Erectile Dysfunction: We Can Help

Erectile Dysfunction: We Can Help

Christopher Marinakis, MS, MD, is a urologic surgeon at Boone Urology Center. His clinical focus includes complex stones, incontinence, pelvic floor therapy and BPH surgery. Learn more about Dr. Marinakis.

Photo of an older coupleMost every man would agree that throughout our lives, sex and intimacy are important aspects of our lives. In a perfect world, all of our parts would continue to work “as advertised” throughout our life.  Unfortunately, that is not always the case. The maladies of aging, including high blood pressure, diabetes, obesity, and heart disease take their toll on our body. Many of these diseases can be “silent” and not cause any appreciable symptoms, but when detected are treatable with diet/exercise or medication.

When sexual function in men begins to falter, it is very apparent and can be quite troubling.  Fortunately, there are many treatment options available that can return sexual function in most every man. In an aging population, erectile dysfunction (ED) becomes much more prevalent. With the introduction of Viagra in the 1990’s, what was once a topic few men discussed became so prevalent that we were flooded with direct-to-consumer marketing on TV and media. In recent years, specialty clinics for men have opened up in metropolitan areas to treat ED, offering such eye-catching headlines as “98% success” and “guaranteed results.”  Often, these clinics are quite expensive and may not be covered by commercial insurance or Medicare/Medicaid.

All urologists receive extensive training in men’s health, including erectile dysfunction and low testosterone/hypogonadism and all the treatment options available at these expensive specialty clinics are available locally with the team of specialists at Boone Urology.


WHY is this happening?


An erection at its most basic level is a hydraulic event where blood flow into the erectile tissues is increased. In many instances, erectile function can be an indicator of overall health. Natural erectile function involves normal blood flow to the penis and normal nerve signals both to and from the brain.  For that reason, conditions that adversely impact on blood flow and nerve signaling such as hypertension, diabetes, atherosclerosis (hardening of the arteries) and heart disease can impact erectile function. In fact, ED may be a harbinger for these conditions if not detected previously. Diet, exercise, avoidance of smoking/tobacco, and maintaining a healthy weight are all important aspects of a healthy lifestyle. Annual wellness checks are essential in early detection of the conditions that can impact sexual function.


Is my ED caused by ‘Low T’?


Testosterone is the hormone that makes men, well …what they are. Having a normal testosterone level is essential for many health aspects for men, aside from libido and sexual function. Testosterone is primarily produced by the testicles. Production begins during a male embryo’s development in the mother’s womb and peaks during adolescence. Unlike women that have an abrupt decline in estrogen levels following menopause, many men will continue to have “normal” testosterone levels throughout their life.

Many factors can impact testosterone production, including obesity, lack of exercise, medications and prior surgery. Common symptoms of “low T” include fatigue, weight gain, loss of muscle mass, decline in libido, mood swings, and loss of erectile function.

Having ED doesn’t mean that testosterone levels are low, and correcting low testosterone may not improve erectile function.

For men that have low testosterone, replacement can give them an added “pep in their step”, improved mood, improved libido and erectile function, better sleep and improved exercise tolerance.  There are many options for testosterone replacement, including topical gels, injections, and implanting testosterone “pellets” just below the skin. Most treatments for low testosterone are covered by insurance.


What treatments can help ED?


Fixing the problem of erectile dysfunction begins with a discussion with your doctor. Correcting modifiable risk factors such as smoking/tobacco use, obesity, sedentary lifestyle, and alcohol use can restore potency for some.

When treatment is desired, the first step is determining if ED is “organic,” or psychogenic, meaning that the dysfunction is brought about by emotional issues or anxiety. Men have nocturnal erections as part of the normal sleep cycle. If men have normal nocturnal/morning erections, but are otherwise bothered by ED, medical management may be unnecessary.

When the underlying source is organic, often the first- line treatment is medication such as Viagra, Cialis and others. Previously, these medications were nearly cost prohibitive, but generic medications are now quite affordable. These medications can be taken prior to sex, or in the case of Cialis, can be taken daily.  These medications are often effective and side effects are minimal. Side effects can include headache, facial flushing and nasal congestion. Men that take nitrate-containing medication for angina (chest pain) must not take these medications as the combination of drugs can markedly lower blood pressure.

When medications like Viagra aren’t effective, other options include use of a Vacuum Erection Device (VED), or injection therapy. Injection therapy is safe, effective, and relatively painless. Most men that try injection therapy are very content to continue it once instructed on how to do this.

Another treatment option is an Implantable Penile Prosthesis (IPP). This is a minor surgical procedure where the existing erectile tissue within the penis is replaced with a prosthetic device. While there are several variations available, the most common is an inflatable IPP.  A small prosthetic pump is implanted into the scrotum and when an erection is desired, the man simply activates the pump resulting in a natural-appearing erection. When not activated, the implanted prosthesis is otherwise unnoticeable. While this is often considered to be a last option, it need not be, as men who have had this surgery express higher satisfaction rates than those using other treatment options.

The urologists at Boone Urology are specialists in diagnosing and treating men’s health issues, and can offer the same treatments that offered at “Men’s Specialty Clinics” at a substantially lower cost.

If you’re concerned about men’s health issues, we can help.  Call us today to schedule an appointment 828-264-5150.


Bladder Control Issues: A common problem that may be overlooked

Bladder Control Issues: A common problem that may be overlooked

Christopher Marinakis, MD, is a urologist at Boone Urology Center. His clinical focus includes complex stones, incontinence, pelvic floor therapy and BPH surgery. Learn more about Dr. Marinakis >

Bladder Control Issues ImageBladder control problems are more common than many realize. Many people assume that this is something they must live with, or is just a part of life. Even worse, many believe that nothing can be done to fix the problem except invasive, painful surgery. While it is true that incontinence predominantly impacts older adults, it is not a natural part of aging.  More women tend to be bothered by bladder control issues than men, but the underlying causes tend to be different. Your primary care provider (PCP) will often screen you for these conditions during your annual wellness visit, but occasionally this problem gets overlooked. There are solutions, and continual leakage is not something that one must live with.

Don’t suffer in silence. Discussing bladder control issues with your provider is the first step to regaining bladder control and improving your quality of life. Call Boone Urology at (828) 264-5150 and we can help answer any questions or concerns. 

What is Overactive Bladder (OAB)?

OAB is a constellation of symptoms that includes urinary frequency and urgency. Urge incontinence arises from being unable to control these factors and results in loss of bladder control. Factors that often go along with OAB include being female, post-menopausal, prior pelvic surgery, excessive fluid intake and caffeine intake. As with many health conditions, prevention is the best strategy. Maintaining a healthy weight and being active can help prevent bladder control issues.

Treatment options for overactive bladder

The first step in improving bladder control is to address this with your PCP. Often, symptoms can be controlled by changing behavior. Try reducing fluid intake, reducing or eliminating caffeine and doing “timed voiding,” which is a trick played on the bladder to empty it prior to the onset of “urgency.” For many, these steps are enough to regain bladder control.

If overactive bladder continues, there are several medications that can improve bladder control. For the patients that do not wish to take medication, or find them ineffective, more advanced treatments can dramatically improve bladder control and quality of life.

Your urologist may recommend sacral nerve stimulation, either with an implanted nerve stimulation device called Interstim, or with a noninvasive treatment called Percutaneous Tibial Nerve Stimulation (PTNS). Interstim is an innovative technology that involves modulating nerve signals to and from the bladder. A simple office test can tell if you may benefit from the technology.

PTNS involves placing a tiny acupuncture needle adjacent to the ankle and connecting a small nerve stimulator to it for a 30-minute session. The treatments are done weekly for several months, and then performed periodically for maintenance of the treatment effect.

Botox is a drug that many associate with injections for facial wrinkles. The reason that it smooths out wrinkles is that it relaxes the muscle, smoothing out the overlying skin. Botox injections can be done in the Boone Urology Center office to relax the bladder muscle resulting in improved bladder control.

“I leak when I cough, sneeze, or exercise”

Stress Urinary Incontinence (SUI) is a condition that affects many women, particularly those that have had multiple vaginal child births. Women with SUI often void normally, but are bothered with the occasional loss of control with exertion. This robs many women of the ability to exercise, or to perform normal household activities. Occasionally, men are bothered with this condition following surgery for prostate cancer.

Treatment Options for Stress Urinary Incontinence

SUI occurs because the muscles that are involved with holding urine tend to become weak. Like any other muscle, this can often be improved with conditioning. Performing Kegel exercises, which involves contracting the muscles that you would use if you wanted to interrupt your urine flow, can improve bladder control. Like any exercise program, this requires some commitment and dedication. Just as having a personal trainer can improve strength training, physical therapists at The Rehabilitation Center can often improve success on pelvic floor therapy to improve bladder control.

Modern surgery for stress incontinence has evolved to minimally invasive, outpatient procedures with quick recovery. It no longer involves large incisions and extended recovery times. The surgery for stress incontinence is done through a ½ inch incision, takes about thirty minutes, and is highly successful.

For some women, SUI can be treated with a simple injection procedure where a drug is injected through a scope to “bulk” up the urethra.

For men that are bothered with SUI following prostate cancer surgery, sometimes simply a “tincture of time” can allow the body to recover naturally from surgery and improve bladder control. For others, implantation of an artificial urinary sphincter can often eliminate pad use.

Do you have bladder control concerns?

Boone Urology Center can help! Call us at (828) 264-5150 today!