial Sloan Kettering Cancer Center

Not to be Reproduced or Distributed.

Shawn Blick, M.D.

Specializes In:

Men's Health Issues:

-ED (Penile Implants) -Male Incontinence (Male Slings, AUS) -Low T -Enlarged Prostates -Prostatitis -Prostate Cancer

Not to be Reproduced or Distributed.

10/5/2015 1

Erectile Dysfunction (ED) What is ED?

Not to be Reproduced or Distributed.

Erectile Dysfunction (ED)

What is it? ? The persistent inability to achieve or maintain an erection firm enough to have sexual intercourse

How Prevalent is it? ? Approximately 1 in 5 American men 20 years old1 ? Approximately 30 million American men2

1. Selvin E, Burnett A, Platz E. Prevalence and risk factors for erectile dysfunction in the U.S. Am Jour of Med 2007 (120) 151-157. 2. National Institutes of Health (NIH) website. . Downloaded 5/14/12. Not to be Reproduced or Distributed.

Main Physical Causes of ED3

Vascular

Diabetes Medication Pelvic Surgery, Radiation or Trauma Neurological Causes Endocrine Problems Other

5% 3% 1% 6%

15% Medication

30% Diabetes

40% Vascular

3. Ridwan Shabsigh, MD, Tom F. Lue, MD. A Clinician's Guide to ED Management. New York: Haymarket Media Inc.; 2006. Not to be Reproduced or Distributed.

10/5/2015 2

Erectile Restoration Treatment Options

Not to be Reproduced or Distributed.

Oral Prescription Medications4-6

? Effective in approximately 60-70% of cases ? Works in response to sexual stimulation ? Usually taken within 1 hour before anticipated sexual activity ? Typically works for up to 4 hours (~36 hours with Cialis?) ? Not to be taken more than once a day ? Some oral medications' efficacy can be affected by food

4. Viagra Prescribing Information, Revised January 2010 5. Cialis Prescribing Information, Revised October 2011 6. Levitra Prescribing Information, Revised November 2011 Not to be Reproduced or Distributed.

Oral Prescription Medications4-6

Common Side Effects

? Headache, Facial Flushing, Stuffy Nose, Upset Stomach, Dizziness

Contraindication

? Cannot take with NITRATES

Some Cautions ? With alpha-blockers: Generally, you should be stable on your alpha-blocker

therapy before using an oral medication ? Should not use these medications if sex is inadvisable because of

cardiovascular status

Tell Your Doctor if You:

? Have ever had any heart problems, stroke or low or high blood pressure ? Have ever had liver or kidney problems

4. Viagra Prescribing Information, Revised January 2010 5. Cialis Prescribing Information, Revised October 2011 6. Levitra Prescribing Information, Revised November 2011 Not to be Reproduced or Distributed.

10/5/2015 3

Vacuum Erection Device (VED)

Product Characteristics7 ? Non-invasive ? Drug free ? Cost effective

Side Effects ? Bruising/burst blood vessels8 ? Penile pain/discomfort8 ? Penile numbness8 ? Delayed ejaculation8 ? Erection is not warm to the

touch; different color9

7. Yuan J., et al. Vacuum therapy in erectile dysfunction ? science and clinical evidence. International Journal of Impotence Research. 2010; 12: 211-219. 8. The Process of Care Consensus Panel. The process of care model for evaluation and treatment of erectile dysfunction. Int J Impot Res. 1999;11:59-70. Position Paper. 9. Miner M.M., Kuritzky L. Erectile Dysfunction: A sentinel marker for cardiovascular disease in primary care. Cleveland Clinic Journal of Medicine. 2007 May; 74 (3); 30-37.

Not to be Reproduced or Distributed.

Urethral Suppository

Alprostadil Suppository (MUSE?)

Product Characteristics10 ? No needles or injections ? Erection within 10 to 15 minutes ? Must be refrigerated

10. MUSE? Prescribing Information, Revised March 2009. Not to be Reproduced or Distributed.

Urethral Suppository

Side Effects10 ? Pain ? penis, urethra or testes ? Urethral Burning ? Urethral bleeding/spotting ? Low blood pressure (Hypotension) ? Dizziness

10. MUSE? Prescribing Information, Revised March 2009. Not to be Reproduced or Distributed.

10/5/2015 4

Intracavernous Injection Therapy

? Alprostadil (Caverject?) most widely used agent11 ? Injected directly into corpora cavernosa12

Product Characteristics ? On-set of erection within 5 to 20 minutes12

11. American Urological Association Education and Research, Inc. The Management of Erectile Dysfunction: An Update. Guideline on the Management of Erectile Dysfunction: Diagnosis and Treatment Recommendations, 2005; 1:16. 12. Caverject? Prescribing Information, Revised August 2009. Not to be Reproduced or Distributed.

Intracavernous Injection Therapy

Side Effects12 ? Penile pain ? Prolonged erection ? Scar tissue ? Blood collection under the skin at injection site

12. Caverject? Prescribing Information, Revised August 2009. Not to be Reproduced or Distributed.

Penile Rehabilitation after RRP/XRT

The use of any drug or device at or after RRP/XRT to maximize erectile function recovery.

12. Caverject? Prescribing Information, Revised August 2009. Not to be Reproduced or Distributed.

10/5/2015 5

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download