"Hey guys, there is hope out there. You can do something."

This was Ron Wohrle's message to a group of men gathered recently at The Community Hospital in Munster to learn more about treatment options for erectile dysfunction and urinary incontinence.

The 59-year-old Elk Grove Village, Ill., man felt compelled to share his success story with other men who may be suffering like he did for three years. Unaware that a treatment existed to help him overcome his loss of bladder control that resulted from his radical prostatectomy, Wohrle had all but resigned himself to a life of absorbancy products which frequently left him wet, smelly and embarrassed.

Incontinence is a problem that affects an estimated 3 million men in the U.S. It is caused by damage to the external sphincter muscle, which controls urine flow. The most common cause is the partial or complete removal of the prostate gland as a treatment for prostate cancer.

As was the case with Wohrle, many doctors and patients are focused on treating the cancer and may not know of solutions that can help with the devastating side affects of the surgery.

It was a chance meeting that led Wohrle to the procedure that changed his life, the InVance Male Sling, developed by American Medical Systems.

In an outpatient surgical procedure done under spinal or general anesthesia, the sling is anchored to the pubic bone and provides support to the urethra and surrounding tissues, restoring the patient's bladder control. It is most appropriate for those with mild to moderate urinary stress incontinence.

"The psychological part of it, of not having to worry about whether or not I'm going to start leaking at an inopportune time is fantastic," says Wohrle, who had the procedure done less than two months ago.

At the seminar, board-certified urologists Dr. Gregory Bales and Dr. Bruce Yalowitz summarized the following treatment options available for incontinence as well as erectile dysfunction.

Erectile Dysfunction

Yalowitz says one in four men older than 65 have some trouble with erections and the percentage goes higher with age. Affecting an estimated 20 to 30 million American men, the problem is commonly associated with smoking as well as diabetes, high blood pressure and cardiovascular disease. It's a common problem, Yalowitz says, regardless of whether men have had prostate surgery or not.

"Even in the best of hands," Yalowitz says, "Being able to preserve erections is maybe 70 percent."

Yalowitz says the preferred approach is to start with the least invasive measures first before exploring the more invasive options.  

Medication

Cialis, Viagra and Levitra are some of the brand names of oral medications to treat erectile dysfunction.

A good starting point and effective for some, Yalowitz says pills are not effective in about 30 percent of cases. The pills need to be taken a half hour to an hour before intercourse and remain effective for four to 36 hours. High fat foods can affect the absorption of the medications and they can't be taken along with medications that contain nitrates. The high cost of the pills is a drawback and he says they are not covered by Medicare.

Vacuum constriction devices

Yalowitz says another option is a vacuum pump to manually bring on an erection.

The device works by pumping the air out of a cylinder placed over the penis, stimulating blood flow. Yalowitz says compliance is generally poor with this option as it can be cumbersome, unnatural and can cause bruising and swelling.

"The number of people that you see come back two years later and are still using it are almost zero," Yalowitz says.

Injection therapy

Yalowitz says intracavernosal injection therapy can be a good option when oral medication has failed. It involves self-injecting an ultra-fine needle into the side of the penis, causing the blood vessels to relax and allow blood flow.

Giving oneself a shot sounds worse than it is, Yalowitz says, and is very effective once the person learns how to do it, coming with little pain and providing results in about 15 to 20 minutes and lasting for a half hour to an hour.

Urethra suppositories

In this option, a suppository is placed inside the urethra that contains the medication known as MUSE. It causes the blood vessels to relax and allow blood flow. In general, this option doesn't seem to work very well, Yalowitz says.

Penile implants

Finally, when less invasive options have failed, Yalowitz may suggest penile implants, a more invasive and expensive measure, but very effective.

On the market for about 30 years, Yalowitz says the satisfaction rate for those opting for the implants is about 93 percent versus only 51 percent satisfaction with oral medication and 40 percent satisfaction with injection therapy.

The most commonly used type of implant is a three-piece inflatable prostheses that is concealed inside the body and manually inflated before intercourse.

Yalowitz says it takes a motivated individual who's tried other options first but that once they learn how to use it, it definitely works.

"It's rare to have someone who's had penile implants that doesn't like them," Yalowitz says.

Incontinence

Dr. Bales said urinary incontinence is most often the result of surgery that damages the sphincter muscle, typically operations to treat prostate and colon cancer.

There are three types of incontinence. Stress incontinence happens when strain is put on the bladder, causing it to leak urine, such as a sneeze, cough, laugh or lifting something. Urge incontinence happens when there is an overwhelming need to urinate and a person can't make it to the restroom in time. Overflow incontinence as a result of weak bladder muscles or a blocked urethra when the bladder doesn't empty all the way causing it to leak later.

Underscoring the prevalence of incontinence, Bales mentioned anecdotally that the manufacturer of adult absorbancy products announced in recent years that it had sold more diapers for adults than for kids.

Non-surgical options to treat incontinence include internal and external collection devices, clamps, catheters and injections, none of which have very good results, Bales says, due to the risk of infection and discomfort.

Unfortunately, he says there are no FDA-approved medications for stress incontinence in men.

There are, however, two surgical options which he says have good results and satisfaction rates.

InVance Male Sling

As described above by Wohrle, this outpatient procedure for mild to moderate stress incontinence, comes with a rapid recovery, small incision and good results says Bales.

Those not a candidate for the male sling include those prone to urinary tract infections, or who have coagulation disorders or are immuno-compromised or have renal insufficiency or urinary tract obstruction.

Artificial urinary sphincter

The gold standard for more severe incontinence, this surgically implanted device mimics a natural sphincter. A cuff placed around the urethra is inflated at rest to contain urine. To release the urine, the individual can discreetly deflate the cuff via a pump in the scrotum. Bales says surveys show a 92 percent satisfaction rate with this option and good long-term results as it has been around for more than 30 years.

Though Bales cautions that 100 percent improvement cannot be guaranteed, he says, "Certainly everybody who has a working artificial sphincter will certainly have significant improvement."

The bottom line, Bales and Yalowitz say about the various treatment options, is that, "men who suffer in silence don't need to."