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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 are one of the pioneering urological specialists offering shockwave treatment for erectile dysfunction.
We strongly believe that when a surgical option for erectile dysfunction is required, 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.
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.
Extracorporeal shock wave therapy (ESWT) for erectile dysfunction is a novel new therapy for the treatment of ED. As opposed to traditional treatments for ED such as oral medications, injection therapy, and vacuum erectile devices, and penile implants, shock wave treatment for ED has the goal of restoring natural erectile function by improving penile blood flow so that a man can achieve normal erections without assistance.
Shock wave therapy for ED utilizes low-intensity pulsatile sound waves to stimulate increased penile blood flow by causing a reaction at a cellular level resulting in neovascularization. Increased blood flow to the penis results in improved erectile function and increased sexual satisfaction.
Miami urologist and ED specialist David Robbins, MD is one of the pioneering urologists in Miami, Fort Lauderdale, and South Florida offering shock wave therapy for ED. Click below in English or Spanish to learn more about this cutting-edge therapy for erectile dysfunction.
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 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.
(Penis implant/penile pump) for refractory erectile dysfunction
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 the implant at will and 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-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 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 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 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.
When considering lifestyle changes as an approach to correct erectile dysfunction, consideration of habits that may be contribute to the condition needs to be addressed. These include:
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.
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.
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.
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 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.
Natural erections are neurovascular events that involve both the nervous system and the vascular system. The nervous system involves nerves and the vascular system involves veins and arteries. The erectile process begins with either tactile or mental stimulation. Tactile stimulation or arousal involves physical sexual stimulation with a partner or masturbation. Mental stimulation involves either mental sexual fantasies or visual arousal such as watching pornography. Sexual stimulation causes an increase in the release of Nitric Oxide (NO) within the corpus cavernosum (the penile erectile capsule). Nitric Oxide then stimulates the production of cGMP a chemical messenger that acts directly on the smooth muscle around the blood vessels in the penile corpora cavernosum resulting in blood vessel dilation and an increase in blood flow and expansion of the penis.
As the penis expands during an erection, it causes increased pressure on the fibrous capsule of the penile corpora cavernosum known as the tunica albuginea. The bridging veins that exit the tunica albuginea get compressed and this decreases the outflow of blood from the penis resulting in a rigid erection. When sexual stimulation decreases, a chemical messenger called phosphodiesterase 5 (PDE5) causes a breakdown of cGMP into GMP and thereby decreases blood flow into the penis. This process results in detumescence-- a loss of the erection. A breakdown in any of the above-described processes or medication to enhance the process has a direct effect on a patient’s erectile capabilities and can either impair the erection (erectile dysfunction) or improve erections.
At Urological Consultants of Florida in Miami, we specialize in all available options to diagnose and treat erectile dysfunction. As board-certified urologists, we are uniquely qualified to treat both surgical and medical causes of erectile dysfunction as well as low libido and hypogonadism. Please be aware that most men's clinics and erectile dysfunction centers are not staffed with urological specialists who are uniquely qualified to diagnose and treat erectile dysfunction.