December 13, 2017

Erectile Dysfunction Expert Dr. Paul E. Perito Says That Erectile Dysfunction Treatments Are Discrete and Customizable to the Patient

Dr. Paul E. Perito

Dr. Paul E. Perito

In a recent interview with Interviewing Experts Blog, Dr. Paul E. Perito spoke candidly about the embarrassing side effects of erectile dysfunction and how penile implants can help.

Interviewing Experts: What type of procedure do you use when you perform a penile implant?

Dr. Paul E. Perito: The implant procedure that I have created is slightly different from ones done in the past. It’s an approach through the area just above the penis called the infrapubic area. And we call it the minimally invasive penile prosthesis, because in 10 min. the entire device can be put inside the body.

Interviewing Experts: So you can’t see anything?

Dr. Paul E. Perito: The entire implant is hidden inside the penis and scrotum. There are the cylinders that fill with saline. The pump goes inside of the scrotum. There’s a third part that I never describe because it’s inconsequential to patient, but that’s the reservoir that allows fluid to go out to the cylinders.

Interviewing Experts: So what does the implant do?

Dr. Paul E. Perito: It re-creates exactly what the patient used to have. Before, when he wanted to have sex, blood would fill the cylinders of the penis, called the corpora cavernosa. In this case saline fills the cylinders. When you want to have sex you pump the pump that is in the scrotum and it fills the cylinders.

Interviewing Experts: So it looks like a natural erection?

Dr. Paul E. Perito: These implants are the most physiologic replication of an erection. When you are done, there is a deflate mechanism and you squeeze and it allows all the fluid to go back into the reservoir.

Interviewing Experts: What does impotence do to the body; specifically to the penis?

Dr. Paul E. Perito: The one thing that you need to know is that the longer you remain impotent without treating yourself, the shorter the penis becomes. And there’s been excellent papers written where we render a guy impotent in a single day with a radical prostatectomy. You take his prostate out and he is rendered impotent in one day and then we follow his penis length in a process called the penile stretch test. A patient can lose anywhere from .5 to 5 cm every 14 months, that is one of the most reliable papers that I’ve seen.

Interviewing Experts: That is a significant loss in length.

Dr. Paul E. Perito: Yes it is. When I take patient measurements at the initial penile stretch test and I will tell them, “this is what you’ve got.”  Then I’ll push their penis up against the pubic bone and I will tell them, “If you wait another year, this is where you will be.”

Interviewing Experts: Is there way to stop the diminishing effects of erectile dysfunction?

Dr. Paul E. Perito: Truly you need to initiate some form of therapy if you are concerned about penile length as soon as erectile dysfunction occurs.

Interviewing Experts: Now are the implants one-size-fits-all?

Dr. Paul E. Perito: No they are not. They can vary considerably in size.

Interviewing Experts: So once you measure the length that is how you decide what size of implant to use?

Dr. Paul E. Perito: Intra-operatively, we measure the length with a device called a Furlow. And with every guy you give them back exactly what they have at that moment.

Interviewing Experts: Will all men retain the same length?

Dr. Paul E. Perito: I just wrote a paper that showed that 75% of men will have the same length postoperatively as they did prior to the procedure. So there is a predictive index that we can utilize.

Interviewing Experts: And this is sometimes covered by insurance?

Dr. Paul E. Perito: Medicare pays for penile implant because the penis is a functioning organ. Studies have shown that ongoing intimacy does indeed lead to a longer, healthier life.  Medicare pays for it, private insurance pays for it, and some HMOs pay for it. Often times it depends upon the cause of the impotence.

Interviewing Experts: Very informative, thank you very much.

Dr. Paul E. Perito: You are welcome.

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Dr. Paul E. Perito graduated the University Of Maryland School Of Medicine in 1988. His Coral Gables, Florida, urology center, Perito Urology, draws patients from around the globe for its innovative and updated Erectile Dysfunction treatments. Having successfully performed over 3,000 penile implants since 2005, Dr. Paul E. Perito is considered a leader in the field. His signature minimally invasive technique, The Perito Approach, has been taught to surgeons worldwide through travel and at Coral Gables Hospital, where he is Director of Urology. Dr. Paul E Perito is has participated in countless medical studies in his quest to simplify the penile implant process and make the procedure safer for his patients.

The information contained in this article is provided by Dr. Paul E. Perito for educational purposes only. It is not intended to treat or diagnose any condition.

Interview with Dr. Paul Perito: The Efficacy of Minimally Invasive Penile Implantation

Dr. Paul Perito

Dr. Paul Perito

Interviewing-Experts Blog recently had the opportunity to speak with renowned Erectile Dysfunction expert, Dr. Paul Perito, about the importance of utilizing a minimally invasive technique when performing a penile implant.

Interviewing-Experts: Good morning, Dr. Paul Perito. Thank you for speaking with us today about such an important topic.

Dr. Paul Perito: Certainly. Men’s health is a subject often ignored. I appreciate the opportunity.

Interviewing-Experts: So, please tell us a little about what makes your technique different from previous procedures.

Dr. Paul Perito: There are several key differences. I do not use a Foley catheter since I do not drain the bladder. I limit my dilatation, ensure that the reservoir is behind the transversalis fascia, use an artificial erection at the beginning of the procedure, and finally, there’s the use of a drain. My approach is infra-pubic, and as minimally invasive as possible. I think there are nuances that make it better than prior procedure techniques.

Interviewing-Experts: What kind of results have you seen from these differences?

Dr. Paul Perito: Our results have been good. Our infection rate was only .91% in the last 1,000 procedures.

Interviewing-Experts: That sounds very promising.

Dr. Paul Perito: Aside from that, there were only 2 distal urethra injuries, which were repaired primarily at the time of the procedure and two scrotal hematomas that were evacuated.

Interviewing-Experts: What do you consider the greatest measure of success for this procedure?

Dr. Paul Perito: How quickly my patients have gotten back to normal sexual function.

Interviewing-Experts: That’s certainly important.

Dr. Paul Perito: Yes, it is. 82% of patients were back to normal function within four weeks; the rest by six weeks.

Interviewing-Experts: Very interesting.

Dr. Paul Perito: These results tell me that the procedure is efficacious, expedient and safe.

Interviewing-Experts: How do you know what size to make the penis with the implant? Is there a way to gauge a patient’s natural penis size?

Dr. Paul Perito: Yes, there is. First, it’s important to know that when you render a man impotent, say with a radical prostatectomy, over the course of the next 14 months he’ll lose anywhere from .5 to 5 cm in length.  I use a penile stretch test to educate patients on what they can realistically expect postoperatively.

Interviewing-Experts: How did you conclude that the stretch test was the best predictive index for length?

Dr. Paul Perito: What I did was took 53 patients and measured their artificial erections, their penile stretch test and finally what they had at the end of the procedure. And, not surprisingly to me, the best predictive Index was the penile stretch test. So now when a patient comes into office and they want a penile implant, I’ll do the penile stretch test and tell them that 72% of the time, this is what they are going to have postoperatively, and if they don’t like that, they should probably not get a penile implant.

Interviewing-Experts: Sound advice, indeed.

Dr. Paul Perito: Additionally, since my procedure does not use a Scott retractor, the cost is reduced. My penile pack costs $72 to the hospital, and these days cutting cost is essential.

Interviewing-Experts: Absolutely. Well, Dr. Perito, we look forward to hearing more about this procedure in the future, and again thank you for taking the time out of your surgery and training schedule to speak with us today.

Dr. Paul Perito: You’re welcome.

 

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Dr. Paul Perito is a 1988 graduate of the University Of Maryland School Of Medicine. His practice, Perito Urology, is considered one of the foremost Erectile Dysfunction treatments centers in the world. Since 2005, Dr. Paul Perito has successfully performed more than 3,000 penile implants, establishing him as a leader in the field. He has streamlined the procedure, making it not only more efficient, but safer, by the development and actualization of a minimally invasive approach. Aside from contributing extensively to medical publication libraries, Dr. Paul Perito heads the training center at Perito Urology where his technique is taught to an audience of surgeons from across the globe.

The information contained in this article is provided by Dr. Paul Perito for educational purposes only. It is not intended to treat or diagnose any condition.