Melrose pharmacy sildenafil

Best wishes, Sarah Chapman [Editor] My husband (52, fit, healthy, normal sexual function before surgery) has just had a radical nerve preserving surgery and was told to start on viagra straight away.

We tried it 3 days after having the catheter, blood drain and stitches out (open surgery) and it failed.

I feel it was too soon to try after having all these tubes removed but the surgeon had stressed the importance of getting things moving again straight away. How long

should

I’m really glad that your husband has got through his surgery well.

As you say, it can seem quite early to start taking viagra so soon after a major operation.

However, there is a bit of evidence emerging (not strong as yet) that starting viagra early, or even before surgery, can help. The message is a little mixed as, from the Cochrane Review we commented on above, the concept of “penile rehabilitation” has essentially been debunked. However, it may be that starting the drug very early catches the vessel and nerve changes at just the right time. It should be emphasised that the purpose of taking viagra this early is not to give immediate erections, but rather to improve future melrose pharmacy sildenafil erections in the weeks and months to follow.

Tadalafil is probably the best PDE5 inhibitor to take for this purpose because of it’s longer half-life, but it is still rather expensive and so, as outlined above, I tend to give my patients a quarter dose (25mg) of sildenafil (viagra) daily which, when prescribed “privately”, can be paid for over the pharmacy counter and is almost as cheap as paracetamol. I have not been part of any survey and had my prostate removed one year ago using the Da Vinci robot. I am still clear with no follow up radiation or hormone treatment.

After not getting on with muse or the cream variant of the same drug I took it upon myself to buy some Viagra over the counter as I had seen some evidence of activity.

To cut a long story short the Viagra helped but I didn’t get a full erection.

I told my post surgical team and they are now trying me on Cialis.

Most recently I have tried the 20mg dose less frequently melrose pharmacy sildenafil and results within a few hours seem further improved. Mr Lamb, it’s very impressive that you’ve attended Mani Menon’s recent presentation at AUA19 on 5 May of the Menon Precision Prostatectomy technique, aimed at reducing ED. Plainly, one should not just MRI the area of the PZ to be left in situ, but also biopsy it too.

Yes, there is a risk that the sliver of PZ which is left in situ may generate CaP.

But in any event, even if you did a full RARP, traditional or Retzius-sparing, my understanding is that the patient will still be taking some risk of biochemical reoccurrence in some circumstances, even if there are “clear” margins at the finish of the operation. It seems to me that it is for the patient to choose what level of risk he’d prefer – and whether he’s willing to take some CaP risk to have a better chance of continued normal erectile function, given that he is, as I understand it, already taking at least some risk of biochemical reoccurrence anyway.

So it seems to me that surgeons, in principle, ought to be prepared to have the technical capacity to “do it the patient’s way” provided that the patient understands and signs up to any extra risk, rather than the surgeon saying ab initio that no sliver at all of PZ can be left and imposing a decision on the patient of greater ED risk when the patient might prefer a better chance of erectile function and be willing to tradeoff some CaP risk, at least if it is found that there is negative MRI report AND a negative biopsy in the area. Someone needs spend a little time with Menon in the USA and bring the learning over the Atlantic because there are lots of men who’d prefer to have this chance if MPPs can be done in a way that makes sense.

yes it does work, viagra should be first consulted by the doctor in this case before consumption.

Mr Lamb, What do you think of the Menon precision prostatectomy technique described by Dr Mani Menon in the link below: early results on the first 50 patients are said to yield a much higher recovery of erectile function (said to be about 95%) compared to the usual robot assisted radical prostatectomy, whether retzius sparing or traditional?

Of course, one could not apply the MPP technique to every case (eg where cancer has invaded the cap of the prostate); but one would think that there must be a significant subset of patients for whom Dr Menon’s suggested technique may reasonably be considered.

Early days yet in relation to proof of this new technique, of course, but looks promising. http://manimenon.com/menon-precision-prostatectomy/ Thank you for your comment Ian. Mani Menon is a legend in our field and I want to learn everything I can from him! However, I do have reservations about his proposed technique, just as I have reservations about any focal therapy in prostate cancer. We know that approx 70% of prostate cancer occurs in the “peripheral zone” of the prostate – the “cap” you refer to in your comment.

And this is precisely the zone that Dr Menon chooses to leave behind.

We also know that up to 30% of negative MRI scans/prostate biopsies actually harbour clinically significant prostate cancer. I am concerned about doing an operation which, by it’s nature, precludes further radical surgery, but which involves the very real possibility of leaving behind prostate tissue harbouring lethal prostate cancer. Until we can precisely determine the presence or absence of small quantities of lethal prostate cancer cells at diagnosis I will not be offering these treatments to my patients. Instead I think we should put our efforts and fundraising into basic scientific endeavour to identify such “lethal clones” in the prostate (http://www.nds.ox.ac.uk/team/alastair-lamb).

I am also very encouraged by the potential of “retzius-sparing” prostatectomy techniques, using both posterior and anterior approaches, early results of which seem to offer very promising erectile function and continence results without compromising radical treatment (several abstracts to be presented this year at EAU19 and AUA19 https://eaucongress.uroweb.org/scientific-programme/.

It’s also available as PRN does of 10mg and 20mg as well as daily doses of 2.5mg and 5mg. The long half-life isn’t the reason it’s given daily! Erectile dysfunction (ED) is a common problem amongst men who have diabetes affecting 35-75% of male diabetics. Up to 75% of men suffering from diabetes will experience some degree of erectile dysfunction (erection problems) over the course of their lifetime. Men who have diabetes are thought to develop erectile dysfunction between 10 and 15 years earlier than men who do not suffer from the disease. Over the age of 70, there is a 95% likelihood of facing difficulties with erectile function. What causes erectile dysfunction amongst diabetics? Causes of ED are extremely complex, and are based around changes that occur to the body over time affecting nerve, muscle and blood vessel functions.

In order to obtain an erection, men need to have healthy blood vessels, nerves, male hormones and a desire to have sex.

Without blood vessels and nerves that control erection, ED can still occur despite a desire to have sex and normal male hormones. Many other factors bear on erectile dysfunction amongst diabetic men.

Being overweight Smoking Taking too little exercise and other lifestyle factors. Surgery can damage nerves and arteries linked to the penis, as can some injuries. Many common medications (including antidepressants and blood pressure drugs) can produce ED. Psychological factors also have an enormous influence. Anxiety, guilt, depression, low self-esteem and paranoia about sexual failure are estimated to cause between 10% and 20% of ED cases.

Erectile dysfunction is diagnosed using several different methods. Patient history often informs the degree and nature of the ED.

Medical and sexual past often has an influence, as does prescription or illegal drug use. ED patients may be physically examined, and bodily features can give clues to the cause. Laboratory tests can also be key for diagnosing ED. Further tests such as monitoring nocturnal erection (nocturnal penile tumescence) can help to cancel some causes out. Furthermore, psychological examination can reveal psychological factors. Are there treatments for men with diabetes and erectile dysfunction?

Men who have diabetes and are

having

Further treatment such as surgery and vacuum devices may also have a role to play in some specific cases. Additional treatments include vacuum constriction devices, intraurethral alprostadil suppository or intracavernous injection therapy and sex therapy.

Vacuum pumps consist of a plastic tube, in which you place your penis. The pump, which may be battery or hand pump operated, creates a vacuum that will draw blood into the penis making it erect.

A rubber ring will need to placed around the bottom of the penis to keep it erect.

A vacuum pump is not for use if you have a bleeding disorder or take anticoagulants.

Alprostadil is a form of hormone medication that stimulates blood flow to penis, and may be given by two different methods: Intracavernosal injection – whereby alprostadil is given by injection into the penis Intraurethral application – whereby a pellet (1.6mm diameter and 6mm length) of alprostadil is inserted into the urethra via a urethral stick.

Alprostadil may be prescribed if you do not respond to other treatments, or you are unwilling to try oral medications or vacuum pump therapy. Your health team may provide training on how to inject or insert alprostadil. The most suitable treatment will depend on the health of the patient and their own ability to tolerate the treatment. Specialists such as urologists can work with individual cases and determine the best treatment. What is the future of diabetes and erectile dysfunction? Better medications, implants, vacuum devices and suppositories have all increased options for diabetic men with ED. Gene therapy is not being tested, and at some point may offer a permanent therapeutic approach to tackling diabetes and erectile dysfunction.

Erectile Dysfunction: Best Options Beyond Medication, Lifestyle Changes. Most men who experience erectile dysfunction (ED) can achieve stimulation through oral medications like Viagra®, Levitra® and Cialis®.

Lifestyle changes can also help remedy the problem. They may quit smoking or lose weight, or undergo psychotherapy. Cleveland Clinic is a non-profit academic medical center. We do not endorse non-Cleveland Clinic products or services.

While these are the most common methods, they may not work for everyone.

For example, male heart patients who take coronary vasodilators (to help open up coronary arteries) should not take medication for ED in the first place because both types of medications lower the blood pressure, and in combination, they lower the blood pressure too much, according to urologist Drogo “Karl” Montague, MD. Fortunately for these men, there are a few other options, each with its own pros and cons.

The choice generally comes down to personal preference, he says.

“We do see an increased percent of ED as men age, but it’s due to age-related disorders, and a lot of those disorders are based on lifestyle,” he says. “ED may also be the result of a relationship disturbance or death in the family.

When you have sudden onset of ED with somebody who has something [emotionally upsetting] going on in his life, it may well be related.” He recommends three other options for ED when medication or lifestyle changes do not solve the problem: 1. Some men use a vacuum device into which they insert their penis: They grease the tube, lower a rubber ring and squeeze a pump that creates a vacuum inside the chamber. With the rubber ring in place for 30 minutes, men often are then able to have sex, Dr. Some find it too mechanical, and it has a “hassle factor,” he says, and the device also can be uncomfortable and/or impede ejaculation.

Other men opt for a penile injection, using a diabetic’s syringe and needle. The injected medication dilates the arteries and increases blood flow every time they want to have sex.

The needle is small, so the injection is not terribly painful, but the treatment can be expensive, Dr. “If the erection starts to become curved, we need to know,” he adds. “If the erection doesn’t go down after two hours, you need to come in for a reversal. Those who would prefer not to use either of these first two options can turn to a surgical procedure.

The surgeon inserts two cigar-shaped cylinders filled with saline attached to a small pump between the testicles and places a saline-filled reservoir inside the abdominal muscles.

None of this is visible from the outside, although you can feel the pump from the outside of the scrotum. Squeezing that pump causes the saline to fill the cylinders, which simulates blood flow into the penis and causes “something close to a normal erection,” says Dr. “The head of the penis doesn’t fill up, but otherwise it’s the same,” he says.

“Each time the man pumps it up, it gets fully firm.

But it gets firm, stays firm, and he doesn’t have to worry about losing the erection.

It doesn’t go down until he withdraws and presses a relief valve.” The downside of implants is a 2 percent chance of infection, which requires removal of the device, and a 6 percent chance of the device failing within five years (and 19 percent within 10 years), Dr. “The attractive thing about an implant is that it’s part of your body,” he says.

“If you go on vacation, you don’t have to remember to take syringes or medications. It’s MRI safe, and it doesn’t set off any detectors at the airport. You can have sex whenever you want, at no cost per use, with the same response every time.” Surgical implants are typically not a man’s first choice, he adds, but men rate them most highly of all options in satisfaction surveys.

A man’s wife or significant other typically is supportive of a patient with erectile dysfunction, in the sense that partners typically say, “Honey, it’s OK. But he encourages partners to mention that it’s a common problem and that there are straightforward solutions that a man can discuss with his urologist.

“She should encourage him to mention this to the doctor as part of his annual checkup,” he says.

If a man has a problem in this area, he will invariably get referred to a urologist. If they fail, then they go to a urologist who specializes in erectile dysfunction.” Cleveland Clinic is a non-profit academic medical center. We do not endorse non-Cleveland Clinic products or services. Can Viagra, testosterone, or other drugs really restore your love life? But the reverse is true, too: Good sex may help keep you healthy.

"A satisfying sex life can foster good emotional health, which in turn can promote good physical health," says Julia Heiman, Ph.D., director of The Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University.

Moreover, sex itself may have direct health benefits.

For example, orgasm or any loving touch may cause the body to release substances that ease pain, bolster immunity, or elevate mood long after the immediate pleasure passes. Indeed, people who have strong, intimate relationships tend to have fewer chronic diseases and to live longer, some research suggests.

So there can be good reasons beyond just pleasure to address any significant loss of sexual appetite or activity, regardless of your age. The introduction of sildenafil ( Viagra ) a decade ago has graphically demonstrated that some sexual problems can be eased.

But it has also fed the misconception that every sexual difficulty can—and should—be cured by popping a pill.

More and more doctors, with little supporting evidence, are now prescribing sildenafil and related drugs not only to men but women too, as well as the hormone testosterone, in an effort to boost libido. And many consumers are buying DHEA (see caution) a potent hormone sold as a dietary supplement that the body converts to both testosterone and estrogen, with hopes of improving their sex drive and performance.

However, psychological issues, not physical ones, are usually the major culprits in the two most common sexual problems—lack of desire in women and premature ejaculation in men. Even with largely physical problems, such as vaginal dryness or erectile difficulties, certain nondrug steps may be worth trying.

Furthermore, not everyone who experiences changes in sexual desire and function as they age is bothered by those changes, and shouldn't be made to feel either abnormal or in need of a cure. This report will help you talk intelligently with your doctor about when sex-enhancing drugs may be appropriate and when other steps-including leaving well enough alone-are enough.

Despite the increasing use of testosterone to stoke waning sexual desire, our consultants say that it's rarely worthwhile, for several reasons.

There is little or no correlation between libido, sexual performance, and the normal age-related decline in testosterone. There's little evidence of the therapy's long-term efficacy and safety.

And many other factors—from stress and lack of sleep to changed feelings about a partner—can contribute to decreased sex drive. When low testosterone levels are well below normal, sexuality and performance may be affected.

But those declines often stem from correctable health problems, notably pituitary or testicular disorders.

Even when those causes have been ruled out, taking testosterone is still a gamble. In men, while it can boost libido in those who have clearly low levels, side effects include breast enlargement and decreased sperm production.

And it may speed the growth of prostate cancer and increase the risk of blood clots.

In women, some research suggests that restoring testosterone to a high normal level can increase sexual desire, at least temporarily.

But it can also cause hair growth and acne, and may raise the risk of breast cancer. And other possible risks are largely unknown because of lack of long-term studies. Moreover, the only testosterone product (EstraTest) approved for women in this country uses a combination that can reduce HDL (good) cholesterol.

And while some doctors and pharmacists now compound special testosterone formulations for women, or use creams or gels intended for men, the safety and efficacy of such products or such use is even less well understood. The reservations about testosterone apply doubly to DHEA, which is still allowed to be sold as a melrose pharmacy sildenafil dietary supplement. That's because there's even less evidence of its safety and benefits and because it may increase both estrogen and testosterone levels. Further, dietary supplements are largely unregulated, so you don't know if what's on the label is in the bottle. And your use of this potentially potent hormone is unlikely to be monitored by a physician. What to do : Our consultants advise avoiding DHEA entirely, and taking testosterone only after evaluation by an endocrinologist, a specialist in hormone therapy.

(See "Testosterone Treatment in Men and Women," below).

Other measures—treating underlying disorders, adjusting drug dosages, reducing stress, or addressing problems in your relationship with your partner, with a therapist's help if necessary—should generally be tried first.

The therapist could be a traditional one, a marriage counselor, or a sex therapist who focuses on negative sexual attitudes or beliefs.

And remember that a lack of sexual desire is only a problem if you think it is.

A recent study published in the November 2008 issue of Obstetrics & Gynecology found, for example, that while 43 percent of women report sexual problems, most commonly reduced libido, only about 12 percent were actually bothered by it. Testosterone treatment in men and women Despite its increasing use, testosterone melrose pharmacy sildenafil should be prescribed only in very limited circumstances, described below.

Men Women Comments Consider testosterone replacement therapy if… You have signs of testosterone deficiency, notably bothersome decline in libido and potency, enlarged breasts, loss of body or facial hair, or osteoporosis, particularly before age 65.

AND Other causes of low testosterone or the associated problems have been ruled out or addressed.

AND You understand that long-term risks, especially for men with moderately low levels, are largely unknown. You have bothersome decline in libido starting after ovary removal or possibly after menopause. AND Other causes of low testosterone or reduced libido have been ruled out or addressed.