Transcript Document

Men’s Health Seminar
Dr. Manuel Perez
June 7, 2012
1001183r3 (10/11)
Satisfying Solutions
Erectile Restoration
Erectile Dysfunction (ED)
What is it?
• The inability to maintain an erection firm
enough to have sexual intercourse
How prevalent is it?
• 1 in 5 American men
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• Over 30 million American men
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• Over 150 million men worldwide
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• Causes: 90% physical, 10% psychogenic
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
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Main Physical Causes of ED4
Vascular
Diabetes
Medication
Medication
Vascular
Pelvic Surgery, Radiation
or Trauma
Neurological Causes
Endocrine Problems
Other
Diabetes
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
Degree of ED by Age
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Prevalence of ED by Age and Severity (%)
100%
80%
Severe
Moderate
60%
40%
20%
0%
5. Data on file at AMS; Dymedex Market Research
Mild or Mild/Moderate
Do you have to live with ED?
NO!
Nearly every man can be successfully treated.
Treatment Options
For Erectile Dysfunction
Oral Medications
• Not effective in approximately 30% of cases
• Work only in response to sexual stimulation
• Must take at least ½ hour to one hour before
anticipated sexual activity
• Viagra® can remain effective for up to 4 hours , Cialis®
can be effective up to 36 hours
• High fat meals can affect absorption of Viagra
• Estimated cost per pill: $15-$30
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VIAGRA® is a registered trademark of Pfizer Inc. CIALIS® is a registered trademark of Eli Lilly
and Company Corporation.
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.pfizer.com/files/products/uspi_viagra.pdf; downloaded 7/21/11
8. http://pi.lilly.com/us/cialis-pi.pdf; downloaded 7/21/11
9A. http://www.buyviagrapillsonline.com/; downloaded 3/3/11
Oral Medications
• Common side effects
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• Headache, Facial Flushing, Stuffy Nose, Upset Stomach
• Some Cautions
• Cannot take with NITRATES
• Precautions with alpha-blockers; medications for high blood
pressure and for prostate problems
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•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
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7. http://www.pfizer.com/files/products/uspi_viagra.pdf; downloaded 7/21/11
8. http://pi.lilly.com/us/cialis-pi.pdf; downloaded 7/21/11
Vacuum Erection Device
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Some Advantages
Some Disadvantages
• Non-invasive
• Cumbersome
• Drug free
• Unnatural erection
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• Cost effective
• Erection is not warm to the touch
• Bruising/burst blood vessels
• Penile pain/discomfort
• Numbness
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• Delayed ejaculation
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9B. 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
10. Yuan J., et al. Vacuum therapy in erectile dysfunction – science and clinical evidence. International Journal of Impotence Research.
2010; 12: 211-219
11. 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
12. 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
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Urethral Suppository: MUSE®
Some Advantages
• No needles or
injections
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Erection within 10 to 15
minutes
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Some Disadvantages
• Penile Pain & Burning
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Inadequate penile ridigity
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Must be refrigerated
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Cost is approximately $25
per application
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Patients with poor manual
dexterity/vision or
severe obesity may find
administration difficult
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MUSE is a trademark of VIVUS, Inc.
13. http://www.muserx.net/res/pack_inserts_PFI_1.3.pdf downloaded 11/12/10
14. http://www.infertility-male.com/erectdys/muse.htm, downloaded 2/15/11
15. Shabsigh R, Lue T.F. A Clinician’s Guide to ED Management. MPR Urologist 2006; 76-77
Penile Injection Therapy
Some Advantages
Some Disadvantages
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Effective
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On-set of erection within
5-20 minutes
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Risk of erection lasting 4 hours or more
(priapism)
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Possible bleeding at injection site
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Possible pain at injection site
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Requires training
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Cavernosal fibrosis
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Poor long-term tolerability
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Fear of sticking needle in penis
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16. http://labeling.pfizer.com/ShowLabeling.aspx?id=589; downloaded 7/21/11
17. 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
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Penile Implants
Ideal for men who have tried other
treatments without success
• On the market for over 30 years
• Over 300,000 implants to date
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• High patient and partner satisfaction
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18. "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
19. 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
20. Montorsi F et al. AMS three-piece inflatable implants for erectile dysfunction; a long-term multiinstitution study in 200 consecutive patients. Eur Urol. 2000; 37:50-55
Penile Implant Versus Other Treatment Options
Overall Patient Satisfaction with ED Treatments
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n=22
n=31
n=32
Percentage Satisfied
17. 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
Three-Piece Inflatable Penile Implant
Some Advantages
• Totally concealed in body
• Device is inflated to provide rigidity
and deflated for concealment
• Erection longevity is controllable
• When deflated, the cylinders are soft and flaccid
• Expands in girth (all AMS 700® cylinders) and
length (AMS 700 LGX® and Ultrex® cylinders)
• AMS 700 with InhibiZone® is the only
inflatable penile prosthesis with clinical
evidence showing a significant reduction
in the rate of revision due to infection
Implants are Highly Recommended
These recommendations pertain to the AMS Two-piece inflatable prosthesis
19. 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
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Benefits
• Offers a long-term solution to ED
• Provides the ability to have an erection
anytime you choose
• Allows for greater spontaneity – have sex when the
mood strikes
• Enables you to maintain an erection as long as you
desire
• Eliminates the need for costly pills or shots
• Feels natural during intercourse
• Does not interfere with ejaculation or orgasm
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19. 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
• Will make latent natural or spontaneous erections as well
as other interventional treatment options impossible
• If an infection occurs, the prosthesis may have to be
removed
• May cause the penis to become shorter, curved or
scarred
• There may be mechanical failures of the prosthesis
• Pain (typically associated with healing process)
As with any medical procedure, there are risks involved
and not all patients are candidates for a penile implant.
Discuss the risks and benefits of this procedure in more
detail with your doctor.
Insurance Coverage
• Is a penile implant covered by insurance
or Medicare?
Summary
• ED is a common problem
• Nearly every man can be successfully
treated for ED
• Penile implants offer a long-term solution
• Talk to your partner, talk to your
Prosthetic Urologist
Brief Summary – AMS 700 and Ambicor
The AMS 700® Series Inflatable Penile Prosthesis and the AMS Ambicor®
Penile Prosthesis are intended for use in the treatment of chronic, organic,
male erectile dysfunction (impotence). These devices are contraindicated in
patients who have active urogenital infections or active skin infections in the
region of surgery or (for the AMS 700 with InhibiZone®) have a known
sensitivity or allergy to rifampin, minocycline, or other tetracyclines.
Implantation will make latent natural or spontaneous erections, as well as
other interventional treatment options, impossible. Men with diabetes, spinal
cord injuries or open sores may have an increased risk of infection. Failure
to evaluate and treat device erosion may result in infection and loss of
tissue. Implantation may result in penile shortening, curvature, or scarring.
Possible adverse events include, but are not limited to, urogenital pain
(usually associated with healing), urogenital edema, urogenital ecchymosis,
urogenital erythema, reservoir encapsulation, patient dissatisfaction, autoinflation, mechanical malfunction, impaired urination, penile curvature, or
sensation change.
Prior to using these devices, please review the Instructions for Use for a
complete listing of indications, contraindications, warnings, precautions and
potential adverse events. Rx Only
Questions on ED?