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admin | Category: Improving Erections | 17.09.2014
Muse or Medicated Urethral Suppository for Erection by Vivus is also known as Prostaglandin E1 and is used to manage erectile dysfunction through its vasodilatory features.
This medication is recommended for men with erectile dysfunction problems but can also be used to preserve a patent ductus arteriosus in the newborn. As for your female partner, she may sometimes experience vaginal burning or itching after sex. Before taking this medication, inform your doctor of all prescription and nonprescription medications you are taking, especially medicines that can sometimes cause erection problems like MAO inhibitors (furazolidone, selegiline, phenelzine), blood thinners (aspirin, warfarin, NSAIDs), phenothiazines (chlorpromazine), anti-anxiety medications, calcium channel blockers or other high blood pressure medications, hydralazine, terazosin, prazosin, propranolol (beta-blockers), guanfacine, guanabenz, disopyramide, clonidine, thiazide water pills, methyldopa, spironolactone, and tricyclic antidepressants. Talk with your doctor about your medical history before taking this medication, especially if you have any history of allergies, prolonged erections from other medications, cancer, physical penis abnormalities, blood or bleeding disorders, low blood pressure, or heart disease. Our doctors will prescribe a maximum of 12 of this product or any equivalent product at a time. This product was added to our catalog on Thursday 02 October, 2008.Caverject is used to treat erectile dysfunction and impotence.
Before we begin the discussion of how to treat ED, let’s quickly discuss how erectile dysfunction is evaluated. We also used to commonly do tests to measure the presence and strength of night time erections to decide if the cause was physical or psychological. Of course the first thing you should do is have a thorough review of your health history and a physical exam by your primary doctor or urologist. Up until 1983 there were only two treatments for ED: behavioral therapy that was popularized by Masters and Johnson, and surgical implantation of a penile prosthesis. Then in 1983 Herbert Brendler amazed a group of urologists gathered for a formal dinner with his personal demonstration of an erection from an injection of the drug Papaverine into his penis. There are 3 drugs which are very good at treating erectile dysfunction: Viagra (sildenifil), Levitra (vardenifil) and Cialis (tadalafil).
These medications don’t automatically give you an erection—they help you get a better erection with stimulation, just like normal sex.
Viagra takes about thirty minutes to get absorbed so you have to give it that long to start to work. Levitra also takes about 30 minutes to get absorbed and will stay in your system for about 4 hours, but it is still absorbed well after a big meal. There is a lot of debate as to how appropriate it is for pharmaceutical companies to supply doctors’ offices with free drug samples.
For the PDE-5 drugs like Viagra, Cialis and Levitra however, samples are an excellent way to start.
After you have tried the samples and know what you want, you can call your doctor and let him know which medicine and which dose you want. For men who do not respond to oral medications like Viagra, or who have prohibitive side effects from the pills, penile injection therapy (PIT) will usually be successful. Sometimes injections may be painful … this is common with Alprostadil, but uncommon with the Tri-mix.
A vacuum erection device, or VED for short, consists of a plastic cylinder that goes over the penis. If you are interested in a vacuum device, a representative from one of the companies will meet with you in our office to show you the device and instruct you in how to use it before you decide whether to purchase one. MUSE is a pellet of alprostadil, which is the same medicine as Caverject used in penile injections, and is inserted into the tip of the penis to create an erection.
It should not be used at home until you have tried it in the doctor’s office under his supervision and instruction. Penile prostheses were developed in the 1970’s and were the first successful treatment for ED. The multi-component inflatable prosthesis consists of two soft, hollow cylinders connected by tubing to a pump and reservoir filled with 2-3onces of fluid. Most men choose the inflatable type because of its superior cosmetic result, but both types work well.
Although nerve sparing during radical prostatectomy improves the chances for potency postoperatively, it is uncommon for erections to return to normal right after surgery. Starting several weeks after surgery, we begin with prescribing a PDE-5 drug 3 nights a week. Any treatment for ED is aimed at getting the patient off treatment.16The longer a man goes without erections after prostate surgery, the more likely he is to suffer permanent erectile tissue damage.
Evidence suggests that the incidence of erectile tissue damage, as measured by the presence of a venous leak, is very uncommon before the fourth month after surgery. Erectile dysfunction is one of the most important quality of life issues following radical prostatectomy. The literature evidence suggests that lack of natural erections during this period of time increases the incidence of venous leak. Recently, there is a growing interest among physicians to interrupt these events by preventing cavernosal hypoxia (lack of oxygenated blood flow to the penile tissue) during the period of neuropraxia (trauma invoked to the nerves during surgical dissection of the neurovascular bundles).
To date, penile rehabilitation has shown promise in helping men who undergo radical prostatectomy (RP) to retain erectile function after surgery.
After a prostate cancer diagnosis, most patients are not thinking so much about the after-effects of prostate cancer treatments. Recovery of erectile function after prostatectomy normally occurs approximately 18 to 24 months after surgery. Phosphodiesterase type 5 inhibitors are medications that increase blood flow to the penis under certain conditions. Muse is an intraurethral suppository of alprostadil (a prostaglandin) used for the treatment of erectile dysfunction.
Raina et al investigated intraurethral alprostadil in 91 healthy, sexually active men, of whom 56 were treated with intraurethral alprostadil and the remaining 35 had erectogenic aids only when needed for sexual intercourse. Patients seeking a treatment option with proven efficacy that provides a fairly natural-feeling erection without a constriction ring may be interested in penile injections.
Penile injections are one of the most effective treatment options for men after prostatectomy, with success rates reported as high as 85% to 95%. Montorsi et al first demonstrated that men should be given early injections of intracavernosal alprostadil as soon as the catheter is removed, usually before the end of the first post-operative month. Postoperative nerve-sparing RP patients who were not enrolled in a pharmacological vasoactive recovery program instituted in the initial year after surgery revealed a progressive increase in venous leakage, varying from 14% at 4 months to 50% at 12 months or longer.
The Cleveland Clinic study concluded that high compliance can be achieved if good counseling education is performed at the time of the initial dose, and proper dose modifications are made according to the efficacy and side effects profile. Vacuum erection devices, also known as vacuum constriction devices, have been used for improving erectile function for more than a century.


FDA-approved devices have pressure pop-off valves to reduce the likelihood of pressure induced penile injury. Probably the most significant disadvantage of the device is that it generates a non-cosmetic erection.
Penile implants, or prostheses, are available in several varieties; the older versions are simpler and bendable, and the newer more complicated ones are inflatable or mechanical. SUNA 2010 Clinical Practice Guideline Prevention and Control of Catheter Associated urinary Tract Infection.
Radiation Oncology, Division of Nursing, James Cancer Hospital and Solove Research Institute, Patient Education Handout, The Ohio State University Medical Center.
Seek Wellness is a leader in the development of targeted health care information on the Internet. This is mostly effective when there is a danger of premature ductus arteriosus closure in a baby with ductal-dependent congenital heart disease including acyanotic lesions (that is, interrupted aortic arch, critical aortic stenosis, hypoplastic left heart syndrome, and coarctation of the aorta). The effect starts about five to ten minutes after administration and can last from about thirty minutes to a whole hour.
You should also be aware that this medication offers zero protection against sexually transmitted infections such as Hepatitis B or HIV (AIDS). If left untreated, this side effect can cause you to have a permanent inability to have an erection. Thirty to forty years ago, ninety percent of ED, known then as only impotence was thought to be a psychological problem and men often underwent extensive psychological and personality testing.
If they have not been done recently, you should have lab tests performed to check your blood sugar, cholesterol and other lipids. The first option didn’t work very well since contrary to the prevailing wisdom of the time, most ED is due to physical not psychological reasons. This was the beginning of the modern era of research into the physiology of erection and the development of treatment for ED, eventually leading to the development of effective oral medications. Some men find this a plus—they can take it one day and if things don’t work out that night, there is always tomorrow to look forward to. Although at least a third of men have some side effects, only 2% have side effects that are bad enough that they decide not to take the medication.
For the men who take Cialis once a day, the side effects usually go away after a few days, a process pharmacologists call tachyphylaxis. Samples may unjustifiably persuade some doctors and their patients to choose a more expensive medication than they really need. A man with ED was not responding to Viagra came to us and told us that, although he was very afraid of needles, his wife was not happy with his ED and he wanted to learn how to do penile injection therapy. Alprostadil, sold under the brand names Caverject, Edex and Prostin, can be used alone but its cost approaches $30 a dose and about a third of men will have painful erections when it is used by itself. If you have an erection last over 6 hours you should call immediately so we can inject you with a different medication to make the erection go down.
This may be due to bleeding at the injection site and irritation from the medications themselves. The devices come with video instructions, but they can be tricky to use and we find more men succeed with personal instruction. Although it is relatively easy to use, there are a few nuances to the insertion necessary to get a good response. The modern prostheses are much better than the first ones, but now they are usually only used if other treatments have failed.
The penis consists of three cylinders: the urethra which carries urine and two corpora cavernosa which engorge with blood and become rigid during erection. When you want to have sex you push on the pump several times, transferring fluid from the reservoir into the cylinders and thereby creating a firm erection. The medication may not produce an erection this soon after surgery but will increase blood flow to the penis at night during REM sleep. However, at eight months after surgery, it occurs in approximately 30% of men, and, at one year, 50% of men have permanent erectile tissue damage.
Owing to favorable safety profiles and ease of use, pharmacological therapy is currently the most attractive treatment option for these patients. The post-treatment phase is an important time for clinicians to provide this education and support. There are men who have fully functional erections at six months, but if you look at the general prostatectomy population, the vast majority of men experience erectile function recovery in the second year and many between 18 and 24 months postoperatively. There is excellent evidence that a man who has good function before surgery, who has nerve-sparing surgery, and who protects his erectile tissue through penile rehabilitation, has an excellent chance of being a PDE5i responder in the second half of the second year after surgery (18 to 24 months). Penile injections use vasoactive medications injected into the side of the base of the penis to dilate the blood vessels causing penile engorgement. Jeffrey Albaugh's study revealed that among post-prostatectomy men at one month after treatment with penile injections, 80% of study participants reported mild or no erectile dysfunction and 25% reported normal erectile function. When a vasoactive recovery program was promptly instituted, Montorsi et al reported a decrease in venous leakage at 4 months postoperatively. The principle involves the use of negative pressure applied to the penis, specifically the erectile bodies (corpora cavernosa), to restore inflow of blood into the erection chambers and erection ensues. Some of the more complicated devices involve a pump and a reservoir for fluid housed in the abdomen or scrotum and inflatable chambers, which are placed in the corpora cavernosa.
Now, with other good treatments available, many urologists have come to regard penile prostheses as a last resort because they involve surgery and carry the risk of complications. Managing and Treating Urinary Incontinence, Second Edition, Health Professionals Press-Baltimore, MD. Specializing in pelvic health and wellness information and backed by leading healthcare professionals, Seek Wellness develops and implements consumer-oriented programs and services. Muse transports the medicine as a penile drug delivery system placed in the urethra for at least ten minutes before you need an erection. Dosage should be determined by your doctor and you will be examined for any unfavorable side effects afterwards.
You should also report the very rare but grave side effects of severe unsteadiness or fainting due to possible blood pressure decrease. If you notice any other side effects not listed in this article, immediately contact your doctor to discuss them. Seek emergency medical attention if you experience a prolonged and agonizing erection after using this medication. The second choice, a penile prosthesis, was more treatment than most men wanted or would accept.


A few people get a blue tint to their vision, which is harmless unless you are an airplane pilot. Try them all and see which drug works best for your circumstances and see which drug has the least side effects.
But after trying it the first time, we have never had a man quit the injections because of pain or fear of the needle again.
He became so anxious with the needle approaching his penis that he pushed me across the room. Mixing the 3 drugs together results in a more potent formula and this allows for smaller doses of each individual drug.
The risk of scarring can be decreased by applying pressure to the injection site for several minutes and by limiting the frequency of injections to not more than 6 times a month. Then you put a large rubber ring around the base of the penis, release the vacuum pump and take the cylinder off. The advantage of MUSE over penile injection therapy is that it is easier to learn how to use and does not involve needles.
It is less likely to work than an injection and only about 30-40% of men get a good erection with it.
Also about 2% of men will become very lightheaded due to the drop in blood pressure within a few minutes. Tubing connects the cylinders to the pump which we place beside the right testicle and the reservoir which we place in the pelvis front of the bladder. After sex you push a release valve on the pump and the fluid goes out of the cylinders and back into the reservoir, making the penis soft once again. Improving blood flow to the penis may help to improve the reliability and rapidity of the return to normal erections. If the erectile tissue becomes scarred, the patient will never get his erection back without medication and will always struggle to respond even with medication. It is believed that this damage results from two main factors: erection nerve injury and the absence of blood (and therefore oxygen) getting into the penis.
Many couples receive no help coping with the sexual changes that occur as a result of prostatectomy (or other prostate cancer treatments), in spite of considerable research supporting ED treatments. The overwhelming majority of men (85%) do not respond to PDE5 inhibitors in the first six months after surgery irrespective of their nerve sparing status. After urination (so the urethra is wet), the Muse applicator is gently slipped into the tip of the penis and goes slightly over an inch down into the urethra.
At three months, 75% reported mild or no erectile dysfunction, and 35% reported completely normal erectile function. Similarly, Brock et al demonstrated that long-term, continuous use of intracavernous alprostadil therapy improved penile hemodynamics and restored spontaneous erections after nerve-sparing RP. Using intracavernosal alprostadil injections, only 2 of 12 patients developed a venous leak compared with 8 of 15 patients who did not receive intracavernosal injections.
The constriction band is applied to the base of the penile shaft to reduce blood flow draining out of the penis and promote maintenance of erection. It takes anywhere from two to 10 minutes to obtain a functional erection, and it takes approximately four attempts at using the vacuum device before patients become proficient with the technique. Complications can include infection, scarring, damage within the corpora cavernosa, or a problem with any part of the prosthesis such as leakage of the reservoir. In contrast, the likewise fast-acting Caverject and Edex are injected directly into the penis's corpus cavernosum. Because of its long half-life, Cilais can either be taken on an as needed basis, just like Viagra and Levitra, or once a day. They may well quit because they or their wife lose interest in sex, but not because of the needle. The risk of priapism is dose related, so we usually start with a small dose and if it isn’t effective, gradually work up to a dose that does work.
Two companies’ devices require a prescription and so are considered “durable medical equipment” and may be covered by insurance. With this type of prosthesis, the penis is always rigid but can be bent downward and out of the way. This operation is also done through a small incision, usually with an overnight hospital stay. As with the medications, the idea isn’t necessarily to have sex, but to improve blood flow to the penis.
Kendirci and colleagues (2006) write that in a study of 1,977 men, about 50% reported receiving ED treatment after undergoing a prostatectomy. The patient depresses the button on top of the applicator to release the Muse into the urethra for absorption. Although the authors concluded that intraurethral alprostadil seems to shorten the time to recovery of erectile function after RP and is safe and tolerable, one has to be critical in evaluating these results as the drop-out rate in the treatment group was 32%.
It is important to place the constriction band as close to the base of the penis as possible. They are more reliable, easier for surgeons to implant, and designed to look more natural in the nonerect phase—even the bendable prostheses, which are more malleable than before. You should be instructed in detail on usage by your doctor before trying to administer the medication by yourself.
Another advantage of a smaller dose is that when you do end up purchasing the pills, you can buy a bigger dose and save money by cutting it in half. He then came back 6-months later, his marriage now in trouble and he had a renewed motivation. With the inflatable type, there is a risk of mechanical failure, which is very uncommon in the first 10 years, but if it occurs a second operation would be perfumed to replace the device.
Some men go with the whole program, some with part of it and some aren’t interested in any treatment. The third step is to begin with penile injections, again to improve blood flow to the penis and, if desired, to have sex. The aim of penile rehabilitation is to keep the erectile tissue healthy while waiting for the nerves to recover from the trauma of surgery. Behind the constriction band, the penis is soft and somewhat unstable, and therefore, if the constriction band is placed on the shaft of the penis, this will result in a hinge effect and the penis will buckle during attempts at penetration.



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