Insufficiency to achieve consistency in penile erection is called Erectile Dysfunction. ED has a myriad of causative factors that can be psychogenic or organ-related. Urinary tract disorders are clinically manifest as Erectile Dysfunction in men. Urology deals with Urinary tract infections, disorders of the reproductive system, and other sexual issues in men.
Restoring sexual function is important even for aging males. Strong associations are seen between Urinary tract infections and the onset of Erectile Dysfunction. Seeking help from a Urologist for ED can be beneficial in many ways:
- They can make you understand the severity of your condition.
- They can figure out the possible risk factor causing it.
- They can advise to scans and tests to make a definitive diagnosis.
- They can uncover the co-morbid conditions and can make your treatment plan wisely.
The first step is to speak to your doctor. Talking about sexual issues and sexual health can be difficult due to either of the reasons:
- Lack of Awareness
- Not knowing where to start
- Lack of confidence
- Conservative sexual beliefs
- Insufficient knowledge of sexual health
Your doctor can refer you to the best urologist for ED. A Urologist will ask you to undergo various tests like Testosterone level, Cholesterol and Lipid profile, Fasting Glucose, Blood pressure, BMI, Waistline circumference, and liver function. He will take a detailed medical history of any ailments in the past and your sexual history.
It is important to trust your specialist and explain to him about your condition. A physical examination of the entire area will rule out any in-growth or outgrowth that can obstruct the blood flow. A Doppler scan if any obstruction is suspected.
It is okay to inquire
Good articulation between the Doctor and the patient is significantly important. Try to communicate your concerns over the treatment. You may start with the following questions:
- Importance of Tests
- The course of Treatment Plan
- Duration of Treatment
- Pros and Cons of the medication
- If surgery is required
- Other symptoms that may occur during treatment
Potential Situations requiring Secondary Care
Urological infections with ED are often accompanied by other conditions like diabetes, cardiovascular diseases, or kidney dysfunction. These situations require a holistic approach and intervention to formulate the treatment plan. The expert opinion will always be taken after your consent.
If you are already undergoing treatment for any other ailment, inform your urologist. Certain medications do not give the desired result or may cause any side-effects when taken along with other medications.
Lifestyle Modification- Cessation of smoking, weight loss, less consumption of alcohol and drugs, and a healthy exercise routine are associated with an improvement in erectile function and underlying conditions like diabetes and CVD.
Stress Management- Stress and behavior management therapies can act as an adjunct to your preliminary treatment plan.
- PDE-5 Inhibitors- They are mainstream medications prescribed to provide temporary relief. They work by improving blood flow and relaxing the penile musculature. These medications are Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil. They bear potential side-effects on prolonged usage and may not show the same results in every individual. They can be taken as oral medications or suppositories.
- Testosterone replacement therapy- Small amount of testosterone helps to achieve an erection by working on the availability of Nitric Oxide. This therapy is administered alongside PDE-5 inhibitors.
- Injectables- Intra-cavernosal and intra-urethral injections have gained popularity and are used when a patient doesn't respond to the medications mentioned above.
Vacuum devices: They can be used in combination with other therapies. They create negative pressure, and a constriction ring achieves penile tumescence or penile fullness at the base of the penis.
Penile Prosthesis Surgery
Penile implants are suitable for patients with severe ED. The two available implants are:
- Malleable – Low cost, easier placement
- Inflatable- Fewer chances of mechanical failure
Antibiotic coated implants are available that have reduced the risk of cross-infection.
The Newer line of therapies is around the corner that will revolutionize ED treatment modalities and offer a more customized therapy. These are
- Stem-cell Therapy
- Gene Therapy
- Low-intensity shockwave therapy
Medically reviewed by Rishabh Verma, RP