A Patient’s Perspective
Erectile Dysfunction (ED) is the inability to either get or keep an erection that is good enough for intercourse. ED is very common, and in fact, about 50% of men over 40 have some form of ED. Many men feel embarrassed, believing they can cope with it on their own. It’s not an easy topic for men to talk about and often times they suffer in silence. A penile implant is a permanent solution for erectile dysfunction. It allows you to be spontaneous again, and that is one of the reasons it has such a high satisfaction rate for both the man and his partner.
Nothing speaks more directly than the words of our own patients. Our patient’s story below shows that you don’t need to accept ED as part of life.
“On Oct 4, 2018 I had an inflatable penile prosthesis implant procedure at the University of Utah. My urological health care team included Dr Hotaling (surgeon) and Ariel Black (physician’s assistant). This turned out to be my health care dream team. I am writing this for two reasons 1) A small appreciation for the support and many kindnesses this group of professionals extended to me and 2) My way of providing information and support for those who are contemplating this procedure
For those who want a quick summary of my experience: Many years suffering with ED, pills and injections failing, scared to death of the IPP and the procedure. Wonderful support and caring from those above. Result: textbook surgery, very little pain (mostly from the catheter not the surgery), very fast recovery. Size, feeling and performance exceeded expectations. Bottom line: Knowing what I know now if I had to, I would sell a kidney to get this wonderful result.
I agonized about this decision. It consumed me for approximately 8 months. If there is anything I would change it would be to lessen the stress I put myself (and my wife) through. I am hoping that by writing this I can ease the stress for others. What follows is my more detailed experience.
Just visiting the Urology department can be stressful. At the urology department there is no such thing as "Private Parts" everything you have seems like it is up for examination and review, it seems that the standard urology greeting is "Hi how are you doing... drop your pants". Not being accustomed to the world of urology I found doing this with strangers stressful and a bit embarrassing. By having the same team examine and treat me there was the comfort of familiarity. I got to know and trust them and they got to understand me and my situation. I can't stress enough how important this was to me and my wife. I will be forever grateful.
I had been dealing with ED for 18 years. I am now 67 years old. Pills, PDE5 inhibitors, worked well for a number of years. My condition progressed such that the pills were no longer effective I was referred to a local urologist. I began Trimix injections. This worked for a while; however, I was slowly increasing the necessary dosages and it was time to consider the next level treatment. My urologist introduced me to the Inflatable Penile Prosthesis (IPP). To be honest I was scared to death. I thought he was crazy. How could putting this device inside me possible be a good thing. I researched the IPP and talked to my primary care physician. My research showed over and over again that the men (and their spouses) who have had this procedure were extremely happy with the result. I was encouraged to look more closely.
I was referred to Dr Hotaling and the University of Utah by my local urologist. I made an appointment with Ariel Black my PA. Miss Ariel became my access to all things medical. She is patient, caring and I never felt rushed or discouraged from asking questions. She took my history, did an exam and analyzed my condition and situation. She explained that I had two chronic and progressive diseases, Coronary Artery Disease and Type II diabetes. Both contributing to my ED. Looking forward, my condition can be expected to worsen. She explained that the male apparatus if not exercised regularly will deteriorate and shrink. Ariel took a stretch measurement. This is what I could expect after surgery.
She asked me what my goal for the IPP was, I told her that I am 67 retiring soon and pray for 10+ years of passion with my wife of 43 years. She told me I was a prime candidate for the IPP.
I had prepared some questions about the surgery and the device. She answered my questions. She recommended that I meet with the surgeon Dr. Hotaling to discuss his surgical approach and finer details of the surgery. She arranged an appointment.
At this point I fully understood my condition, the treatment options and outcomes. The IPP would provide the best outcome. Was I ready to go ahead... Not really. The IPP solution is an irreversible permanent surgical modification. I need to know more. I was not sure this was right for me. I was still afraid.
While waiting for my appointment with Dr. Hotaling, I did more research, lots of research. I reviewed the websites and techniques of the best implant surgeons in the US, I read medical journal articles, I watched hundreds of IPP surgery videos. I wanted to learn everything I could about this procedure, particularly how to get the best results with no complications.
What I learned was that the satisfaction rate was very high, the device is extremely reliable and effective. Among the men unhappy with their result, my research indicated that by far the biggest factor was the lack of skill and experience of the surgeon. This is a specialized surgery and device. My attention turned to the surgeon. While waiting for my appointment, I put together a folder of my research and a long list of detailed questions.
I first looked closely at Dr. Hotaling’s credentials, Dartmouth undergrad double major, magna cum laude, Duke medical school, then university of Washington studying under Dr Wessel a pioneer in this field. His credentials are stellar, impeccable.
My wife came with me for our first appointment with Dr. Hotaling. Another lesson learned was that my best asset facing this was an involved loving spouse. Time with the surgeon is very precious. Having her there increased the chances that we would understand and remember what he was telling us. Looking back Dr. Hotaling was very kind and patient. I had spent a lot of time researching the issues and problems associated IPP surgery. I wanted to assure myself that this surgeon was skilled, experienced and dedicated to the very best outcome for me. Dr. Hotaling does 50 or more of these a year. He uses the latest “ No touch technique”. What I remember most from that first meeting was that in our discussion of surgical complications including infection, he saw how frightened I was, he put his hand on my shoulder looked me in the eye and said “ If anything happens I will be with you every step of the way.” I believed him and was very moved.”