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Urological Services, P.C.
Michael J. Macksood, D.O., F.A.C.S.

WHAT DO I DO WHEN VIAGRA DOES NOT WORK?

By Michael Macksood, DO, FACS

The oral medications that are available today for impotence, including Viagra, Cialis and LEVITRA, have a very high patient satisfaction rate. These medications work in approximately 50% to 80% of men, depending on the etiology of their impotence. They are very safe medications in the vast majority of patients, as long as the patient has good cardiovascular status and is not taking any medications that contain nitroglycerin.

However, the question often comes up; What we do with those patients that do not respond to these oral medications? It is important that men are informed that impotence is always a treatable condition.

If oral medications do not work, the next step for most men would be a trial of intraurethral prostaglandin. This is a suppository that is about a third the size of a grain of rice. It is inserted by the patient into the urethral meatus, approximately 30 minutes before intercourse is anticipated. It is easy for most men to learn how to use the medication and it works well with a good result in 30% to 60% of patients who fail oral medications. The medication is safe and it does not have systemic effects. The main side effects would be the possibility of priapism or, more frequently, urethral discomfort after insertion of the medication.

If prostaglandin intraurethrally is not effective, various vacuum suction devices are available. The vacuum suction devices work by inserting the penis into a plastic tube and then there is some sort of a pump mechanism to create a negative pressure within the tube, which will help draw blood into the penis. A constricting band is then placed at the base of the penis to help hold the erection. This works in a small percentage of patients who have the manual dexterity to operate the device and do not find the necessary equipment too cumbersome.

Penile prosthesis surgery is still a very effective treatment for the impotent man who does not respond to conservative measures and still desires treatment for his impotence. The penile prosthesis has been around for many years. It has a success rate of well over 95% and it has a low complication rate. It is now performed almost exclusively as an outpatient surgery with a very low complication rate. The two major devices available are a malleable device and an inflatable device.

It is important that men with erectile dysfunction be informed that when oral medication does not work to treat their problem, they still have other options available to them. For more information please call the number below for an appointment.




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Urological Services, P.C.
1121 West Hill Road
Flint, MI 48507
Tel: 810.232.8888
Fax: 810.232.9190
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