Prostate Health - Presented at WakeMed's Men's Health Event on 9/21/11

Men’s Health Solutions for Incontinence and Erectile Dysfunction Dr. Kevin Perry, September 21, 2011

Satisfying Solutions Understanding Male Continence

What is Incontinence? ,[object Object],[object Object],“ My plumbing has a faulty washer”

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Types of Incontinence

How Does the Process Work? ,[object Object],[object Object],[object Object],[object Object],[object Object]

What Causes Incontinence? ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],28 Hunskaar s, Sandvik H. one hundred and fifty men with urinary incontinence. Scand J Prim Health Care 1993 v. 11 p.193-196 Why Treat Incontinence?

Am I the only one suffering from Incontinence? ,[object Object],[object Object],[object Object],NO! 29. AMS Market Research on file 30. Tewari A. et al. Anatomic Restoration Technique of Continence Mechanism and Preservation of Puboprostatic Collar: A Novel Modification to Achieve Early Urinary Continence in Men Undergoing Robotic Prostatectomy. Urology. 2007; 69(4): 726-731.

Can you Live Life Dry? Do you have to live with Incontinence? NO! YES!

Treatment Options for Stress Incontinence

Behavioral Modification and Medication ,[object Object],[object Object],[object Object],[object Object],[object Object]

Absorbent Products: Pads, Diapers ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],Absorbent Products: Pads, Diapers 31. Brown J.A., Elliott D.S., Barrett D.M. Post prostatectomy Urinary Incontinence: A Comparison of the Cost of Conservative Versus Surgical Management. Adult Urology. 1998; 51(5): 715-720 Cost Comparison of Wearing 5 Pads a Day for 10 Years Entrust Undergarments $0.99 each Active Style Pads $0.52 each Coveen Drip Collectors $1.05 each Depends Undergarments $0.52 each Cost/10 years 31

Devices: Clamps 32 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],32. http://www.prostate-cancer.com/coping-with-prostate-cancer/incontinence-penile-clamps.html; downloaded 1/7/10

Devices: Catheters 33 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],33. http://www.prostate-cancer.com/coping-with-prostate-cancer/incontinence-condom-catheter.html, downloaded 11/17/10

Collagen Injections ,[object Object],[object Object],34 Klingler HC et al. Incontinence after radical prostatectomy: surgical treatment options. Curr Opin Urol 2006; 16:60-64.

[object Object],[object Object],Surgical Options

AdVance Male Sling: Benefits ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],35. Rehder P., Gozzi C. Transobturator Sling Suspension for Male Urinary Incontinence Including Post-Radical Prostatectomy. Eur Urol 2007

AdVance Male Sling System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],Artificial Urinary Sphincter

1 2 3 Full Bladder Empty Balloon Cuff filled w/ saline

36. Litwiller SE, et al. Post-prostatectomy incontinence and the artificial urinary sphincter; a long-term study of patient satisfaction and criteria for success. J of Urol 1996; 156:1975-1980. Artificial Urinary Sphincter ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

AMS 800 Artificial Urinary Sphincter ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],Brief Summary – AMS AUS 800

Satisfying Solutions Erectile Restoration

Erectile Dysfunction (ED) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1. Selvin E, Burnett A, Platz E. Prevalence and risk factors for erectile dysfunction in the US. Am Jour of Med 2007(120) 151-157 2. Sun P, Seftel A, Swindle R, Ye W, Pohl G. The costs of caring for erectile dysfunction in a managed care setting: evidence from a large national claims database. J Urol. 2005 Nov;174(5):1948-52 3. Mulligan T, Teitelman, J. Geriatric sexual dysfunction. Va Med Q. 1991 Spring;118(2):97-9.

Main Physical Causes of ED 4 Vascular Diabetes Medication Pelvic Surgery, Radiation or Trauma Neurological Causes Endocrine Problems Other 4. Goldstein I. Male sexual circuitry. Working Group for the study of central mechanisms in erectile dysfunction. Sci Am ., Aug 2000;283(2):70-75. Vascular Diabetes Medication Vascular

Degree of ED by Age 5 5. Dymedex Market Research Data on file at AMS Prevalence of ED by Age and Severity (%) Severe Moderate Mild or Mild/Moderate 100% 80% 60% 40% 20% 0%

Heart Disease and ED… ,[object Object],[object Object],[object Object],[object Object]

Nearly every man can be successfully treated. Do you have to live with ED? NO!

Treatment Options For Erectile Dysfunction

Oral Medications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],6 Goldstein I, Lue TF, Padma-Nathan H, Rosen RC, Steers WD, Wicker PF, for the Sildenafil Study Group. Oral sildenafil in the treatment of erectile dysfunction. N Engl J Med. 1998 May 14;338(20):1397-404 7 http://www.viagra.com/taking-viagra/viagra-erectile-dysfunction/how-viagra-works.aspx; downloaded 3/3/11 8 http://www.cialis.com/Pages/what-to-know-about-cialis.aspx; downloaded 2/15/11 9 http://www.viagra.com/taking-viagra/how-to-take-viagra.aspx; downloaded 2/15/11 10 http://www.buyviagrapillsonline.com/; downloaded 3/3/11 Viagra is a trademark of Pfizer, Inc., Cialis is a trademark of Lily ICOS and Muse is a trademark of VIVUS, Inc.

Oral Medications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],7 http://www.viagra.com/taking-viagra/viagra-erectile-dysfunction/how-viagra-works.aspx; downloaded 3/3/11 12 www.cialis.com/Pages/index.aspx; downloaded 11/12/2010

Vacuum Erection Device ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],13. Levine L, Dimitrious R. Vacuum constriction and external erection devices in erectile dysfunction. Urologic Clinics of North America 2001 May (28) No. 2, 335-341 14. Yuan J., et al. Vacuum therapy in erectile dysfunction – science and clinical evidence. International Journal of Impotence Research. 2010; 12: 211-219 15. 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. 16. 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 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Urethral Suppository: MUSE ® ,[object Object],[object Object],MUSE is a trademark of VIVUS, Inc. 17. http://www.muserx.net/res/pack_inserts_PFI_1.3.pdf downloaded 11/12/10 18. http://www.infertility-male.com/erectdys/muse.htm, downloaded 2/15/11 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Penile Injection Therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],19. http://www.caverject.com/AboutCI.aspx, downloaded 2/15/11 20. Pharmacia and Upjohn Company http://media.pfizer.com/files/products/ppi_caverject_powder.pdf; October 2002 21. http://www.caverject.com/ISI.aspx; downloaded 3/8/11 22. Rajpurkar A, Dhabuwala CB. Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice. J Urol Jul 2003 v.170(1)p.159-63.

Penile Implants ,[object Object],[object Object],[object Object],[object Object],23 "Penile Prosthesis." The Sexual Medicine Web Site. 2008. European Society for Sexual Medicine. 23 Jan 2009 http://www.essm.org/patient-area/penileprosthesis.asp; downloaded 1/8/09 24 Levine LA, Estrada CR, Morgentaler A. Mechanical reliability and safety of, and patient satisfaction with the Ambicor inflatable penile prosthesis: results of a 2 center study. J Urol. 2001 Sep;166(3):932-7

Penile Implant Versus Other Treatment Options 25. Rajpurkar A, Dhabuwala CB. Comparison of satisfaction rates and erectile function in patients treated with sildenafil, intracavernous prostaglandin E1 and penile implant surgery for erectile dysfunction in urology practice. J Urol Jul 2003 v.170(1)p.159-63. Overall Patient Satisfaction with ED Treatments 25 Percentage Satisfied n=22 n=31 n=32

Three-Piece Inflatable Penile Implant ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Implants are Highly Recommended 26 26. Levine LA, Estrada CR, Morgentaler A. Mechanical reliability and safety of, and patient satisfaction with the Ambicor inflatable penile prosthesis; results of a 2 center study. J Urol. 2001 Sep; 166 (3) :932-7 These recommendations pertain to the AMS Two-piece inflatable prosthesis

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Benefits 27 Levine LA, Estrada CR, Morgentaler A. Mechanical reliability and safety of, and patient satisfaction with the Ambicor inflatable penile prosthesis; results of a 2 center study. J Urol. 2001 Sep; 166 (3) :932-7

Possible Risks ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object]

Insurance Coverage ,[object Object]

Summary ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prostate Health - Presented at WakeMed's Men's Health Event on 9/21/11

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