Services & Procedures

Treatment for Erectile Dysfunction

What is erectile dysfunction?
Psychogenic erectile dysfunction
Lifestyle changes
Medication changes
Drug therapy for erectile dysfunction
Intraurethral pellets
Penile Injection therapy
Inflatable penile prosthesis (Penis Implant/Penile Pump)

Miami urologists Dr. Amery Wirtshafter and Dr. David Robbins are proud to offer patients the latest medical and surgical treatments for men suffering from erectile dysfunction. In fact, Dr. Wirtshafter and Dr. Robbins 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 even in the context of prior penile surgery or episodes of prolonged priapism.

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

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

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.

Penile injection therapy

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 of 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 of the blood vessels of the penis 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.

Inflatable Penile Prosthesis surgery (Penis implant/penile pump) for refractory erectile dysfunciton

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 patients body and would not be noticable 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. Wirtshafter and Dr. Robbins provides both length and girth expansion.

A three piece 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 natural flaccidity 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 medical condition, lifestyle, personal preference and cost. As with all surgeries, there are associated risks that include pain, infection and other complications.

Miami urologists Dr. Amery Wirthsafter and Dr. David Robbins 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.