• Treatment of impotence
• No-scalpel vasectomy
• Male urinary incontinence
• Peyronie's disease
• Urological prostheses

Never, before the advent of Viagra, has the problem of erectile dysfunction been so openly addressed. Now even TV advertising explains that there can be many different physical causes and multiple possible solutions.

Although all causes of impotence can be treated successfully, there is no one answer that is right for every patient. The most satisfactory solution requires individualized attention. Our role is to serve as your advocate to ensure that your most appropriate choice is selected.

We appreciate that erectile dysfunction inevitably leads to isolation. Men almost never discuss this with other men. Women are seldom aware of the severe impact that this condition has on their partner's self-esteem. Personalized, private care is absolutely essential in order to resolve your condition and restore your sexuality.

Our approach has been specifically designed to minimize the time and extent of the assessment required. Our experience allows us to find a solution to your problem in a convenient, confidential and professional manner.

© 1999, Patrick E Wherry M.D. Inc

To read more about impotence, here is a link to detailed information - Impotence/erectile dysfunction (Healthcommunities).

No-Scalpel Vasectomy

Vasectomy is considered to be the safest and most reliable method of permanent male sterilization. Indeed, it is thought to be free of known long-term side effects. It is also the most common method of male contraception in the USA, where about 500,000 vasectomies are performed each year.

No-scalpel vasectomy is an improved technique which results in decreased procedure time, less discomfort, more rapid recovery and lower complication rates. In a conventional vasectomy, small incisions are made in the skin with a knife. These are usually large enough that sutures, or stitches, are required to close the cuts. In the no-scalpel vasectomy, a microsurgical approach is used to make a tiny puncture into the skin with a special instrument. This opening is so small that no stitches are needed for closure. Instead, it will automatically contract and heal with little, or no, scarring.

No-scalpel vasectomy was developed in China in 1974 and introduced into the USA in 1988. It is now used, in this country, by doctors who have mastered the technique. Not all urologists are using this newer method.

Our focus has been, and continues to be, on continuously improving this minimally invasive approach. No shaving is required. Only small amounts of local anesthetic are needed, and sedation is not necessary. Patients are able to drive themselves home and to return to full activity within several days time.

No-scalpel vasectomy is the ideal approach if permanent male sterilization is desired.

© 1999, Patrick E Wherry M.D. Inc

To read more about vasectomy, here is a link to detailed information - Vasectomy (Healthcommunities).

Male Urinary Incontinence

Incontinence is the involuntary loss of urine that causes a social, or hygienic, problem. Although this is fairly common it is not usually discussed but is more often only silently accepted. Indeed, about one in five older men experience this during their lifetimes.

Normally there is a satisfactory balance between the musculature of the bladder wall and the sphincter control mechanism that encircles the outflow portion of the urinary passageway. Despite the fact that this is an extremely complex arrangement it usually functions so well that it can be taken for granted. However, abnormalities in either, or both, of these areas can disrupt the equilibrium and result in the inability to properly control urinary flow. The variable patterns of incontinence that can result are due to the fact that there are multiple, potential, causes that can interfere in many, interacting, ways.

Neurological problems such as multiple sclerosis, strokes, and spinal cord injuries can disrupt the nervous messages to these structures. Sometimes an overly sensitive, or even a small bladder, may exert excessive pressure on a normal sphincter mechanism. Often the sphincter muscle itself may have been damaged by a surgical procedure. Although this can occur after operations for benign prostatic disease this most commonly occurs after surgery for prostatic cancer. Unfortunately some patients, after enduring the difficult challenge of major surgery, never regain normal bladder control. Indeed, if this has not occurred by six months after a procedure it is usually very unlikely to return naturally.

As the sphincter muscles surround both the entrance to, and the exit from, the prostate they are extremely vulnerable to being damaged, or removed, especially when operating on a cancerous growth within the gland. This can result in an incompetent, or absent, sphincter mechanism and subsequent severe and debilitating incontinence. Although the risk of this initially seemed unimportant, in comparison to the threat of the cancer, the emotions accompanying the continuing incontinence often seem magnified now that the original problem is only a memory. The anxiety about the leakage often does not allow the full experience of emotional relief that should accompany the satisfactory removal of the malignancy. This usually only occurs when the incontinence has been resolved and no longer serves as a constant reminder about the possibility of an unsuccessful result.

This sphincteric incontinence is often best addressed by implantation of an artificial genitourinary sphincter. This is a small, fluid-filled, device that is designed to mimic the natural process of urination. By delivering physiologic tissue compression this prosthesis duplicates the normal function of the sphincter mechanism and allows you to regain voluntary urinary control. As all the components are internal, and placed entirely within the body, this will not be apparent to others and will let you retain both your privacy and your self esteem.

Although some manual dexterity is required this is seldom a limiting consideration. Most of the device function is automatic and control is very simple to learn.

If you believe that you are suffering from urinary sphincteric incontinence do not let the embarrassment prevent you from once again feeling confident. There always is a solution. Often it is simpler than anticipated.

© 1999, Patrick E Wherry MD Inc

Peyronie's Disease

This condition is not uncommon and occurs in about 1% of men. Typically it presents in middle age. There is a definite racial difference with this being most prevalent in Caucasians. It is less frequent in Blacks and is probably even more infrequent in Orientals.

Expansion of all of the tissues of the penis is required for a normal erection. When this stretching has reached it's limit, and when it can no longer occur, then slight further filling converts the engorgement of partial erection to the firmness of full rigidity. If this normal elasticity were decreased then penile expansion, engorgement and rigidity could all be reduced. If the changes were not evenly distributed then curvature, in addition, could occur.

In Peyronie's disease scarring occurs in the firm, outer, covering of the bodies most responsible for the rigidity of erection. As the process is usually asymmetric some bending will almost always result. If the changes are severe enough some pain could also be present. If both sides are involved some penile shortening could even occur.

Although the underlying cause has not been clearly defined penile trauma has become increasingly more suspect. This may be most likely to occur when the age related change of slightly decreased rigidity allows buckling of, and subsequent microscopic fatigue injuries to, the erectile bodies. The subsequent healing may result in exuberant, internal, scar formation and the changes noted in Peyronie's disease. As the causative reason remains ongoing, and as healing tries to remodel the continuing scarring, a dynamic process then develops. Usually several years are required for the process to slowly evolve and eventually stabilize. Often the original abnormalities will improve and sometimes they will even resolve. More usually they result in a stable, but persistent, penile curvature accompanied by a gradual deterioration of erectile firmness.

Usually a period of observation is required in order to determine if the disease process is still active or has become quiescent. During this time medication can be tried and, occasionally, this appears to be effective. Those in commonest use at this time are vitamin E (scavenger of free radicals), para-aminobenzoic acid ( Potaba, supposedly decreases scar formation) and colchicine (usually used for gout, also may interfere with scar production in addition to decreasing inflammation). Tamoxifen (decreases the inflammatory response) has been utilized in Europe. If painful erections are present then Seldane or Allegra (both interfere with histamine release) could be considered. However, all of these drugs are recommended only on anecdotal evidence and some are even off-label applications. There have been no conclusive pharmacologic studies validating their effectiveness.

Even less compelling data exists for the injection of pharmacologic agents, radiation therapy (occasionally used for particularly painful early disease), ultrasound treatment and iontophoresis.

When the disease has reached a stable, mature, phase then surgical correction can be considered. If erectile function is still adequate then a procedure designed to correct the deformity could be used. Many techniques have been devised but only a few are still employed. Unfortunately these approaches can only straighten the penis. Although the erectile rigidity should be preserved this goal is often not obtainable. If further loss of rigidity is a significant possibility, or if the erectile firmness is definitely inadequate, then the erectile dysfunction should be treated with the implantation of a multi-component penile prosthesis and an associated procedure to straighten the penile curvature. This combination is often the more simplistic, and reliable, solution. Usually this approach is the only way to restore adequate performance.

© 1999, Patrick E Wherry MD Inc