SOURCE: Advanced Urological Care, PC

erectile dysfunction (ED) -

May 18, 2010 19:15 ET Dr. J. Francois Eid, MD Discusses the Benefits of Being "Awake" During Penile Implant Surgery

NEW YORK, NY--(Marketwire - May 18, 2010) -  Each year, many patients must pass up on elective minor surgeries because of the serious risks attached, especially with regards to anesthesia. However, more and more surgeries are being performed while the patient is sedated but generally "awake," resulting in reduced risks and side effects, such as nausea or stress to the heart and lungs. These side effects make surgery very risky for patients with existing heart and lung conditions. And a majority of patients that suffer from advanced erectile dysfunction (ED) unresponsive to treatment with oral medications (Viagra, Cialis, Levitra), usually also have heart or vascular conditions. So when one of these patients needs surgery for a penile implant or prosthesis, an "awake surgery," conscious sedation or twilight anesthesia might be the answer, says Dr. J. Francois Eid, director of Advanced Urological Care, and Clinical Associate Professor of Urology at Weill/Cornell Medical College in New York City. "As a matter of fact because this type of anesthesia has worked so well for our high risk patients, we now use it routinely for all patients undergoing this procedure," further states Dr. Eid.

Dr. Eid's main area of expertise is with penile pumps or Inflatable Penile Prostheses (IPP). He believes in the effectiveness of IPPs, since he has performed more internal penile prosthesis surgeries than anyone in the world, over 300 per year. In recommending this minor procedure for a patient with heart disease, the issue of anesthesia becomes a tricky one. Most general anesthetics make the heart pump less efficiently. They can also dilate the blood vessels around the body, resulting in a drop in blood pressure. The lungs are also put under stress, rendering them unable to clear out secretions as efficiently as they would otherwise.

With regional anesthesia and conscious sedation, sedatives lower the patient's level of consciousness without putting them into a deep sleep, requiring endo-tracheal intubations and a respirator as with general anesthesia. A pain medicine is also administered, usually through an IV. These medications cause temporary forgetfulness, so patients may not remember the procedure. Depending on the level of sedation, the patient may be awake and able to respond physically to questions, listen to music or have a pleasant conversation with the anesthesiologist. Patient's blood pressure and pulse are monitored during this process. Oxygen saturation and breathing levels are closely monitored by an anesthesia professional during the entire procedure.

According to Dr. Eid, the advantage to "awake surgeries" would allow his patients to undergo surgery with regional anesthesia, or 'blocks.' By blocking sensation with a local anesthetic around the specific nerves near the groin area of surgery, it would make his routine IPP operation faster and safer. Currently, the practice is being used in surgeries for hands, feet and limbs, but Eid believes that this is the ideal way of performing IPP surgeries. 

There are inherent advantages of being awake and receiving a regional during IPP surgeries. Shortly after the local anesthesia is administered, full expansion and engorgement of the penis occurs. This facilitates sizing of the penis and results in a placement of a bigger implant. Reservoir placement of the prosthesis is also much easier for the surgeon. Better antibiotic penetration of the penis and surrounding tissues is also likely to occur from the dilation of blood vessels. Deep vein thrombosis of the legs, a complication of general anesthesia, almost never occurs following brief regional anesthesia. Even after the procedure is finished, prolonged relief of pain is noted from the regional anesthesia, preventing the need for oral or intravenous medications thus avoiding their side effects such as drowsiness, nausea and constipation. 

"Not only is there an increased safety factor, but the use of local anesthesia will also allow patients to be released from the hospital or ambulatory surgery center sooner, most on the same day, which would save patients, hospitals and insurance companies lots of money," explained Dr. Eid. Eid's own "No-Touch" penile implant surgery, which boasts an infection rate of less than one percent, is also cost-efficient, as it reduces the need for prolonged antibiotic treatment and re-implant procedures.

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