Andrology & Urology Centre in Bangalore | Dr. Praveen Joshi

Contact us for Best Andrologist (Male Sexual Health), Urologist Services in Bengaluru.

Tel: 080 - 42070577, +918197371247

Male Sexual Health

Male infertility means a male's inability to cause pregnancy in a fertile female. Approximately 15% of couples are unable to conceive after one year of unprotected intercourse. A male factor is solely responsible in about 20% of infertile couples and contributory in another 30-40%.

Male factors contributing to infertility

  • Oligo, Astheno, Teratozoospermia
  • High DNA Fragmentation Index
  • Poor acrosomal capacitation
  • Unexplained
  • Azoospermia
  • Erectile dysfunction
  • Anejaculation and Retrograde ejaculation

Correction of the problems

  • Hormonal balancing
  • Varicocele ligation
  • Antioxidants
  • Surgical sperm retrieval
  • Correction of erectile and ejaculatory disturbances

It is important that the problem is diagnosed early-on to ensure appropriate intervention, and treatment mechanisms.

A normal erection relies on a combination of psychogenic, hormonal, neurological, and vascular factors.

Erectile dysfunction = Endothelial dysfunction.

Penile Erection requires:

  • Neural transmission of pro-erectile impulses
  • Intact arterial blood flow supply
  • Functional erectile tissue in the corpus cavernosum

Erectile Dysfunction is Multi factorial

Erectile Dysfunction is Multi factorial

To address all issues and concerns related to Erectile Dysfunction, book an appointment with Dr. Joshi’s at the earliest.

Erectile dysfunction is defined as ‘the inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual activity.

Erectile dysfunction = Endothelial dysfunction.

Global Prevalence

The reluctance of many men to admit to suffering from erection problems causes difficulties in determining its prevalence. However, stats indicate:

  • Worldwide prevalence of ED is between 10% and 20%, and it is strongly correlated with aging
  • Among younger men, 8% of 20- to 29-year-olds and 11% of men ages 30-39 experience ED
  • Approximately 52% of men ages 40-70 experience ED
  • 71% of men over 70 experience ED
  • Estimated prevalence for 2025 = 300M men worldwide

Erectile Dysfunction is Multi factorial

Erectile Dysfunction is Multi factorial

The ‘common’ Erectile Dysfunction is ‘not common’

A commonly prevalent condition Erectile Dysfunction, described as the inability to have and maintain an erection firm enough for sexual intercourse at least 80 percent of the time.

For men especially in the age group of 30s – 50s, the Erectile Dysfunction can be a symptom of a cardio-vascular disease. A new diagnosis of Erectile Dysfunction indicates that the risk of a stroke, heart attack, or any other kind of cardiac event may be high.

The diagnosis, identification, timely treatment and rectification is critical for normal sexual intercourse, procreation as well as general health, as the case may be. The line of treatment ranges from pills, hormonal medication, injections to surgery and implants.

To know more and address on priority,

Call 080 - 42070577, +918197371247 to book an appointment now.

You can also visit:

https://bit.ly/3vh9L1N

Do NOT ignore or shy away from the ‘common’ Erectile Dysfunction. It may be an indicator of a deeper problem.

A commonly prevalent condition Erectile Dysfunction, described as the inability to have and maintain an erection firm enough for sexual intercourse at least 80 percent of the time.

For men especially in the age group of 30s – 50s, the Erectile Dysfunction can be a symptom of a cardio-vascular disease. A new diagnosis of Erectile Dysfunction indicates that the risk of a stroke, heart attack, or any other kind of cardiac event may be high.

The diagnosis, identification, timely treatment and rectification is critical for normal sexual intercourse, procreation as well as general health, as the case may be. The line of treatment ranges from pills, hormonal medication, injections to surgery and implants.

To know more and address on priority,

Call 080 - 42070577, +918197371247 to book an appointment now.

You can also visit:

https://bit.ly/3vh9L1N

GUIDE to good male sexual health

Do you experience voluntary erections more than 80% of the time?

Optimal male sexual health includes sexual desire (libido) and the ability to get and sustain an erection (erectile function). Although physiology can affect both the desire for sex and the ability to have sex, mental health and emotional factors also play important roles.

Why is it important?

Apart from ensuring qualitative sexual gratification, good sexual health among males is also an indication of their overall physical, physiological, mental and emotional health. One should be aware and address issues on a precautionary basis.

Symptom of a deeper problem

In the absence of a normal or healthy sexual quotient of wellbeing, it can actually be an indicator of a deep-lying problem. Many things can cause ED, including stress, depression, relationship issues, abnormally low testosterone, damage from urological surgery, and even cholesterol-clogged arteries.

Beat the taboo and get a check-up done NOW!

Call 080 - 42070577, +918197371247 to book an appointment now.

You can also visit:

https://bit.ly/3vh9L1N

There are several and diverse reasons for Erectile Dysfunction. Medical investigations and research studies over the years indicate both physical and mental health issues as responsible. Physical issues like heart disease, high cholesterol, high blood pressure, diabetes, obesity, and smoking can all cause erectile dysfunction. On the other hand, depression, anxieties, stress, relationship problems, and other mental health concerns can also interfere with sexual feelings.

Diseases that commonly cause ED include:

Vascular disease: These affect blood vessels and account for 70% of physical-related causes of ED, restrict blood flow to the heart, the brain, and--in the case of ED--to the penis.

Diabetes: Diabetes can cause nerve and artery damage that can make achieving an erection difficult. Between 35% and 50% of men with diabetes experience ED.

Kidney disease: These cause chemical changes that affect hormones, circulation, nerve function, and energy level. These changes can lower libido (sex drive) or sexual ability. Drugs used to treat kidney disease may also cause ED.

Neurological (nerve and brain) diseases: The nervous system plays a vital part in achieving and maintaining an erection. It is common for men with conditions such as stroke, multiple sclerosis (MS), Alzheimer’s disease, Parkinson’s disease, and spinal cord injuries to experience ED. This is due to an interruption in the transmission of nerve impulses between the brain and the penis.

Prostate cancer: Prostate cancer doesn’t cause ED on its own, but treatment for prostate cancer can lead to erectile problems.

To learn more and address Erectile Dysfunction,

Call 080 - 42070577, +918197371247 to book an appointment now.

You can also visit:

https://bit.ly/3vh9L1N

Address Erectile Dysfunction at the earliest!

Do you suffer from Erectile dysfunction?

Males with ED may feel the penis returning to a flaccid state before they have ejaculated or can complete intercourse with a partner. A person with ED may also: be unable to achieve an erection at any time. be able to achieve an erection that does not last long enough for sex.

Erectile dysfunction symptoms might include persistent:

  • Trouble getting an erection
  • Trouble keeping an erection
  • Reduced sexual desire

Effects

Erectile dysfunction should not be considered a minor issue and certainly, should not be ignored. If it persists, however, it can cause stress, affect your self-confidence and contribute to relationship problems.

Treatment and Remedy

ED is very common and can usually be reversed by using natural remedies or medications to treat the underlying cause. Early intervention can often detect a serious medical condition, and determining the cause of ED early may increase the likelihood of reversing it. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and a risk factor for heart disease.

To address the issue,

To book an appointment, please call:

Call: 080 - 42070577, +91 8197371247

You can also visit:

Erectile dysfunction treatment

Kidney Stones, also called nephrolith or renal calculi, is amongst the most common health condition associated with the urinary system.

If you have suddenly or recently developed lower back pain, nausea and/or vomiting with the pain, blood in your urine & while urinating, compulsion to urinate frequently and fever combined with chill attacks, chances are that you are having kidney stones. In particular, a fever with a kidney stone or a urinary tract infection (UTI) with a kidney stone are surgical emergencies.

Kidney stones are hard collections of salt and minerals often made up of calcium or uric acid. They form inside the kidney and can travel to other parts of the urinary tract. Stones vary in size, while some are as small as a dot, or a fraction of an inch, others grow to be a few inches across and can also fill up the entire kidney.

A kidney stone forms when too much of certain minerals in your body accumulate in your urine. Lack of adequate hydration in the body is a most common reason for the formation of stones. The urine becomes more concentrated with higher levels of certain minerals.

To read more, visit: https://alias.joshiuroandrology.com/Kidney-Stone

To book an appointment, please call:

Call: 080 - 42070577, +91 8197371247

Are you suffering from Stress Urinary Incontinence, leading to embarrassment, loss of confidence and helplessness?

Urinary Incontinence is a common and increasing occurrence especially in the age group of 35 – 65. Also called Stress Urinary Incontinence (SUI, this is a condition when urine leaks out with sudden pressure on the bladder and urethra, causing the sphincter muscles to open briefly. There are high chances that one may isolate, limit work, social life, also avoid physical and leisure activities.

Symptoms include leaking urine when one coughs, sneezes, bends over, lifts something heavy, and exercise. An urge to repeatedly relieve oneself also is a symptom to watch out for!

How to address Stress Urinary Incontinence?

A UROLOGY EXPERT will be the best resource to address the problem. If diagnosed early, the condition can be completely reversed to normalcy. Remedies may include medication and treatment. Suggested therapy includes – pelvic floor muscles, fluid consumption, healthy lifestyle, yoga and breathing techniques for relaxation, bladder training and more.

Dr Joshi’s Urology and Andrology Centre has UROLOGY specialists who can address the issue, with expertise and care. You can be rest assured of a seamless experience from diagnosis to treatment.

Book an appointment and seek expert advice.

Call: 080 - 42070577, +91 8197371247

About

Male reconstructive surgery is a procedure in which urologists reconstruct or rebuild a penis and surrounding structures. This procedure is also called male genitourinary reconstruction or penile reconstruction.

Purpose

Male reconstructive urology (also called male genitourinary reconstruction) can be used to treat physical abnormalities, repair trauma related to major surgery or accidents, or manage certain bladder control problems like incontinence and OAB. The surgery also restores the ability to urinate or engage in sexual activity in individuals who experience trauma, injury, or illness. The surgery aims to restore the groin area to a functional state with normal appearance.

Reasons can be broadly categorized as:

  • External Trauma
  • Urethral Structures
  • Prostatectomy Complications
  • Incontinence
  • Enlarged Prostate
  • Gender Affirmation

With increasing proficiency and expertise, technology like Robotics and applied innovation, the success rate is high, assuring patients of normalcy. It also results in increased self-confidence, enhanced mental health, improved physical health and appearance.

Most Men are shy to express their health issues, even with their family members. Owing to this, health conditions will only deteriorate and result in further complications.

Early detection and medical intervention would help to resolve health conditions, resulting in good quality of sexual life.

It’s ideal to consult a medical professional(Andrologist) in this domain at the early stage of detection.

To consult an Andrologist contact…

General male fertility and sperm counts are declining globally, studies indicate. Over the last few decades, the fertility rates amongst men has declined by 50%.

One of the rising causes of male infertility is the reduction in sperm production. Several factors including air pollution, extensive use and exposure to insecticides, pesticides and harmful chemicals, use and exposure to heavy metals are amongst key imperatives for the deterioration.

It is established that adverse environmental factors have a significant and detrimental impact on male fertility. Certain industrial chemicals, environmental pollutants and radiation are known to contribute to or cause infertility. Lead poisoning, for example, has long been associated with infertility in both men and women.

Potential causes of this male fertility crisis include exposure to environmental endocrine disrupting chemicals (e.g., plasticizers, bisphenol A, and phthalates), rising rates of obesity, and the trend of delayed parenthood. Other causes include tobacco and alcohol consumption, illicit drugs, being exposed to toxins and more.

This condition can be addressed though medical intervention, changes to lifestyle, and mental-physical wellbeing. To know more, please book an appointment

Erectile dysfunction is three times more common in Diabetics compared to Non-Diabetics

Erectile dysfunction is much more common than retinopathy and nephropathy.

Erectile dysfunction may be first symptom in 12% of Diabetics

Hypertension and Erectile dysfunction

Erectile dysfunction in hypertensive patients is two times more common

Dyslipidemia and Erectile dysfunction

It has been found that there is an Improvement in Erections after lowering LDL cholesterol

Metabolic Syndrome is also associated with low Testosterone levels and Low Te levels are associated with two times increased cardiovascular risk. Low Te increases insulin resistance and worsens DM, and thus the vicious cycle.

Cardiovascular risks and men’s health

Prevalence of silent coronary artery disease in patients with ED is ranged between 8% and 56%. Erectile dysfunction has been independently associated with Cardiovascular Disease.

Relative risk of Cardiovascular Disease is higher among younger patients with Erectile dysfunction, and risk decreasing linearly as age in years increased. Improvement of Testosterone levels by TRT has shown reduction in the mortality by 50%.

Osteoporosis

One in 6 men will sustain a hip fracture by age 90, and risk of death from complications of a hip fracture is 34%

Treatment includes making healthy lifestyle changes, including getting 1000 mg to 1200 mg of calcium daily

Vitamin D3 should be above 30ng/ml

Use bone forming agents, if Bone mineral Density is -2.5.

Take home message

  • Cardio-metabolic risk assessment is crucial aspect of Men’s Health evaluation
  • Lifestyle modification is one of the fundamental pillars of treatment
  • Collaboration with other disciplines is inseparable part of Men’s Health management
  • Multi-disciplinary and holistic approach is very important
  • Irrespective of age, Males should Consult a professional Andrologist, if they are any symptoms. Don’t neglect of feel shy to share with family members/friends, as they could assist/direct you to the right medical professional

Erectile dysfunction (ED) is the inability to get or sustain an erection firm enough to have sexual intercourse good enough for partner satisfaction. It’s also sometimes referred to as impotence.

ED can be caused by only one of these factors or several. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions.

Causes:

There are many possible causes for ED and they can include both emotional and physical disorders. Some common causes are:

  • Cardiovascular disease
  • Diabetes
  • Hypertension
  • Dyslipidemia
  • Smoking
  • Obesity or being overweight
  • Damage caused by cancer/ surgery to the nerves
  • Stress
  • Anxiety
  • Relationship problems
  • Substance abuse
  • Alcohol use

Treatment at Erectile Dysfunction treatment in Bangalore:

There are various levels of treatment.

  • Lifestyle modifications
  • Medicines – Like Sildenafil, Tadalafil
  • Low Intensity shock wave therapy
  • Intra cavernosal injections
  • Vaccum erection device
  • Surgery – Venous ligation, Penile prosthesis

It is important to diagnose any Erectile Dysfunction symptoms early-on so to ensure minimal medical intervention.

Here is a basic Diagnostic Framework:

ed-treatment

Clinical trials have demonstrated that stem cells can restore enough erectile function to allow previously impotent men to engage in spontaneous sexual activity. Stem cell therapy has also resulted in patients regaining erectile function to engage in sexual activity.

Stem cell Regenerative Therapy

Hypothesis is that stem cells can differentiate into a wide variety of cells including endothelial cells, Schwann cells, smooth muscle cells, and neurons. These have beneficial effects, leading the host tissue to initiate a regenerative or healing response to diseased or injured tissue responsible for ED.

One reported case series of seven men treated using Stem Cell Therapy. In this series, 6 out of 7 diabetic patients ranging from 57 to 87 years age regained morning erections. Another phase 2 trial with 12 patients with post Radical Prostatectomy patients have shown significant improvement by 6 months.

It is said Stem cell therapy achieves at least 50% improvement in patients with erectile dysfunction (impotence) after initial administration.

Male Infertility – Identification and Treatment Methods

Male infertility means a male's inability to cause pregnancy in a fertile female.

Approximately 15% of couples are unable to conceive after one year of unprotected intercourse.

Male factors contributing to infertility

  • Oligo, Astheno, Teratozoospermia
  • High DNA Fragmentation Index
  • Poor acrosomal capacitation
  • Unexplained
  • Azoospermia
  • Erectile dysfunction
  • Anejaculation and Retrograde ejaculation

Indications of the problem includes:

  • Mild male infertility
  • Unexplained infertility
  • Mild Endometriosis, Cervical factors
  • Erectile dysfunction
  • Anejaculation during the intercourse but can give sample by masturbation

There are different routes to treat this problem. The approaches may include –

  • Hormonal balancing
  • Varicocele ligation
  • Antioxidants
  • Surgical sperm retrieval
  • Correction of erectile and ejaculatory disturbances

Definition

A varicocele is when veins become enlarged inside your scrotum (the pouch of skin that holds your testicles). These veins are called the pampiniform plexus. Varicoceles often produce no symptoms but can cause low sperm production and decreased sperm quality, leading to infertility.

Impact of the Disorder and its occurrence in Males

  • 15% overall male population
  • 35-50% primary infertility
  • 69-81% secondary infertility
  • 70% of asymptomatic males with varicocele have abnormal, semen analysis

Presence of Abnormality

  • Abnormal dilatation of the pampiniform plexus
  • Impairment of a counter current heat ex-change mechanism
  • Impaired spermatogenesis and steroidogenesis

Unfavourable Factors

  • Cryptorchidism
  • Testis tumors
  • Trauma
  • Torsion or infection

Book an appointment for timely diagnosis, treatment and remedy.

About

Stem Cell Therapy and its advanced research has indicated promising results in the treatment of Erectile Dysfunction. This is considered to be a type of #regenerativetherapy with the hypothesis that the stem cells can differentiate into a wide variety of cells including endothelial cells, Schwann cells, smooth muscle cells, and neurons. Interestingly, Stem cells have beneficial effects lead the host tissue to initiate a regenerative or healing response to diseased or injured tissue responsible for Erectile Dysfunction.

Prevalence

Worldwide prevalence of ED is between 10% and 20%, and it is strongly correlated with aging. Among younger men, 8% of 20- to 29-year-olds and 11% of men ages 30-39 experience ED. Also, about 52% of men ages 40-70 experience ED and 71% of men over 70 experience ED.

Failing to address these issues on time may lead to further health vulnerabilities like increased stress levels, delay in addressing any underlying cardio-vascular diseases and more.

Book an appointment to address on priority.

Erectile Dysfunction itself is often related to an underlying problem, such as heart disease, diabetes, liver disease, or other medical conditions. Other factors like depression, anxieties, stress, relationship problems, and other mental health concerns can also interfere with sexual wellbeing.

The Men’s Attitudes to Life Events and Sexuality (MALES) study assessed the prevalence of erectile dysfunction (ED) and related health issues in the general male population in Europe and North and South America, and examined the attitudes and behavior of men in relation to these health issues.

In Phase I, 27,839 men (20–75 years) from eight countries (United States, United Kingdom, Germany, France, Italy, Spain, Mexico, and Brazil) were interviewed using a standardized questionnaire.

Phase I compared the prevalence of hypertension, angina, increased cholesterol, diabetes, and depression/anxiety in men with ED vs men with no ED. Prevalence was significantly higher in men with ED for all co-morbidities assessed (p < 0.0001).

Rosen RC, Fisher WA, Eardley I, et al. The multinational Men’s Attitudes to Life Events and Sexuality (MALES) study: I. Prevalence of erectile dysfunction and related health concerns in the general population. Cur Med Res Opin. 2004;20(5):607–617.

chart

Graphical view of the PENIS

chart

Erectile problems related to serious health issues:

It is important to know and build awareness about Erectile problems and its possible hidden or underlying health signals. Erectile problems can also be a key indicator of serious health issues.

chart

Recommended Treatment includes:

  • Lifestyle changes
  • Risk factor modification
  • Education Counseling

PDE 5 Inhibitors

Phosphodiesterase 5 Inhibitors (PDE5Is) are now widely used in the management of Erectile Dysfunction(ED). Their ability to improve symptoms of ED was discovered while researchers were examining their potential use for high blood pressure and angina. PDE5 inhibitors is usually used to treat ED caused by poor blood flow to the penis.

Treatment for ED Caused by Physiological Factors

It is important to note that PDE 5 Inhibitors is typically used to treat ED caused by physiological factors and not psychological ones especially stress and anxiety.

The four major types of PDE5 inhibitors available include:

Recommended Treatment includes:

  • sildenafil (Viagra)
  • tadalafil (Cialis)
  • vardenafil (Levitra or Staxyn)
  • avanafil (Stendra)

Common side effects include:

  • Headaches
  • Nausea
  • Indigestion
  • Dyspepsia
  • Nasal congestion
  • Altered vision
  • NAION (Non-arthritic anterior ischemic optic neuropathy)

PDE5 inhibitors have a vasodilating effect on the penis, primarily, helping the blood vessels relax and increasing blood flow. It is important to note that these drugs have to be administered only under the guidance of a physician.

Erectile dysfunction (ED) is a major health problem that seriously affects the quality of life of patients and their partners. Gene therapy approaches are discussed in terms of the possible role of gene therapy for the treatment of ED, potential targets for gene transfer, vectors to carry targeted genes, and gene strategies for ED in certain disease states, such as diabetes, ageing, arterial and venogenic insufficiency, and cavernous nerve injury.

Recent preclinical and clinical trials have demonstrated that gene therapy strategies may be feasible for these purposes. Gene therapy offers a minimally invasive option to treat men who do not respond to traditional pharmacologic therapies or do not want surgery. It is believed that gene therapy will become a therapeutic treatment in the near future.

Genes that stimulate smooth muscle cell relaxation, such as neuronal, inducible, and endothelial nitric oxide synthase, or that inhibit smooth muscle cell constriction can restore erectile function in aging, diabetic, and other model systems.

The future of erectile dysfunction gene therapy may lie in the use of tissue specific and regulated gene expression, advanced viral vectors, or the combination of multiple genes to fine tune smooth muscle relaxation. Maxi-K ion channels, are transferred to the penile tissues. Tunica albuginea has slow turnover rate facilitating the study of prolonged gene action. Maxi-K ion channel activators increase potassium currents and thereby increasing the relaxation of smooth muscles.

Body Dysmorphic Disorder

This is a mental health condition that disrupts how you see and feel about your own body and appearance. This has a societal bearing, wherein, people experience low esteem, or low confidence, accompanied by a sense of shame about their body, especially their genitalia. This affects their sense of wellbeing in the long run, bringing in many disorders like stress, anxiety and personality disorder.

Penile Dysmorphic Disorder

Penile dysmorphic disorder, sometimes abbreviated as PDD, is a manifestation of body dysmorphic disorder where the main bodily area of fixation is the size of the penis. PDD on its own is not a recognized disorder. In such cases, the size or shape of the penis causes them discomfort and under confidence. An individual with penile dysmorphic disorder often has a debilitating or excessive fear of judgment by others.

Perceived Fears and Inhibitions

In cases of PDD, the person has a perceived notion of what is normal. Even though the organ functioning is normal, the appearance becomes the bane. The person experiences a sense of body shaming, and a gnawing feeling that the person cannot fit in, does not look good or is not normal. The person is so troubled, disturbed and affected, that it becomes an obsession to deal with. It is of serious concern, when the person takes to different means of addressing it. One approach is to go to cosmetic upliftment that is not recommended, taking medicines that is unnecessary or meeting quacks! This is highly dangerous and one is recommended not to pursue this path.

One has to learn to accept some shortcoming in one’s personality and accept it, rather than approaching it with doubt, and taking up wrong means to address, when in reality, the problem does not require any form of medical intervention at all.

Male infertility means a male's inability to cause pregnancy in a fertile female. Approximately, 15% of couples are unable to conceive, even after one year of unprotected intercourse. A male factor is solely responsible in about 20% of infertile couples and contributory in another 30-40%.

Medical factors contributing to Male Infertility:

  • Oligo, Astheno, Teratozoospermia
  • High DNA Fragmentation Index
  • Poor acrosomal capacitation
  • Unexplained
  • Azoospermia
  • Erectile dysfunction
  • Anejaculation and Retrograde ejaculation

Grading of Male Infertility based on Semen Analysis:

  • 10 M/ml to 15 M/ml - Mild
  • 05 M/ml to 10 M/ml - Moderate
  • < 05 M/ml – Severe

Correction methods include:

  • Hormonal balancing
  • Varicocele ligation
  • Antioxidants
  • Surgical sperm retrieval
  • Correction of erectile and ejaculatory disturbances

Consult now to get a holistic analysis, treatment approaches and resolution.

Intrauterine insemination (IUI) is a simple procedure that puts sperm directly inside the uterus, enabling the healthy sperm get closer to the egg. During an intrauterine insemination (IUI) procedure, sperm is placed directly into the uterus using a small catheter. Injection of prepared sperms into the uterine cavity through a fine catheter during peri-ovulatory phase in a natural or stimulated cycle. This is performed, through a fine catheter during peri-ovulatory phase in a natural or stimulated cycle. The objective here, is to improve the chances of fertilization by increasing the number of healthy sperms reach the fallopian tubes, during the most fertile period, in a woman’s cycle.

It is predominantly used to treat:

People facing infertility due to medical conditions (e.g., endometriosis or low sperm count or quality), and also couples with unexplained infertility. This procedure is a widely used treatment option because it is a minimally invasive, lower-cost alternative to in vitro fertilization (IVF), and it can be conveniently performed in Dr. Joshi’s hospital.

Some key factors requiring IUI include:

  • Mild male infertility
  • Unexplained infertility
  • Mild Endometriosis, Cervical factors
  • Erectile dysfunction

How does it help?

  • Deposition of large number of motile sperms near the site of fertilisation
  • Halves the distance to be travelled by the sperm
  • Doubles the probability of fertilisation

Metabolic syndrome refers to the presence of a cluster of risk factors specific for cardiovascular disease. Metabolic syndrome greatly raises the risk of developing diabetes, heart disease, stroke, or all three. Metabolic syndrome includes high blood pressure, high blood sugar, excess body fat around the waist and abnormal cholesterol levels. The syndrome increases a person's risk of heart attack and stroke.

Threats for Male Fertility

This condition may result in hypogonadism, increased scrotal temperatures, impaired spermatogenesis, decreased sperm count, leading to about 50% of cases of couple infertility worldwide. The condition or in medical terms, the pathophysiology involves a complex crosstalk of psychological, neuromuscular, endocrinological, and vascular factors along with their correlations with several lifestyle habits like cigarette smoking and alcohol consumption and sometime due to some drug side effects.

This condition is primarily detected by the presence or indications of:

  • Abdominal obesity
  • High blood pressure of 130/80 mm Hg (millimeters of mercury) or higher.
  • Impaired fasting blood glucose
  • High triglyceride levels of more than 150 mg/dL
  • Low HDL (good) cholesterol

In addition to changing one’s lifestyle, and adopting healthy practices including meditation, yoga, exercise or therapy, one needs to consult an expert Andrologist, to seek specific guidance and line of treatment is crucial in addressing this syndrome. The Andrologist can provide a comprehensive approach to diagnosis and treatment methods.

PART 1

There are many established and recommended methods to treat Erectile Dysfunction from medication, surgery, therapy, exercises, testosterone replacements, penile implants, psychological counseling and more. Medical management, penile injections, vacuum devices, penile surgeries with implants are diverse methods used to treat the condition.

A penile implant is an implanted device intended for the treatment of erectile dysfunction. A penile implant is an erection assistance device that is designed to help a man get an erection and is completely hidden inside the body. There are many factors governing the approach to penile implants. If the person does not respond adequately to medication, if the outcomes of medical management are insufficient or cannot sustain, surgical intervention for penile erection, penile prosthesis or implants, is the suggested route.

The person must be declared, in medical terms, as a case of Refractory Erectile Dysfunction, if he does not respond to any of the treatment methods. Usually, the implants are then recommended for males above 30 years.

Cultural framework impacts treatment of Erectile Dysfunction

In Western countries, sex and sex-related issues or challenges are openly discussed and addressed. In India, sex continues to be a taboo, sex-related health issues and treatment methods are still inhibited. Most men refuse to discuss it openly, admit it even to themselves, thereby, allowing the issue to persist or continue.

In the Indian society, even women are protective about their partner’s or husband’s sexual health. The perception is that the man should not undergo any surgery or procedure, with an assumption that there is no medical condition. Unfortunately, they do reach out for medical intervention much later, when the case has reached a state of irreversibility.

Benefits of Implants

Among the benefits of Implants, an important one is that it enables a more spontaneous sex life that requires no external devices or tools. One can resume sexual activity four to six weeks after penile implant surgery. Post surgery, the erection looks and feels natural, and more significantly, does not change sensations during sex or the ability to climax. This gives not only physical relief, satisfaction and happiness, it also rebuilds confidence, and relieves stress from the individual. Unlike other treatments for erectile dysfunction (ED), a penile implant restores spontaneity and allows a man to get an erection without any planning or waiting. The device is implanted during a procedure through a small opening in the skin.

Reconstructive urology is surgery to restore normal function by repairing, rerouting, or recreating areas of the upper and lower urinary tract and some reproductive organs. Genital and pelvic reconstruction aims to restore normal anatomy and function of the genitourinary tract.

Reconstructive urologic surgery involves the treatment of the problems that patients may suffer from after the treatment of urologic and pelvic cancers or after trauma sustained to the urinary tract.

Some of the commonly managed diagnoses include:

  • Urethral strictures
  • Management of hypospadias complications
  • Ureteral strictures
  • Ureteropelvic junction obstruction
  • Urinary tract fistulas
  • Urinary Incontinence
  • Erectile dysfunction
  • Complications of prior surgery

Reconstructive urologic surgery can restore normal function after damage or disease of the penis, prostate, scrotum, testes, or urinary tract, which includes the:

In the Indian society, even women are protective about their partner’s or husband’s sexual health. The perception is that the man should not undergo any surgery or procedure, with an assumption that there is no medical condition. Unfortunately, they do reach out for medical intervention much later, when the case has reached a state of irreversibility.

  • Kidneys, where urine is made
  • Ureters, the tubes connecting the kidneys to the bladder
  • Bladder, where urine is stored
  • Urethra, the tube through which urine exits the body

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Placement of an inflatable penile prosthesis (IPP) is the mainstay of surgical treatment for patients with erectile dysfunction (ED). The management of ED usually starts with clinical assessment, lifestyle changes, and modifying drug therapy that may cause ED. The treatment follows a sequential process covering medication to surgical intervention, subject to patient’s degree and level of improvement.

Firstly, pharmacotherapy is administered usually, with oral phosphodiesterase type 5 inhibitors. If these treatments are not successful, vacuum constriction devices, intraurethral alprostadil, and intracavernous injection of a vasoactive drug are available as second-line treatments, followed by penile prostheses (PP) as a third-line treatment. Inflatable penile prostheses are the most commonly implanted devices for medically refractory ED patients and for those with contraindications to pharmacotherapy.

However, loss of penile size is a common complaint that can negatively affect patient satisfaction rates following successful penile prosthetic implant surgery. Strategies to preserve and potentially increase penile size are of great importance to all implanters. As with other sexual dysfunction therapies, the outcome of PPI surgery is largely dependent on patient and partner satisfaction. Most frequent implanters will realize that perceived inadequacy of penile size, be it penile girth or penile length, are practical issues that need to be addressed in clinical practice, and may be best suited for a full discussion pre-operatively, to set realistic expectations.

It is noted that IPPs are superior to malleable implants in attaining greater postoperative penile lengths and girths. Post- operative penile length was 6.37 times more likely to rise above preoperative post-ICI stretched length in inflatable penile implants compared to malleable implant cases (12.5% vs 1.96%) (P value=0.0105). IPPs were 2.5 times more likely to increase the girth of the penis (27.2% vs 10.9%) (P value <0.05). IPPs were 2.1 times less likely to cause a decrease in circumference in comparison to malleable implants (9.1% vs 19.2%) (P value <0.05).

Revision surgery due to implant dissatisfaction was observed as least in IPP. Hence it is a viable option for those experiencing ED, as advised by the specialist.

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