Archive for February, 2016

Penile Implants

February 27, 2016

Andrew Siegel MD 2/27/16

With respect to male sexual dysfunction,  implantation of a penile prosthesis is a highly effective procedure capable of restoring erectile function in those men who do not respond to simpler treatment measures.  In many ways it is as quality-of-life-restoring as a total knee replacement is to one suffering with arthritis, converting a penile “cripple” into a functional male with restored erections and resolution of the psychological and emotional devastation resulting from loss of manhood.

There are two principles that can be pretty much applied to all situations in life:

  1. If it ain’t broke, don’t fix it. (Pardon the English.)
  2. If it is broken, try the simple and conservative before the complex and aggressive.

These concepts are commonly applied to medical issues in general and male sexual dysfunction in specific.  If erections are satisfactory, no treatment is necessary (but maintaining a healthy lifestyle will sure help keep things that way).   However, if erections are flimsy and feeble, the following sensible tiered strategy is in order:

First-Line Approach

Lifestyle makeover. This includes a heart-healthy (and penis-healthy) diet, getting down to “fighting” weight, exercising regularly, drinking alcohol moderately, avoiding tobacco, minimizing stress, getting enough sleep, etc. Aside from general exercises (cardio, core, strength training, flexibility), specific pelvic floor muscle exercises (“man-Kegels”) are beneficial to improve the strength, power and endurance of the penile “rigidity” muscles.

Second-Line Approach

ED meds/Penile vibratory stimulation therapy/Penile pump.  Viagra, Cialis, Levitra and Stendra are pharmacological options.  As an alternative to medications, penile vibratory nerve stimulation (Viberect device) can be an effective means of helping resurrect erectile function. Alternatively, the vacuum suction device is a means of drawing blood into the penis to obtain an erection; the system uses a constriction band to maintain the erection.

Third-Line Approach

Urethral suppositories/Penile injection therapy. Suppositories are medicated pellets that are placed in the urethra (urinary channel) that  increase penile blood flow and induce an erection. Penile injections of vasodilator medications do the same and more effectively so, but require the medication to be injected directly into the penile erectile chambers. (Blog on this subject forthcoming next week.)

Fourth-Line Approach

Penile implant. This is a device made of synthetic materials that is surgically implanted under anesthesia, typically on an outpatient basis. It is totally internal, with no visible external parts and aims to provide sufficient penile rigidity to permit vaginal penetration. For the right man under the appropriate circumstances the penile implant can be a life changer.

There are two types of penile implants: semi-rigid and inflatable. I liken the difference between these two implants to the distinction between a Volkswagon and Mercedes, both effective and functional, but one with many more “bells and whistles.”

A semi-rigid penile implant (a.k.a. malleable implant) is a “static” implant that always remains rigid, not unlike the os penis (penis bone) present in many primates, except that this implant can be hinged. It is bent upwards to put it to use and is bent downwards to conceal it. It consists of two cylinders that are implanted within the penile erectile chambers through a small incision.

Print

(Coloplast semi-rigid penile implant)

The advantage of the semi-rigid implant is its simplicity, the fact that it is less expensive than an inflatable device and its utility for handicapped patients with dexterity issues or those who have limited reaches. Its disadvantage is that it cannot go from a flaccid state to an inflated state as can the inflatable penile implant, thus creating some potential issues with concealment. Furthermore, by virtue of the constant pressure of the implant on the soft tissues of the penis, it can be more uncomfortable than the inflatable variety and has the potential for thinning the penile flesh.

The inflatable penile implant (IPP) is a “dynamic” device designed to mimic the characteristics of a normal erection, with the capacity to inflate and deflate by virtue of a self-contained hydraulic system. Dual cylinders (inner tubes) are implanted in the erectile chambers. The length of the erectile chambers is precisely measured in order to size the implant properly, similar to measuring the size of your feet in order to ensure a good shoe fit. A control pump is implanted in an accessible area of the scrotum. The third element is the reservoir, which contains the fluid necessary for inflation. The reservoir is typically implanted behind the pubic bone or within the abdominal wall. Tubing connects the control pump to the cylinders and to the reservoir.

Titan Touch product anatomy

(Coloplast inflatable penile implant)

When an erection is desired in a man who has an IPP implanted, the scrotal control pump is repeatedly squeezed, which transfers saline from the reservoir into the penile cylinders. As the cylinders fill, an erection develops and with each consecutive squeeze, more fluid is flows into the cylinders, creating a more rigid erection of wider girth. The erection will remain until the release bar on the control pump is activated.   After the completion of sexual intercourse, by activating this release bar, the fluid in the cylinders returns to the reservoir where it is again stored, returning the penis to its flaccid state. Some IPPs are designed to increase in girth only, whereas others can increase in length and girth.

IPPs have been available for over forty years and have been improved remarkably over the years. The current devices are well-engineered, sophisticated,  highly effective devices. Penile sensitivity, sex drive and ability to ejaculate are essentially unchanged following an IPP implantation. It is important to know that unlike a normal erection, the IPP erection does not result in swelling of the head of the penis nor the erectile tissue surrounding the urethra. Nonetheless, it results in a penetrable and durable erection that can restore sexual function in a man who is incapable of achieving an erection.

Advantages of the IPP are its ability to inflate and deflate, creating no issues with concealment. The penis can be kept inflated for as long as desired, whether it be 60 seconds or 60 minutes and will not deflate after ejaculation, unlike what typically occurs under normal circumstances. Disadvantages include its additional expense (although it is usually covered by insurance), the fact that it requires some degree of manual dexterity to operate, and the fact that it is more susceptible to mechanical malfunction than the semi-rigid variety because of its complexity.

Bottom Line: The penile implant is a fourth-line approach for ED that is a highly effective means of providing erectile rigidity on demand, capable of restoring sexual function in a man who is incapable of achieving a functional erection.

Thank you to the Coloplast Corporation for providing the images.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym and PelvicRx: comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training programs. Built upon the foundational work of Dr. Arnold Kegel, these programs empower men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.  

Pelvic Rx can be obtained at http://www.UrologyHealthStore.com, an online store that is home to quality urology products for men and women.  Use code UROLOGY10 at check out for 10% discount. 

When You Can GET It Up, But Can’t KEEP It Up

February 20, 2016

Andrew Siegel MD 2/20/16

Lost In Evolution

Many mammals have a bone in the penis (os penis) that maintains constant penile stiffness. This is the case with primates including gorillas and chimpanzees, but–for better or for worse– is not the case with human males. The good thing about having an os penis is that there is no such thing as ED in primates, as males are “ever ready.”  The bad thing is having a 24/7/365 “boner,” literally and figuratively. Furthermore, having a bone in the penis makes it much more susceptible to injuries such as a fracture of the penis.

The Human Penis

The human penis is a highly evolved and unique organ comprised of 3 cylindrical chambers that contain erectile sinus tissue. These cylinders run the length of the external and internal aspects of the penis. The main “erectile apparatus” consists of the paired cavernous chambers with the ischiocavernosus muscle (IC) that surrounds and supports them. The auxiliary “erectile apparatus” is the head of the penis (glans) with the solitary spongy erectile chamber that envelops the urinary channel and the bulbocavernosus muscle (BC) that surrounds and supports it. The IC and BC muscles are two of the all-important pelvic floor muscles that provide supportive, sphincteric and sexual functions.

The paired cavernous erectile chambers become rigid at the time of sexual stimulation and provide the wherewithal for vaginal penetration. The head of the penis and spongy chamber provide additional plumpness and fullness, but not rigidity.

Corporal Bodies And Glans Clean

Blue arrows point to paired cavernous chambers that become rock-hard with stimulation. Red arrow points to solitary spongy chamber and yellow arrow to head of penis, both of which become plump with stimulation. (From Gray’s Anatomy of the Human Body, 20th Edition, original publication 1918, public domain)

12muscles

IC and BC muscles that surround the inner aspects of the cavernous chambers and spongy chamber respectively.  These pelvic muscles support the roots of the penis and when they contract they push pressurized blood into the external penis, creating rock-hard rigidity. (Illustration by Christine Vecchione from “Male Pelvic Fitness: Optimizing Sexual & Urinary Health”)

Did you know that penile erectile sinus tissue is virtually identical to nasal sinus tissue? …  IDENTICAL: a pathologist would be hard pressed (no pun intended!) to tell the difference between the two under a microscope.  Congested sinuses =  penile erection. The oral ED medications increase blood flow to both the nasal and penile sinuses and thus commonly cause sinus congestion as a side effect.   

Clever Mother Nature

Nature evolved a brilliant alternative to the os penis for human males. In the absence of such a practical bone,  nature capitalized on principles of hydraulics. Blood—not used for its typical purpose (transporting oxygen and other nutrients)—is pressurized to create rock-hard penile rigidity. This process has 3 requirements:

  1. arterial inflow of blood to the penis
  2. relaxation of the smooth muscle within the erectile sinus tissue to allow the penis to inflate
  3. trapping blood to maintain the erection

The blood trapping mechanism is incompletely deciphered, but our current understanding is that as the erectile sinus tissue becomes swollen with blood, the vessels that conduct blood away are pinched closed. The IC and BC muscles also play a key role by tourniquet-like compression of the inner erectile chambers, forcing pressurized blood into the erectile chambers. Penile high blood pressure in excess of 200 mm– the only place in the body where hypertension is desirable and necessary –is what is responsible for penile rock-hard rigidity.

Did you know that Dr. Gray of Gray’s Anatomy 1909 textbook referred to the IC muscle as the “erector” muscle and the BC as the “ejaculator” muscle?

Observe Your IC and BC Muscles In Action

The next time you get an erection, stand up and observe your penis. Vigorously contract your IC and BC muscles (by tightening up the anus) and observe what happens as more hydraulic fuel (blood) surges into the penis: the erect penis should lift up and point to the heavens above…pelvic floor muscle magic!

Erectile Dysfunction

ED can result from a problem in any of the three hydraulic requirements. If you cannot obtain an erection, it is most often due to impaired arterial blood flow to the penis or to a problem with the smooth muscle of the sinus tissue, which fails to relax appropriately and thus will not allow penile inflation. Similar to high blood pressure—which is commonly due to arterial smooth muscle becoming stiffer—failure of relaxation of the smooth muscle within the erectile sinus tissue is often an age-related problem.

If you can achieve an erection but lose it prematurely, it is often due to two causes: One is venous leakage of blood from the sinuses. The other is weakened IC and BC muscles. Unfortunately, there is not a lot that can be done about age-related impaired functioning of the erectile sinus tissue that promotes venous leakage.  However, healthy lifestyle measures will optimize function of the erectile sinus tissue and smooth muscle.  This includes the following: good eating habits, maintaining a healthy weight, engaging in exercise, obtaining adequate sleep, consuming alcohol in moderation, avoiding tobacco and minimizing stress.  The good news is that the IC and BC muscles are capable of being strengthened to improve their form and function, improving the blood trapping mechanism to enhance erectile rigidity and durability.  This is possible through Kegel exercises, a.k.a. pelvic floor muscle training programs (see below).

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

When Ejac-“elation” Becomes Ejac-“frustration”

February 13, 2016

Andrew Siegel MD  2/13/2016

800px-Fireworks4_amk

(Fireworks, 8/2007, author AngMoKio)

In the arena of male sexual dysfunction (MSD), ejaculation problems play second fiddle to erectile dysfunction (ED). Today’s entry explores common issues with ejaculation other than premature ejaculation, which I have previously addressed: https://healthdoc13.wordpress.com/tag/premature-ejaculation/

What my patients tell me: 

“It takes me too long.”

 “I can’t ejaculate.”

 “It happens, but not much fluid comes out.”

 “It just dribbles out with no force.”

 “I barely know that it happened; I just don’t get the same feeling that I used to.”

One would think that MSD is the same as ED, which seems to get all the press. However, MSD is more complex and all-encompassing than having soft or short-lived erections, which is just one aspect of MSD. Sex drive (libido) is an important part of the picture. Ejaculation is another vital component. With regard to ejaculatory issues, premature ejaculation (rapidly achieving climax) gets all the attention. However, there are other ejaculatory issues that contribute in a major way to MSD.

The processes of having an erection and ejaculating are separate, even though they usually occur at the same time. However, it is possible to have a rock-hard erection and be unable to ejaculate, and conversely, to ejaculate with a limp penis. Regardless, it sure is nice when the two processes harmonize. All things being equal, with a good quality erection, ejaculation will be more satisfying.

Why is ejaculation better with a rigid erection than without?

The urethra (tube within the penis that conducts semen) is the “barrel” of the penile “rifle.” It is surrounded by spongy erectile tissue called the corpora spongiosum (“spongy body”) which constricts and pressurizes the “barrel” to optimize ejaculation and promote the forceful expulsion of semen, the “ammo.” The word ejaculation derives from ex, meaning out + jaculari, meaning to throw, shoot, hurl, cast for a good reason!

Additionally, the pelvic floor muscles play a key role in the process of ejaculation. The bulbocavernosus (BC) is a compressor muscle that surrounds the spongy body and at the time of ejaculation it contracts rhythmically, sending wave-like pulsations rippling down the urethra to forcibly propel the semen in an explosive eruption, providing the horsepower for forceful ejaculation. This BC muscle engages when you have an erection and becomes maximally active at the time of ejaculation.

Issues with ejaculation are extremely common complaints among middle-aged and older men. These are often bothersome and distressing, and include the following:

  • Delayed ejaculation
  • Absent ejaculation
  • Skimpy ejaculation volume
  • Weak ejaculation force and arc
  • Diminished ejaculatory sensation

Ejaculatory problems often correlate with aging, weight gain, the presence of lower urinary tract symptoms and ED. The older you are, the heavier you are, the more that you are having problems with urination and obtaining/maintaining an erection, the greater the likelihood that you will also have ejaculatory problems. This is often on the basis of an age-related decline of sensory nerve function as well as weakened pelvic floor muscles. Additionally, aging reproductive glands produce less fluid and the ducts that drain genital fluids can obstruct. Furthermore, medications that are used to treat prostate enlargement can profoundly affect ejaculatory volume.

So What’s The Big Deal Anyway?

Most men do not appreciate meager, lackadaisical-quality ejaculations and orgasms. Sex is important and getting a rigid erection is vital, but the culmination—ejaculation and orgasm—is equally important. We may be 40, 50, 60 years old or older, but we still want to point and shoot like we did when we were 20 and desire to retain that intensely pleasurable feeling of yesteryear.

Delayed Ejaculation

I have previously addressed this topic:

https://healthdoc13.wordpress.com/2015/02/21/im-almost-there-what-you-need-to-know-about-delayed-ejaculation/

Absent Ejaculation

This is part of the spectrum of delayed ejaculation, except in this instance, climax is never achieved. Alternatively, it happens with surgical removal of the reproductive organs, as occurs with radical prostatectomy or radical cystectomy for prostate and bladder cancer, respectively.  It can also occur in the presence of  neuropathy, e.g., with diabetes and other neurological disorders. In these circumstances, orgasm can still be experienced, although ejaculation is absent.

Skimpy Ejaculation Volume

This is very common with aging as the reproductive organs “dry out” to some extent. It also happens with certain medications that either reduce reproductive gland secretions (Proscar, Avodart) or cause some of the ejaculate to go backwards into the urinary bladder (Flomax, Rapaflo, Uroxatral).

Weak Ejaculation Force, Arc and Sensation

What was once an intense climax with a substantial volume of semen that could be forcefully ejaculated in a arc several feet in length gives way to a lackluster experience with a small volume of semen weakly dribbled out the penis.  These issues clearly correlate with aging, weakened pelvic floor muscles and ED.

Bottom Line: In addition to sex drive issues, erectile dysfunction and premature ejaculation, there are a spectrum of other male sexual problems that are bothersome and distressing.  With aging, weight gain and weakening of the pelvic floor muscles, ejaculation and orgasm often become less spirited, with diminished volume, force and trajectory. However, there are solutions!

 To Optimize Ejaculation:

  1. Maintain a healthy lifestyle: good eating habits, healthy weight, engage in exercise, obtain adequate sleep, consume alcohol in moderation, avoid tobacco and minimize stress.
  1. Pelvic floor muscle training: Whereas a weakened BC muscle may result in semen dribbling with diminished force or trajectory, a strong BC can generate powerful contractions to forcibly ejaculate semen. Keep the BC and the other pelvic floor muscles fit through pelvic floor muscle exercises.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”: www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.

Sleep Apnea: Bad For Your Health (General, Sexual & Urinary)

February 6, 2016

Andrew Siegel MD   2/6/16

guy-32820_1280

(Thank you Pixabay for image)

This is an important topic, an issue that the medical community is just getting wind of (pardon the pun) with respect to how common a problem it is and how significant its consequences are. Obstructive sleep apnea (OSA) negatively affects all aspects of health, including sexual and urinary function. Many patients with OSA present with urological symptoms that are not genital/urinary in origin, their root cause being the OSA.  When the OSA is treated, the urological symptoms improve dramatically. 

Obstructive sleep apnea (OSA) is a chronic medical disorder that adversely affects one’s sleep, health and quality of life. It is characterized by repeated complete or partial interruptions of breathing during sleep due to mechanical obstruction of the upper airway passage. Muscle relaxation during sleeping—including those muscles that support the tongue and throat—results in the soft tissues in the throat sagging and collapsing under the force of gravity, pulling the airway closed and causing intermittent suffocation. This reduces or halts breathing and causes below-normal levels of oxygen in the blood, giving rise to insomnia and restless sleep with frequent awakenings. OSA sufferers wake up fatigued and have excessive daytime sleepiness, which correlates with an increased chance of motor vehicle accidents, “fatigue” eating and sleep deprivation-related cognitive impairment and mood disturbances.

OSA is present in about 25% of men and 10% of women in the USA. It is more prevalent with aging and with obesity.  Snoring in a loud and exaggerated fashion is typical, and snorting and gasping for air is characteristic. Other manifestations of OSA are a dry mouth and throat and abnormal daytime breathing patterns–particularly loud, shallow mouth breathing. It is not uncommon for those with OSA to have anatomical irregularities, including a thick neck, enlarged tonsils and palate and jaw abnormalities.

Obesity and OSA share much in common, both chronic diseases that give rise to serious medical issues affecting quantity and quality of life. OSA results in hypoxia (lack of oxygen supply), an unhealthy state since every cell, tissue and organ in our body depends upon oxygen to fuel proper function. A spectrum of serious medical issues can result, including headache, impaired glucose metabolism/type 2 diabetes, depression, chronic kidney disease, peripheral neuropathy, glaucoma and cardiovascular disease. OSA is detrimental to endothelial cell function, the specialized cells that line arteries, and OSA-related cardiovascular disease includes high blood pressure, heart attack, stroke, congestive heart failure, arrhythmia and atrial fibrillation. OSA increases the risk of premature mortality.

OSA is associated with urological issues including decreased sex drive, low testosterone levels, sexual dysfunction in both men and women, overactive bladder and frequent nighttime urinating (a.k.a. nocturia).

OSA and Urination

Many with OSA have urinary symptoms because of the OSA and not because of problems with their bladder, prostate, kidneys, etc. They often end up in a urologist’s office because their primary symptoms are urinary. The two most prevalent urinary issues associated with OSA are nighttime urination and overactive bladder.

Nocturnal urine production by the kidneys is based upon many factors including fluid intake as well as the production of certain hormones. The two key hormones involved are anti-diuretic hormone (ADH) and atrial natriuretic peptide (ANP). ADH is a pituitary hormone that regulates water excretion by the kidney, restricting urine production so that humans maintain their blood volume. ANP is the opposite—a diuretic that increases water excretion by the kidney, causing abundant urine production, as well as inhibiting ADH.

Here is what happens with OSA: Vigorous efforts to breathe against an obstructed airway result in negative pressures in the chest. This increases the volume of venous blood that returns to the heart, causing distension of the right heart chambers (atrium and ventricle). The heart responds to this distension as a false sign of fluid volume overload, with a hormonal response of secreting ANP. As a result of the ANP secretion, high volumes of urine are produced during sleep, resulting in sleep-disruptive nocturia. There may be as many as 6 or more nighttime awakenings to urinate. When OSA is treated it results in a significant improvement, if not complete resolution, of the sleep disruptive nocturia.

In contrast to nocturia, overactive bladder is more of a daytime issue. Its symptoms include the sudden and urgent desire to urinate (a.k.a. “gotta go”), urinating frequently, and possibly urinary leakage (urgency urinary incontinence). The cardinal symptom of OAB is urgency, the sudden and compelling desire to urinate that is difficult to postpone. Studies have shown a direct relationship between the severity of OSA and the severity of OAB symptoms.

 OSA and Sex

Sexual issues are common among men and women with OSA. Men typically experience a loss of interest in sex, low testosterone and difficulties obtaining and maintaining erections.  Women can experience a loss in sex drive and other symptoms of female sexual dysfunction.  Neurological testing of patients with OSA-related erectile dysfunction has shown an absent or impaired bulbo-cavernosus reflex, which is a measure of pelvic floor muscle response to sexual stimulation. The extent of impairment is directly proportional to the severity of the OSA. Essentially, this is peripheral neuropathy—nerve damage that negatively affects sexual function.

 Diagnosing OSA

Despite growing awareness of OSA, 90% of those with the disorder are undiagnosed and untreated. The diagnosis is made with overnight sleep studies, performed under the care of a pulmonologist, an internist who specializes in lung problems. This study records sleep stages, heart rhythm, leg movements, breathing patterns and oxygen saturations. OSA is defined as a complete cessation of airflow lasting more than 10 seconds (apneic episodes). The degree of OSA is based upon the number of episodes per hour of breathing cessation:

  • Mild OSA: 5-15 apneic episodes per hour
  • Moderate OSA: 15-30 apneic episodes per hour
  • Severe OSA: more than 30 apneic episodes per hour

As an alternative to overnight sleep studies that require an overnight stay in a sleep lab, home sleep testing machines are now available.

Treating OSA

Since many with OSA carry the burden of extra pounds–which contributes in a major way to the problem–the first-line treatment is lifestyle improvement. This includes healthy eating, weight loss, exercise, smoking cessation, etc. Additionally, alcohol and other sedative medications (that can further interfere with breathing) should be avoided. Positional therapy–avoiding the supine position and instead sleeping upright–can be helpful as well.

Continuous positive airway pressure (CPAP) is the most common and effective treatment for OSA and is considered the gold standard. This is an apparatus that maintains the airway and airflow, preventing apnea and the negative consequences of lack of oxygen. The problem with CPAP is that it is a somewhat cumbersome device that some people tolerate poorly. Alternatively, oral appliances that are fitted by a dentist can be effective, are less cumbersome than CPAP and do not require an electrical source. A procedure under investigation is the implantation of a hypoglossus nerve stimulators, which can help prevent some of the involved muscles from sagging and causing obstruction. On occasion, surgery such as uvulo-palato-pharyngoplasty performed by an ear/nose/throat surgeon is needed to help alleviate the obstructed breathing passage.

Bottom Line: OSA causes reduced levels of oxygen in the blood and therefore diminished oxygen supply to all cells in the body. Oxygen is vital for cellular function, and similar to the mechanical choking of one’s neck from OSA, so the cells, tissues and organs of the body “choke” in response to insufficient oxygen. The symptoms of OSA are due to the collateral damage from this lack of oxygen with impaired nerve and blood vessel function being particularly detrimental. Many urological issues can develop as a result of OSA, including sleep-disruptive nighttime urination, overactive bladder and altered sexual function. Fortunately, OSA is a treatable condition.

A shout-out to my friend and dentist extraordinaire who has expertise on OSA and the use of oral appliances:  Warren Boardman, DDS, Bergen County Center for Snoring, Sleep Apnea & CPAP Intolerance, 75 Chestnut Street, Ridgewood, NJ, 07450, 201-445-4808

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Author of Male Pelvic Fitness: Optimizing Sexual and Urinary Health: available in e-book (Amazon Kindle, Apple iBooks, Barnes & Noble Nook, Kobo) and paperback: www.MalePelvicFitness.com. In the works is The Kegel Fix: Recharging Female Pelvic, Sexual and Urinary Health.

Co-creator of Private Gym, a comprehensive, interactive, FDA-registered follow-along male pelvic floor muscle training program. Built upon the foundational work of Dr. Arnold Kegel, Private Gym empowers men to increase pelvic floor muscle strength, tone, power, and endurance: www.PrivateGym.com or Amazon.