Other treatment methods

Zinc

Zinc is known to help prevent the conversion of testosterone to estradiol, and testosterone is essential for proper erectile function and the synthesis of sperm (testosterone deficiency is a primary contributor in many cases of erectile dysfunction). Moreover, zinc levels have been found to be significantly reduced in both chronic bacterial prostatitis (CBP) and non-bacterial prostatitis (NBP). Many doctors and nutritionalists recommend zinc for prostate or erectile problems.

Zinc is best taken in lozenge form, as in tablet form the zinc is difficult to absorb, and can irritate the stomach lining.

Penile Artery Bypass Surgery

Penile revascularization is one of the treatments that have the potential to permanently cure patients, that is, allow return of spontaneously developing erections without the necessity for any medications or internal/external devices. This procedure has undergone many refinements since its first description 1973. The specific objective of the surgery is to increase the erection (cavernosal) artery blood inflow in patients with blood flow related ED secondary to trauma. Young men, without other vascular risk factors (diabetes, high blood pressure, lipid disorders, cigarette smoking), who have ED due to pure artery blockage, represent the ideal patient population for this procedure.

All young patients with a history suggestive of trauma-associated impotence (pelvic fractures and perineal trauma) undergo routine hormonal evaluation to ensure adequate circulating levels of testosterone. The patients undergo a night-time penile erection test to rule out nerve damage or psychological ED. Finally, they undergo blood flow assessment, using either duplex Doppler ultrasound of the penis or dynamic infusion cavernosometry/cavernosography (DICC). The purpose of the investigation is to ensure that the ED is the result of a pure artery blockage. In these cases, an angiogram is performed to identify the site of the blockage and the presence of a donor and recipient artery.

A list of criteria have been developed that the patient and surgeon must meet to ensure optimum results. The criteria include: (a) patient must have strong sex drive, (b) patient must experience a consistent reduction in erectile hardness during sexual activity, (c) normal hormonal evaluation (d) normal neurologic evaluation (e) arterial insufficiency on vascular testing (f) arterial blockage located in the common penile artery or cavernosal artery (g) the presence of a donor (inferior epigastric) artery of sufficient length and (h) the surgeon must be trained in microvascular surgery. The operation that Dr. Mulhall, a fully-trained urologic microvascular surgeon, performs at the Sexual Medicine Program at The New York Presbyterian Hospital joining the dorsal artery of the penis, to the inferior epigastric artery.

The operation is generally performed in a 23-hour fashion (the patient returns home the day after surgery). Complications are minimal and include abdominal or scrotal pain/swelling and occasional temporary numbness on the top surface of the penis. Abstinence from sexual activity involving the erect penis is recommended for the first 6 weeks after the operation. In the hands of a surgeon trained to perform this procedure, this form of surgery is potentially curative for the carefully selected patient with ED. Any young male with ED that may be related to pelvic fracture, trauma to the perineum or prolonged bicycling may be a candidate for this form of surgery.

Venous Ligation Surgery

In general, the long-term benefits of venous ligation surgery have been limited, with short-term success rates cited between 30-50%. Venous leak is believed to be a manifestation of structural changes in the erectile tissue and the concept that ligation of venous channels external to the corporal body itself can remedy venous leak in a long-term fashion has little scientific basis. Venous ligation surgery is currently recognized as a purely investigational form of surgery. However, preliminary evidence supports the use of such surgery in young men with traumatic or congenital leakage from the most posterior portions of the erectile bodies, the crura.

At the Sexual Medicine Program at The New York Presbyterian Hospital, ligation of the crura is used to combat crural venous leak. No long-term data are available in a large cohort of patients and at this time this procedure is considered investigational. Prior to being considered for this procedure, young men need to undergo routine evaluation and the vascular study, DICC. If venous leak is identified to be present solely in the crura of the penis, then the patient is counseled about this form of surgery.

Suggested Reading

1 Goldstein I et al: Vascular diseases of the penis: impotence and priapism., in Pollack HM: Clinical Urography. Philadelphia, W.B. Saunders, 1990.
2 Hassan AA, et al: Long-term results of penile venous ligation for corporeal venous occlusive dysfunction. Canadian Journal of Surgery. 38: 537-41, 1995.
3 Lue TF: Penile venous surgery. Urologic Clinics of North America 16: 607-11., 1989.
4 Lue TF: Surgery for crural venous leakage. Urology. 54: 739-41., 1999.
5 Rogers RS et al.: Penile venous surgery benefits patients under 40 years of age. Journal of Urology 161: 258, 1999.
6 Wespes E et al: Venous leakage: surgical treatment of a curable cause of impotence. Journal of Urology. 133: 796-8., 1985.
7 Hatzichristou, DG et al.: Arterial bypass surgery for impotence. Current Opinion in Urology 1: 1991
8 Microvascular Arterial Bypass Surgery For Arteriogenic Erectile Dysfunction. Mulhall JP et al. In Carson et al (eds). Textbook Of Erectile Dysfunction, p309-316. ISIS Medical Media, Oxford, 1999.

Watermelon: A Natural Viagra?

Researcher Says Popular Summer Fruit May Have Viagra-Like Effect on Blood Vessels

July 1, 2008 - Men hoping for some fireworks in their love life this Fourth of July may want to skip the burgers and beer at the barbecue and eat plenty of watermelon.

Watermelon may be a natural Viagra, says a researcher. That's because the popular summer fruit is richer than experts believed in an amino acid called citrulline, which relaxes and dilates blood vessels much like Viagra and other drugs meant to treat erectile dysfunction (ED).

"We have known that watermelon has citrulline," says Bhimu Patil, PHD, director of the Fruit and Vegetable Improvement Center at Texas A&M University, College Station. Until recently, he tells WebMD, scientists thought most of the citrulline was in the watermelon rind. "Watermelon has more citrulline in the edible part than previously believed," he says.

How could watermelon be a natural Viagra? The amino acid citrulline is converted into the amino acid arginine, Patil says. "This is a precursor for nitric oxide, and the nitric oxide will help in blood vessel dilation."

So, the burning question: How much watermelon does it take?

"That is a good question," Patil says. Unfortunately, "I don't have an answer for that."

He does know that a typical 4-ounce serving of watermelon (about 10 watermelon balls) has about 150 milligrams of citrulline. But he can't say how much citrulline is needed to have Viagra-like effects.

He's hopeful that someone will pick up on his research and study the fruit's effect on penile erections.

Watermelon's Viagra-Like Effects

On hearing about the Texas finding, Irwin Goldstein, MD, editor-in-chief of The Journal of Sexual Medicine, was underwhelmed. Suggesting a man feast on watermelon to boost performance, he says, "would be the equivalent of someone dropping a beer bottle in Minneapolis, where the Mississippi River starts, and hoping to see it make an impact on someone in New Orleans."

"To say that watermelon is Viagra-like is sort of fun," says Goldstein. "But to even vaguely hope that eating watermelon will alleviate ED is misleading."

"The vast majority of Americans produce enough arginine," adds Goldstein, medical director of Alvarado Hospital Medical Center, San Diego, and clinical professor of surgery, University of California San Diego School of Medicine. "Men with ED are not deficient in arginine."

Though arginine is required to make nitric oxide, and nitric oxide is required to dilate blood vessels and have an erection, "that doesn't mean eating something that is rich in citrulline will make enough arginine that it will lead to better penile erections," Goldstein says.

Goldstein has served as a consultant for many companies that make ED drugs.

Calling watermelon a natural Viagra is "clearly premature," says Roger Clemens, DrPH, adjunct professor of pharmacology and pharmaceutical sciences, University of Southern California, Los Angeles, and a spokesman for the Institute of Food Technologists.

Clemens studied the amino acid arginine himself, researching a supplement to improve vascular flow for patients with hardening of the arteries or atherosclerosis He has since abandoned that line of research, he says.

It can require a lot of watermelon to boost blood levels of arginine, he adds. In a study published in 2007 in Nutrition, he says, volunteers who drank three 8-ounce glasses of watermelon juice daily for three weeks boosted their arginine levels by 11%.

Watermelon is low in calories and provides potassium and the phytonutrients lycopene and beta-carotene, in addition to the citrulline.

Clemens' advice on watermelon and the Fourth of July? "Put salt on it and enjoy."

Just don't expect fireworks anywhere but in the sky.

SOURCES: Bhimu Patil, PhD, director of Texas A&M University Fruit and Vegetable Improvement Center, College Station. Roger Clemens, DrPH, adjunct professor, pharmacology and pharmaceutical sciences, University of Southern California, Los Angeles; spokesman, Institute of Food Technologists. Irwin Goldstein, MD, editor-in-chief, Journal of Sexual Medicine; medical director, Alvarado Hospital Medical Center; clinical professor of surgery, University of California San Diego. Clevidence, B.A. Nutrition, March 2007; vol 23: pp 2 61-266.