Understanding Impotence/Erectile Dysfunction (ED)

Impotence, also known as erectile dysfunction (ED), is a condition that affects many men around the world. It involves difficulty achieving or maintaining an erection suitable for sexual intercourse. Various treatment options exist, but one of the most well-known and commonly used is sildenafil, better known by its brand name, Viagra.

Introduction to Viagra and Sildenafil

Viagra, chemically known as sildenafil, is an oral medication that was the first of its kind approved for the treatment of ED. It works by enhancing the body's natural mechanisms that lead to an erection, primarily by improving blood flow to the penis. Notably, vardenafil (Levitra, Staxyn), tadalafil (Cialis), and avanafil (Stendra) are other oral medications with a similar function.

How Viagra Works: Blood Flow and Erection

Viagra operates by facilitating the physiological processes involved in achieving an erection. It increases blood flow to the penis during sexual stimulation, a crucial factor in obtaining an erection. However, it's important to note that Viagra requires sexual stimulation to work - it does not induce an erection independently.

The Age Group Affected: Males 18 Years and Older

Viagra is a prescription drug approved for use in males ages 18 years and older. While ED is more common in older men, it can affect men of all ages, and treatments like Viagra offer a potential solution.

The Role of Viagra: Does it Cure ED or Just Provide Temporary Relief?

Herein lies the crux of the question: does Viagra cure impotence? According to clinical studies, Viagra has proven effective in treating ED, enabling men who use the drug to achieve and maintain an erection more reliably. However, Viagra does not cure ED or increase sexual desire. It offers symptomatic relief, enabling an erection when sexual stimulation occurs, but it doesn't resolve the underlying causes of ED.

Viagra and Sexual Desire: A Misunderstood Relationship

A common misconception is that Viagra, or any ED medication, can increase sexual desire. This is not the case. These medications aid the mechanical process of gaining an erection, but they do not influence libido or sexual desire.

Comparison: Viagra and Other Available Drugs for ED

While Viagra is perhaps the most well-known ED medication, it is not the only one. Alternatives include vardenafil (Levitra, Staxyn), tadalafil (Cialis), and avanafil (Stendra). They operate on the same basic principle as Viagra - increasing blood flow to facilitate an erection - but may differ in terms of duration, onset of action, and potential side effects. Importantly, Viagra doesn't work for every man, and in such cases, these alternatives might be considered.

Personalizing Treatment: The Best Fit Drug for an Individual's ED

ED treatment is not a one-size-fits-all situation. What works best depends on the individual, the cause of their ED, and how they respond to treatment. If Viagra doesn't work, a higher dose or a different medication may be recommended.

The Quest for a Cure: The Current State of ED Treatment Options

So, can erectile dysfunction be cured? Yes, it can, but it heavily depends on the cause. Some causes of ED are easier to address than others. ED can result from physiological issues like blood flow problems, psychological issues like anxiety, or a combination of factors. Some of these can be resolved without the need for medication, while others may require ongoing treatment. In the latter case, Viagra and similar drugs offer a means to manage the symptoms of ED effectively, even if they don't offer a definitive cure.

In the end, Viagra and other ED drugs play a significant role in treating impotence.

While they

 
 
 
 
 
 
 

 

 

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About GreenLight: For men with bladder outflow obstruction due to an enlarged prostate, this technique allows genuine day case surgery with dramatic early results and minimal early side-effects.      Most men can now be treated without a post-operative catheter.  It is possible for prostates of all sizes to be treated. Even patients with retention of urine can go home the same day, sometimes with no catheter. Bleeding and recovery time are usually minimal.

As the first team in the UK to use the GreenLight system, and having pioneered and developed the GreenLight prostate vaporisation system in Europe, we have  now virtually given up other surgical methods of benign prostate surgery.

GreenLight Patient Information     How does it work?      

Information for GP's    Training Courses for Surgeons

Watch patient information video

By clicking on the flash image you will be able to watch a video where patients share their experiences and an explanation is given of the techniques. You will need to have Flash player installed to watch it.

To download our operation information (Adobe PDF) click here

 

If you prefer to read the information online then click here to go to our operation info page

   

 

NHS Innovation Awards

The adoption of this technique led to the NHS  clinical excellence award for innovation being awarded to King's College Hospital.

How does it work?

Although we had in TURP a very good and tested operation, there are side effects and costs associated with it. This led to many minimally invasive approaches over the last decade. Sadly most of these were abandoned due to or a high risk of pain or other side effects compared to TURP, or because they simply did not work!

Previous Attempts with Lasers

Many laser energies have been used in the prostate before now, but limitations on laser power have meant removal of significant amounts of prostate tissue (the real test) has been impossible or unfeasibly slow. The only two contenders for the TURP crown up until now have been prostate electrovaporisation (easy to learn but higher risk of infection, impotence and incontinence) and holmium laser prostate enucleation (as effective as TURP but extremely difficult to learn and associated with severe operative complications in all but the most expert hands).

The Greenlight HPS system from AMS addresses this problem by means of delivering a very powerful modulated  laser beam which is absorbed by the haemoglobin pigment in tissue. This means that when the laser is applied to prostate tissue massive localised heating of the tissue occurs resulting in instantaneous vaporisation: due to the laser -  characteristically bleeding is close to zero.

Our results show that prostates of any size can be treated, with most men seeing their symptoms improve by two or three fold in the first six weeks. Many men have continuing benefits developing up to nine months after surgery

The technique allowsrapid creation of a generous prostate cavity with almost no bleeding.  More than 50% of men can leave hospital on the day of surgery without a catheter, with most others having a soft small catheter for around 18 hours at home (many men remove this themselves)Althoughwe placed catheters post operatively in our initial evaluation period, only a few men have had to have a catheter for more than 12 hours (these have usually been in urinary retention patients, and nearly all have voided extremely well on final catheter removal.  Strikingly, very few patients report pain after the procedure: pain and burning on urinating have limited both laser techniques and TURP in the past. About one man in ten will get some burning which may need a fe weeks of simple painkillers to ease the discomfort. Sexual side effects are reduced compared to the standard technique.  While very long term results are awaited, the figures after five years of follow up show improvements in symptoms and urological measurements comparable to historical TURP data (about one man in fifty requiring reintervention each year).  In particular it appears the prostate tissue removal seen at the time of surgery is genuine when assessed by post-operative prostate ultrasound (between 40-60% of tissue reduction is seen).  

Post operative bleeding and discomfort can occur, but aremuch  less than with standard TURP, and many men have gone back to work or normal activities within a couple of days, with sport and other activities being possible within a week or two. Of course, some men do take longer to recover and those men with very overactive bladders or catheters pre-operatlively may take some time to settle afterwards.

Anticoagulation, large prostate size (>100g) and poor cardiac status are not contraindications to the procedure, even as a day case.

Our results have been presented at a number of international meetings including the European Association of Urology and the American Urological Association Meeting. In particular our data on large prostates and the absence of absorption of irrigating fluid has attracted much interest. Mr Muir isa founder member of the International GreenLIght Users' Group, which seeks to fine tune and improve further the results from this therapy.

IPSS Symptom scores changes following PVP to one year

The initial score of 23 on the IPSS system shows that most men were suffering severe symptoms which reduced by almost threefold within sixweeks.

Urine flow rates at the same stage and out to five years in our series showimprovements of more than 100%.  

 

 

 

 

 

 

GreenLight Training Courses at King's College Hospital

(for urological surgeons wishing to learn the technique)

 

Course director: Gordon Muir, Consultant Urologist

The course will be in the format of small group teaching with a mixture of didactic presentations linked to live 2 way videoconferencing observing a number of prostate vaporisations in the operating theatre downstairs from our conference room.. There will be an opportunity to visit our state of the art integrated operating theatres during procedures to observe the set-up and logistical issues relating to prostate laser surgery.

The objectives of the course will be that at the end of the course participants will be able to:

  • Understand the indications and contraindications for GreenLight PVP
  • Explain the mechanism of action and efficacy of high power KTP-YAG laser energy
  • Control an operating theatre with a GreenLight laser installation
  • Apply their understanding of the GreenLight PVP procedure to their clinical practice

Topics covered in the course include:

GreenLight PVP results

Previous lasers: problems and successes

Why green light? Laser physics and safety

Live cases

Theatre and nursing issues

Discussion: how to startup, avoiding complications

 

Certificates of GreenLight laser training and CME credits will be awarded to those who have successfully completed the training course. CME accreditation has been applied for.

Refreshments and lunch are included in the course fee

Course dates at King's College Hospital

6th April 2009

11th May 2009

8th June 2009

6th July 2009

 

Training video (NB this is NOT a substitute for attending a properly run course and having mentoring for the surgical technique)

for further information on courses contact [email protected]

 

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GreenLight Training Courses

We are able to offer formal training courses for doctors interested in knowing about the GreenLight procedure. Formal half day courses are run in the Day Surgery Teaching UNit at KIng's College Hospital.

Programme for visitors to King’s College Hospitalfor GreenLight PVP training

 

Course director: Gordon Muir, Consultant Urologist

The course will be in the format of small group (max 10) teaching with a mixture of didactic presentations linked to live 2 way videoconferencing observing a number of prostate vaporisations in the operating theatre downstairs from our conference room.. There will be an opportunity to visit the operating theatres during procedures to observe the set-up and logistical issues relating to prostate laser surgery.

The objectives of the course will be that at the end of the course participants will be able to:

Topics covered in the course include:

 

Certificates of GreenLight laser training and CME credits will be awarded to those who have successfully completed the training course

CME accreditation has been applied for.

Refreshments and lunch are included in the course fee