Phillip Gilson, MD, urologic surgeon and erectile dysfunction expert with St. Vincent Medical Group, has two decades of experience helping patients solve frustrating problems. His high-volume practice and history of success make him an expert in finding the right option for each patient’s circumstances.
Not long ago, men typically kept concerns about erectile dysfunction (ED) to themselves. However, ED is a common condition, affecting about 40 percent of men in their 40s and almost 70 percent of men in their 70s, according to the Massachusetts Male Aging Study. Rates are higher for men with health complications that can damage blood vessels or nerves, such as diabetes or hypertension, as well as for men who smoke. Recent studies suggest that rates of ED in men younger than 40 are higher than was previously thought.
Dr. Gilson divides his experience into what he calls the “pre- and post-Viagra days,” meaning that as medications have become more widely available and have seeped into everyday parlance, patients are more willing to talk about ED and ask for treatment options.
Men who have ED may first ask their primary care physician for an oral medications, which typically work for 75 percent. Unfortunately, medications of this sort work only half the time for men who have diabetes — common sufferers of ED.
“That leaves a lot of men needing alternative treatment options,” Dr. Gilson says. “If you look at studies from the 1970s, ED was reported to be about 10 percent medical and 90 percent psychology in etiology. Today, these numbers have flipped. This is a medical disease that requires medical treatment.”
“Specifically, ED is a vascular disease of the penis. The reason patients have difficulty with erections is they cannot deliver sufficient blood flow to produce engorgement, and the most common causes are damage to the small vessels that deliver the blood and to the nerves that cause the vessels to dilate. Men with diabetes experience damage to the vessels and also the nerves, making these men especially challenging to treat.”
When medications fail these men, Dr. Gilson can offer options such as a vacuum erection device and intercavernosal injections. Both are problematic, however, because they can be uncomfortable or time-consuming to use, and patients often stop treatment after a year or so.
For a long-term solution, the penile prosthesis offers an effective solution that requires little forethought or hassle once the device has been implanted.
“The penile prosthesis bypasses the vascular requirements for an erection, meaning anyone can experience an erection with one of these devices,” Dr. Gilson says. “It’s a surgically implanted prosthesis that will work in the absence of blood flow to the penis.”
Patients undergo an outpatient procedure that takes 30 to 45 minutes, and by two weeks after surgery, patients typically experience no more pain or swelling. Effectiveness is almost 100 percent, says Dr. Gilson, who implants 80 to 100 penile prostheses each year.
“In my experience, it always works,” he explains. “Patient and partner satisfaction rates are about 95 percent when asked whether they are happy with the procedure and would do it again. It’s the highest satisfaction rate of any treatment we offer.”
While there is a concern with implant infection, Dr. Gilson offers a prosthesis with an antibiotic-impregnated layer, lowering infection rates to fewer than 1 percent, he says. In fact, he’s seen only one infection in more than 1,000 implants performed over 16 years.
Of these patients, most are still satisfied, even after having their devices for close to two decades, he says. Revision surgeries are almost never required.
A Solution for a Vexing Problem
Dr. Gilson also offers treatment for a male urinary incontinence, a condition that is especially challenging for patients.
“The most common cause by far is radical prostatectomy for prostate cancer,” he says. “Approximately 5 percent of men will have stress incontinence following the procedure.”
Some of those patients are helped with dietary and behavioral changes, while others can find relief through medication. However, Dr. Gilson says, some men continue to experience stress incontinence and approach a urologist for assistance.
Common treatments include a periurethral implant, in which the physician injects a substance to add bulk to the urethra and increase resistance, holding back the flow of urine. These implants are effective and require almost no recovery time, but they are effective only for minimal incontinence and must be repeated from time to time. A sling, or mesh device, may be inserted to elevate the urethra, but these devices have problematic side effects and are ineffective for severe incontinence.
“The gold standard for male urinary incontinence treatment is the artificial urinary sphincter,” Dr. Gilson says. “This device is placed around the urethra to mimic the body’s natural sphincter action by closing off the urethra and holding urine in the bladder. To empty it, the patient activates a pump in the scrotum, draining the bladder. It does require some dexterity and mental awareness to operate, but it is the best treatment option for men with bothersome stress incontinence.”
Again, Dr. Gilson offers this treatment as an outpatient surgery, with the procedure taking about an hour and a half. Infection rates are low. After six weeks of recovery time, patients may begin to use the device, which takes only five to 10 seconds to operate.
“I have offered this options to patients for the past 20 years,” Dr. Gilson says. “The vast majority are still extremely satisfied.”
When to Consider Referral
Most men who experience incontinence are already under the care of a urologist, Dr. Gilson says, but patients with ED may never discuss their concern with a physician. The man’s distress may translate to unhappiness in his personal relationships.
“When ED is addressed, it’s a gain for everyone,” Dr. Gilson says. “Not just the sex portion — it’s everything about their lives. The men are more confident after surgery. Everyone is happier they have received treatment.”
Primary care physicians and endocrinologists caring for men with diseases that cause vascular or nerve damage should initiate a conversation about erectile function when necessary.
“Primary care physicians may prescribe oral medications for ED without reservation,” Dr. Gilson says. “However, if a patient is not successful taking oral medication and is highly motivated to open that part of his life up again, the provider should refer him to a specialist. Look for an experienced, high-volume surgeon with expertise in the field, one who takes an interest in helping these patients.”
If you would like patient information about erectile dysfunction or male urinary incontinence, please contact Dr. Gilson at St Vincent Medical Group Urology, 920 S Hebron Ave, Evansville, IN 47714 (812) 473-1111