Subspecialty Areas » Impotence

Overcoming Impotence

John is a successful businessman. He is happily married and has two children. He is 50 and in the prime of his life, but he has a problem. John has erectile dysfunction (impotence)—he can't maintain a rigid erection during sexual intercourse. John is frustrated, and worried that something is seriously wrong. He feels inadequate, embarrassed, and has lost confidence in his sexual capabilities. He doesn't know where to turn; his worries are starting to interfere with his business and family life.

John is not alone. Roughly 30 million American men are impotent. Many are too embarrassed to ask for help, and others have received advice or treatment that was unsatisfactory. Impotence can occur at any age, and at any time in a man’s life. The myth that impotence is “all in your head” has been shattered. Medical research has proven that impotence usually stems from a physical cause. The good news is that impotence can be reversed. Virtually all impotent men can be successfully treated.

Each year hundreds of men visit the Philadelphia Impotence Foundation to find a solution. Our confidential evaluation can determine the cause of their impotence. We explain the medical and surgical treatment options, and choose the best options available. And they return to their partners, ready and capable of enjoying a full and satisfying sexual relationship.

The important thing is to overcome your embarrassment, and get the help that you need. Imagine how much enjoyment you could experience, once your sexual capabilities have been restored. Our patients trust and depend on us because of our experience and reputation. Our medical director is an internationally-known, Board Certified Urologist who specializes in the treatment of impotence. Why wait any longer? The end to impotence and the beginning of a satisfying sex life is as near as your telephone. To schedule a confidential evaluation, or get a second opinion, call us today.

Bruce B. Garber, MD, FACS
The Philadelphia Impotence Foundation

What is impotence?

Impotence (erectile dysfunction or “ED”) is the inability to obtain or maintain a penile erection that is rigid enough for satisfactory sexual relations.

How do normal erections occur?

When an erection is desired, the brain sends a signal through the penile nerves. This signal tells the penile arteries to allow blood to flow into the penile erection chambers. The venous valve system then closes, trapping blood within the penis and allowing it to become rigid.

What are the causes of impotence?

Psychological impotence may be due to a man’s fear that he will not be able to perform sexually (“performance anxiety”). This can be triggered by one incidence of sexual failure caused by fatigue, guilt, or too much alcohol. Other problems such as depression or stress can also play a role.

Physical impotence is by far the most common finding. Abnormalities of the penile arteries, veins, and smooth muscle are the most common causes. Risk factors include advancing age, years of cigarette smoking, high cholesterol, high blood pressure, obesity, “poor circulation,” heart disease, and diabetes. Men with diabetes have a very high chance of becoming impotent, often at a surprisingly young age. Other physical causes include pelvic surgery, radiation therapy, prostate cancer, nervous system diseases, and hormonal imbalances. Many men with physical impotence develop performance anxiety, making a bad situation worse.

How are the causes determined?

To diagnose the causes of impotence, a detailed medical and sexual history and physical examination is required. Blood and urine tests are needed, to measure your hormone levels and to check for diabetes and prostate cancer. Completion of a simple, validated questionnaire such as the International Index of Erectile Function is helpful. Measurement of nighttime erections and/or penile blood flow is indicated in some patients.

How is impotence treated?

The Philadelphia Impotence Foundation offers successful treatment options for virtually all impotent men. We regularly review the medical literature and the Internet for the latest impotence treatments. Recognizing that many of our patients come from a distance, we try to condense the diagnostic procedures and simplify the treatment. Our goal is to restore your sexual capabilities as quickly as possible.

Impotence treatments that are currently available include the following:

1. PDE-5 inhibitors. Viagra®, Levitra®, Cialis®, and Staxyn® have revolutionized the treatment of erectile dysfunction. These FDA-approved medications improve penile rigidity in more than 50% of men. However, they are not an effective treatment for all men! Some men develop side effects; others do not get a good erection with these medications. Some men can’t take them because they use nitrates or alpha-blockers; others find these medications are too expensive or inconsistent.
2. Testosterone supplements. For men whose impotence is due to a low testosterone level, testosterone patches, gels, and pellets are available. This treatment will raise your male hormone level, and has replaced the testosterone shots used previously.
3. Penile injection therapy. Caverject® and Edex® (alprostadil) are FDA-approved medications which can produce an erection when injected into the penile erection chambers. Some men find this to be a satisfactory solution to their erection problems, but penile injection therapy is often somewhat painful. Many men discontinue penile injection therapy after a period of time. Penile Injection Therapy can be expensive, and may cause penile scarring and curvature.
4. Vacuum constriction devices (VCD’s). VCD’s consist of a plastic cylinder, a vacuum pump, and a constricting band. VCD’s have been improved over the years, and are a satisfactory solution for some men. However, many men find these devices cumbersome and messy. They require the use of a constricting ring at the base of the penis, which cuts off penile blood flow and blocks ejaculation.
5. Trans-urethral medications. MUSE® (a small alprostadil pellet) is inserted directly into the penile urethra to produce an erection. This method uses no needle, and is a successful treatment for some impotent men. However, this approach is less successful than injection therapy, and may cause urethral burning and bleeding.
6. The Erektor™. The Erektor is a new, external penile support device. Click here to see photos of the device and it’s application. Little published data is available concerning this treatment option.
7. Penile implants. Penile implants are often selected by men who do not respond to simpler treatments. Inflatable implants give the most natural-appearing erection, and have been available for more than 30 years. Implants are placed into the penile erection chambers and surrounding tissues, and are completely internal. After you have healed, the penis and scrotum look normal. These implants give a stiff, reliable erection when inflated, and a natural-appearing penis when deflated. With a penile implant, you can have sex as often as you like, and for as long as you wish. An implant not only restores erections, it can also restore a man’s sexual confidence, which is a tremendous benefit. Many insurance plans cover a penile implant procedure. Potential advantages of a penile implant include the following:
   • Implants have been available for >30 years
   • Are a permanent solution for erectile dysfunction
   • Are usually inserted through a small incision
   • Usually an outpatient procedure
   • Allow an erection at any time, in a few seconds
   • Erection lasts indefinitely
   • You control the erection hardness
   • You can have an erection as often as you want
   • Does not interfere with penile sensation, ejaculation, or orgasm
   • Erection does not go down after climax
   • Covered by many insurance plans
   • Avoids ongoing costs of pills & injections, which are frequently not covered by prescription plans
   • FDA-approved
   • Recently upgraded with infection-resistant coatings
   • Have high published satisfaction rates, and low complication rates (see Dr. Garber’s 2005 and 2008 review articles below, for a more complete discussion of these topics)
   • Are undetectable by most women. To read a woman’s perspective on having sex with a man who has a penile implant, click here.
   • Are easy to operate
   • With an implant, you know you will be able to obtain and maintain a hard erection indefinitely. When you are using pills, shots, or other treatments, you are never sure if you will get an erection, how hard the erection will be, or how long it will last. A tremendous advantage of an implant is that it can restore your sexual confidence!
   
   Photos and Videos
   
   (Click here to view photos of a penile implant surgical procedure, Figures 1-13)
   (Click here to view photos of men who have an inflatable penile implant, Examples 1-5)
   (Click here to view an implant animation video with the original Genesis pump)
   (Click here to view an implant animation video with the new One Touch Release pump)
   (Click here to to see Dr. Garber give a mini-seminar on erectile dysfunction)
   (Click here to see a surgical video of Dr. Garber inserting a Coloplast Titan inflatable penile implant with a One Touch Release pump)
   (Click here to see other types of penile implants.)
   (Click here to watch patient testimonials.)
   (Click here to watch Dr. Garber give a PowerPoint audiovisual presentation entitled "Erectile Dysfunction-Overview and Causes")
   (Click here to watch Dr. Garber give a PowerPoint audiovisual presentation entitled "Erectile Dysfunction-Diagnostic Strategy")
   (Click here to watch Dr. Garber give a PowerPoint audiovisual presentation entitled "Erectile Dysfunction-Medical Treatments")
   (Click here to watch Dr. Garber give a PowerPoint audiovisual presentation entitled "Erectile Dysfunction-Surgical Treatment, Penile Implants, and MPLG--Maximal Penile Length and Girth Technique")
   (Click here to visit Dr. Garber’s YouTube page.)

Internationally-known surgeon

Dr. Garber has developed special expertise in the medical and surgical treatment of male impotence. Dr. Garber’s professional and personal dedication to the treatment of impotence led him to start The Philadelphia Impotence Foundation. He is internationally recognized for his work with penile implants, and has over 25 years of experience. His reputation as an expert surgeon has brought Urologists from throughout the United States to Philadelphia for training in penile implant techniques, and prompted Mentor Corporation to film Dr. Garber’s techniques for worldwide distribution. Most recently, the distinguished journal Expert Review of Medical Devices asked Dr. Garber to write a review of inflatable penile implants, which was published in 2005, and updated in May of 2008. If you read these articles, you will become very knowledgable about penile implants.

(Click here to view the 2005 article as a PDF download)
(Click here to view the 2008 article as a PDF download)

In addition, after successfully completing more than 3000 inflatable penile implant procedures, Dr. Garber received an award from Coloplast Corporation. There are very few Urologists anywhere in the world that can offer this degree of experience to their patients. Dr. Garber is currently one of the top 5 penile implant surgeons in the United States.

Dr. Garber uses careful and meticulous surgical techniques, to obtain the best (and largest!) possible result for each of his patients. He analyzes each patient’s medical and surgical history, and tries to pick the optimal approach, technique, and implant. One size or technique does not fit all! He is familiar with all implantation techniques, including transverse or vertical infrapubic (above the penis) approaches, and the transverse or vertical scrotal approaches, with or without a counter-incision. He has all of the currently manufactured implants (including malleable rods, positionable rods, 2-and 3-component inflatable implants) available in all sizes, and will select the optimal implant for your particular situation after reviewing the various implants with you. He also uses a rigorous and extensive protocol to prevent infection. This protocol includes intravenous and oral antibiotics, extensive skin preparation, and antibiotic soaked or coated implants. Dr. Garber’s current rate of infection for first-time penile implant insertion is less than 1%. His goal is to customize each procedure for each patient, to achieve the optimal result. Correction of penile curvature can be carried out once the implant has been completely installed.

Dr. Garber is not a very fast surgeon; he is a careful, meticulous and safe surgeon, with an unparalleled safety record. In over 2000 implant procedures, none(0) of Dr. Garber's penile implant reservoir insertions have caused injury to the bowel, bladder, or major blood vessels. Few if any other penile implant surgeons can report this level of safety!

Dr. Garber also handles a large number of difficult cases referred to him by other Urologists, including patients with previous implant infection, malfunction, multiple prior implant surgeries, hernias, cylinder erosion, penile curvature or asymmetry, priapism, corporal fibrosis, unsatisfactory or difficult-to-operate implants, and morbid obesity. A large portion of his practice includes men who are diabetic, or have had a radical prostatectomy for prostate cancer. Dr. Garber’s youngest patient was 20 years old; he developed impotence due to a penile injury. His oldest implant patient was 93!

Dr. Garber has pioneered the use of the new Coloplast Titan implant with One Touch Release (OTR)Pump. He has presented his initial data at the American Urological Association Meeting in 2009, and has published a larger series in 2011.

Click here to see a PowerPoint presentation of Dr. Garber’s initial 50 patients, comparing the new OTR pump to the previous pump.

Click here to see Dr. Garber’s article, published in January 2011, reviewing the first 100 patients who received an OTR pump.

Dr. Garber was also one of the first to use the new Coloplast cylinders with soft silicon tips and zero-degree tubing.

Dr. Garber continually strives to learn the latest surgical techniques, and has travelled throughout the world teaching other physicians and learning their techniques. In June of 2015, Dr. Garber went to the Gangnam district of Seoul, Korea and visited with Dr. Sean Park. Dr. Park is a world-expert in penile length and girth enhancement (phalloplasty), and Dr. Garber received extensive training in this procedure from Dr. Park. Drs. Garber and Park also discussed and improved their penile implant surgical techniques. Dr. Garber was recently featured on Dr. Park’s website www.sewum.com Also, a documentary film of Dr. Garber’s visit is available: click here to see this film (it is mostly in Korean!)

In 2013, Dr. Park visited Dr. Garber in Philadelphia, PA, USA.

In 2015, Dr. Garber visited Dr. Park in Seoul, Korea!

A brief list of Dr. Garber’s impotence-related publications is as follows:

1. Garber, B.B. 1989. Mentor GFS penile prosthesis-initial experience. Abstracts, Mid-Atlantic section, AUA, p. 96.
2. Garber, B.B. 1993. Penoscrotal or infrapubic approach: which is better? Mentor Urology Issues and Answers, volume I, issue 1.
3. Garber, B.B. 1994. Mentor Alpha I inflatable penile prosthesis: patient satisfaction and device reliability. Urology 43: 214-217.
4. Garber, B.B. 1994. Mentor Alpha I inflatable penile prosthesis: patient satisfaction and device reliability. Journal of Urology 152: 1662.
5. Garber, B.B. 1995. Mentor Alpha I inflatable penile prosthesis cylinder aneurysm: an unusual complication. International Journal of Impotence Research 7: 13-16.
6. Garber, B.B. 1995. Retraction method for implantation of penile prosthesis. British Journal of Urology 76: 411.
7. Garber, B.B. 1996. Inflatable penile prosthesis: results of 150 cases. British Journal of Urology 78: 933-935.
8. Garber, B.B. 1996. Intracorporal lengths of organically impotent men. International Journal of Impotence Research 8: 259-260.
9. Garber, B.B. 1996. Guide to outpatient penile implant surgery: a review of evolving trends. American Medical Systems publication #23600018.
10. Garber, B.B. 1997. Outpatient penile prosthesis insertion. Urology 49: 600-603.
11. Garber, B.B. and Marcus, S.M. 1998. Does surgical approach affect the incidence of inflatable penile prosthesis infection? Urology 52: 291-293.
12. Garber, B.B. and Marcus, S.M. 1999. Does surgical approach affect the incidence of inflatable penile prosthesis infection? Journal of Urology 161: 1727.
13. Garber, B.B. 2003. Inflatable penile prosthesis: site-specific malfunction analysis. International Journal of Impotence Research 15: 22-25.
14. Garber, B.B. 2003. Inflatable penile prosthesis: site-specific malfunction analysis. Journal of Urology 170: 680-681. (Click here to view the article)
15. Garber, B.B. 2005. Inflatable penile prostheses for the treatment of erectile dysfunction. Expert Review of Medical Devices 2(3): 341-350.
16. Garber, B.B. 2008. Inflatable penile prostheses for the treatment of erectile dysfunction: an update. Expert Review of Medical Devices 5(2): 133-144.
17. Garber, B.B. 2011. Coloplast Titan inflatable penile prosthesis with one-touch release pump: review of 100 cases and comparison with Genesis pump. Journal of Sexual medicine 8: 310-314.
18. Garber, B.B., and Tapscott, A.H. 2012. Prostate cryoablation in patients with multiple-component inflatable penile prostheses. Urology 79: 722-724. (Click here to view the article)
19. Garber, B.B., and Morris, A. 2012. Intravesical penile implant reservoir: case report, literature review, and strategies for prevention. International Journal of Impotence Research 25:41-44. (Click here to view the article)
20. Stember DS, Garber BB, and Perito PE. 2014. Outcomes of abdominal wall reservoir placement in inflatable penile prosthesis implantation: a safe and efficacious alternative to the space of Retzius. Journal of Sexual Medicine 11: 605-612. (Click here to view the article)
21. Garber BB, and Khurgin J. 2014. Use of BioPatch® (Protective Disk with Chlorhexidine Gluconate) in closed-suction drainage for penile implant surgery. Current Urology 7: 191-194. (Click here to view the article)
22. Garber BB, Khurgin JL, Stember DS, and Perito PE. 2014. Pseudo-malfunction of the Coloplast Titan inflatable penile prosthesis One-Touch Release pump. Urology 84: 857-859. (Click here to view the article)
23. Garber BB, and Bickell M. 2015. Delayed postoperative hematoma formation after inflatable penile prosthesis implantation. Journal of Sexual Medicine 12: 265-269. (Click here to view the article)
24. Garber BB, and Bickell M. 2016. Subcutaneous placement of inflatable penile prosthesis reservoirs. Urology 88: 93-96. (Click here to view the article)
25. Gross MS, Phillips EA, …Garber BB, et al. 2017. Multicenter investigation of the microorganisms involved in penile prosthesis infection: an analysis of the efficacy of the AUA and EUA guidelines for penile prosthesis prophylaxis. Journal of Sexual Medicine 14: 455-463. (Click here to view the article)
26. Garber BB, and Lim C. 2017. Inflatable penile prosthesis insertion in men with severe intracorporal fibrosis. Current Urology 10: 92-96. (Click here to view the article)
27. Gross MS, Stember DS, Garber BB, and Perito PE. 2017. A retrospective analysis of risk factors for IPP reservoir entry into the peritoneum after abdominal wall placement. International Journal of Impotence Research 29: 215-218. (Click here to view the article)
28. Chou HL, Mohsen NA, Garber BB, and Feldstein DC. 2018. CT imaging of inflatable penile prosthesis complications: a pictorial essay. Abdominal Radiology, September 01, 2018. (Click here to view the article)
29. Garber BB, Gross MS, and Stember D. 2019. Sub-external oblique placement of inflatable penile prosthesis reservoirs—initial experience. International Journal of Impotence Research, published online 1-3-19. (Click here to view the article)

MPLG ® TECHNIQUE

Dr. Garber has recently developed a revolutionary new surgical technique:

MPLG ® (Maximum Penile Length & Girth) Technique for inflatable penile implant insertion.

Click here for more information.

TEACHING VIDEOS:

• Mentor Alpha I inflatable penile implant: infrapubic technique, by Bruce B. Garber, MD. Distributed by Mentor Urology, Santa Barbara, California, 1998.
• Coloplast Titan inflatable penile implant with One Touch Release pump: surgical techniques, by Bruce B. Garber, MD. Distributed by Coloplast Corporation, Minneapolis, Minnesota, 2010. Click here to watch this video.

It is estimated that less than 5% of impotent men get help for their problem. Isn’t it time to let impotence end, and a full life begin? Don’t wait any longer—help is only a phone call away.

LINKS

To read the experiences of other patients who have a penile implant, or to share your experiences, visit this website:
www.patient-advisors.com

Box 686
Bryn Mawr, PA 19010
Phone: 610-613-9251