Dear Dr. Roach: I had a radical prostatectomy in 2012 and two subsequent inguinal hernias. Due to having three surgeries in eight and a half months and the recovery from them, my desire for intimacy was very low. My understanding is that the longer you delay intimacy, the greater the chance of erectile dysfunction. Am I correct? Daily pills did not work; Muse was successful, but painful. The Trimix injections were somewhat successful, but my essential tremors really inhibited the injection process. I am now using a pump, which is awkward and not very successful; I am still in the learning stage. Next month will be four years since my prostatectomy, and I thank God I am cancer-free. I am thinking of an implant.
First of all, what percentage of men get ED after prostatectomy and can recover? Did the hernias enhance the ED? Do many men have issues like this? Do you have comments about the implant, especially after four years?
Anon.
About 60 per cent of men identify moderate-to-severe problems with sexual function two months after radical prostatectomy, and 40 per cent two years after surgery. The older a man is at the time of surgery, the more likely he is to develop erectile dysfunction. 听
My colleagues in urology who perform implant surgeries tell me that without erections, the penis can develop fibrosis, making it a more difficult surgery and lessening the likelihood of success. For this reason, some centres recommend early treatment with oral or injection medications or a vacuum device to preserve sexual function. I have had quite a few men undergo surgical placement of the implant, and the vast majority have been happy with the results. Most studies have shown 90 to 95 per cent satisfaction rates. 听
Dear Dr. Roach: We have a friend who鈥檚 currently undergoing ozone therapy for a bone-on-bone knee condition. He was told that the ozone therapy will 鈥渂uild up tissue,鈥� apparently referring to the area between the knee bones. I have been led to believe that one cannot grow back replacement tissue between the bones. It sounds pretty far-fetched to me. What are your thoughts?
H.J.
It sounded pretty far-fetched to me, too, but a 2015 study from Brazil showed that injecting ozone into the knees of people with osteoarthritis relieved pain and improved the ability to do daily activities. The study was presented at a prestigious conference but has not been published yet. Ozone has not been compared with other standard treatments, and although the group that did the study is looking at MRI scans to see whether the cartilage improved, that part isn鈥檛 clear.
Ozone is not approved in the U.S. (or Brazil, for that matter), and special care was taken in the study to avoid inhaling ozone, which is toxic. Two subjects in the study had 鈥減uncture accidents.鈥�
Given the preliminary nature of the evidence, the lack of approval for the procedure, the potential for harm and the inability to compare with standard treatments, I can only say that ozone looks promising, but I can鈥檛 recommend it outside of a study situation. I have seen many instances where a treatment looks great in early trials but fails completely when subjected to more rigorous analysis. 听
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].听听
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