Use the links below to find information relating to various urological procedures.
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Many men have micro-plaque in their penises without realizing it. Contact sports, other athletic activity, and vigorous sex can cause the formation of micro-plaque. As a man accumulates micro-plaque over time, he can develop conditions like Peyronie’s disease, which can cause erectile dysfunction. Peyronie’s disease leads to painful curvature of the penis that can make sex impossible or unenjoyable. GAINSWave® therapy breaks down micro-plaque to treat or prevent Peyronie’s disease.
Pelvic Floor Rehabilitation(PFR) is a therapy to reinforce your pelvic floor muscles which play a significant role in sustaining an erection. The experienced pelvic floor therapist, with the help of specialized equipment, ensures stronger muscles especially ischiocavernosus and bulbospongiosus. These muscles lead to stronger erections and better ejaculations with the increase in Ejaculatory time.
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All of this is available to ensure a proper diagnosis of your ED. It allows your ED specialist to customize a treatment specifically for you!
Start by lying on your back, hands flat on the floor, and knees comfortably bent and pointing upwards.Try to draw your penis inwards towards your body and hold for five seconds, then release.Now squeeze your anus muscles as if you are trying to stop a bowel movement and hold for five seconds, then release.Repeat steps two and three, eight to 10 times, and do three to five sets.
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The authors stated that this was the first study evaluating serum melatonin level as a causative factor in this patient group. A low serum melatonin level may result in an inadequate erection by preventing sufficient antioxidant capacity. There is a need for additional studies to determine the exact role of melatonin deficiency in ED patients. The drawbacks of this study were the absence of Doppler ultrasound findings, the lack of a treatment group and follow-up data on melatonin levels and the small sample size (n = 62). They stated that future studies may evaluate the association or a possible correlation between serum melatonin levels and Doppler ultrasound parameters of erectile function. Pelvic Floor Muscle Training for Erectile Dysfunction Following Radical Prostatectomy Use of Serum Homocysteine Levels as Biomarkers for the Development and/or Progression of Erectile Dysfunction
People with erectile dysfunction (ED) have difficulty getting and/or keeping an erection. The difficulty may be constant or occasional. While ED is sometimes called “impotence,” healthcare professionals have increasingly moved away from a term that can be perceived as pejorative or confused with nonmedical definitions of the word.
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The successful treatment of erectile dysfunction (impotence) has been demonstrated to improve couple intimacy, improve sexual satisfaction, improve male self-esteem, and overall quality of life. In some men, it may also relieve symptoms of depression.
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Recent stroke or heart attackSevere heart disease, such as unstable angina or irregular heartbeat (arrhythmia)Severe heart failureUncontrolled high blood pressureUncontrolled diabetesVery low blood pressure
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4. Extend the time. Gradually increase the length of contractions and relaxations. Work your way up from three to five seconds, to 10.
These changes can be very difficult to deal with because for most men sexuality and erection remain important throughout their whole life. You may even go into denial or suffer from depression. That is why the effect of ED on your quality of life should not be underestimated.
Gerbild agrees, but stands by the recommendation as a goal for people looking to improve erectile function.
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Most effective form (Trimix) not covered by most insurance plans and may be quite expensive
Pull up on your pelvic floor. In order to do so, think of pulling in your genitals and lifting them up. Hold the muscles taut for five seconds before releasing for five. Try to perform ten repetitions several times a day.
A penile implant is a device that is placed into a man’s body and is designed to help him get an erection. It is an alternative long-term treatment, that is covered by many insurance plans, which allows an erection as often as you like, for as long as you wish. Appointments and Referrals
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Some men have occasional trouble getting or keeping an erection, which can be considered normal.
Pelvic area muscles are the ones that help in increasing the blood flow to the groin and helps in maintaining erections. Strengthening the muscles with pelvic floor exercises can actually improve sexual functioning like erections, ejaculations, and orgasm.
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PDE5 inhibitors have not been studied in individuals with a condition, retinitis pigmentosa, and thus their use is not recommended for these individuals.
According to a survey taken by a hospital, about 5% of males that are more than 40 years of age have complete ED, and this percentage increases gradually up to 15 percent when the age reaches 70. And not only Erectile Dysfunction but the risk of other sexual problems also increases as the age of a man increases.
The best-suited treatment can be advised by the doctor after a thorough diagnosis only.
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To learn more about erections, such as what they are and how they form, see Cancer, Sex, and the Male Body.
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To ensure any lifestyle changes are sustainable and realistic, start slow and work your way up.
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Infection is a concern after placement of a prosthesis and is a reported complication in 8%-20% of men undergoing placement of a penile prosthesis. If a prosthesis becomes infected (redness, pain, and swelling of the penis and sometimes purulent drainage are signs of infection), the prosthesis must be removed. Depending on the timing and severity of the infection and your surgeon's preference, the area can be irrigated extensively with antibiotic solutions and a new prosthesis placed at the same time or removal of the infected prosthesis and an attempt to place a new prosthesis made at a later time when the infection is totally cleared.
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You get an erection when blood fills two chambers known as the corpora cavernosa. This causes your penis to expand and stiffen, much like a balloon as it is filled with water. Impulses from the brain and genital nerves start the process. Anything that blocks these impulses or restricts blood flow to the penis can cause ED.
A surgical procedure that involves the placement of a balloons inside the shaft of the penis that a patient is able to manually pump the device to inflate and get an erection. The erection lasts as long as needed and with a simple push of a button, the penis is once again soft. Learn more about the implant option by clicking here. ED is rarely caused by severe pelvic trauma from major accidents in younger patients. Revascularization is an operation to bring new or additional blood vessels to the penis to improve the circulation that may have been severed by the initial trauma. This is a very rare type of treatment and is not recommended for the typical patient. After identification of a psychogenic source for ED, we will refer patients to a therapist with expertise in treating sexual dysfunction. We often recommend low dose medications for ED in conjunction with the therapist’s recommendations.
Appropriate treatment options should be applied in a step-wise fashion, balancing invasiveness and risk versus efficacy. If possible, the partner should be involved in the decision-making. The decision depends on the patient preferences and expectations as well as the experience and judgment of the physician. Oral phosphodiesterase type-5 inhibitors are first line therapy.
Some men who get radiation will notice that their erections change for the worse over the first year or so after treatment. This change most often develops slowly. Some men will still have full erections but lose them before reaching climax. Others no longer get firm erections at all.
If the medicines aren’t right for you, you could try using a penile implant, vacuum pump devices, or have surgery. Your doctor may send you to a urologist to talk about these options. How long will I have to take medicine for erectile dysfunction? What is the difference between tadalafil (Cialis), vardenafil (Levitra), and sildenafil (Viagra)? Are there any lifestyle changes I should make? How can I talk with my partner about my problem? Is there something I can do other than take medicine to help? What other medicines cause this problem?
Injection therapy: The modern age of such drug therapies began in 1993 when the injection of papaverine (Pavabid), an alpha-blocker that produces vasodilatation (widening of the blood vessels), was shown to produce erections when injected directly into the penis. Soon afterward, other vasodilators, such as prostaglandin E1 (PGE 1) monotherapy (Caverject, Edex), PGE1 and phentolamine (Regitine), and Trimix (papaverine, phentolamine and prostaglandin E1), were demonstrated to be effective. The benefit of combination therapy is the decreased dosing of each with less side effects. Most important is the reduction of the prostaglandin PGE1 dosing, which is associated to the localized pain.
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Penile re-vascularization is considered experimental and investigational for other indications because its effectiveness for indications other than the one listed above has not been established. Consistent with clinical guidelines of the American Urological Association, Aetna considers arterial reconstructive procedures, dorsal vein arterialization procedures, or penile venous occlusive surgery (e.g., venous ligation, dorsal vein ligation) in men with erectile dysfunction secondary to arteriosclerotic occlusive disease experimental and investigational because such procedures have not been proven to be effective.
If BPH is Your Diagnosis, HoLEP May be Your Best Treatment OptionNovember 19, 2021
The NHS says PE falls into two categories - primary or secondary, based on whether men have always had the issue or it recently developed.
The doctor or nurse will ask about your lifestyle and relationships, and any problems you might be having.
They're not always available on the NHS. Speak to a doctor about where to get a vacuum pump.
“We chose to make the cut there because we could see an effect when people trained on average a little over the half hour exercise recommended by the Danish Health Authority. No doubt it also helps to follow the official recommendation for exercise, but if you want to solve problems or maintain the beneficial effects for impotency, then you probably need to do a little more,” she says.
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DiabetesHigh blood pressureHeart or thyroid conditionsClogged arteries (atherosclerosis)DepressionNervous system disorders, such as multiple sclerosis or Parkinson disease
Aetna considers continuation of Xiaflex (collagenase clostridium histolyticum) for the treatment of Peyronie's disease medically necessary when all of the following criteria are met: The member meets all initial selection criteria; and The member has curvature deformity of at least 15 degrees at the time of the continuation request; and The member has received less than 8 injections total, including any injections the member has received for any previous treatment. Dosage and Administration Peyronie’s Disease
Bullet point: In men with ED, assessing androgen status is a simple evaluation, and therapy when indicated can be beneficial, and in most men, safe.
Metabolism (breakdown) of vardenafil can be slowed by aging, liver disease, and concurrent use of certain medications (such as erythromycin [an antibiotic], ketoconazole [Nizoral, a medication for fungal/yeast infections], and protease inhibitors [medications used to treat AIDS]). Slowed breakdown allows vardenafil to accumulate in the body and potentially increase the risk for side effects. Therefore, in men over 65 years of age with liver disease, or who are also taking medication(s) that can slow the breakdown of vardenafil, the doctor will initiate vardenafil at low doses to avoid its accumulation. For example,
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Men with a known hypersensitivity to alprostadil should not use intraurethral prostaglandin E1.
Some chemo drugs like cisplatin, vincristine, paclitaxel, bortezomib, and thalidomide can damage parts of the nervous system, usually the small nerves of the hands and feet. (This is called peripheral neuropathy.) These drugs have not been found to directly injure the nerve bundles that allow erection. But some people have concerns because the drugs are known to affect nerve tissue, and there are many nerves involved in sexual function.
Uric Acid- The blood uric acid test measures the amount of uric acid in a blood sample. Uric acid is produced from the natural breakdown of your body's cells and from the foods you eat.
Information about your personal and sexual history may be useful when making a diagnosis. Your doctor might ask questions, such as:
There are various ways to treat erectile dysfunction. The treatment options range from home remedies to medications and therapies.
Get the painless, non-invasive, drug-free, safe, and effective erectile dysfunction treatment. The latest and most advanced shock wave therapy machine from Germany is now available at the Institute of Andrology and Sexual Health (IASH), Jaipur. Low-intensity extracorporeal shock wave therapy (Li-ESWT) has been proposed as a new non-invasive treatment for erectile dysfunction, causing blood vessels to carry blood to the penis.
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The Mount Sinai Sexual Health Program offers a comprehensive approach to the diagnosis and treatment of ED, combining thorough medical evaluation, counseling, and therapeutic interventions. Using the most advanced diagnostic techniques available, our specialists, led by Natan Bar-Chama, MD, Director of Male Reproductive Medicine and Surgery, and Doron Stember, MD, evaluate underlying hormonal, neurogenic, vascular, and psychological causes of your sexual dysfunction. Then we help you navigate the many treatment options available. Once we understand the causes and nature of your difficulties, we develop a personalized treatment plan for you. Lifestyle changes Oral medications Hormone replacement therapy Counseling Intraurethral agents Penile injection therapy Vacuum Erection Devices Penile implants Reconstructive surgery
Sildenafil has been on the market for over 20 years and is generally well tolerated. You should not take sildenafil if you: have previously had an allergic reaction to it, have serious liver or heart problems, have recently had a heart attack or stroke, suffer from certain inherited eye diseases such as retinitis pigmentosa or optic neuropathy, are taking medicines for angina or high blood pressure.
Where erectile dysfunction is predominantly due to a physical cause, patients may describe a gradual onset of symptoms, which may occur across a variety of settings and different stimuli. Where the psychological component is the main factor, patients may describe a sudden onset in symptoms with erectile dysfunction varying dependent on the situation.
Treatment depends on what is causing it. If it is caused by uncontrolled blood sugar and high blood pressure, take your medicine and follow your doctor’s instructions.
NOTE: Some of the information provided contains graphic, medical images which individuals may find upsetting
In some cases, more extensive exams might be necessary to see if you have other conditions that could be causing your ED symptoms.
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Treatment of Erectile DysfunctionShockwave Therapy for Erectile Dysfunction in Jaipur
In some cases, ED can be a warning sign of a more serious disease. One study suggests it can predict heart attack, stroke, and even death from cardiovascular disease. If you’re diagnosed with ED, get checked for cardiovascular disease. This doesn’t mean every man with ED will develop heart disease, or that every man with heart disease has ED, but you should be aware of the link.
A very rare but more serious visual complication is shared by all PDE5 inhibitors. This would be non-arteritic anterior ischemic optic neuropathy (NAION). A number of cases have been reported and generally risk factors for this very rare form of blindness are severe cardiovascular conditions. In summary, men at high-risk for cardiovascular disease with congestive heart failure or unstable angina should not receive treatment for sexual dysfunction until their cardiac condition has stabilized. The FDA advises patients to stop taking these medicines and call a doctor immediately, if they experience sudden or decrease vision loss in one or both eyes. Furthermore, patients taking or considering taking these products should inform their healthcare professionals if they have ever had severe loss of vision, which may reflect a prior episode of NAION. Such patients are at an increased risk of developing NAION again.
Contributors DFM and NB wrote the majority of the manuscript. MK wrote the section on testosterone and made review comments and approved the final manuscript along with the attached figure.
Erosion of the prosthesis, whereby it presses through the corporal tissue into the urethra, may occur. Symptoms and signs may include pain, blood in the urine, discharge, abnormal urine stream, and malfunction. If the prosthesis erodes into the urethra, a physician must remove it. If the other cylinder remains intact, it can be left in place. A physician leaves a catheter in place to allow the urethra to heal.
Most men will experience occasional ED. This can be due to triggers such as stress, anxiety or drinking too much alcohol. Frequent erectile dysfunction can be a sign of an underlying health condition or emotional problems. If it happens regularly you should see your GP or visit a sexual health clinic.
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