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Erectile Dysfunction

Erectile Dysfunction

Erectile Dysfunction could be caused due to the following reasons:

 

  • Diabetes: Causes damage to the blood vessels and nerves that control the blood flow to the penis
  • Cardiac problems: Decrease the blood flow to the penis with blocked arteries or leaking veins causing erectile dysfunction
  • Injury/Surgery done on bladder, prostrate, colon or rectal area resulting in nerve damage and
  • spinal cord injuries
  • Medications including antidepressants as raised BP may impair blood flow to penis
  • Hormonal problems: Problems of pituitary gland and testes
  • Lifestyle including smoking, alcohol & substance abuse and lack of exercise

Diagnosis

 
Assessing Erectile Dysfunction
1.Detailed History – A thorough history of the patient is required for differential diagnosis of Organic or Psychogenic ED, the latter being treated by a psychiatrist. There are a number of validated questionnaires available to obtain information regarding a patient’s sexual function. These include the International Index of Erectile Function (IIEF) which has 15 items to assess erectile function, orgasmic function, sexual desire, intercourse satisfaction and overall satisfaction, as well as the severity of ED.
2.Sexual Health Inventory for Men (SHIM) is a five question instrument that can easily define the presence of ED. This should be followed by taking the medical and surgical history of the patient and attention should be focused on vascular, neurological, endocrinological, operative and psychological issues that may represent risk factors for sexual dysfunction.
3.Physical examination The physical examination of the patient presented with sexual dysfunction should focus on


  • Secondary sexual characteristics
  • Abdominal examination
  • Major pulse examination
  • Neurological assessment
  • External genitalia examination

4.Investigations


  • Serum Testosterone
  • Penile Doppler study

5.Evaluation of Endothelial Dysfunction

Treatment

Erectile Dysfunction Shock Wave Therapy (EDSWT) is an innovative approach to vasculogenic ED delivered by ED1000, a device that uses advanced acoustics technology. Until today, therapies for erectile dysfunction of vascular etiology would occasionally treat only the symptom but not the actual cause which is reduced blood flow in penile cavernous bodies. However, it seems that this novel therapeutic method renders feasible the treatment of the disease itself, for Shock Waves induce penile revascularization. Shock Waves are high-energy electro hydraulic waves, similar to the waves used therapeutically in many medical specialties, such as Urology, Orthopedics, Cardiology and Otorhinolaryngology. In a non-invasive way, the Andrologist uses a special probe with mirrors on the penile skin to convey shock waves to the target-site (cavernous bodies of the penis).

Unlike conventional ED treatment such as PDE5 inhibitors which may have side effects, EDSWT does not causes side-effects or systemic load on other organs and healthy tissues. The non-invasive, painless EDSWT procedure is performed during a series of brief visits to the hospital, and requires no sedation or anesthesia. Discernable improvement in the erectile function of the penis can be visible within two weeks after therapy begins. Recent clinical studies revealed that patients reported a high rate of satisfaction for more than two years after treatment – all without reliance on PDE5 inhibitors. In clinical tests, EDSWT has shown significant long-term effectiveness.
More importantly, the treatment is associated with high level of partner satisfaction.The treatment is painless and is performed on five different sites on the penile shaft and muscle attaching to the pelvis. Initially, the treatment is given twice a week for three weeks, and then there is a break for three weeks, followed by further treatment, if required. This is done in an out-patient setting. An initial consultation would be done with a doctor prior to any treatment being undertaken.

ED1000 is a non-invasive and entirely pain-free treatment that does not require any additional medication. A gentle tapping sensation may be felt during the treatment. To date, there are no reported side effects during or after the treatment and the treatment is considered to be safe. Patients are able to return to their daily routines immediately following each treatment session.

Medical Management

Oral medications: Several medications that can improve blood flow to the penis are available and this combined with sexual stimulation can help in producing a sustainable erection.

Surgical Management

Penile Prosthesis
A penile prosthesis is a surgical treatment option for men with erectile dysfunction due to either a vascular cause or a neurogenic cause or a combination of causes. A penile implant can be placed in any patient with clear medical cause for ED as most of the problems fail to resolve completely with non-surgical treatments. Sometimes a penile prosthesis is implanted to reconstruct the penis when scarring has caused penis to curve (Peyronie’s Disease) which prevents sexual intercourse.

Penile implants are either malleable or inflatable. Several companies manufacture these implants but we at Manipal Fertility use only those that are FDA approved.
Malleable Penile Implants
penile
The simplest type of penile prosthesis consists of a pair of malleable rods surgically implanted within the penis. With this type of implant the penis is always rigid, though it can be bent and can be moved in any desired position determined by the man himself. However, because it is hard, it is slightly difficult to conceal and may need stiffer innerwear. Far from normal, this was the first penile implant and has been a reliable form of treatment for ED for over 50 years now.


3-Piece Prosthesis
This implant has got 3-parts concealed within the body and is referred to as 3-piece inflatable prosthesis. Two inflatable cylinders inserted in the penis are connected to a reservoir filled with fluid implanted behind the abdominal wall. A pump is placed in the scrotum to inflate the prosthesis.The user presses on the pump in the scrotum thus transferring the fluid from the reservoir to the cylinders in the penis causing an erection. A deflation valve on the pump will allow the fluid to return to the reservoir to deflate the penis returning it to its normal flaccid state, thus not making it obvious that there is penile implant. A 2-piece implant is also available with cylinders and the combined pump with a reservoir and installing this takes a shorter duration. There is no abdominal component however, and hence, this may not result in adequate erection.

A malleable implant is generally rigid and hence difficult to conceal but with proper attire it can be concealed completely. However, inflatable implants can be completely deflated and can return the penis to its flaccid state.

When the penis is inflated, the prosthesis makes the penis rigid resulting in similar to natural erection. The implant renders one with hard rigidity and allows for normal satisfactory sexual activity. It does not change the sensation of the skin of the penis and thus allows the man to reach orgasm and ejaculation is also not affected in any way. 90-95 % of men are able to have erections after the implants and 80-90% of men are satisfied with the results.

No hobby, sport or past time is precluded due to penile implants. The penile implant does not set off security alarms at airports or guarded buildings. And patients once healed, can proceed to lead a normal active lifestyle.

Preference is for a spinal anesthesia as it dilates the penis prior to the procedure and provides for pain relief after the procedure is finished. It is also very safe and easily performed by the anesthesiologist. However, this procedure may also be performed with general or epidural anesthesia.
The procedure requires 48 hours hospitalization and the patient usually feels normal the first evening. However the patient is retained for further 24 hours to ensure complete recovery and advised rest for 3-4 days post discharge.
Diabetics Are Prone To Infection And/Or Long Healing Process. Is This Condition Troubling In The Prosthesis Procedure?
We have observed that diabetic men have fewer infections than non-diabetics though the reason is unknown. One explanation is perhaps that diabetics have decreased blood flow to the penis and therefore bleed less during surgery. Collection of blood in the cavity of the scrotum increases the risk of infection and this is less likely to occur in patients with poor circulation.

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