As men age, there are two common problems that can send them to a urologist: erectile dysfunction and benign prostate disease. Brian Christine, MD, with Urology Centers of Alabama says recent developments with both conditions make treatment easier and more effective. Erectile dysfunction "Erectile dysfunction is such a very common problem," says Christine. "Age 40 on, there's a significant percentage of the male population that suffers from at least some degree of erectile dysfunction." Oral medications such as Viagra, Levitra and Cialis are generally the treatment of first choice. "A man can take a pill and get a more rigid erection. It's easy," Christine says. "The kicker is that only about 70 percent of men will get a good response from the oral medication. And they are fairly expensive. That can be a problem for patients. "The good news," he continues, "is that in addition, there are several things that one can do to treat erectile dysfunction. There is penile injection therapy, where we teach the patient how to inject medications into the penis to produce an erection. It sounds like a horrible thing to do to one's own penis, but the needles we use are the same size needles a diabetic would use for insulin. The injection process is minimally uncomfortable, and that works out pretty well for a lot of patients." If neither of these options is viable, a third option that works "incredibly well" is an implantable penile prosthesis. "The surgery is fairly minor surgery, and the patient satisfaction rate is consistently over 90 percent. And the spouse satisfaction is consistently above 95 percent," he explains. Ten to 15 years ago the breakage rate of the prosthetics was relatively high, and infection could be a problem. "Those are problems that have largely been overcome," says Christine. "There are a lot of patients who have erectile dysfunction who aren't getting the response they want from more conservative measures and are going on to prosthetic surgery and doing very well." Christine reminds physicians in other specialties that erectile dysfunction can often be a red flag for other health problems. "We know that if a patient has poor blood flow to the penis resulting in erectile dysfunction, there's a very good chance that they've got poor blood flow to the heart, they've got poor blood flow to the lower extremities and the brain. The same pathologic process that gives us heart attacks and strokes is the same thing that can lead to erectile dysfunction. As an internist or general practitioner, you've got to ask 'are you having chest pain; are you having symptoms that might indicate slowing of blood flow to the brain?' It's really important to query the patient about erectile dysfunction." Benign prostatic enlargement (BPH) BPH is another common problem for men as they age. "The hallmark of treatment is medications that relax the muscle around the prostate and urethra and thereby allow the urine to flow more easily," explains Christine. "That class of medicines is called alpha blockers. Those medicines help the symptoms pretty significantly." Some patients don't respond to the medications, however, and others do respond for a time, but as the prostate continues to grow, the symptoms become overwhelming despite the medication. For these patients, surgical options must be considered. The standard operation for years, TURP, is known by many laypeople as the roto-rooter job. "It's like coring out an apple," Christine says. "You are enlarging the urine channel. It's very, very effective, but the prostate is a very vascular organ with a lot of blood supply, so it's a very bloody operation. Patients can have significant bleeding, are in the hospital for two or three days, and they have a catheter for two or three days." Christine and other urologists now do a similar surgery that uses a laser to vaporize the tissue. "It's a tremendously better way to do it," he says. "The bleeding is minimal and it opens up the channel very nicely. About 80 percent of the time, I'm able to send the patient home on the same day with no catheter. It's a significant improvement." In addition, patients on blood thinners can stay on their medications for this surgery. "That's a very exciting thing," says Christine.