SIUH’S REMARKABLE GAMUT OF TREATMENTS TO ADDRESS MALE SEXUAL DYSFUNCTION
BY JESSICA JONES-GORMAN • PHOTOS © AMESSÉ PHOTOGRAPHY
When Viagra was approved by the FDA in 1998 (and later Levitra and Cialis), it revolutionized the way sexual dysfunction was treated: No longer a taboo topic, the “little blue pill” was famously marketed as a viable option for men suffering from certain types of erectile dysfunction (ED). But what about the population of ED patients estimated at 30 percent in a 2014 Harvard Health Publishing article, who did not respond to this form of therapy?
Staten Island University Hospital is now offering a range of groundbreaking procedures for people in that category.
“A great deal of my patients are those who have failed primary therapies,” noted Dr. Miguel Pineda, who serves as director of male sexual dysfunction and urologic prosthetics at SIUH, which is bringing several treatment advances to borough residents. “Our minimally invasive techniques help solve issues that those traditional medicines could not fix.”
Offering injection therapy and penile prosthesis, the hospital is on the cutting edge of clinically proven techniques that are changing the way ED is treated.
“Penile injections stimulate blood flow and provide better function,” Dr. Pineda explained. “It’s an effective treatment for erectile dysfunction, but for the patient who doesn’t respond to injections, there is a treatment that surgically places an inflatable prosthetic directly inside the penis.”
While not engaged in sexual activity, he explained, the prosthetic remains flaccid and no medicine is necessary to activate it. A manual pump implanted in the scrotum fills the device after about a minute of pumping.
“The patient gets a full, rigid erection that is long-lasting and won’t deflate until the release button is pressed,” Pineda said. “The satisfaction rate of this procedure has been high 95 to 98 percent compared to the 60 to 80 percent satisfaction rate of injections and Viagra because it puts the patient back in control.”
The division of male sexual dysfunction is part of SIUH’s branch of Urology, which handles disorders of the urinary, genital, and reproductive organs. Surgeons in the department are trained in the medical and surgical correction of disorders of the adrenal gland, kidney, ureter, bladder, urethra, prostate, testes, penis and scrotum, as well as a variety of inflammatory conditions and malformations.
Minimally invasive techniques like partial kidney surgery and robotic prostatectomy that result in less trauma are the division’s specialty: By performing surgical procedures robotically through a single port or through small keyhole incisions, doctors have been able to correct many urological issues with much quicker recovery times than those associated with standard operating procedures.
“Penile prosthetics are my specialty, but here at SIUH we are also performing some revolutionary procedures for urinary incontinence,” Pineda said. “Many men experience urinary incontinence as a side-effect of radical prostatectomies performed to eliminate prostate cancer, or because of prior treatment of erectile dysfunction. They are forced to use diapers or urinary pads and experience a diminished quality of life because of the constant fear of leaking urine.”
The procedure, in which an artificial sphincter is surgically implanted around a man’s posterior urethra, involves an inflatable cuff filled with saline that provides pressure, squeezing the urethra when pumped, allowing complete bladder release.
“Again, this allows a man to be in full control, regain his confidence and comfort,” Pineda said.
A uretheral sling for men with a milder form of urinary incontinence is also offered, providing support and backing to the urethra without the pump.
Dr. Pineda, who does an average of six or seven penis implants per month, has the highest volume in the borough for these procedures.
He decided to study urology after his mother had a kidney transplant when he was in junior high school.
“I was exposed to this area of healthcare because her condition required a lot of doctor visits for dialysis, surgical evaluation, and finally transplant,” Pineda said. “I was inspired by it, and my thought process as a kid was that I could become a nephrologist and take care of my mom. But as time went on and I got into college and then med school, I started being exposed to things beyond nephrology and it changed the trajectory of my career.”
A graduate of the Weill Cornell Medical College at Cornell University, Pineda did his general surgery residency at Cornell and urology residency at Brookdale Hospital Medical Center in Brooklyn. While finishing the latter, he decided to do a fellowship in male sexual dysfunction at Johns Hopkins.
“I was still inspired by my mom to care for kidneys, but found with urology I could also take care of kidney stones and tumors along with the rest of the urinary tract,” he said. “And by specializing in sexual dysfunction, I could help another category of patients.”
Pineda was a rst-year medical student when his mother’s transplant failed. So, he donated his kidney undergoing surgery in Cornell Hospital where he was a med student.
“I had shadowed both the transplant surgeon and urologist that took my kidney out,” he recalled. “It was certainly a surreal experience, but one I was glad to participate in.”
Fourteen years after the surgery, Mrs. Pineda’s kidney function is perfect, and her son has just completed his third year at SIUH.
Other procedures Pineda performs include the UroLift and Ruzem, both minimally-invasive options for treating Benign Prostatic Hyperplasia also called prostate gland enlargement, a common condition for men as they age.
“Both procedures are offered in the office; no general anesthesia is necessary because we are not shaving the prostate, as is done in more traditional surgeries for this condition,” said Pineda. “Our younger patients between the ages of 40 and 50 are good candidates for this option because it allows them to recover without loss of sexual function and maintain good urinary ow. Older patients who might have significant medical problems are also good candidates because there is less risk involved without general anesthesia.”
e procedures have gotten many men o of chronic catheters and enabled them to return to normal activities in a reasonable amount of time. Both are just a part of the innovations currently marking his specialty.
“And there’s a lot more on the horizon,” he concluded. “It’s really exciting to be able to help people with these new and innovative techniques.”
Staten Island University Hospital | Northwell Health
Miguel Angel Pineda, MD
Department of Urology
900 South Avenue, Suite 103, Staten Island / 718.226.6461