This podcast is for you, the Modern Man. I'm Dr Anne

Truong, your host. I'm an intimate health medical doctor

and best selling author of the book, Erectile Dysfunction Fix.

I'll do a deep dive into sexual health and performance and how

it affects men of all ages and backgrounds. So let's get

started, and be sure to visit my website at

sexualhealthformenpodcast.com for more information and

resources from the show. See you on the inside.

Hello there, Modern Man. In this episode, we're going to talk

about penile implant, how, what, and when, and also what are some

of the complication related to it. So stay tuned to the end,

because you are going to learn a lot of stuff and know everything

about penile implant. So let's touch a little bit on kind of

approach to a man that has ed that come to your office, what's

the algorithm? And then talk about penile implant and the

indication for that.

Dr. Mohit Khera: Sure. And I think we talked a little bit

earlier. Talking about the partner, making sure you check

the hormones, diet, exercise, sleep and stress, modify the

risk factors, making sure that there's not something a

medication that's causing the ED is important. And once you go

through all those you want to also, obviously, detail history,

detail physical you want to then go through and talk about all

the treatment options. But the new AUA guidelines, it's not new

2018 but basically it's not a step wise approach anymore. We

go via an injection and implant. The new is shared decision

making. We give them every treatment option available, we

talk about the risks and benefits of each treatment

option, and then we let them choose. So if someone says, I'm

not going to go with the pill, I'd like to go with the

injection first. That's completely fine, as long as they

were counseled appropriately. But the penile implants actually

a fascinating device, so invented 1973 here at Baylor

College of Medicine, and it's been really revolutionized the

way we treat men for reptile dysfunction. Essentially what it

is, it's a surgery that if you think about the anatomy that

male penis has two tubes, we call those cavernous bodies, and

they're filled with muscle. And what we do is we put two

balloons in them. Think of my balloons in there, and those are

cylinders. There's a small pump in the scrotum, and then there's

a small reservoir that holds normal saline behind the pubic

bone, typically. And when a man takes off his clothes, you would

not be able to tell that he has a penile implant in he would

reach down into the scrotum, he pressed this pump, and it would

induce an erection, just simply by pulling normal saline out of

the reservoir, putting into the cylinders. When he finishes

engaging in sex activity, it will release the pump, and all

the fluid goes back. So a very, very more popular these days.

It's covered by Medicare, surprisingly. So Medicare is one

of the best payers for the penile implant. But if you gave

questionnaires to men who've tried pills, injections,

vacuums, penal implant, penile implant always gets the highest

satisfaction out of anything they can get and use, but it's a

surgery. So some men are a little more apprehensive and

say, I'm not sure I want to do the surgery, but most men will

say, I wish I'd done this sooner, because it really does

make a big impact on their ability to have sex.

So who are the candidate and who are not the

candidate for penile implants?

Dr. Mohit Khera: Well, there's several types of implants.

There's the malleable, which is the one piece, which is always

rigid, but you can bend it up and bend it down, then there's

the one I described, which is the three piece. If someone has

poor manual dexterity and cannot squeeze, then you cannot put a

three piece in, because it will not make any sense. So that's

very important. We always careful on high risk patients

also, because, remember, it is surgery, and this is elective,

and someone's a poor surgical candidate, I'm not going to put

them to sleep and take that risk if, because they could, you

know, if they're high risk surgical candidates, you're

going to be careful. But, I mean, I think it's very

important to also get the female partner involved in the

discussion. Sometimes there are patients that say, I don't want

my wife to know I'd like to do this, that say, I really feel

it's important to have her here involved in the discussion all

the way through. Those are the much better success stories.

Okay, so that's very important there. And so who

are the one that are not surgical candidate?

Dr. Mohit Khera: Well, you know, we get anesthesia clearance if

they say, Look, he has a high cardiac risk and he's got

significant stenosis. Unless you clear the stenosis, you know,

there's not going to be a good sort of I mean, those are some

high risk patients. We used to say that if someone had a

hostile pelvis with a lot of abdominal colostomy and they had

other issues, but that's not really a contraindication

anymore. We can make a counter incision. We can place it

safely, but the hostile pelvis is not a contraindication just

making sure that they're a surgical candidate. I mean, I do

have to put them to sleep. They do have to have anesthesia.

There are some institutions, and I know in Korea that are now

doing it under local, which I have not had the experience of

doing, but we still put patients to sleep under anesthesia. And

how long does the surgery take? About 45 minutes or so. Wow,

pretty fast. Yeah. I mean, I would say we're not trying to. I

mean, it's going to be under an hour, and most. Patients go home

the same day, and you just can't use it for six weeks, until it

heals. But after six weeks, then you can use the prosthesis.

And what are the complication of penile implant?

Dr. Mohit Khera: There are several. So first is that you

can have an infection, and literature supports that's less

than 2% but it can get infected. If it gets infected, I have to

take it out. I can't leave it in your body, but if I do take it

out and I catch it early, I can salvage it by putting a new one

in in certain cases, the second is that you can have

malfunction, and anywhere from about 10 years or so, they can

malfunction. You may have to replace the pump, which is easy

to do, or replace a component, but it can malfunction. Some

patients will complain of loss of penile length, but most

studies show that you really don't lose significant penile

length. It's just that the penis has had some atrophy over time.

So patients say, I remember the penis was this large when I was

18. I said, I cannot make it as large as 18. I can only make it

as large as it is today. So I can whatever cylinders fit, is

what we can use. So I think that's another important

characteristic, but you can always have some intraoperative

complications such as urethral injury or bladder perforation,

but those are extremely rare.

Gotcha. So essentially, you put in the two

cylinder down the corpus cavernosum or the penis muscle,

then all the penis muscle atrophy around?

Dr. Mohit Khera: Yes, it's just pushed to the side. You just

push to the side. So now, instead of having the muscle

expanding, you have balloons that are expanding and the

muscles still on the side. We don't take the muscle out, we

just compress it against the wall.

Gotcha. Okay. And what's the satisfaction rate?

Dr. Mohit Khera: Well, it depends on what we look at.

Sometimes they say greater than 86%, someone said greater than

92%, and it's for patient and partner. Partner satisfaction is

important as well.

Okay, so have you looked at the partner

satisfaction that their research, where they have a plan

as well?

Dr. Mohit Khera: They have shown that the partner satisfaction is

also very high with when the male gets the penile implant.

What's the perception from a woman

perspective with the implant?

Dr. Mohit Khera: Well, I mean, it's still the patient's own

natural body. It's his own natural skin. There's nothing

artificial about it. And what's nice is he can maintain that

erection as long as he wants. So even if he climaxes, has an

orgasm, he still is able to maintain the erection. And so

tell some patients say, Look, this may even be better than

when I was younger, because I can have sex whenever I want, as

long as I want, without any drugs, without any pills. And so

it has really made a significant improvement in the relationship

many couples because of the ability to once again engage in

such activity without a lot of barriers.

Gotcha. And they also can ejaculate as well. So

no problem with that?

Dr. Mohit Khera: No problem, no issue.

Right. Because the corpus spongiosum is not touched

at all. Left alone.

Dr. Mohit Khera: Yeah, spongiosum is not touched at

all, and that gives the rhythmic contraction of the bulb. You're

right. But yes, there are still orgasm. There's still a jacket.

What about the glands? So the glands important because the

glands is part of the urethra, the urinary system, so you are

not going to get enforcement typically, of the glands, but

you can put the cylinders right behind the glands, up to in the

mid glands, so you still get rigidity there. But you're

right. In some cases you will not see, some people still get

some mild engorgement, but most cases, you will not get

engorgement of the glands.

Okay. And what age you usually recommend this for?

Great. I'm glad we presented all that as well, too.

Dr. Mohit Khera: It's interesting, because it's really

any age. I mean, you have young men who develop priapism

sometimes in their 20s and 30s. It's devastating. And now they

have permanent ED and if you don't put the penal implant in

early within the first three months, we call that, they

become a penile cripple. It's hard to get it in later. So

sometimes, because of the condition, you may treat them

earlier in life, but typically, most men in their late 50s, 60s,

is where you start seeing most of the penile implants.

So having said that, what advice canyou give to our listeners

that has ED right now? What can he do right now, this moment,

that we'll see some leverage, some improvement in his life and

his sexual function?

Dr. Mohit Khera: So be proactive about prolonging your sex span.

Do not wait till you have full blown ED to start treating the

issue. And you will be proactive by many of the things we

discussed today. Maintain a diet that's low inflammation,

antioxidants and glycemic high glycemic index. So Mediterranean

diet is just one example, but any diet that you can maintain

to decrease the high carbohydrate intake, high

inflammation will be very helpful. Second the exercise,

exercising, even 40 minutes, four times a week, has been

shown to significantly improve erectile function and preserve

erectile function. Three sleep. Remember, we only make

testosterone when we sleep. If you're not sleeping, the T

levels will go down. That's been shown, and we say that you

should sleep at least seven hours a night, preferably eight,

and keep make sure that that sleep is good quality sleep and

mitigate your stress. Stress can significantly shut down erectile

function. Now that's easier said than done. We live in a very

stressful world, and there's things going on, but you can

find ways to reduce your stress. Meditate. Mindfulness. Find

things that you enjoy doing, taking time out. It's very

important to take time out for yourself and reduce your stress

for your overall health and your sexual function.

Thank you so much for your wisdom. And I totally

enjoy our conversation. And I know that there are lots of

pearls, lots of things to unpack. I think you need to

listen to this episode at least twice to unpack, because I've

learned something as well. Anytime Dr. Khera says

something, I'm always learning something from that as well. And

so I hope that you guys enjoyed this episode. Thank you, Dr.

Khera. for being with me today and sharing your wisdom.

I hope you enjoyed this episode, modern man, it will be the world

to me if you get notification, subscribe to the channel and

share this with somebody you think will be beneficial with.

Also know that you do not have to live with ED and suffer with

ED in silence. It can be treated. It it can be addressed.

That's why I created the Modern Man Club. It's for you to get

the resources that you need and the information that you need

and the coaching from us to get you out of ED into sexual

confidence, and that way you do not have to feel alone. You do

not have to figure it out yourself. We have the success

path for you in the Modern Man Club. It is a safe and discreet

space where we get you out of erectile dysfunction into sexual

confidence. Check it out, the Modern Man Club, at noedman.com.

So having said that, let's create a sexual revolution

together where we can empower everyone to have sexual

longevity for life. See you in the next episode.

Are you struggling and frustrating in finding a

solution for ED? Well, I have just the thing for you. It's

called The Modern Man Club led by yours truly, Dr. Anne.

Together, we're redefining male sexuality and embracing a

holistic approach to overcoming ED without medication or

surgery. I will provide a protective environment for

community and proven strategy to overcoming ED. It is a safe

place, expert coaching by me and my team. We provide holistic

approach to overcoming ED and an empowering community of men with

ED supporting one another and lots and lots of educational

resources. Visit mensexualityclub.com, at the

link here on my right, and connect with us and reclaim

control over your sexual health. I'll see you there.

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