Erectile Dysfunction (ED) - Male Urology

What is it?

Erectile dysfunction(ED), or impotence, is the persistent inability to obtain or maintain an erection firm enough for completion of sexual intercourse. It is very common, estimated to affect over 30 million men in the United States. In fact, almost 1 in 4 men over 40 years old report some degree of erectile dysfunction.

What is the cause or symptoms?

Once thought to be a psychological problem, it is now known that over 90% of cases are caused by physical problems. Common contributing factors include diabetes, high blood pressure, high cholesterol, smoking, and previous prostate surgery.

What can be done to treat ED?

Fortunately, erectile dysfunction can almost always be successfully treated. Oral drugs to treat erectile dysfunction, such as Viagra, Levitra, and Cialis, are among the most commonly prescribed drugs today. However, many patients cannot take or tolerate these drugs. In those that can, approximately 30% don't have a satisfactory response.

Many patients seen at Urologic Specialists for erectile dysfunction have already tried oral medications unsuccessfully. We can offer a range of treatment options that are successful when other treatments fail.

Non-surgical options include medicines that can be injected directly into the penis or inserted into the urethra. Vacuum erection devices pull blood into the penis to create an erection without medicine or surgery.

When these more conservative treatments are unsatisfactory, ED can be permanently cured with a simple outpatient surgical procedure, the inflatable penile prosthesis. The penile prosthesis can be placed through a single, small opening on the lower abdomen or scrotum in a procedure that takes less than 30 minutes. The device is completely concealed within the body, and is easily activated to create a rigid erection that lasts until the patient decides to deflate it. Satisfaction rates are consistently higher than with other ED treatments, over 95% in studies. In most cases, the procedure is covered by insurance, including Medicare.

Peyronie's Disease

Another urologic problem that often coexists with ED is Peyronie's disease. Peyronie's is an acquired curvature of the penis that can lead to pain with erection, diminished firmness of erection, and, when severe, can interfere with satisfactory sexual intercourse. Once thought to affect only about 1% of men, it is now believed to occur in up to 10% of men. In a small percentage of men, this condition can improve or resolve spontaneously. In severe cases requiring treatment, it can be very frustrating for patients and treating physicians alike. Most physicians will prescribe medications or recommend over the counter supplements that may theoretically improve blood flow or promote healing of the scarred tissue. In reality, little evidence exists that oral medications successfully treat Peyronie's disease. Urologic Specialists offers in-office treatments that can improve pain and curvature. When conservative treatments are not adequate, we can perform outpatient surgeries which can correct the curvature.

Low Testosterone

Hypogonadism, more commonly known as low testosterone (low T) can coexist with erectile dysfunction or on it's own. In addition to worsening erectile dysfunction, low T can lead to lack of energy, irritability, lack of interest in usual activities, and loss of sexual desire.

A simple blood test allows us to evaluate your testosterone level. Once we receive the results, we can determine if treatment is needed and which one will offer the greatest benefit. There are a number of tools available for treating low testosterone, ranging from injections to gels applied to the skin to small pellets inserted under the skin. Your urologist will prescribe the best course of treatment for you and then follow your progress.

While it has been the subject of some debate recently, testosterone therapies are considered safe, as long as they are appropriately administered and monitored. The benefits of a normal testosterone level include increased energy, increased libido, better sleep, better mood, and possibly improvements in erectile function. There is considerable evidence that those with normalized testosterone levels will see improvement in blood pressure, cholesterol, and diabetes control, when compared to men with untreated low testosterone.

Low T is a condition covered by Medicare and nearly all commercial insurance carriers meaning there should be little or no reason to pay out-of-pocket for diagnosis or treatment.

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