The HEALTH : June 2018 | Page 15

JUNE, 2018 | The HEALTH

GOODHEALTH

A flaccid and an erect penis with an inflatable penile implant.

Low-risk

Figure 2: Treatment algorithm for determining level of sexual activity according to cardiac risk in ED( based on 3rd Princeton Consensus) [ 60 ].

Advice. treat erectile dysfunction

Sexual inquiry of all men

Erectile dysfunction confirmed

Pass

Low-risk

Exercise ability

Intermediate risk

Stress test

Fall

Low-risk

Table 6. Common adverse events of the four PDE51s currently EMA-approved to treat ED *

High-risk

Intermediate risk

Adverse event Sildenafil Tadalafil Vardenafil Avanafil, 200mg Headache 12.8 % 14.5 % 16 % 9.3 % Flushing 10.4 % 4.1 % 12 % 3.7 % Dyspepsia 4.6 % 12.3 % 4 % uncommon Nasal congestion 1.1 % 4.3 % 10 % 1.7 % Dizziness 1.2 % 2.3 % 2 % 0.6 % Abnormal vision 1.9 % < 2 % none Back pain 6.5 % < 2 % Myalgia 5.7 % < 2 %

* Adapted from EMA statements on product characteristics.

PENILE prostheses are highly effective in the treatment of erectile dysfunction( ED). Serendipitously, using an external vacuum device to augment prosthetic erection provides a dramatic objective improvement in erection and increases overall satisfaction with intercourse.

Pantai Hospital Kuala Lumpur vising consultant urologist Dr Poongkodi Nagappan explained that there are three types of methods that are used to promote prosthetic erection:

• Vacuum constriction devices

• Implantable devices

• Vascular reconstructive surgery

Vacuum constriction devices non-invasive consists of a vacuum chamber, pump and a constriction ring.

She explained that this method is done by first lubricating, loading the ring onto cylinder base, placing the cylinder over penis and pressing base firmly against the pubis, slowly activating the pump, pulling the constriction band onto base of penis and finally removing the cylinder.

This takes two to three minutes to achieve an erection while the constriction band is placed for 30 minutes.

“ Results are close to normal with sufficient rigidity and has been proven with patient and partner satisfaction rates, especially older men in long-term relationships.”

However, the vacuum constriction devices are cumbersome. It can also cause purple, cold and numb bruising.

This method, she said is inappropriate in mild ED and ineffective in severe ED, vascular insufficiency and fibrosis.

Penile prosthesis implantation

There is two methods; the malleable implant and the inflatable implant.

The malleable implant consists of two semi-rigid, bendable rods that can be manipulated to create an erection. It is easier to use, provides constant penile rigidity with a lower risk of

How a vacuum constriction device is used

mechanical failure. It is also generally less expensive.

The Inflatable implant, on the other hand, consists of a pair of cylinders, pump and a reservoir.

“ When a man desires sexual activity, all he has to do is squeeze the pump that is located in his scrotum firmly a few times until an erection is achieved. By squeezing the pump, fluid is transferred from the reservoir into the cylinders. A man’ s erection after implant surgery looks and feels so natural that there have been cases where a partner has not even been aware that an implant was present,” she said.

It also has a reliability rate of 97.5 per cent at five years with a lifetime replacement policy. by affecting the amount of blood that the vessels deliver and remove from the penis.”

“ Hence, PDE5 inhibitors hinder phosphodiesterase-5, which destroys the cGMP. Thus, PDE5 inhibitors stops the destruction of cGMP and allow cGMP to accumulate and persist longer.”

Sildenafil and vardenafil work best if taken without having eaten food within the last two hours. Tadalafil may be taken without regard to food.

Meanwhile, Tadalafil has a longer duration of action( up to 24-36 hours) compared with Sildenafil and vardenafil which works from four to 12 hours. Tadalafil can be consumed without regard to sexual intercourse.

Common adverse effects include headache, flushing, runny nose, stomach pain, back pain( Cialis) and indigestion. It may also cause dizziness or a sudden drop in blood pressure.

Examples of vacuum constriction devices.