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Health & Body

Erectile Dysfunction

Treatment of Erectile Dysfunction

Erectile Dysfunction Explained

Erectile Dysfunction is seen in 1 in 4 men in the United States and is especially common in men with heart disease, diabetes, and prostate cancer.  In fact, erectile dysfunction can occur in 15-90% of patients who have undergone prostate cancer treatment. Erectile dysfunction following treatment of prostate cancer can be due to neuropraxia (stunning of the nerves from prostate cancer treatment) and arterial insufficiency (poor blood flow to the penis).

Prolonged lack of erections and penile blood flow can result in scarring of the erectile bodies within the penis leading to loss of penile length and girth as well as an end stage erectile dysfunction called Veno-Occlusive Disease.

Diagnosis and Early treatment of Erectile Dysfunction

1

PDE5 Inhibitors (Oral Medications):

  • Early stages of erectile dysfunction are typically treated with PDE5 inhibitors such as Viagra, Cialis, Levitra and Stendra. Oral medications for ED increase nitric oxide, thus increasing blood flow into the penis. Side effects of these medications include temporary blurry vision, heart burn, muscle aches, nasal congestion, and headaches. These medications should not be taken if you use nitrates or “poppers” for chest pain.

2

Freedom+™ Treatment for ED due to pelvic floor weakness

  • Functional Magnetic Stimulation (FMS™), Enabling Fast And Easy Strengthening Of The Pelvic Floor Muscles Without Effort.
  • Stimulates powerful supramaximal contractions delivering the equivalent of up to 25,000 Kegels in a treatment of the entire pelvic floor musculature.
Learn More

3

Daily Use of a Vacuum Erection Device and/or a PDE5 Inhibitor

  • For patients who recently underwent prostate surgery or who are concerned about lack of consistent blood flow in their penis, we often times recommend daily PDE5 inhibitor and/or Vacuum Erection Device use. This is to reduce scarring that can occur from a consistent lack of erections or lack of penile stimulation.
  • Vacuum erection devices can be used with a constriction ring or clamp to help prolong erections for penetration.

4

Penile Doppler Ultrasound

  • Ultrasound of the penis is a non-invasive diagnostic test that allows your Urologist to assess your blood flow patterns and cause of erectile dysfunction. It may involve one to two small injection(s) on the penis to trigger an erection and better assess your erection patterns.
  • This diagnostic test allows your urologist to assess if you are a candidate for other treatments outside of just oral medications.

Advanced treatments for Non-responsive Erectile Dysfunction

1

Intraurethral Gels or Pellets (Muse)

  • These gels are injected into the urethra.
  • These gels are excellent adjuncts to PDE5 inhibitors for patients that
    respond only moderately to the medications or have shown a strong.
    response to the injection given in clinic.
  • Associated side effects include urethral burning, penile pain,
    and priapism (erection lasting >3-4 hours) that could require a trip to the emergency room for reversal.

2

Intracavernosal (Penile) Injections

  • These are injections that can be given in the penis to induce
    an erection.
  • Patients usually undergo a trial of injection at the time of
    penile ultrasound to help your doctor get the dosing just right.
  • These injections can be used 10-15 minutes prior to intercourse.

3

Penile Implant Surgery

  • This is often considered the gold standard for men who do not respond to penile injections.
  • This treatment is usually covered by insurance.
  • This is a 30-45 minute outpatient surgery that involves placement
    of either bendable rods (malleable penile implant) or an inflatable
    device (inflatable penile implant) that will allow you to have
    intercourse whenever you want.
  • This treatment does not impact sensation, orgasm, or ejaculation.
  • While penile implant surgery may result in penile length loss, it is more often the case that patients who have had ED for an extended period of time are already experiencing length loss. (A Vacuum erection device can be used daily to try to reverse this “disuse atrophy” prior to surgery).
  • Dr. Shah is able to offer length restoration options at the time of penile implant surgery. 
  • Data shows 94-98% of patients are satisfied with their penile implant.