The recent proliferation of accessible medical information has increased the general awareness that there are often many, and different, treatment alternatives. Patient preference is naturally directed towards those solutions that are non-invasive and that are the least aggressive. Although such approaches may superficially seem more desirable, and are usually not harmful, they are not always the most effective, or the most prudent, of choices. Often they only delay, or prevent, the use of the most appropriate therapies.

Unfortunately, especially in those areas related to self esteem, the information provided is usually primarily designed to encourage the continued use of some product. This typically occurs when the touted benefits are questionable and when the end results do not justify either the risks or the costs. Sometimes other more relevant treatment choices may even be actively discouraged. This planned disinformation only compounds the patient's original concerns.

This purposeful marketing has been particularly obvious in those personally vulnerable areas of impotence and male urinary incontinence.

• Impotence

  Adequate rigidity, and reliable performance, are absolutely crucial to a satisfactory male sexual response. Anything less decreases a man's self-image and eventually leads to intimacy avoidance. Partners, although they are probably well aware that that there could be a physical cause (common examples are cardiac disease, hypertension, diabetes, prostatic cancer etc), instead typically blame this apparently declining interest on what they perceive as their own decreasing desirability. Both parties, despite their conscious awareness of the other's concerns, are often unable to overcome their own self-esteem barriers.

  In order to be successful any treatment of male erectile dysfunction must address this pattern. Ideally this typical, almost instinctive, response would best be completely avoided. Even if established it can still be reversed by using the correct approach. However, continuing with , or selecting, inadequate choices will usually only aggravate the problem and decrease the possibility of success. The most appropriate solutions restore firm, reliable, erections and encourage the rapid re-establishment of the sexual relationship. Less invasive treatments often fail to achieve this goal and may not be the most desirable. By failing to resolve these issues they may only worsen the problem. In this particular situation most easy is not more better. Often the seemingly more conservative treatments only guarantee failure.

  Although there is no one treatment that is right for every patient there is a choice that is the most appropriate for you. This correct answer can only be determined after evaluation, and testing, have identified the underlying problem. If the disorder is found to be permanent then it may require the implantation of a penile prosthesis.

  This procedure represents the ultimate achievement of cosmetic surgery. Even though the implanted device is entirely internal and completely concealed, and even though the appearance of the genitalia remains totally unchanged, normal sexual function can also be restored. This is minimally invasive plastic surgery that is able to mimic natural behavior.

  Excellent results require experienced selection. Although good rigidity is mandatory it is equally important to have normal flaccidity. This can only be achieved by using the specific multi-component device that is best suited to your anatomy and requirements. At the present time only two prostheses satisfy these demands. One is the Mentor Alpha One and the other is the AMS 700 CX. Each has its own definite benefits and indications. Individual device selection is determined by which prosthesis will best serve your specific needs. Although other models are available they are usually not able to duplicate the desired cosmetic, and functional, results and preferably should be avoided.

  Even more experienced judgment is required when there is a device malfunction or a complication. Usually the problems can be corrected and almost always the function can be salvaged. Unfortunately these prostheses' related difficulties should be, but are not always, infrequent occurrences. Finding the most appropriate solutions to these problems is our area of particular interest and specialization.

• Male Urinary Incontinence

  Most commonly this represents an unfortunate side effect of prior prostatic surgery. Although conservative solutions should initially be tried these are not always successful especially if the sphincteric damage has been significant. The resultant defect can usually be corrected by simply duplicating the normal urinary control mechanism. This is done by implanting a small, fluid-filled, device that is designed to mimic the natural process of urination. The components of this artificial genito-urinary sphincter remain entirely internal and completely concealed. They will not be obvious to others. Your privacy will be preserved.

  Here again embarrassment, and decreased self-esteem, only add to the frustration of the continuing incontinence. These will only be resolved when the leakage has been adequately addressed. Any treatment which prevents finding a better result then becomes part of the problem. Often a minimally invasive, plastic, surgery is far more conservative than persisting with inadequate, non-invasive, non-solutions.

  The only proven, time-tested, device that is currently available is the AMS Sphincter 800. This is an ingenious, simplistic, prosthesis that meets the demands of adequate continence and reliability. Although usually used in men this can also be employed for similar problems in women.

  It is not necessary to continue making excuses. Both impotence and incontinence can be resolved. If you truly want to you can feel confident again.

© 1999, Patrick E. Wherry MD