• Rezum
• 2024-08-24

Rezum Water Vapour Therapy

Should I Consider Minimally Invasive Treatments?

As men get older, the prostate gland naturally enlarges, leading to urinary symptoms and discomfort.

Traditionally, treatment options for BPH have often been limited to surgery or medication, but recent advancements in medical technology have opened the door for less invasive yet highly effective treatment options.

In this article, we will explore minimally invasive surgical therapies, more commonly known as MIST, to help you answer a very common question – should you consider getting a minimally invasive treatment to alleviate your BPH symptoms?

What is MIST?

Firstly, let’s begin by breaking down exactly what MIST is. Minimally invasive surgical therapies (MIST) for benign prostatic hyperplasia (BPH) are procedures that can be done without general anesthesia or a hospital stay.

These minimally invasive procedures have minimal downtime, are outpatient procedures, and do not always require patients to wear a catheter post-procedure. Patients who undergo these treatments are able to return to their daily activities within a few days after the procedure.

They relieve patients of BPH symptoms without the use of medications or permanent implants, and allow patients to experience symptom relief within two weeks.

Benefits of Minimally Invasive Therapies

So, what are the benefits to getting a minimally invasive procedure? Well, there are quite a few, including the following:

• The procedures have minimal downtime. The main difference between MIST treatments and other BPH treatments is that they are minimally invasive with minimal downtime. Patients do not have to spend time in the hospital, or take significant time off. Instead, they are able to return to their regular activities within a couple of days.
• They preserve sexual function. MIST treatments can preserve sexual function. They do not generally produce sexual side effects, nor do they interfere with patients’ ability to perform during intercourse. Patients have reported that these treatments do not cause erectile or ejaculatory dysfunction that may arise with other BPH treatments.
• They are non-invasive and drug-free. MIST treatments relieve symptoms of BPH safely and effectively, without requiring patients to take any medications or have any permanent implants. Patients generally experience symptom relief within just two weeks after the procedure.

Am I a Candidate for MIST?

After learning more about these procedures, you may be asking yourself – am I a candidate for a minimally invasive procedure?

Well, MIST therapies are typically suited for men that do not want to take any medication for their BPH symptoms on an ongoing basis, or have had a previous bad experience with medication. It is also recommended for men that do not wish to undergo the risks of a standard surgical intervention.

If satisfactory treatment results can be obtained with a MIST option, then this is usually the preferable option to avoid the risks and side effects of surgery or medication.

• BPH
• 2024-08-24

BPH: Myths vs. Facts

BPH: Myths vs. Facts

Navigating the misconceptions and uncertainties surrounding Benign Prostatic Hyperplasia (BPH) can be quite difficult. As a common condition affecting men, BPH often finds itself entangled in myths that can hinder an accurate understanding and timely intervention.

Here, we aim to unravel the truths surrounding BPH, distinguishing between myths and facts. We will debunk common misconceptions and gain a clearer understanding of this aspect of men’s health.

MYTH: Having BPH Automatically Means You Have Cancer

This is probably the most common myth that circulates the issue of BPH. No, having BPH does not automatically mean that you have cancer. While BPH and prostate cancer do share some similar symptoms, they are completely distinct conditions.

BPH is a non-cancerous condition that commonly occurs in aging men, and involves the enlargement of the prostate gland. Prostate cancer, on the other hand, is a malignant growth of cells in the prostate gland. It is important not to jump to conclusions, as many men with BPH do not develop prostate cancer.

MYTH: A Larger Prostate Causes Worse Symptoms

Once again, this is a myth. Having a larger prostate does not necessarily mean that you will have worse symptoms. While a larger prostate does not guarantee issues, a smaller one does not guarantee avoiding treatment.

When it comes to BPH symptoms, what matters is not the size of the prostate, but rather what is happening inside of it. If a doctor feels a large prostate during a rectal exam, it does not automatically mean there is an obstruction inside.

FACT: BPH is Extremely Common in Men

Yes, it is true that BPH is a common condition in men, particularly as they age. The prostate naturally grows larger as men get older, and this enlargement can lead to various urinary symptoms.

In fact, the prevalence of BPH increases with age, and it is estimated that about 50% of men aged 51 to 60 have some degree of prostate enlargement. By the age of 80, around 80% of men may experience symptoms of BPH. While BPH is common, not all men with an enlarged prostate will necessarily develop significant symptoms.

FACT: BPH Can Cause Other Serious Issues

While BPH itself is not considered a serious or life threatening condition, it can lead to complications and affect a person’s quality of life. BPH can lead to incomplete emptying of the bladder, increasing the risk of urinary tract infections (UTIs). Additionally, the inability to completely empty the bladder may result in the formation of bladder stones.

In some cases, BPH can cause a sudden and complete inability to urinate, leading to a medical emergency known as acute urinary retention. Severe cases of BPH, if left untreated, may lead to chronic kidney problems due to urinary retention and backflow of urine into the kidneys.

• Urology
• 2024-08-24

Get Rid Of Kidney Stones With Scarless Laser Treatment

Get Rid Of Kidney Stones With Scarless Laser Treatment

Retrograde Intrarenal Surgery (RIRS) is an endoscopic surgery performed to remove renal stones. The procedure is done using a flexible ureteroscope, which is placed through the urethra (the urinary opening) into the bladder and then through the ureter into the kidney (intrarenal area). Through this device, a laser fiber (Holmium laser) is used to treat the stones.

How Kidney Stones Are Treated With RIRS?

The ureteroscope has a small camera fitted at its end which is used to inspect the kidney stones. A monitor screen present in the surgery room displays the entire anatomy of the patient’s kidney captured by the ureteroscope. Through an ultrasound wave or a laser probe, the stones are crushed into fine powder or pieces. These fine pieces can pass easily through the urination process.

What Are The Advantages Of RIRS Over Older Techniques Like PCNL (Key Hole Surgery)?

RIRS is definitely less invasive than older techniques like PCNL, laparoscopic or open surgery as it is completely scarless. Because we enter the kidney passing through normal urinary tract and there is no need to make any cuts on skin or hole into the kidney (as in PCNL), there is lesser risk of severe bleeding, hospital stay is very short (daycare surgery in most cases), there is markedly shorter period of recovery and patient can very soon get back to his normal routine.

Who Can Perform RIRS?

RIRS is performed by a urologist (endourologist) with special expertise in RIRS.

What Is The Advantage Of Using A High Power Laser In RIRS?

The best outcome for patients can be given with the use of High power laser. Stone clearance in patients with kidney stones up to 4 cm (staghorn stones) can also be possible only with a high power holmium laser.

Is A Stent Required To Be Placed After RIRS? Is It A Permanent Stent?

Yes, like any other kidney stone surgery, a double J stent is placed in the ureter in most cases of RIRS. The purpose of Double J stent is to keep the ureter open while the laser fragments of stone are washed out and it also decreases the risk of ureteric stricture formation after any intervention. No, Double J stent is only kept temporarily for 2 to 4 weeks and then removed through urethra endoscopically which is a short procedure and the patient can go home the same day after getting it removed.

Can RIRS Be Used To Treat Other Diseases Apart From Kidney Stones?

Yes, RIRS can be used to treat blockages in the ureter (Strictures/PUJ obstruction), Ureteric and collecting system tumors (for diagnosis as well as treatment).

RIRS is the future of stone surgery. It does require a reasonable amount of experience to master the technique of RIRS but it is immensely beneficial to the patient. At Sarvodaya Hospital, we have a specialized Institute of Laser Urological Surgery equipped with the latest technology and highly advanced Holmium Laser machine to treat several types of complicated kidney stone cases. A patient coming to the hospital with a kidney stone today can walk out of the hospital after surgery the next day itself and soon return to work. The patient has to take a lesser number of days off from work after surgery.

• Urology
• 2024-08-24

Kidney Stones Treatment

Kidney Stones Treatment

Because kidney stones are a common disease, it is natural to seek effective remedies for these vexing stones.

Of course, there are numerous methods for treating kidney stones. And none of us wants to be sorry later for choosing the ‘insufficient’ solution for any condition.

When someone wants to get rid of a painful problem to avoid subsequent complications, picking a treatment option that is both painful and potentially dangerous is not a good decision.

A successful kidney stone treatment must be both safe and effective. The current kidney stone operation with laser accomplishes the intended result.

Meaning Of Laser Lithotripsy

Short and powerful infrared light pulses are used in laser lithotripsy. When employed correctly, these pulses are so powerful that they can shatter any type of stone into small bits. The same method is used in laser lithotripsy to remove kidney stones, in which the stones in the kidney are shattered into tiny pieces and expelled through urine.

It is a painless normal operation, and the patient can recover quickly as opposed to conventional and traditional forms of surgery that are not only difficult but also take time to assist people in recovering.

Advantages of ureteroscopy compared to other stone treatments

• Flexible ureteroscopy has the advantage of allowing entrance into all sections of the kidney if the kidney stones are of acceptable size and position. As long as the ureter is large enough to allow the ureteroscope to pass through, the stone may be shattered and removed in a single surgery.
• Unlike SWL, a kidney or ureteral stone can be viewed directly by the ureteroscope, allowing laser lithotripsy followed by basketing and removal. Patients are requested to pass stone particles themselves during shock wave lithotripsy, which may cause further pain or obstruction. Furthermore, shock wave lithotripsy may not break up extremely dense, hard stones (termed SWL-resistant stones). If the stone is visible to the ureteroscope, ureteroscopy with a contact holmium laser can break it up. Furthermore, ureteroscopy can treat stones not visible on standard x-ray (“acid” stones).
• Unlike percutaneous procedures, the ureteroscope is passed through natural bodily orifices and does not require any skin incisions. It is an outpatient surgery, whereas PCNL necessitates at least an overnight stay in the hospital. Certain patient groups that cannot be treated with ESWL or PCNL (such as those on blood thinners, pregnant women, the extremely obese, and airline pilots/astronauts) can be safely and efficiently treated using ureteroscopy.

Things that happen on surgery day

Before treating kidney stones with laser, your surgeon will advise you on handling your medications and food. Most laser kidney stone treatments are outpatient procedures, so you can go home the same day.

You will be sedated during the procedure because you will be under general anesthesia. It ensures that you remain still while the small instruments are within your body. Newer lasers are more precise and powerful, making it easier for surgeons to control and break the stone. It shortens the duration of your procedure, allowing you to sleep less and return to your daily routine sooner.

Feeling after surgery

After laser surgery, you may still feel pain. If you have a stent between your kidney and ureter, the stent is likely to be the source of your pain because it can rub on your kidney or bladder. It can also make you feel the need to urinate, and it may cause some blood in your urine. Men may also have pain in the penis or testicles.

Following surgery, your doctor will prescribe medications. They may generally include an antibiotic to prevent infection, pain relievers, and medication to ease bladder spasms and burns during urination.

Drink plenty of water to keep the stent lubricated and any tiny stones out of the kidney. You may probably need to urinate more frequently, so have a restroom nearby.

You can return to your normal activities the next day or as soon as you feel comfortable. High-intensity exercise should be avoided until your stent is removed. Some pain relievers prohibit activities such as driving, so read the label carefully. Additional guidelines will be provided by your doctor.

Follow-up care is required

After surgery, you will see your surgeon or his assistants about a week later. If you have a stent, it will be removed using a little illuminated instrument at this point (cystoscope). It is done again through your bladder and can be done while awake in the office. If your surgeon believes it will aid in healing, the stent may be left in place for a longer period. The stent can remain in place for up to three months, so don’t be concerned if your stent removal is delayed. The stent must be removed, so don’t forget to schedule your post-surgery check-up.

The surgeon will have sent one of your kidney stones for analysis after removing them. Your doctor will advise you on how to avoid future kidney stones based on the stone’s makeup. The doctor may also offer recommendations based on urine analysis. For example, the doctor may advise you to make dietary modifications or to take supplements or drugs.

Because kidney stones are a chronic condition, they may reoccur at some point in the future. You now understand the symptoms and that effective remedies are accessible. Follow your urologist’s advice to help prevent additional kidney stones, and don’t hesitate to call if symptoms return.

Complications & Risks

Ureteroscopy with laser lithotripsy is a safe and effective therapy with a quick recovery. As a result, there are no dangers or difficulties linked with the operation. However, unusual side effects include nausea and a brief period of bleeding.

Conclusion

Kidney stones can surely be excruciatingly painful and make your life miserable. Having them operated on with standard treatments takes time to cure, and recovery is also slow. Fortunately, we can now treat kidney stones with ureteroscopy and laser lithotripsy. The risks are minor, and the patient heals rapidly with no significant side effects. The entire treatment is risk-free and takes anything from 10 minutes to an hour, depending on the severity of the operation.

If you have kidney stones for an extended period, you should consult a doctor about advanced laser treatment. It is unquestionably the best option for dealing with the stones ruining your life.

• Penile Implants
• 2024-08-24

What You Need to Know About Penile Implants Surgery

What Are Penile Implants?

Erectile dysfunction can affect any man at any age. There are various treatment options like medications, pills, testosterone treatment, and injections. But some of those treatments may not work for some men. Some doctors might recommend getting a penile Implant. There are two types of penile implant procedures that can help with different problems. One is inflatable, and one is non-inflatable. The purpose is to help with erectile dysfunction and with transgenders. Sometimes it’s used to help reconstruct a penis, if necessary. Here, Happy Urology will discuss penile implants surgery, from how it works to how much it costs.  

How Does a Penile Implant Work?

Penile implants work to help maintain an erection or to help with cosmetic effects. The main two types are inflatable implants and non-inflatable. An inflatable penile implant consists of two cylinders and a pump. The two cylinders are placed in the penis, and the pump is in the scrotum. To achieve an erection, the person will squeeze the pump and the cylinders by filling them with saline solution. The non-inflatable implant has a surgeon implanting two flexible rods into the penis. The rods don’t change in size or stiffness. The implants are always semi-rigid, causing the penis to feel the same way. But people can move it into any position they want.  

Life With Implants?

After the procedure, it will take about 4-6 weeks to recover from penile implant surgery. People with both implants have high satisfaction with the results after the procedure. Some people report not having any loss of sensation during intercourse. Ejaculation was not affected after surgery. The implant leaves a small surgical scar that most people cannot see. When wearing clothes, the implants are not noticeable, so you can feel confident wearing the clothes you want. In most cases, the penile implant can last between 15 and 20 years.

How Much Does the Implant Cost?

The penile implant can cost around $14,000 dollars or more. Some insurance companies will cover the cost if it’s for erectile dysfunction. The majority of health insurance companies, however, do not cover penile implant surgery, and it will come out of the patient’s pocket. Some doctors offer a payment package pricing and give some discounts to patients.

Success Rate

No surgery is entirely free of complications, though about 90% of penile implant surgeries are successful. Some of the risks are.

• Infection
• Scar tissue
• Pump failure
• Fluid not properly draining

The majority of the complications can be fixed with additional surgery. The implant is still a mechanical device, so it has the risk of breaking. If any complications arise, contact your doctor immediately.

Happy Urology

If you are experiencing erectile dysfunction and have tried many different treatment options, contact Happy Urology for a consultation or to learn more about penile implants surgery. We will help you with any questions or concerns about penile Implants or erectile dysfunction medication. We also offer many different urological services for your needs.

• Urology
• 2024-11-10

Green laser vaporization for the prostate

Why it's done?

Prostate laser surgery helps reduce urinary symptoms caused by BPH, including:

Frequent, urgent need to urinate
Difficulty starting urination
Slow (prolonged) urination
Increased frequency of urination at night
Stopping and starting again while urinating
The feeling you can't completely empty your bladder
Urinary tract infections

Laser surgery might also be done to treat or prevent complications due to blocked urine flow, such as:

Recurring urinary tract infections
Kidney or bladder damage
Inability to control urination or an inability to urinate at all
Bladder stones
Blood in your urine

Laser surgery can offer several advantages over other methods of treating BPH. It can take several weeks to months to see noticeable improvement with medications. 

Improvements in urinary symptoms from laser surgery are noticeable right away. The advantages over traditional surgery, such as transurethral resection of the prostate (TURP) and open prostatectomy, can include:

Lower risk of bleeding. 

Laser surgery can be a good option for men who take medication to thin their blood or who have a bleeding disorder that doesn't allow their blood to clot normally.

Shorter or no hospital stay. 

Laser surgery can be done on an outpatient basis or with just an overnight hospital stay.
Quicker recovery. 

Recovery from laser surgery generally takes less time than recovery from TURP or open surgery.

Less need for a catheter. 

Procedures to treat an enlarged prostate generally require use of a tube (catheter) to drain urine from the bladder after surgery. With laser surgery, a catheter is generally needed for less than 24 hours.

• Procedures
• 2025-01-15

Rezum prostate Vaporisation Full explanation of the procedure

Rezum is a minimally invasive treatment for benign prostatic hyperplasia (BPH), a common condition in aging men where the prostate enlarges and affects urinary function. It uses water vapor (steam) to reduce prostate tissue. Here are the advantages of the Rezum procedure:

1. Minimally Invasive
    •    Performed as an outpatient procedure, often without the need for general anesthesia.
    •    Short recovery time compared to traditional surgical options like TURP (Transurethral Resection of the Prostate).

2. Preserves Sexual Function
    •    Lower risk of side effects such as erectile dysfunction or retrograde ejaculation compared to other BPH treatments.

3. Quick Procedure
    •    The treatment takes only 10–15 minutes, making it convenient for both patients and providers.

4. No Need for Long-Term Medication
    •    Reduces reliance on daily medications for BPH, which can have side effects like dizziness or decreased libido.

5. Effective Symptom Relief
    •    Patients experience significant improvement in urinary symptoms, including reduced frequency, urgency, and nighttime urination (nocturia).

6. Durable Results
    •    Studies show that the benefits of Rezum can last for several years.

7. Lower Risk of Complications
    •    Fewer risks of severe bleeding or infections compared to traditional surgeries.

8. Versatility
    •    Suitable for a wide range of prostate sizes and configurations.

9. Minimal Downtime
    •    Most patients can resume normal activities within a few days, with some temporary restrictions on heavy lifting and vigorous activities.

10. Covered by Insurance
    •    Many health insurance plans, including Medicare, cover the Rezum procedure.

Despite these advantages, it’s essential to consult with a healthcare provider to determine if Rezum is the right option, as it may not be suitable for everyone, particularly those with severe symptoms or very large prostates.

• Procedures
• 2025-01-15

Explanation of the filler procedure

These are minimally invasive treatments intended to increase the girth. These fillers typically consist of substances like hyaluronic acid (HA), a biocompatible material also used in facial fillers. Here’s an overview:

Procedure:
    1.    Consultation: A doctor assesses your goals, anatomy, and overall health to determine if you’re a good candidate.
    2.    Filler Selection: HA fillers are commonly used because they are temporary, safe, and reversible.
    3.    Application: Local anesthesia is applied, and the filler is injected into the subcutaneous tissue of the penile shaft.
    4.    Recovery: Minimal downtime, though minor swelling or bruising may occur. Results are immediate.

Benefits:
    •    Non-surgical, quick procedure.
    •    Reversible with an enzyme (hyaluronidase) if needed.
    •    Can improve confidence in appearance.

Risks:
    •    Bruising or swelling.
    •    Irregular texture or asymmetry.
    •    Rarely, infection or allergic reaction.

For permanent options, materials like PMMA (polymethylmethacrylate) or surgical fat transfer might be suggested. Always consult with a board-certified urologist to explore options safely.

• Empowering Your Sexual Health
• 2025-02-01

Why a Penile Implant Might Be the Right Choice

Introduction
Erectile dysfunction (ED) can affect more than just physical health—it can impact your emotional well-being and relationships. For men who haven’t found success with other treatments, a penile implant might offer a new lease on life. In this post, we delve into the reasons why many choose penile implants as part of their journey to improved sexual health.

Restoring Confidence and Self-Esteem
Erectile dysfunction can lead to feelings of inadequacy or loss of confidence. Penile implants provide a reliable solution that helps restore the natural function of the penis, leading to enhanced self-esteem and a renewed sense of masculinity.

Comparing Treatment Options
    •    Oral Medications vs. Implants: While drugs like sildenafil (Viagra) can be effective for many, they aren’t always suitable for every patient.
    •    Long-Term Reliability: Unlike temporary solutions, penile implants provide a more permanent fix, giving many men peace of mind and reducing the anxiety of performance issues.

Improved Relationship Satisfaction
Many couples find that addressing ED through a penile implant can significantly improve intimacy and overall relationship satisfaction. Open discussions with your partner and healthcare provider can help set realistic expectations and foster mutual support during the recovery and adaptation process.

Conclusion
Choosing a penile implant is a highly personal decision—one that can empower you to reclaim your sexual health and improve your overall quality of life. If you’re exploring your treatment options, consider speaking with a specialist to determine if this surgical solution aligns with your long-term health goals.

Disclaimer: This post is for educational purposes only and is not a substitute for professional medical advice.

• Procedures
• 2025-04-13

Hydraulic Penile Implant

Hydraulic Penile Implant: Your Comprehensive Guide to Erectile Dysfunction Treatment in Dubai

We are committed to providing a unique and premium treatment experience in Dubai, combining expert medical care with outstanding tourism services. When you book through our website, you’ll enjoy advanced treatment in the UAE, with a pre-planned itinerary covering both your medical journey and leisure activities.

Introduction to the Hydraulic Penile Implant

The hydraulic penile implant is a groundbreaking solution for chronic erectile dysfunction, especially in cases where medications like Viagra have proven ineffective. This advanced technology allows for precise control over erections through a sophisticated pumping mechanism, making it an ideal option for men with physical conditions or post-surgical complications.

What is a Hydraulic Penile Implant?

It is a medical device surgically implanted into the penis, utilizing a hydraulic system that pumps fluid into flexible cylinders to achieve a controlled, natural-looking erection. Unlike rigid implants, this solution offers flexibility and the ability for the patient to activate it only when desired—ensuring more comfort in everyday life.

Key Features:

• Complete control over the timing and duration of the erection.

• Natural appearance in both flaccid and erect states.

• Long-lasting solution (lasting for years) with a success rate exceeding 95%.

• Suitable for patients with diabetes, pelvic injuries, or chronic erectile dysfunction.

Types of Hydraulic Implants

The choice of implant depends on the patient’s needs and the doctor’s recommendation:

1. Two-Piece Implant:

   • Combines the pump and fluid reservoir into a single unit.

   • Implanted within the penis and scrotum.

   • Offers simpler installation with less complexity.

2. Three-Piece Implant:

   • Includes a separate pump, a fluid reservoir implanted in the abdomen, and flexible tubing.

   • Provides more precise control and a more natural look and feel.

How is the Hydraulic Implant Installed?

Surgical Steps:

1. Anesthesia: General or spinal anesthesia.

2. Accessing the Corpora Cavernosa: Through a small incision at the base of the penis.

3. Implanting the Components:

   • Cylinders are inserted into the corpora cavernosa.

   • The pump is placed in the scrotum, and (for the three-piece implant) the reservoir is implanted in the abdomen.

4. Closure: Using absorbable stitches and sterile dressings.

Surgery Duration:

The procedure takes one to two hours, with the possibility of same-day discharge.

When is a Hydraulic Implant Recommended?

• Failure of medication or natural remedies.

• Erectile dysfunction due to chronic illnesses (e.g., diabetes).

• Post-surgical complications (e.g., after cancer or pelvic surgeries).

• Desire for a permanent solution without relying on medication.

Pros and Cons of the Hydraulic Implant

Pre- and Post-Surgery Tips

Before Surgery:

• Undergo blood tests and imaging.

• Stop blood thinners and smoking one week prior.

• Fast for 6–8 hours before the procedure.

After Surgery:

• Avoid physical activity for two weeks.

• Use cold compresses to reduce swelling.

• Refrain from sexual activity for 4–6 weeks.

• Attend follow-up appointments regularly.

Hydraulic vs. Malleable Implants

Frequently Asked Questions

Does the implant cause pain?
Mild discomfort may occur after surgery, which can be managed with pain relievers.

When can I return to sports?
After 4–6 weeks, depending on the doctor’s advice.

Does it affect sensation or ejaculation?
It does not affect natural sexual functions.

In Conclusion:

Dubai offers an exceptional treatment experience, merging cutting-edge medical technology with holistic care. For inquiries or bookings, get in touch with us and let’s plan your journey to restored confidence and vitality. 🌟

• Empowering Your Sexual Health
• 2025-07-23

Erectile Dysfunction (ED)

What is Erectile Dysfunction?

Erectile dysfunction, or ED, is the most common sex problem that men report to their doctor. It affects as many as 30 million men.

ED is defined as trouble getting or keeping an erection that's firm enough for sex.

Though it's not rare for a man to have some problems with erections from time to time, ED that is progressive or happens routinely with sex is not normal, and it should be treated.

ED can happen:

• Most often when blood flow in the penis is limited or nerves are harmed 
• With stress or emotional reasons
• As an early warning of a more serious illness, like: atherosclerosis (hardening or blocked arteries), heart disease, high blood pressure or high blood sugar from Diabetes

Finding the cause(s) of your ED will help treat the problem and help with your overall well-being. As a rule, what's good for your heart health is good for your sex health.

How Erections Work

During sexual arousal, nerves release chemicals that increase blood flow into the penis. Blood flows into two erection chambers in the penis, made of spongy muscle tissue (the corpus cavernosum). The corpus cavernosum chambers are not hollow.

Diagram of How Erections Work

Enlarge

During erection, the spongy tissues relax and trap blood. The blood pressure in the chambers makes the penis firm, causing an erection. When a man has an orgasm, a second set of nerve signals reach the penis and cause the muscular tissues in the penis to contract and blood is released back into a man's circulation and the erection comes down.

When you are not sexually aroused, the penis is soft and limp. Men may notice that the size of the penis varies with warmth, cold or worry; this is normal and reflects the balance of blood coming into and leaving the penis.

Updated June 2018

Symptoms

With Erectile Dysfunction (ED), it is hard to get or keep an erection that is firm enough for sex. When ED becomes a routine and bothersome problem, your primary care provider or a Urologist can help.

ED may be a major warning sign of cardiovascular disease indicating blockages are building in a man's vascular system. Some studies have shown men with ED are at significant risk of getting a heart attack, stroke or circulatory problems in the legs. ED also causes:

• Low self-esteem
• Depression
• Distress for the man and his partner 

If ED is affecting a man's well-being or his relationships, it should be treated. Treatment aims to fix or enhance erectile function, help circulatory health and help the quality of a man's life.

Updated June 2018

Causes

ED can result from health problems, emotional issues, or from both. Some known risk factors are:

• Being over age 50 
• Having high blood sugar (Diabetes)
• Having high blood pressure 
• Having cardiovascular disease
• Having high cholesterol
• Smoking
• Using drugs or drinking too much alcohol
• Being obese
• Lacking exercise

Even though ED becomes more common as men age, growing old is not always going to cause ED. Some men stay sexually functional into their 80s. ED can be an early sign of a more serious health problem. Finding and treating the reason for ED is a vital first step.

Physical Causes of ED

ED happens when:

• There is not enough blood flows into the penis
  Many health issues can reduce blood flow into the penis, such as hardened arteries, heart disease, high blood sugar (Diabetes) and smoking.
• The penis cannot trap blood during an erection
  If blood does not stay in the penis, a man cannot keep an erection. This issue can happen at any age.
• Nerve signals from the brain or spinal cord do not reach the penis
  Certain diseases, injury or surgery in the pelvic area can harm nerves to the penis.
• Diabetes can cause small vessel disease or nerve damage to the penis
• Cancer treatments near the pelvis can affect the penis' functionality
  Surgery and or radiation for cancers in the lower abdomen or pelvis can cause ED. Treating prostate, colon-rectal or bladder cancer often leaves men with ED. Cancer survivors should see a Urologist for sexual health concerns.
• Drugs used to treat other health problems can negatively impact erections
  Patients should talk about drug side effects with their primary care doctors.

Emotional Causes of ED

Normal sex needs the mind and body working together. Emotional or relationship problems can cause or worsen ED.

Some emotional issues that can cause ED are:

• Depression
• Anxiety
• Relationship conflicts
• Stress at home or work
• Stress from social, cultural or religious conflicts
• Worry about sex performance

Updated June 2018

Diagnosis

Finding the cause of your ED will help direct your treatment options.

Diagnosing ED starts with your health care provider asking questions about your heart and vascular health and your erection problem. Your provider may also give you a physical exam, order lab tests or refer you to a Urologist.

Health and ED History

Your doctor will ask you questions about your health history and lifestyle. It is of great value to share facts about drugs you take, or if you smoke or how much alcohol you drink. He/she will ask about recent stressors in your life. Speak openly with your doctor, so he/she can help you find the best choices for treatment

What Questions Will the Health Care Provider Ask?

Questions about your health:

• What prescription drugs, over-the-counter drugs or supplements do you take?
• Do you use recreational drugs?
• Do you smoke?
• How much alcohol do you drink?
• Have you had surgery or radiation therapy in the pelvic area?
• Do you have any urinary problems?
• Do you have other health problems (treated or untreated)?

Questions About ED

Knowing about your history of ED will help your health provider learn if your problems are because of your desire for sex, erection function, ejaculation, or orgasm (climax). Some of these questions may seem private or even embarrassing. However, be assured that your doctor is a professional and your honest answers will help find the cause and best treatment for you.

Questions about your ED symptoms:

• How long have you had these symptoms? Did they start slowly or all at once?
• Do you wake up in the morning or during the night with an erection?
• If you do have erections, how firm are they? Is penetration difficult?
• Do your erections change at different times, like when going in a partner, during stimulation by mouth, or with masturbation?
• Do you have problems with sex drive or arousal?
• Do you have problems with ejaculation or orgasm (climax)?
• How is this problem changing the way you enjoy sex?
• Do you have painful with erections, feel a lump or bump in the penis or have penile curvature? These are signs of Peyronie's Disease which can be treated but calls for an expert in urology to assess and manage.

Questions About Stress and Emotional Health

Your health care provider may ask you questions about depression or anxiety. He or she may ask about problems in your relationship with a partner. Some health care providers may also ask if they may talk to your sex partner.

• Are you often under a lot of stress, or has something recently upset you?
• Do you have any anxiety, depression or other mental health issues? 
• Are you taking any drugs for your mental health?
• How satisfied are you with your sex life? Has there been any changes lately?
• How is your relationship with your partner? Has there been any changes lately?

Physical Exam

A physical exam checks your total health. Examination focusing on your genitals (penis and testicles) is often done to check for ED. Based on your age and risk factors, the exam may also focus on your heart and blood system: heart, peripheral pulses and blood pressure. Based on your age and family history your doctor may do a rectal exam to check the prostate. These tests are not painful. Most patients do not need a lot of testing before starting treatment.

Lab Tests

Your health care provider may order blood tests and collect a urine sample to look for health problems that cause ED.

Other Tests

Questionnaires are often used by health experts to rate your ability to initiate and keep erections, gauge your satisfaction with sex and help identify any problems with orgasm.

Advanced Erectile Function Tests

For some men with ED, specialized testing may be needed to guide treatment or re-assess you after a treatment fails.

• Blood work to check Testosterone and other male hormones
• Blood work to measure blood sugar (Diabetes)
• Ultrasonography (penile Doppler) to check blood flow
• A shot into the penis with a vascular stimulant to cause an erection
• Pelvic x-rays like arteriography, MRI or CT scanning are rarely needed to check ED unless there is history of trauma or cancer
• Nocturnal penile tumescence (NPT), an overnight test to check for sleep erection

Updated June 2018

Treatment

The treatment for ED starts with taking care of your heart and vascular health. Your doctor may point out ‘risk factors' that can be changed or improved.

You may be asked to change certain food habits, stop smoking, increase workouts or stop using drugs or alcohol. You may be offered alternatives to the drugs you take. (Never stop or change prescription drugs without first talking to your health care provider.)

Your health care provider may also suggest treating emotional problems. These could stem from relationship conflicts, life's stressors, depression or anxiety from past problems with ED (performance anxiety).
The treatments below are available to treat ED directly.

ED Treatments

Non-invasive treatments are often tried first. Most of the best-known treatments for ED work well and are safe. Still, it helps to ask your health care provider about side effects that could result from each option:

• Oral drugs or pills known as phosphodiesterase type-5 inhibitors are most often prescribed in the U.S. for ED (Viagra, Cialis, Levitra, Stendra)
• Testosterone Therapy (when low testosterone is detected in blood testing)
• Penile Injections (ICI, intracavernosal Alprostadil)
• Intraurethral medication (IU, Alprostadil)
• Vacuum Erection Devices
• Penile Implants
• Surgery to bypass penile artery damage for some younger men with a history of severe pelvic trauma. Penile vascular surgery is not recommended for older men with hardened arteries.

Oral Drugs (PDE5 inhibitors)

Drugs known as PDE type-5 inhibitors increase penile blood flow. These are the only oral agents approved in the U.S. by the Food and Drug Administration for the treatment of ED.

• Viagra ® (sildenafil citrate)
• Levitra ® (vardenafil HCl)
• Cialis ® (tadalafil)
• Stendra ® (avanafil)

For best results, men with ED take these pills about an hour or two before having sex. The drugs require normal nerve function to the penis. PDE5 inhibitors improve on normal erectile responses helping blood flow into the penis. Use these drugs as directed. About 7 out of 10 men do well and have better erections. Response rates are lower for Diabetics and cancer patients.

If you are taking nitrates for your heart, you SHOULD NOT take any PDE5 inhibitors. Always speak with your health care provider before using a PDE5 inhibitor to learn how it might affect your health.

Most often, the side effects of PDE5 inhibitors are mild and often last just a short time. The most common side effects are:

• Headache
• Stuffy nose
• Facial flushing
• Muscle aches
• Indigestion

In rare cases, the drug Viagra ® can cause blue-green shading to vision that lasts for a short time. In rare cases, the drug Cialis ® can cause or increase back pain or aching muscles in the back. In most cases, the side effects are linked to PDE5 inhibitor effects on other tissues in the body, meaning they are working to increase blood flow to your penis and at the same time impacting other vascular tissues in your body. These are not ‘allergic reactions'.

Testosterone Therapy

In those rare cases where a low sex drive and low blood levels of Testosterone are at fault for ED, Testosterone Therapy may fix normal erections or help when combined with ED drugs (PDE type 5 inhibitors).

Vacuum Erection Device

A vacuum erection device is a plastic tube that slips over the penis, making a seal with the skin of the body. A pump at the other end of the tube makes a low-pressure vacuum around the erectile tissue, which results in an erection. An elastic ring is then slipped onto the base of the penis. This holds the blood in the penis (and keeps it hard) for up to 30 minutes. With proper training, 75 out of 100 men can get a working erection using a vacuum erection device.

Diagram of a Erectile Dysfunction Vacuum

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Intracavernosal (ICI) and Urethra (IU) Therapies

If oral drugs don't work, the drug Alprostadil is approved for use in men with ED. This drug comes in two forms, based on how it is to be used: intracavernosal injection (called "ICI") or through the urethra (called "IU therapy").

Self-Injection Therapy

Alprostadil is injected into the side of penis with a very fine needle. It's of great value to have the first shot in the doctor's office before doing this on your own. Self-injection lessons should be given in your doctor's office by an experienced professional. The success rate for getting an erection firm enough to have sex is as high as 85% with this treatment. Many men who do not respond to oral PDE5 inhibitors can be ‘rescued' with ICI.

ICI Alprostadil may be used as a mixture with two other drugs to treat ED. This combination therapy called "bimix or trimix" is stronger than alprostadil alone and has become standard treatment for ED. Only the Alprostadil ingredient is FDA approved for ED. The amount of each drug used can be changed based on the severity of your ED, by an experienced health professional. You will be trained by your health professional on how to inject, how much to inject and how to safely raise the drug's dosage if necessary.

ICI therapy often produces a reliable erection, which comes down after 20-30 minutes or with climax. Since the ICI erection is not regulated by your penile nerves, you should not be surprised if the erection lasts after orgasm. The most common side effect of ICI therapy is a prolonged erection. Prolonged erections (>1 hour) can be reversed by a second injection (antidote) in the office.

Men who have penile erections lasting longer than two to four hours should seek Emergency Room care. Priapism is a prolonged erection, lasting longer than four hours. It is very painful. Failure to undo priapism will lead to permanent penile damage and untreatable ED.

Intraurethral (IU) Therapy

For IU therapy, a tiny medicated pellet of the drug, Alprostadil, is placed in the urethra (the tube that carries urine out of your body). Using the drug this way means you don't have to give yourself a shot, unfortunately it may not work as well as ICI. Like ICI therapy, IU Alprostadil should be tested in the office, before home usage.

The most common side effects of IU alprostadil are a burning feeling in the penis. If an erection lasts for over four hours, it will need medical attention to make it go down.

Surgical Treatment

The main surgical treatment of ED involves insertion of a penile implant (also called penile prostheses). Because penile vascular surgery is not recommended for aging males who have failed oral PDE5 inhibitors, ICI or IU therapies, implants are the next step for these patients. Although placement of a penile implant is a surgery which carries risks, they have the highest rates of success and satisfaction among ED treatment options.

Penile implants are devices that are placed fully inside your body. They make a stiff penis that lets you have normal sex. This is an excellent choice to improve uninterupted intimacy and makes relations more spontaneous.

There are two types of penile implants.

Semi rigid Implant (Bendable)

The simplest kind of implant is made from two easy-to-bend rods that are most often made of silicone. These silicone rods give the man's penis the firmness needed for sexual penetration. The implant can be bent downward for peeing or upward for sex.

Inflatable Implant

With an inflatable implant , fluid-filled cylinders are placed lengthwise in the penis. Tubing joins these cylinders to a pump placed inside the scrotum (between the testicles). When the pump is engaged, pressure in the cylinders inflate the penis and makes it stiff. Inflatable implants make a normal looking erection and are natural feeling for your partner. Your surgeon may suggest a lubricant for your partner. With the implant, men can control firmness and, sometimes, the size of the erection. Implants allows a couple to be spontaneously intimate. There is generally no change to a man's feeling or orgasm.

Penile Implant

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What is the Surgery Like?

Penile implants are most often placed under anesthesia. If a patient has a systemic, skin, or urinary tract infection, this surgery should be postponed until all infections are treated. If a man is on blood thinners, then he may need to talk with a medical expert about stopping the medications for elective surgery and healing.

Most often, one small surgical cut is made. The cut is either above the penis where it joins the belly, or under the penis where it joins the scrotum. No tissue is removed. Blood loss is typically small. A patient will either go home on the same day or spend one night in the hospital.

Recovery Time after Penile Implants:

• Most men will feel pain and will feel better with a narcotic pain-relief drug for one to two weeks. After the first week, over- the-counter pain drugs (such as acetaminophen or ibuprofen) may be substituted for narcotic pain drugs.
• Discomfort, bruising and swelling after the surgery will last for a few weeks.
• For the first month, men should limit their physical activity. The surgeon will explain when and how much exercise to do during the healing period.
• Men most often start having sex with their penile implants by eight weeks after surgery. If there is persisting swelling or pain, the use of the implant may be delayed. The surgeon or health care expert in the surgeon's office will talk about how to inflate and deflate the implant.

There are risks to prosthetic surgery and patients are counselled before the procedure. If there is a post-operative infection, the implant will likely be removed. The devices are reliable, but in the case of mechanical malfunction, the device or a part of the device will need to be replaced surgically. If a penile prosthesis is removed, other non-surgical treatments may no longer work.

Most men with penile implants and their partners say that they're satisfied with the results, and they return to more spontaneous intimacy.

Clinical Trials

Several restorative or regenerative treatments are under investigation for the future treatment of ED:

• Extracorporeal shock wave therapy (ESWT) - low-intensity shock waves that aim to fix the erectile tissues and help restore natural erections.
• Intracavernosal injection of stem cells - to help cavernous tissue regrowth
• Intracavernosal injection autologous platelet rich plasma (APRP) - to help cavernous tissue regrowth 

These are not currently approved by the FDA for ED management, but they may be offered through research studies (clinical trials). Patients who are interested should discuss the risks and benefits (informed consent) of each, as well as costs before starting any clinical trials. Most therapies not approved by the FDA are not covered by government or private insurance benefits.

Supplements

Supplements are popular and often cheaper than prescription drugs for ED. However, supplements have not been tested to see how well they work or if they are a safe treatment for ED. Patients should know that many over-the-counter drugs have been found on drug testing to have ‘bootlegged' PDE 5 Inhibitors as their main ingredient. The amounts of Viagra, Cialis, Levitra or Stendra that may be in these supplements is not under quality control and may differ from pill to pill. The FDA has issued consumer warnings and alerts.

More information may be found here. 

Updated June 2018

After Treatment

All of the treatments for ED (except for implant surgery) are used as needed for sex and then wear off. The treatments help the symptoms, but do not fix the underlying problem in the penis.

If medical treatments don't work as well as hoped:

• Changing the dosage (for PDE5i, IU or ICI alprostadil) as prescribed by the doctor may help
• Reviewing the instructions again may reveal a missing step in a treatment plan
• Considering a different path may be necessary: emotional/relationship counselling, a vacuum erection device or penile implant are all good alternatives when others methods fail. Don't give up!

Updated June 2018
 

More Information

Frequently Asked Questions

How do I know my ED is physical and not mental?

It's hard to know. Health providers now realize that most men have an underlying physical cause of ED. For most patients, there are both physical and emotional factors that lead to ED. It is impossible to prove that there is no psychological part to a man's ED.

If I worry about being able to get an erection, can I make a bad condition worse?

Nothing happens in the body without the brain. Worrying about your ability to get an erection can make it difficult to get one. This is called performance anxiety and can be overcome with education and treatment.

Can I combine treatment options?

This is often done. However, only combine treatments after talking with your health care provider about this. Erections can last too long with drug therapy, which is dangerous. Ask your doctor for proper instructions.

I was fine until I began taking this new drug, what should I do?

Never stop or change a prescription medication without first talking with your health care provider.

Many drugs can cause ED, but some cannot be changed because the drug's benefits are too important for you. If you feel sure that a specific drug has caused the ED problem, ask your health care provider if you can change drugs. If you must stay on the drug that is causing the problem, there are ED treatments that can help.