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Urology

Urological Conditions

Erectile Dysfunction

Treatment

Treatment for erectile dysfunction depends on its causes and its severity. They range from medication to surgery to psychotherapy.

Oral Medications

  • The most popular prescription drugs for erectile dysfunction are selective enzyme inhibitors. They are taken orally (as pills) up to once a day. They cause the smooth muscles of the penis to relax and allow blood to flow into the erectile tissue. Normally, these drugs are taken 30 minutes to 1 hour before sexual intercourse. The most commonly prescribed selective enzyme inhibitors are:
    • Sildenafil (brand name: Viagra®)
    • Vardenafil HCl (brand name: Levitra®)
    • Tadalafil (brand name: Cialis®)

    Selective enzyme inhibitors are not recommended for men taking nitrate drugs (used to treat chest pain) or alpha-blockers (used to treat high blood pressure and BPH). Tadalafil is not recommended for men who have had a heart attack or stroke within the past 6 months or who have medical conditions that make sexual activity inadvisable (such as uncontrolled high blood pressure, severe low blood pressure or liver disease, unstable angina). Also, men with kidney or liver disorders should take only limited doses of tadalafil.

    Possible side effects of selective enzyme inhibitors include headache, reddening of the face and neck (flushing), indigestion, and nasal congestion. Tadalafil may cause muscle aches and back pain. All of these side effects are mild and usually disappear on their own.

  • Yohimbine is an alpha2 adenoreceptor antagonist. It was widely used for erectile dysfunction years ago prior to Viagra and other effective PDE5 inhibitors, as patient treatment preference was for oral agents over injection or surgical therapy. It probably does not work directly on the penis, as another alpha2 antagonist injected into the penis did not cause an erection. It may work centrally on the nervous system. It has shown marginally greater effect than placebo in treating ED and now is rarely employed in the treatment of ED.

Injection Therapy

This therapy involves self-injection; you use a short, very thin needle to inject medicine directly into the base or side of your penis. Though it may be surprising, the procedure is not really painful. The most common drug used is alprostadil, a synthetic version of the hormone prostaglandin E, which helps the smooth muscles of the penis to relax and allow blood to flow into the erectile tissue. (Brand names are Caverject®, and Edex®). Another drug, phentolamine (brand name: Regitine®) is a heart medicine with similar effects recommended by some doctors to treat ED. The procedure usually takes between about 5 and 20 minutes to work. Possible side effects include bleeding from the injection, a burning sensation in the penis, dizziness, heart palpitations, and flushing, scarring or fibrous tissue forming at the injection site, and prolonged erection.

Intraurethral Therapy

This can be considered a variation of injection therapy because the same medications are used in a different form. This treatment involves using an applicator to insert a tiny suppository into the tip of your penis. The suppository usually contains the same medicine used for injection therapy, and produces the same results with the same possible side effects. Some tests suggest this method can be less effective than injection therapy.

Hormone Medications

Only a relatively small number of men have ED because of insufficient levels of sex hormones. However, for those that do, the problem is relatively easy to solve with hormone replacement medicines.

Vacuum Devices

Vacuum devices are essentially small, hand-operated pumps used to manually create an erection. You place a plastic tube over the penis and against the body to form a seal. The hand pump creates a vacuum in the tube that draws blood into your penis. When you have an adequate erection, you remove your penis from the tube and put a small, soft rubber band around the base of your penis. This keeps the blood from flowing out of your penis. These devices are easy to use and have virtually no side effects.

Penile Implants (prostheses)

There are several kinds prosthetic devices that can be implanted in the penis. The two main types are inflatable silicone or plastic tubes and semi-rigid rods (made of metal covered by silicone or polyurethane). Implanting these devices is a surgical procedure requiring anesthesia and possibly an overnight in the hospital, with all the possible side effects of any surgery.

Surgical Treatment

For men whose ED is caused by vascular blockage (blocked blood supply to the penis) because of injury to the penis, pelvic area, or other vascular problems, vascular surgery of the penis may be the solution. There are several types of surgery including:

  • Vascular reconstructive surgery: bypassing blocked veins or arteries by transferring a vein from the leg and attaching it so that it creates a path to the penis that bypasses the area of blockage

  • Venous ligation: removing or binding veins that allow blood to leak out of the penis.

Neither of these surgeries is common and they’re recommended only for men with very specific conditions.

Counseling and Psychotherapy

If your ED is caused by emotional and/or psychological issues, you owe it to yourself to get professional counseling and psychotherapy. If you’re in a long-term relationship, it can be especially helpful to attend therapy sessions with your partner. In any case, keeping your relationship close, honest, trusting and based on open and supportive communication is essential to successful therapy for ED.

More Information

For more information about erectile dysfunction, see the following websites:

American Urological Association
Men's Health Network
Urology Channel

The following organizations also offer valuable information and support:

Sexual Function Health Council
c/o American Foundation for Urological Disease
1000 Corporate Boulevard, Suite 410, Linthicum, MD 21090
Phone: 800-242-2383

Impotence Institute of America (IIA) & Impotents Anonymous
220 Pennsylvania Ave NW, Suite 292, Washington DC 20006

National Kidney and Urologic Diseases
Information Clearing House, 3 Information Way, Bethesda, MD 20892-3580
Phone: 301-654-4415

American Diabetes Association
National Center, 1660 Duke Street Alexandria, VA 22314
Phone: 800-232-3472