Hi guys Rena Malik, urologist, and pelvic surgeon. This week i am doing one of your favorites,
reacting to Grey's Anatomy and this episode's really exciting because there is an elderly
gentleman who wants a specific surgery and his family is not so interested in supporting him on
that so make sure you check it out and find out how it turns out. Also, November starts bladder
health month and if you check out my instagram, every week I will be releasing an instagram live
with another physician specializing in a variety of different disciplines talking about how the
bladder interacts with your gastrointestinal system or your poop, how you how your bladder
interacts with what you eat, and how you can improve your bladder symptoms with weight loss.
So make sure you check it out on my instagram page. If you guys want to see those instagram
lives on youtube make sure you comment below and let me know so i can upload them here as well
and what i'm really here for is AMS 700 the uh all right yeah well usually the first step in
treating erectile dysfunction's drug therapy i can uh if you're having symptoms right so yeah
absolutely the first step in treating erectile dysfunction is not a penile pump particularly
you will typically start with medications like viagra cialis or levitra and these are brand
names for medications that you can take that can help you with erectile function typically when
you take them you need to take them on an empty stomach or at least a very light meal and you
need some foreplay for them to work so people who don't have success with them you want to make sure
that you're actually using them correctly also if those things don't work you don't go straight
to having a surgery for a penile implant the next step there are other options there are things like
vacuum pumps or intraurethral suppository or tiny tiny little suppositories that go in the
urethra or there are intracavernosal injections which are small injections that you give yourself
in the erectile tissue of the penis to obtain an erection and that is probably the most effective
option for erectile dysfunction short of having surgery no no no no no no i took
those pills years ago they never even gave me a lift off and then my wife died and i gave up but
i'm seeing this new gal from the east wing she's a younger woman and i don't want to disappoint
good friend but it is a surgical procedure so there is a question of safety given your age
now come on can you give an old man a working johnson
okay so age is not necessarily the only consideration for this surgery you want to
make sure before you have any surgery particularly in elective surgery for a penile implant that you
don't have any other abnormalities that might make it difficult for you to go to sleep or difficult
for you to heal from surgery so we typically check your heart with an ekg your lungs with a
chest x-ray and if you're diabetic we also want to make sure that your diabetes is well controlled so
that you can heal appropriately from the surgery and that you don't have other complicating factors
that may make healing difficult from surgery what we do is we surgically place the silicone implant
into the penis and when the pump is squeezed before intercourse where does the pump go in
the scrotum so to pump it up i just squeeze the jewels so let me show you exactly what this pump
looks like okay so some of you may have seen this device before on my video where i talk
about a gentleman who was scheduled to get one of these after he got a new penis made after his
fell off after an infection if you missed that one make sure you check it out but essentially what it
is is there is a pump right here that goes into the scrotum and you pump it up and when you do
these are placed into the erectile tissue and you pump it up and fluid goes from this reservoir
right here that sits in the lower abdomen and you pump it up and it causes the fluid to go in to
these cylinders to make them firm and then when you are done you press this other small button
right on top and squeeze the cylinders and the fluid goes out
of the cylinders and into this reservoir
it's it's ridiculous you're 82 years old so i shouldn't have a sex life come on talk you're
just getting to the good part no no listen to me this is major surgery they have to cut your
they cut you open dad you could bleed or you want to die huh over an erection wars have been fought
over an erection son irving i i'm sure that a a thing like this isn't covered by medicare
all right well so i have not been in a situation where a patient's family has gotten involved in
this particular situation because men typically are old adults and they can make their decisions
for themselves and absolutely if an 82 year old man wants this device and he is able to receive
one because his heart is strong and his lungs are clear and he is not going to get an infection it
is absolutely his prerogative to get one i think that in society there is this idea that elderly
people should not be having sex or should not be having intercourse but i think that's completely
unfair so ultimately i think if this guy can get the surgery and he wants one there should be no
reason if he has tried all the other options and this is what he understands and wants to do after
going through a full informed consent meaning that he has had a discussion with his doctor about the
risks and benefits and he understands them completely and still wants to proceed then i
think that that's totally fair and possible as far as risks of having an inflatable penile prosthesis
there is a little bit of bleeding however the risk of needing a blood transfusion is extremely rare
the big risk is a risk of infection because if the device gets infected then we have to remove the
entire device can't just treat it with antibiotics and if we do that it becomes much more difficult
to place another device later and you essentially be completely unable to have an erection after
the surgery is completed because in order to place the device we have to actually make a space in the
erectile tissue for the cylinders to sit and when we remove that that space closes down and scars
up making it difficult for you to ever have an erection again after this device is placed so this
is kind of the end of the line when you've tried everything else and you really want to continue
having penetrative intercourse and you want to have an erection you know the kids think this
is all vanity but i really need this surgery doc wow she loves you she'll understand if you can't
perform so i see this a lot i think a lot of patients who want to have this surgery feel very
desperate and feel like this is really important for them to be able to satisfy their partner and
i think if this is something that is important to somebody and they feel really strongly about it
i would not discourage them if they were able to have the surgery and i think that's really
important so if this is something that's really important to you and valuable to you then there's
no reason not to move forward with it you're gonna wake up and all the big stuff all the milestones
you've been looking forward to graduation wedding having kids your grandkids it's all behind you
it's all over all you got is a bunch of yesterdays and very few tomorrows
i haven't wanted to make love with a woman since sylvie died over 20 years ago
and then one night one night they sat me down at the bingle table with marion and you just knew
she's my tomorrow guys that is just so sweet and so romantic i do agree with dr sloan that
if this gentleman you know if she loves him she will completely understand and she will not be
upset because there are other ways to be intimate but again if this is what he wants i think this
is what he should be able to get as long as it's safe to do so his bp is normal his blood work is
pristine he uh appears to have the heart of a 50 year old so what does that mean that means he's
cleared for surgery and you're really going to go through with this dad you bet i am champ oh
that place is causing you to make irrational decisions you go what is she a drug sneaking
into her room at night it's not appropriate for a man your age come on it's just an erection
excuse me all the guy wants is a woody god forbid you get to be his age and your kids won't let you
have one he's your father he's taking care of you your entire lives giving you everything
and now he needs something and you want to throw that in his face you know how many people would
jump at the chance to give back to their parents who would sacrifice everything without blinking
go mark sloan and there's nothing wrong with dating a younger woman it keeps you young and
that's my professional opinion so again i think that this is a little bit weird obviously that his
children are involved in this decision and trying to tell him that it's inappropriate
for a man of his age again it goes back to the whole society thing of people thinking
that older people shouldn't have intercourse uh of course you should involve your family in
the decision to have a major surgery like this particularly your partner who you're having the
surgery for should be aware uh but ultimately it's his decision and them telling him what's
appropriate or not for his sex life is just not okay okay so make sure you come back next week
monday to see my reaction to the second part of this episode where he actually goes through
with the surgery let's see what happens and i'll let you know what i think of it
thanks so much for watching always remember to take care of yourself because you're worth it