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U.S. News and World Report: America's Best Hospitals, Urology, 2012-13

 

Improving Male Sexual Health

UW Health urologist Dan WilliamsIn 2008, the University of Wisconsin-Madison Department of Urology started its Male Sexual Health Program.

 

Founders and co-directors David Paolone, MD and Daniel Williams, MD have had specialized training to offer state-of-the-art medical and surgical therapies to restore Erectile Function.

 

One of the primary focuses of the program is penile rehabilitation therapy following Radical Prostatectomy. There may be irreversible damage occurring in cavernosal tissue during the period of Erectile Dysfunction that immediately follows a radical prostatectomy. This period may last up to two years as a result of neuropraxia experienced by the cavernous nerves.

 

Animal studies have demonstrated an increase in smooth muscle apoptosis within the corpus cavernosum following cavernous nerve injury. Collagen deposition has also been demonstrated in this model. Collagen content may also be influenced by oxygen tension in a chronically flaccid state.

 

Penile Rehabilitation Following Radical Prostatectomy

 

The goal of penile rehabilitation is to preclude these changes by minimizing the disruption of normal nocturnal erections and sexually stimulated erections, thereby increasing a man's long-term prospects for re-establishing normal erectile function following prostatectomy.

 

Post-prostatectomy penile rehabilitation strategies have included use of phosphodiesterase type-5 inhibitors, vacuum erection devices and intracorporeal injection therapy. Many of the early studies regarding these treatments lacked randomization and placebo control. Nonetheless, there has been a suggestion of a greater return of spontaneous erections in those men who employ some form of treatment for their erectile dysfunction on a regular basis versus those men who pursue no early treatment.

 

UW Urology's current strategy for penile rehabilitation includes a consultation with a urologist prior to surgery to discuss and develop individualized pre-treatment strategies for the preservation of post-prostatectomy erectile function.

 

Approaches to this include the initiation of a daily phosphodiesterase type-5 inhibitor before and immediately following prostatectomy. Men who do not respond to oral medications are offered intracorporeal injections and vacuum erection device therapy.

 

Eventually, some patients are able to stop daily therapy if spontaneous erections return while others continue to use medications on an as-needed basis but with better results than had they not performed the rehabilitation protocol.

 

Finally, Penile Implants are offered to men who do not respond to medical therapy. Inflatable penile prostheses are the premier treatment of post-prostatectomy erectile dysfunction. They restore durable, long-term erectile function and result in both patient and partner satisfaction rates of over 90 percent.

 

Male Sexual Dysfunction

 

As the aging population continues to grow, we are seeing a parallel increase in the prevalence of male sexual dysfunction. The etiology of erectile and ejaculatory disorders is typically multifactorial and includes many causes:

  • Physiological (diabetes, obesity, metabolic syndrome, dyslipidemia, vascular disease, hypertension, hypogonadism)
  • Psychological (relationship discord, anxiety, depression)
  • Neurological (spinal cord injury, diabetic neuropathy)
  • Environmental (tobacco use, drugs, medications, post-surgical)

video icon Watch Our Male Sexual Health Videos

 

The emotional impact of sexual problems can be devastating to both men and their partners. Dr. Dan Williams addresses many male sexual issues in a series of videos on our Web site. Watch the Videos