Urologist treats ED due to blockages

Dear Dr. Roach: Some months ago, you wrote that the blood flow to the penis could be reduced by blockages in the arteries. What kind of doctor should a guy go to, and what tests should be asked for?

Answer:

J.

Low blood flow to the penis is one common cause of erectile dysfunction. Without adequate blood to the arteries supplying the penis, an adequate erection may not be possible.

It is unusual that those arteries are the only ones blocked. Men with ED should be have an evaluation for other arterial blockages, such as to the legs, heart or brain.

Although family doctors, internists and cardiologists all do evaluation for arterial disease, a urologist who specializes in erectile dysfunction may have additional tools available.

Dear Dr. Roach:

I was discharged from the Army with an epigastric hernia. Recently I was examined and told that my hernia could be fixed by surgery. I’m concerned because I had a heart attack a few years ago and had four blocked arteries. I feel that at age 82, surgery is too dangerous.

My cardiologist recommended against surgery. Should I get surgery?

A.H.

Answer: A hernia is a defect in the abdominal wall, with the possibility that the abdominal contents, such as bowel, could come through the opening.

Although surgery is typically lower risk, any surgery has risks, and because of your history of heart attack and known blockages, your risk is higher than an average 82-year-old’s.

The fact that your cardiologist is recommending against this should be taken very seriously.

In absence of symptoms, or with very mild symptoms, I would not recommend surgery for a person in your situation. The risk of complications from an epigastric hernia is small. The most dangerous complication is a loop of bowel coming through the hernia opening and getting stuck or worse yet, losing its blood supply. These are surgical emergencies, and happen in 2%-3% of people every year.