Get Treatment For Erectile Dysfunction

Erectile dysfunction (ED) also known as impotence is the persistent disability to get an erection which is sufficient enough to have sexual intercourse or inability to maintain an erection till the end of the sexual intercourse. Treating an underlying cause at the right time will reverse the erectile dysfunction.

Surgical Procedures Performed at Cedars-Sinai Marina del Rey Hospital for Erectile Dysfunction

Surgical treatment for erectile dysfunction will be chosen only if other medications are ineffective. Surgery is the last option and used in the most severe conditions. The recovery time differs and the success rates are high.

Surgical options to treat erectile dysfunction include the following:

• Penile Implants - semirigid or malleable rod implants, noninflatable & inflatable implants
• Artery Repair Surgery for Erectile Dysfunction - vascular reconstructive surgery

Each procedure has its own advantages as well as drawbacks.

Penile Implants

As much as 9 in 10 men derive satisfaction with this procedure and it is permanent. Men who are candidates for implant surgery include:

• patients who have undergone radical prostatectomy
• men with diabetes which may permanently damage the blood vessels of the penis
• men with structural problems
• individuals who have failed with the use of other less invasive procedures

There are 2 types of penile implants: inflatable and non-inflatable.

Inflatable: it has 2 rods and it would be filled with a fluid from a reservoir located near the bladder and a pump is placed in the scrotum. After the rods get filled with fluid, the erection of the penis is achieved. The main advantage of this type of implant is that when the rods have no fluid, it will fully deflate the penis and makes the implant unnoticeable. Generally, it remains functional for around 7-10 years. There are 2 types of inflatable implants:

• fully inflatable implant
• self-contained inflatable implant

Fully Inflatable Implants

Advantages of a fully inflatable implant include:

• resembles the natural process of rigidity-flaccidity
• the state of erection can be controlled by the user
• no concealment problems and looks natural
• the width of the penis is increased when activated
• the success rate is 70-80%
• highly effective

Disadvantages of a fully inflatable implant include:

• high rate of mechanical failure
• risk of infection is increased
• most expensive implant
• may injure or alter permanently erection bodies

Self-contained Inflatable Unitary Implants

Advantages of a self-contained inflatable implant are:

• similar to the natural process of rigidity-flaccidity
• the state of erection can be controlled by the user
• no concealment problems and natural appearance
• simpler surgery
• success rate is 70-80%
• highly effective

Disadvantages of a self-contained inflatable unitary implant include:

• activation becomes sometimes difficult in this type of implant
• it does not increase the width of the penis
• mechanical breakdowns are possible
• risk of infection
• relatively expensive
• injures or permanently alters erection bodies

Non-inflatable (semirigid or malleable)

These implants are improving and becoming more reliable. The life period of these implants is about 10 years, maximum life period is 25 years. In both cases, an incision is made under the penis where the penis and scrotum meet. A pump is placed near the scrotum (right or left side) in an inflatable implant.

Advantages of malleable rod implants are:

• simple surgery
• relatively few complications
• least expensive implant
• 70-80% success rate
• highly effective

The major disadvantages of malleable rod implants are:

• cosmetic appearance of the penis
• the implantation of the device causes the destruction of the natural mechanism of the penis
• more risk of infection
• possibility to have pain or erode through the skin
• constant erection
• doesn’t increase the penis width

Artery Repair Surgery for Erectile Dysfunction

In healthy men who have blood vessel damage due to pelvic injury, erectile dysfunction can be corrected with the artery repair surgery by bypass method. The vascular reconstructive surgical procedure improves blood flow and it bypasses the blocked arteries or veins.

Advantages of artery repair surgery:

• natural in appearance
• when the procedure is successful it restores natural appearance
• no implant required

Disadvantages of artery repair surgery are:

• technically difficult surgery
• scar tissue formation with distortion of the penis, risk of infections and painful erections
• may cause shortening or numbness of the penis
• it is very expensive and has high relapse rate
• long-term effect of this surgery is only 2 years or less

Drugs and Other Treatment Needed for Erectile Dysfunction

Medications »

Alprostadil Self-injection »

Testosterone Replacement »

Vacuum Device »

Symptoms of Erectile Dysfunction

The symptoms of erectile dysfunction include:

• Inability to obtain penile erection
• Penile erection that is not hard enough for penetration
• Reduced sexual desire

Diagnosis of Erectile Dysfunction

• Physical examination
• Rectal examination - to evaluate your prostate gland
• Nocturnal penile tumescence (NPT) test - an NPT test done by a portable, battery-powered device which the patient has to wear on the thigh while sleeping and it evaluates nocturnal erection quality. This data is stored and is accessed by the doctor.
• Urine tests (urinalysis) - these are done to check for signs of diabetes and high protein in urine which is the sign of kidney damage and can cause erectile problems
• Lipid profile - high levels of LDL cholesterol can lead to atherosclerosis
• Ultrasound - a wand-like a device (transducer) is held over the blood vessels that supply the penis to check for blood flow problems and sometimes injection is given at the same time to activate blood flow and induce an erection
• Psychological exam -  many questions are asked to screen for depression and other possible psychological causes of erectile dysfunction
• Serum creatinine - an abnormal serum creatinine is the result of kidney damage
• Liver enzymes and liver function tests - in some men, liver enzyme test is done to detect liver disease (cirrhosis) which can cause low testosterone leading to ED
• Total testosterone levels - blood samples for total testosterone levels are checked in the early morning
• Other hormone levels - luteinizing hormone, prolactin level, and cortisol level will give clues to other underlying causes of testosterone deficiency and erectile problems, like pituitary disease or adrenal gland abnormalities
• PSA levels - prostate-specific antigen levels and prostate examinations are done to rule out prostate cancer before starting testosterone treatment because testosterone can aggravate prostate cancer

Risk Factors for Erectile Dysfunction

Various risk factors can contribute to erectile dysfunction, including:

• medical conditions such as heart conditions, diabetes
• obesity
• some medical treatments such as radiation treatment for prostate cancer
• tobacco use can restrict blood flow to arteries and veins which in over a period of time can lead to erectile dysfunction
• trauma which may cause damage to the arteries or nerves that control erections
• medications such as antidepressants, antihypertensives, medicines used for prostate conditions
• drug and alcohol use especially long-term consumption

Causes of Erectile Dysfunction

There are many possible causes for ED including:

• hypertension
• diabetes
• cardiovascular disease
• damage from cancer or surgery
• hyperlipidemia
• injuries
• stress
• age
• obesity
• anxiety
• relationship problems
• alcohol consumption
• drug use
• smoking

Herbal Remedies: these herbs and supplements have been shown to have different degrees of success for the treating ED:

• L-arginine
• DHEA
• Yohimbe
• Ginseng
• Asparagus racemosus

Acupuncture: studies on acupuncture are limited and inconclusive. It may help in treating psychological ED. While selecting an acupuncturist, look for a certified practitioner who follows U.S. Food and Drug Administration guidelines.

If a person reduces the chances of developing heart disease, diabetes, and hypertension, it will, in turn, reduce the chances of developing ED. A healthy diet, quitting smoking, exercising daily also decrease the possibility of developing ED.

Are you suffering from erectile dysfunction? For any questions, information or guidance related to erectile dysfunction treatment, get in touch with our specialty-trained physicians at Cedars-Sinai Marina del Rey Hospital.