54 Hopedale Street, Suite 3
Hopedale, MA 01747

Men’s Health

As one of the preeminent urologists in the Boston area, Dr. Jeffrey Steinberg is an expert in conditions affecting men’s health. Learn more below.

Enlarged Prostate/BPH
Erectile Dysfunction
Low Testosterone
Peyronie’s Disease
Male Fertility

Enlarged Prostate / BPH

The prostate is located directly beneath the bladder and in front of the rectum. Because the upper portion of the urethra passes through the prostate, if the gland becomes enlarged, it can obstruct the passage of fluid through the urethra and result in a weak stream, excessive daytime or nighttime urination, or a complete inability to urinate (retention).

Medications

After a complete evaluation, Dr. Steinberg may prescribe one or a combination of medications for most men who require treatment for an enlarged prostate. Alpha-blockers, such as tamsulsoin (Flomax®) relieve symptoms within a few weeks, but do not stop the process of prostate enlargement. 5-alpha reductase inhibitors, such as dutasteride (Avodart®) or finasteride (Proscar®), may reduce the size of an enlarged prostate, but may take 6 months or more to show any effect on symptoms.

Phosphodiesterase-5 (PDE-5) inhibitors such as tadalafil (Cialis®) may help reduce BPH symptoms. PDE-5 inhibitors are well-known medicines for erection problems and may be prescribed for patients with both BPH and ED.

GreenLight Laser Vaporization

Dr. Steinberg has been specially trained to perform GreenLightTM Laser PVP (photoselective vaporization of the prostate) for BPH. Performed on an outpatient basis, GreenLightTM uses laser light as an alternative to transurethral resection of the prostate (TURP) to precisely remove tissue.

Laser vaporization is a less invasive procedure that minimizes blood loss, so it is suitable for patients who must take medications to thin their blood to treat heart disease or other vascular conditions.

Gyrus Bipolar Vaporization (GBV)

Dr. Steinberg has been performing gyrus bipolar vaporization for over 10 years. GBV is a safer, less invasive procedure compared to TURP, which permanently treats urinary tract obstruction from an enlarged prostate.

Gyrus bipolar vaporization utilizes a small, button-shaped device inserted into the urethra through a telescope, which creates low-temperature plasma energy instead of heat to remove prostate tissue. This procedure is performed under general anesthesia on an outpatient or inpatient basis, depending upon the patient’s overall health condition.

Erectile Dysfunction (ED)

Erectile dysfunction (impotence) is the inability to get and keep an erection firm enough for sex. Having erection trouble from time to time isn't necessarily a cause for concern. If erectile dysfunction is an ongoing issue, however, it can cause stress, affect self-confidence, and contribute to relationship problems.

Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment, and a risk factor for heart disease down the road. Dr. Steinberg is an expert in the confidential evaluation and treatment of ED.

Oral Medications

After a complete evaluation, Dr. Steinberg may prescribe a customized regimen of oral medications that are extremely successful at treating erectile dysfunction for most men, including:

  • Sildenafil (Viagra®)
  • Tadalafil (Cialis®)
  • Vardenafil (Levitra®, Staxyn®)
  • Avanafil (Stendra®)

All four medications enhance the effects of nitric oxide, a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows an erection in response to sexual stimulation.

Intraurethral Medication (MUSE)

Alprostadil intraurethral (MUSE) therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. Dr. Steinberg teaches patients to use a special applicator to insert the suppository into your urethral opening. The erection usually starts within 10 minutes and lasts between 30 and 60 minutes.

Penile Injection Therapy

Several medications are commonly injected directly into the penis to achieve an erection. Dr. Steinberg may prescribe Trimix for patients, a custom-compounded medication that combines two prostaglandins (phentolamine and alprostadil) and a vasodilator medication (papaverine). These drugs increase blood flow to the penis and cause strong erections.

Dr. Steinberg teaches patients to use a fine needle to inject the medications into the base or side of your penis. Injection therapies typically produce an erection that lasts about 20 to 40 minutes. Because the needle used is very fine, pain from the injection site is usually minor.

Vacuum Erection Device (VED)

Dr. Steinberg may prescribe and teach patients to use a vacuum erection device, which is a hollow tube with a hand-powered or battery-powered pump placed over your penis. This creates a vacuum that pulls blood into your penis.

Once patients get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm and then remove the device. If it works well, the use of a VED is generally more cost-effective than filling prescriptions for medications.

Penile Implant Surgery

Dr. Steinberg is an expert at penile implant surgery. This procedure involves surgically placing devices into both sides of the penis, which consist of either inflatable or semirigid rods. Inflatable devices allow patients to control when and how long patients have an erection. The semirigid rods keep the penis firm but bendable.

Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among men who have tried and failed more conservative therapies.

Low Testosterone

Hypogonadism is a condition in which the body doesn't produce enough testosterone – the hormone that plays a key role in maintaining a man’s energy level, sex drive (libido), and erection quality.

Blood Tests

Dr. Steinberg will order the measurement of morning total and free testosterone blood levels, which can help establish the diagnosis of hypogonadism. LH and FSH are specialized blood tests that determine whether the problem arises from the testicle or from abnormal brain hormone levels.

To further clarify the cause of hypogonadism, Dr. Steinberg may order additional hormone testing such as serum prolactin, thyroid function tests, and sex hormone binding globulin levels.

Testosterone Gels

Testosterone gel is mainly used as a first-line treatment for low testosterone in men. Common testosterone gels include Androgel®, Fortesta®, and Testim®. Testosterone gel is noninvasive. It is rubbed onto the shoulders or upper arms once daily.

Testosterone gel is available in either packet or pump form and is generally clear and colorless. If testosterone levels are low, Dr. Steinberg customizes a dosage and type of testosterone gel for each patient depending upon the results before lab tests.

Testosterone Injections

Testosterone may also be given by a deep muscular injection every 2 weeks. Dr. Steinberg will instruct you or your partner on the technique of drawing up the medication and injecting it into the arm, thigh, or buttock.

As with any form of testosterone supplementation, testosterone levels, complete blood count, and prostate specific antigen levels need to be monitored on a regular basis.

Testosterone Implants

Dr. Steinberg performs testosterone implants in the form of small pellets (Testopel®), which slowly deliver testosterone over the course of 3 to 6 months. During a 15-minute office procedure, the testosterone pellets are implanted under the skin in the buttock using local anesthesia and gradually dissolve over a few months. This testosterone delivery method gives a slow, steady, and constant infusion of testosterone into the body.

Peyronie’s Disease

Dr. Steinberg is a recognized expert in treating Peyronie's disease, a condition in which scar tissue, called plaque, forms along the length of the corpora cavernosa, the erectile muscular bodies within the penis. This plaque may cause the penis to bend, making sexual intercourse difficult, painful, or occasionally impossible.

Transdermal Verapamil Gel

Dr. Steinberg may prescribe a specially compounded transdermal verapamil gel as an effective and noninvasive treatment for Peyronie’s disease. Pain typically resolves within 90 days of starting treatment and there is usually softening and remodeling of the plaque. Patients should expect to apply the medication for 9 to 12 months to complete their treatment course.

Xiaflex® Injection

Dr. Steinberg has the most experience in central Massachusetts performing Xiaflex® injections for Peyronie’s disease. Xiaflex is the only FDA-approved medication that is injected directly into the plaque to reduce bending of the penis and improve sexual function.

Xiaflex requires a series of three 15-minute office visits within 2 weeks and may be repeated for up to four cycles. Patients are instructed to perform home exercises and typically experience straightening of the penis and improved erection quality after the first couple cycles of Xiaflex.

Male Fertility

Dr. Steinberg has over 25 years of experience in the treatment of infertility and regularly collaborates with regional infertility programs in the evaluation and treatment of infertile couples.

A man should be evaluated for infertility when a couple fails to conceive after 6 months of timed intercourse. The most common causes of male infertility are related to sperm health and may include low sperm count, abnormally shaped sperm, poor sperm motility, or poor sperm quality.

Dr. Steinberg’s recommended testing may include semen analysis, a scrotal ultrasound, hormone testing, genetic tests, and if needed, testicular biopsy.

Varicocele Surgery

Varicoceles are dilated varicose veins in the spermatic cord. They may cause scrotal pain or a low sperm count and may even impair the growth of the testicle. Evaluation usually involves an ultrasound performed in the office.

Varicocele surgery is a minor outpatient procedure that involves tying off the abnormal veins through a very small incision, enabling patients to return to work and exercise within a few days of surgery.

Vasectomy

Dr. Steinberg has performed thousands of vasectomies in his career. Vasectomy, the safest form of sterilization, is a 30-minute office procedure performed under local anesthesia. Oral sedation may be prescribed, or if preferred, vasectomy may also be performed under IV sedation or general anesthesia in the hospital.

To learn more and discuss before treatment options with Dr. Steinberg, call Urology Specialists of Milford at (508) 473-6333.

Urology Specialists of Milford, LLC

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