Erectile Dysfunction (ED) affects more than 50% of men over the age of forty. This incidence increases dramatically in patients with comorbidities such as diabetes, hypertension, coronary artery disease, peripheral vascular disease, obesity, smoking and excessive alcohol consumption. The introduction of medications such as Viagra, Levitra and Cialis has offered men with mild to moderate ED a reliable and generally safe solution. In addition, it has increased public awareness and discussion of this common problem. The result is that increasing numbers of men with even severe ED are seeking help. Although it is not as simple as taking a pill for many of these men, many other safe and effective options are available and being used successfully.
Vacuum erection devices (VED’s) are plastic cylinders (made by several manufacturers) designed to fit over the penis and by using a suction mechanism pull blood into the penis. An elastic band is then deployed from the device around the base of the penis to hold the blood in the erectile bodies of the penis. These devices are safe and can be used indefinitely. They are particularly useful for the patient who does not get fully erect with oral ED medication in that they allow him to complete and hold the erection. VED’s are also useful in erection rehabilitation after radical or robotic prostatectomy to keep the penile tissues stretched and supple as well as in the treatment of peyronies disease which is often associated with penile curvature and calcified penile plaques.
Penile injections and suppositories are designed to deliver prostaglandin directly to the penis which facilitates blood flow into the penis and prevents leakage out of the penis. Suppositories known by the trade name Muse are inserted into the urethra using a small applicator. They then dissolve in approximately 10 minutes delivering the medicine transuretherally into the corpora cavernosa. Injectables known by the trade names Caverject and Edex are injected directly into the corporal bodies with a small needle and work directly. They very effective, even in men with nerve damage from prostate surgery. They are also safe and easy to use.
For those who do not respond to oral medications or injectables minimally invasive surgery offers an excellent option. The inflatable penile prosthesis (IPP) is a safe and effective option for all forms of refractory ED. It is an outpatient surgical procedure whereby two inflatable cylinders are placed within the corporal bodies of the penis and a small pump is placed within the scrotum. The incisions are tiny and hidden within the pubic hair. The complication rate is minimal, and the procedure can be performed under general or spinal anesthesia as an outpatient requiring approximately 30 minutes.
As public awareness about ED has increased so too has patient longevity. The result is that larger numbers of men each year seek treatment for ED. For almost every case there is a solution that provides successful results, minimal risk and a favorable safety profile. Affecting over half of men over the age of forty, ED can often be a sign of other medical problems that may have led to this condition. Despite these trends, most men are still too self-conscious to bring it up with their physicians at the time of their annual physical examinations. Some feel that it is a normal part of the aging process. It is important that patients are asked about their sexual function both to offer them help as well as to potentially uncover other underlying medical conditions. An additional consideration is the fact that if patients do happen to mention their ED and are provided with samples of an oral ED medication, it may or may not work. If it does not work, they are not likely to call back to schedule an appointment for “Viagra not working,” and it may be another year before the problem is addressed again. Therefore, if a patient does have ED, urological referral may be a good option to complete the evaluation, and establish a successful treatment program that includes close follow-up with modifications through the entire range of options when necessary.