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Erectile Dysfunction

  • What is erectile dysfunction?
  • Inflatable penile prosthesis (Penis Implant/Penile Pump)
  • Penile Injection therapy
  • Psychogenic erectile dysfunction
  • Lifestyle changes
  • Medication changes
  • Drug therapy for erectile dysfunction
  • Intraurethral pellets
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Miami urologists David Robbins, MD and Amery Wirtshafter, MD are proud to offer patients the latest medical and surgical treatments for men suffering from erectile dysfunction. In fact, Dr. Robbins and Dr. Wirtshafter are recognized leaders in the treatment of erectile dysfunction in Miami and specialize in treating complex cases of erectile dysfunction including the management of Peyronie's disease and the placement of an inflatable penile prosthesis (penile implant) even in the context of prior penile surgery or episodes of prolonged priapism.

We strongly believe that penile implant surgery should be performed by an experienced surgeon in order to achieve optimal cosmetic and functional results. David Robbins, MD and Amery Wirtshafter, MD have extensive experience with penile implant surgery and are well known throughout Florida and the surrounding region for their expertise in the treatment of erectile dysfunction and penile implant surgery.

What is erectile dysfunction?

Erectile dysfunction, or male impotence, is the inability to get or keep an erection to have successful intercourse. Approximately 94 million men worldwide suffer from erectile dysfunction and, most importantly, nearly every man who has the condition can be helped.

Talking with your doctor is the first step in getting the proper treatment for erectile dysfunction. The treatment process begins with a physical exam that can include examination of your vascular system, nervous system, thyroid, prostate and genitals.

Treatment Options

Minimally Invasive Penile Implant

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David Robbins, MD is proud to offer patients the option of a minimally invasive penile implant procedure. A minimally invasive penile implant procedure is performed completely by way of a single 2 cm incision 1-2 cm above the penis below the pubic bone. This incision is completely concealed within the pubic hair once it is healed. The infrapubic approach to penile implant additionally has the advantage of significantly less post-operative scrotal swelling and discomfort. This allows the patient to have an easier post-operative course and an earlier activation of the penile implant permitting the patient to return to sexual activity. Dr. Robbins is one of only a small group of penile implant surgeons with expertise is this minimally invasive penile implant technique.

Inflatable Penile Prosthesis surgery

(Penis implant/penile pump) for refractory erectile dysfunction

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In cases of erectile dysfunction refractory to traditional medical treatments such as with oral medications, intraurethral suppositories or injection therapy, placement of a penile prosthesis (penis implant/penile pump) is an excellent option to restore erectile function. A 3-piece penile prosthesis consists of two erectile cylinders placed into the corpora cavernosum (erectile bodies), a pump in the scrotum that allows the user to self-inflate and deflate at will with ease, and a reservoir of fluid that is placed below the abdominal fascia through the same single incision that allows the fluid to flow into the cylinders when the pump in the scrotum is activated. The entire device is entirely concealed in the patient’s body and would not be noticeable in a locker room.

The 3-piece penile prosthesis (penis implant/penile pump) provides for a natural appearing erection with greater flaccidity in the deactivated position than the two piece penile prosthesis or malleable penile implant. Each prosthesis is custom fit for each individual patient. The current AMS penile prosthesis typically placed by Dr. Robbins and Dr. Wirtshafter provides both length and girth expansion.

A 3-peice penile prosthesis (penis implant/penile pump) is ideal for a patient with refractory erectile dysfunction with good mental capacity and adequate manual dexterity desiring a natural appearing erection with more a natural flaccid state than a two piece penile prosthesis or a malleable penile implant.

A penile implant (penis implant/penile pump) is an excellent option for patients with Peyronie's disease (penile curvature) and erectile dysfunction and can be used to simultaneously correct the curvature and provide excellent erectile function.

Considerations for choosing the appropriate implant include concomitant medical conditions, lifestyle, personal preference and cost. As with all surgeries, there are associated risks that include pain, infection and other complications. Miami urologists David Robbins, MD and Amery Wirtshafter, MD have significant experience with penile prosthesis surgery even in complex cases and have helped countless patients to regain their sexual function and sense of confidence.

Penile injection therapy

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Penile injection therapy is the most effective non-surgical method for the treatment of erectile dysfunction. Penile injection therapy for erectile dysfunction is used as a second line therapy when oral medications have failed. Typically, in the office we prescribe a potent three drug combination injection consisting of phentolamine, alprostadil and papaverine. The injection is placed by the patient or his partner in the lateral aspect of the penis towards the base and under optimal conditions results in an automatic erection within 3-5 minutes. The medication works by causing relaxation of the smooth muscle in the blood vessels of the penis thereby allowing increased blood flow and subsequently an erection. There is an increased risk with penile injection therapy for priapism (a sustained erection lasting longer than 4 hours) and therefore dosing for penile injection therapy must be titrated carefully by a urologist.

Psychogenic erectile dysfunction

Psychogenic erectile dysfunction is when ED is caused by emotional rather than physical factors. Anxiety, depression and stress can both cause by themselves and contribute to erectile dysfunction. Although psychological counseling may be helpful, psychogenic ED can often be resolved with stress management and supportive care. Temporary treatment with oral medications is often very helpful as well.

Lifestyle changes

When considering lifestyle changes as an approach to correct erectile dysfunction, consideration of habits that may be contribute to the condition need to be addressed. These include:

  • Decreasing or limiting the consumption of alcohol
  • Dietary changes to reduce the intake of fat and cholesterol
  • Eliminating the use of tobacco and substance abuse
  • Losing weight
  • Exercising regularly

Medication changes

A physician's review of the medications you are presently taking may result in changes to them especially if they are known to cause erectile dysfunction.

Drug therapy

Non-invasive treatments that include the use of oral medications such as Viagra, Cialis and Levitra are all proven to improve blood flow to the penis by working directly on the blood vessels. They allow the arteries to expand to produce an erection. Note that while widely available today, they do not work for 20 to 30 percent of men.

Appliances

Vacuum pump therapy may be prescribed as a non-invasive alternative. The pump device is placed over the penis and a vacuum is created mechanically enhancing the flow of blood into the penis. A rubber ring placed at the base of the penis helps to maintain the blood maintaining the erection. These cannot be prescribed for patients with bleeding disorders, are on anti-coagulants or those with sickle cell anemia.

Intraurethral pellets for erectile dysfunction

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The patient inserts a small dose of medication directly into the urethral opening at the end of the penis where the medication becomes absorbed into the erectile tissue. This causes the blood vessels to relax so that the penis fills with blood and becomes erect. Possible side effects of intraurethral pellets include priapism (a sustained erection lasting longer than 4 hours) and a burning discomfort in the urethra from the pellet.

At Urological Consultants of Florida, Miami Urologists David Robbins MD and Amery Wirtshafter MD understand that erectile dysfunction is a significant issue that can immensely impact a man's ego and esteem. We routinely screen our patients regarding the issue of impotence and erectile dysfunction. Each affected patient is assessed using the latest diagnostic technologies which may include color flow doppler imaging and subsequently an individualized treatment algorithm is developed that best suits each patient's needs and goals.