Archive for Impotence

Move over Viagra

// November 15th, 2010 // No Comments » // Impotence

Ever since sildenafil (Viagra, Pfizer) hit the market in 1998 as the first oral medication for erectile dysfunction (ED), people have been wondering, “What’s next?”

New data presented at a recent meeting of the European Association of Urology demonstrated strong results for two potential new treatments. Bayer AG presented promising data for its investigational phosphodiesterase (PDES) inhibitor, vardenafil, now in phase III studies. In an analysis of 580 patients, vardenafil improved erections in up to 80% of men, as well as increasing the ability to complete sexual intercourse with ejaculation.

In a separate study, vardenafil was found to be highly selective at targeting the PDE5 enzyme. PDE5 selectivity is of potential clinical importance because phosphodiesterases are widely distributed throughout the body, with PDE3, for example, playing an important role in cardiac contractility.

Lilly/ICOS unveiled compelling results for its next-generation PDE5 inhibitor, IC351 (Cialis). In a placebo-controlled phase III study in men with difficult-to-treat diabetes-related ED, up to 64% of men reported improved erections, compared with 25% for placebo.

In preclinical investigations, Cialis demonstrated an even higher affinity for the PDE enzyme than sildenafil did. Researchers saw no significant changes in clinical laboratory values, ECGs, or blood pressure in the phase III trial.

Black Men and the New Sex Pills

// November 13th, 2010 // No Comments » // Impotence

BROTHERS might not want to admit it right away, but Sisters and the doctors who know about these things will tell you in a minute that, despite the dominant myths about Black male sexuality, Black men–like all men–can experience sexual problems brought on by life’s typical stresses, relationship tensions, medical conditions or just plain old aging.

Now, thanks in part to a media blitz on the new sex pills, experts are saying they have seen a growing admission among Black men that they can have a sexual problem, and a growing use of a pill to resolve that problem. The result is a high level of satisfaction among those Brothers who have used the pills and enjoyed sex, and a marked improvement in the health of their relationships.

“No question about it,” notes Atlanta-based urologist Dr. James Bennett, who has seen an increase in Black men who are taking sex pills. “Usually, when African-American men come in, it’s at the insistence of their spouse,” says Dr. Bennett, who also hosts “Radio House Call” in Atlanta. “Even the radio show callers tell me how the drug has changed their lifestyle.”

Once thought of as private, sexual performance problems these days are being discussed everywhere, blaring in headlines, in news accounts and ads for new sex pills Viagra and Levitra with their sports celebrity pitchmen, to be followed soon by Cialis, which has been approved for U.S. sales. And a fourth drug, Uprima, is on the pharmaceutical horizon awaiting approval.

Although there are differences among the pills currently on the U.S. market–which cost about $10 apiece–they basically take the same approach, blocking certain enzymes to allow an erection. They merely allow nature to take its course with sexual stimulation.

Clinical trials conducted on behalf of the pharmaceutical companies have shown the pills work for Black men. Viagra showed an 81 percent satisfaction rate among Blacks, and Levitra showed Blacks, Hispanics and Whites at 80 percent. The pills that are out or are coming out try to distinguish themselves in going after the huge segment of the potential market that has been left out. The main differences with these pills are in their relative effective periods–usually about 4 to 5 hours, although newcomer Cialis boasts effectiveness up to 36 hours, giving rise to its French nickname, “Le Weekender.” There also are relative differences in the amount of time it might take for the pills to kick in–from 30 to 60 minutes–and differences with side effects that can include headaches, backaches or facial flushing.

Surprisingly, apart from efficacy studies that show satisfaction levels, there have been no research studies on the impact of the new sex pills on Black sexuality or on Black health. It is still early, but experts in this area say there is need for just that kind of research.

It has been estimated that up to 30 million men in this country have at least some episode of impotency at some point, with a number of men facing chronic occurrences after they pass age 60. Reportedly as many as 50 percent of men over age 40 can be affected to some extent, and even much younger men can have episodes–sometimes health-related.

While there are no hard figures, there is reason to believe Black men–especially Black men over age 40–may face increased risk. Apart from the emotional causes, like problems in a relationship or everyday stress, there are certain medical conditions that are commonly associated with male sexual performance. Diabetes, coronary disease, hypertension and certain cancers all can give rise to sexual performance problems, and these are medical problems that affect Blacks to a higher extent than the general population.

That is why it is critical for Black men to address any sexual problem right away. It just might be an early warning sign of more serious medical problems, according to Dr. Bennett, who also served as lead investigator for American clinical trials on the efficacy of Levitra. “That’s the message we need to send out to our community. Regardless of your age, whether you’re in your late teens or twenties or thirties, if you have any signs of erection problems,” he advises, “that is a sign that you could have some underlying cardiovascular problems. And you need to get checked out. It’s nothing to get embarrassed about, but it may save your life down the road from a stroke or a heart attack or even going into renal failure.”

A doctor will also advise on potential side effects, how certain products might affect Black men with special health concerns, and whether a man’s particular physical condition poses a risk. Your medical history and prescriptions are critical in making this determination, because there is the very real possibility that certain medical conditions and medications for those conditions—like hypertension medication–can be adversely affected by use of sex pills. No one who is on nitrates–prescribed for certain heart conditions–should use these medications. Similarly, a recent heart attack or heart irregularity would likely bar any use of these drugs for a certain period of time. Diabetes and prostate cancer might be factors in determining not to use certain medication.

Still other men might have simpler causes of sexual problems that can be addressed without drugs. “So I think it is a matter of making sure you have the right assessment to determine whether you need medication,” suggests Dr. David Satcher, director of the National Center for Primary Care at the Morehouse School of Medicine. “There are many men who will not need medication in order to deal with their erectile dysfunction,” says Satcher, the former U.S. Surgeon General, who notes that physical activity or counseling just might be enough.

Everyone agrees that women partners should be involved in any effective counseling, improving the overall satisfaction in the relationship. “It says that my partner cares enough about me to go in to the doctor to talk about something so that our lives can be better,” notes Dr. Gail Wyatt, sex therapist and professor of psychiatry and behavioral science at UCLA. “No matter what the outcome is, we’re going to get better because we’re in this together,” she says.

Despite the growing acceptance of medical treatment among Black men, dealing with it so openly still is hard. “Men do hide from this and they will ask for the pills through their wives or they will ask someone else about the medication,” notes Dr. James Wyatt, an obstetrician/gynecologist and sex therapist. “They don’t like to present themselves at a physician’s office saying, ‘I am not a stud, I can’t perform,’” says Dr. Wyatt who, with his wife Dr. Gall Wyatt, co-authored the book No More Clueless Sex: Ten Secrets to a Sex Life that Works for Both of You. “It’s embarrassing and it’s self-deflating for them to do that.”

Looking ahead, experts say, Black men will have to face the reality of life, rejecting the myth of Black male sexuality. In the end, for couples who have a healthy attitude about their sexuality and their relationship and where the man can use a sex pill, the relationship benefits. “It certainly can increase desire because if you’re able to perform, you’re going to want to try again,” Dr. Gall Wyatt says. “If you’re not, then you’re going to want to avoid sex, and avoid intimacy.”


An informal, unscientific survey in the Black community suggests that many Sisters applaud high-profile sex pills such as Viagra and Levitra and say that these drugs are saving marriages and, in some cases, lives. “We know that if the sex is not good in a relationship, it can affect that relationship in various ways,” says Charlotte, N.C., psychologist Elaine Stevens, founder and president of the relationship consulting company, Matters of the Heart, Inc. “The positive thing that has happened in Black relationships is that a lot of couples, where the partner was once impotent, are now able to have an enjoyable sexual relationship, so their marriage is back.”

Los Angeles-area sex therapist Rosie Milligan, author of Satisfying the Black Man Sexually, Made Simple, agrees, adding that these sex drugs also save lives. “Black men [suffer] higher fates of high blond pressure and diabetes, and the prescribed medications for these ailments may impair their ability to perform,” Milligan says. “Before [the new sex pills] came along, many men would rather risk their lives by not taking their blood pressure medicine.”

But if it takes two to tango, many Sisters have one burning question:

Where’s our miracle drug to combat sexual dysfunction?

“Viagra enables men to have more confidence in themselves and to perform, and that’s a blessing,” says Nr.w Ynrk-area psychologist Vera S. Paster, author of Staying Married.” A Guide for African American Couples. “But the real problem is that there should be a ‘Viagra’ for women.”

To date, there still isn’t an FDA-approved impotence medication for women on the market. Same doctors, however, are experimenting with low doses of Viagra and Levitra to treat female patients; and others, like Shaft Goldman, a Chicago-area gynecologist, told a reporter that she considers testosterone therapy for women who say they suffer from low libidos.

Alicia Simon, assistant professor of sociology at Clark-Atlanta University, says women’s sexual issues are gradually becoming the focus of research.

“The [impotency drug] revolution is a good thing, because once they do address the male reproductive issues, then our issues will gel addressed as well, so eventually we will all benefit.”

Perhaps the greatest benefit is the promise of re-igniting the passion in Black relationships, says Detroit-area psychologist and attorney Paris M. Firmer Williams, author of Marital Secrets: Dating, Lies, Communication and Sex. Dr. Finner-Williams believes that couples who become intimate at least once every 72 hours are more likely to succeed.

“Sex is very important in keeping spirituality between the couple,” she says. “Despite all of the issues and concerns that are surrounding us, if we are able to make love and appreciate each other’s spirits, we can once again reassure ourselves that there is a compromise. We can make it. We can resolve whatever our issues are. And we are not going to let those issues separate us.”

Fake viagra

// October 31st, 2010 // 1 Comment » // Impotence

Email Systems, a company that measures spam emails on the INTERNET, reports that in the first three months of 2005 two in five spam emails were offering drugs for sale. As the volume of spam is now almost 90 per cent of all email sent, that means one out of every three emails sent is offering you cut-price drugs over the net.

fake viagra

fake viagra

In September 2003, Dr Nic Wilson, a researcher at the University of London, announced to the British Pharmaceutical Conference in Manchester that she had been testing samples of internet-bought it accurately measures the ingredients in each tablet. The result was that half of the pills were lakes. ‘The user runs the risk of poor quality and possible toxicity, not to mention the fact that there is a high probability that the tablets have no clinical effect,’ she told her audience, who probably looked around the room to see who was blushing – Brits being the largest consumers of Viagra in Europe.
It’s comparatively easy to set up a Viagra factory, and some crooks have gone into the business in a big way: an example is 44-year-old Londoner Allen Valentine, convicted in November 2004 at Harrow Crown Court and sentenced to five and a half years in prison for supplying class C drugs. In effect, he was sentenced as if he had been supplying large amounts of cannabis.
His factory in Wembley was more than just a cement mixer: it could create 500,000 tablets a day. On the side, he was also making steroids and anti-stress medication, and a great deal of cash: the day before his arrest in April 2004. he had offered cash for a £1.25 million house and bought a new jeep.
Valentine knew how much people wanted Viagra – he was previously a rep for Viagra’s manufacturer, Pfizer.
The little blue pill is a common find for the drugs squads of Europe, the US and Asia. In January, £1 million of fake Viagra was found in an abandoned car outside Glasgow. ‘It is quite common to recover one or two thousand fake Viagra pills. They are usually found along with Class A drugs like cocaine, heroin and ecstasy,’ said Detective Sergeant Ken Simpson of Strathclyde Drugs Squad.
This is no cottage industry: Richard Widup recalls a case from his time at the FDA: ‘It was over the Christmas holidays 2002, in Southern California…  There were 700,000 counterfeit Viagra.

Life after phentermine

// October 31st, 2010 // No Comments » // Impotence

Doubtless many of the millions of Americans who have been using dexfenfluramine (Redux) or or fenfluramone (Pondimin, better known in combination with phentermine, as fen-phen) to lose weight will regard this week’s withdrawal of both drugs from the market as bad news, indeed. The cloud, however, is not without its silver lining.

There were, after all, very good medical reasons to remove the drugs from public consumption. The reason the FDA asked manufacturers to stop selling the drugs – and the reason the manufacturers, including the French company that distributes the drugs internationally, complied – was because there is strong evidence they cause heart-valve problems. The FDA reviewed the records of 291 patients and found that echocardiograms, which measure heart-valve function, showed abnormalities in the valves of 30 percent of them – none of whom had yet experienced any symptoms. Thirty percent is a very high percentage, much higher than the FDA expected to find. And heart-valve damage is no laughing matter. So, the good news is that the withdrawal will most likely save many people from some very serious damage to their health.

Of course, there are people whose health is seriously endangered by obesity itself, and who have had so little success losing weight through diet and exercise that Redux and fen-phen have seemed the last, best hope. For them, there are other medical possibilities, including the appetite suppressant phentermine, which is the “phen” part of fen-phen. And new diet drugs are in the offing, including one that inhibits the absorption of fat by the body.

Unfortunately, all diet drugs, new and old, including even so-called “natural” fen-phen, which contains the potentially dangerous ephedra, could be dangerous in one way or another. And, while Redux and fen-phen have unquestionably been helpful to dieters, even if only as a sort of reassurance and reminder to stay on the diet and keep up the exercise, diet drugs are no magic bullet. As doctors who have prescribed them clearly understand, even with the drugs, the keys to successful weight loss are diet and exercise.

The depressing truth is that for all people looking to lose weight, a restricted diet of some kind and strenuous exercise of some kind are absolutely necessary, drugs or no drugs. And for most people looking to lose weight, they are, simply, sufficient. Though the danger of diet drugs will pose a dilemma for doctors treating the dangerously obese, it is not the end of the world that the non-dangerously overweight and the not-at-all overweight, those afflicted with the American obsession to (almost literally) get down to the bare bones, are left once again with those two dreadful old standbys.

Penile Injection

// October 30th, 2010 // No Comments » // Impotence

Puncturing one’s penis with a needle is not for the squeamish. Piercing the penis with a needle and then injecting a chemical to enhance one’s sexual potency sounds more like a bizarre, sadomasochistic nightmare from the annals of Krafft-Ebing Psychopathia Sexualis than a doctorrecommended treatment of impotence. Nevertheless, many men, with guidance from their physicians, practice self-injection of the penis to achieve an erection. Three types of medications — phentolamine (an alphablocker), papaverine (a smooth-muscle relaxant), and alprostadil (a prostaglandin) — may be loaded into syringes and injected directly into the penile erectile chambers to provoke an erection.

Phentolamine, papaverine, and alprostadil are all effective in stimulating erections because they overcome neurologic signals that normally keep the penis in a limp or flaccid state and help encourage the release of intrapenile chemicals like nitric oxide and cyclic GMP to increase blood flow into the corpora cavernosae. Neurologic control of erections is vested in the sympathetic nervous system.

To understand how the sympathetic nervous system works, it is useful to create a simple scary example. Imagine that you are alone at night walking down a dark street. There is no sound. Then, as you are absorbed with your thoughts, someone comes up behind you and says, “Boo!”

Your sympathetic nervous system immediately swings into action to cause, among other reactions, an increase in pulse rate and blood pressure. The change in pulse and blood pressure is caused by internally produced adrenalinelike compounds with unique properties designated “alpha” or “beta.” Beta forces cause you to have palpitations and an increase in pulse rate, while alpha influences raise your blood pressure.

What does this have to do with erections? The penis is richly endowed with extensions of the sympathetic nervous system, specifically nerves of the alpha type. Alpha signals either facilitate or inhibit normal erections.

When the alpha forces dominate, the penis remains at rest. An injection of a medication that blocks the erection-inhibiting alpha nerves makes it possible for a full and unrestrained flow of blood to be directed into the

erectile bodies of the penis. Medications like phentolamine, an alphablocker, and prostaglandin El, a muscle relaxant with probable alpha-blocking activity, cause erections by blocking the nerve signals that maintain the penis in a limp state.

It is somewhat more difficult to understand exactly how papaverine works. There are no papaverine receptors in the penis. Papaverine, unlike alpha-adrenergic compounds or prostaglandins, is not made by the body. However, papaverine has one characteristic that is useful in inducing an erection; it is a smooth-muscle relaxant.

The body has two types of muscles, striated and smooth. Striated muscles are literally striped in appearance and are, for the most part, under voluntary control. The muscles of the arms, legs, and face are striated muscles. Smooth muscles are not under volitional control. For example, the muscles in the intestines are smooth muscles. The muscles lining the penile blood vessels that must dilate for an erection to occur are also smooth muscles. It is presumed that papaverine induces an erection by causing these intrapenile smooth muscles to relax, thereby allowing or encouraging increased blood flow into the penis.

To be fully effective, alprostadil (Caverject) or other similar medications must be injected directly into one of the penile erectile bodies, the corpora cavernosae. (The medication will naturally migrate over to the other side of the penis so that symmetrical erection is acquired.)

A cross section of the penis illustrates the corpora cavernosae surrounded by the thick outer fibrous sheath (tunica albuginea).


// October 30th, 2010 // No Comments » // Impotence

Penile prosthetic surgery is expensive. The cost of the prosthesis, hospitalization, and urologic surgeon’s fees can be as high as $10,000 to $12,000. This figure is applicable to those men who have their surgery and three to five days of postoperative care in the hospital. Most medical insurance plans cover the cost of surgery only for patients with documented organic impotence. With improved anesthetic skills and pressure to cut down on the high cost of hospitalization, some urologists have been experimenting with same-day ambulatory outpatient surgery. It is too early to determine whether this novel approach will safely replace the more traditional threeto-five-day hospitalization.


// October 30th, 2010 // No Comments » // Impotence

The initial brouhaha attending the introduction and early years of penile prosthesis surgery has subsided. It is now possible to reflect and cast a sober eye on the role of penile prostheses in the treatment of impotent men. It is clear now that surgical skills alone are not enough to solve the problem of impotence.The penile prosthesis industry is highly lucrative and competitive. The five penile-prosthesis manufacturers collectively accounted for $60 million in worldwide sales up to 1998.It is too early to know whether the availability of Viagra will dampen enthusiasm for penile prosthesis implantation. Still, the most optimistic estimates indicate that Viagra is effective in restoring erectile function in about 65 percent of impotent men. Among those 35 percent of impotent men who have a suboptimal response to Viagra are men who have become impotent as a result of:

• Radical prostatectomy
• Neurogenic impotence
• Diabetes mellitus

Thus, the remaining 35 percent of men with erectile dysfunction who do not respond satisfactorily to Viagra are precisely those men who have, in the past, been considered to be ideal candidates for penile prosthesis surgery. However, these are the same men who may also respond to penile injection therapy or intra-urethral alprostadil (medicated urethral suppository, or MUSE) therapy. With so many treatment options now available to correct erectile dysfunction, significant adjustments in strategy will be needed to decide exactly what treatments are best for the 30 percent of men who do not benefit from Viagra.


// October 30th, 2010 // No Comments » // Impotence

Prostheses have been implanted in men with virtually every known type of impotence, but some men are more appropriate candidates for surgery than others. Urologic surgeons prefer to implant devices in men whose impotence is a result of a physical cause, either neurogenic or vasculogenic. Included in the category of neurogenic impotence are men with diabetes mellitus, spinal-cord injuries, and multiple sclerosis, along with paraplegics and men whose pelvic nerves have been damaged or severed during prostate or lower abdominal surgery. Vasculogenic impotence applies to men with either decreased penile arterial inflow or increased venous outflow; vascular surgery is the preferred form of treatment for these men. But they are not always willing to go through the somewhat more complex surgical procedures and may elect prosthetic implantation instead.

As noted, patients with Peyronie’s disease have no difficulty achieving an erection. The problem is that the erection bends, so the penis deviates, often creating a J-shaped erection unsuitable for intercourse. Peyronie’s disease occurs when fibrous bands grow in the outer lining of the penis and tug at the penile shaft. The bands can be removed surgically, but this is only a temporary solution because these strictures tend to recur at the same or different locations in the penis. Implanting a prosthesis is often the only way to circumvent the problem.Men with endocrine disorders, whose potency can be restored with appropriate hormonal therapy, and men with overt psychologic problems, who require psychotherapy, psychiatric medications, or both, are the only groups to whom physicians do not routinely offer penile prosthetic implants.


// October 30th, 2010 // No Comments » // Impotence

Although surgical success rates for some devices now approach 90 to 95 percent, patient satisfaction does not parallel this impressive figure. A major problem is disappointment with postoperative penile length and width. Some men never attempt intercourse after the prosthesis is implanted; others have intercourse for only a brief time and then abandon sexual activities. Additional areas of disaffection with prostheses have surfaced in response to specific questions.

The majority of urologists are men, and in the beginning, the male perspective distinctly colored the reported results of prosthesis surgery. Female health-care professionals saw things differently. They approached the issue of satisfaction after implantation by interviewing both partners. Some couples were not having intercourse at all. Of those who were having intercourse, 25 percent reported restriction in positions because of the decreased penis size. Fifteen percent of the men experienced diminution of orgasmic intensity. Still, 79 percent of men said that they would, if given the opportunity, undergo the operation again. Only 59 percent of their partners had no hesitation.

Some urologists claim that satisfaction depends on the type of prosthesis, with IPP recipients being generally more satisfied than those who receive other prostheses. Because they are easily concealed and readily activated, one would have anticipated that the multicomponent IPP would have emerged by now as the dominant, if not the only, penile prosthetic device implanted.

This has not turned out to be the case, for two reasons. Significant problems with the internal hydraulics of IPPs remain, and mechanical failures are common. Perhaps more troublesome is the fact that a certain amount of manual dexterity is required to inflate the IPP.Originally, in an effort to mimic the genital caressing that is a natural component of sexual foreplay, the man’s sexual partner was encouraged to play an active role in pumping the scrotal bulb so that fluid could be transferred from the abdominal reservoir to the prosthesis, a maneuver intended to mimic a stimulated erection. This has not been as warmly embraced as expected.Sexual partners are often unwilling to participate in the pumping procedure. Some are simply not deft at manipulating the scrotal bulb. As a result, inadequate amounts of fluid are transferred from the reservoir to the prosthesis shaft, and a suboptimal erection ensues. In such cases, failure of the device has been ascribed not to mechanical problems of the unit itself but to the inadequate level of participation of sexual partners. Those who have been unwilling to become involved as vigorous squeezers of the scrotal bulb have been decried as “timid pumpers.” Other factors may also have a significant impact on postoperative sexual satisfaction. Any of the following put the couple’s satisfaction at risk:

• Extreme obesity
• Psychogenic impotence
• Impotence not the only sexual problem
• Sexual dysfunction in woman
• Severe marital conflict
• Unreasonable expectations
• Partner opposed to surgery
• Woman pressuring man to have surgery
• Couple ceased all sexual touching

Obese patients are often displeased following penile prosthesis surgery because the length of the unit protruding beneath their lower abdominal fat pad is limited. Most prostheses are approximately eight inches in length. If there is an extensive overhanging fat pad, then perhaps only an additional four inches of rigid penile tissue will protrude for purposes of sexual intercourse. If the patient’s partner is also obese, it will be very difficult for the couple to find a position in which penile-vaginal penetration and adequate vaginal containment is possible. For obese couples, postoperative sexual gratification may be limited.

Inappropriate expectations are high on the list of reasons for postoperative patient-partner dissatisfaction. The prosthesis provides only the penile rigidity necessary to achieve vaginal penetration. Patients who anticipate

that the equipment will allow them to recapture the real, or imagined, sexual prowess of their youth are likely to be displeased.

Patients whose impotence is attributed to psychogenic factors do not derive as much long-term benefit from prosthetic surgery as those whose impotence is caused by either neurogenic or vasculogenic factors.

On occasion, impotent men have sexual problems other than erectile dysfunction. Lack of spontaneous arousal, limited libido, and ejaculatory disorders are not corrected by penile prosthesis implantation.

The level of preoperative patient-partner interaction is a critical determinant in evaluating postoperative satisfaction. If, for example, the female partner has her own sexual dysfunction, such as pain during intercourse, then she may be fearful of experiencing vaginal penetration again. A man may choose to have a penile prosthetic implant without notifying his partner. Such a decision is commonly interpreted as a rejection of the partner. In addition, some women are fearful that their previously impotent partners, now outfitted with penile prostheses, will seek other lovers. Limited studies exploring this question have indicated that penile prosthesis recipients are no more susceptible to seduction than other comparably aged potent men, nor do they routinely seek out new sexual opportunities more often than their potent peers.

On the other hand, some female partners of impotent men, frustrated after long periods of sexual abstinence, may pressure the men into surgery. Any discordance in patient-partner desires for penile prosthesis surgery is considered a major risk factor for postoperative dissatisfaction.

Couples who have distanced themselves sexually from each other and have ceased hugging, touching, and all sensual and erotic contact may not be able to retrieve all aspects of normal sexual function merely by placing a prosthetic rod in the penis. Clearly, satisfaction is maximal only when both partners are involved in all discussions and decisions from the beginning.


// October 30th, 2010 // No Comments » // Impotence

With continued experience, physicians have learned much more about who is and is not a good candidate for penile prosthesis surgery. For example, impotence is common in diabetic men who can usually resume sexual intercourse after a penile prosthesis is implanted. However, diabetics are prone to develop infections, particularly when their diabetes is not well controlled. One test commonly performed to assess the adequacy of diabetic control is a test called a glycohemoglobin, which should be no higher than 6.9 percent. Diabetic men strive for but do not consistently achieve this goal. If they are far off the ideal mark and have a glycohemoglobin over 11.5 percent, the chance of infection is so high that some urologists will refuse to install a penile prosthesis. Only when diabetic control is more satisfactory, as judged by a closer-to-normal glycohemoglobin, will surgery be contemplated.

In the early days of penile prosthesis surgery, problems inherent in prosthesis design resulted in mechanical failures, and this structural breakdown

was the primary reason some men who had penile prosthesis surgery had to have the defective implant removed and a new one installed in a second operation. With technical advances in prosthesis design, mechanical failures now occur less frequently and infection is now the major reason for repeat penile prosthesis surgery.

The data in the tables are as reported by Dr. Ronald Lewis from the experience of the Department of Urology at Mayo Clinic. Men who are having their first penile implant should anticipate a reoperation rate of 10-15 percent between five and ten years after the original surgery, whereas those who have already had one penile prosthesis revision should be advised that fully 25 percent of them can anticipate a need for reoperation in less than five years. The majority of men who have penile prostheses implanted do not require any more surgery, making patient and partner satisfaction the primary determinants of the success of the surgery.