Erectile Dysfunction Diagnosis and Treatment

Erectile dysfunction (ED), also called impotence, is a man’s inability to achieve or maintain an erection that’s hard or firm enough for sexual intercourse. Occasional ED is quite common among men, particularly during times of severe fatigue or stress. However, frequent erectile dysfunction can be a signal of serious health, relationship or emotional problems and requires treatment.

Major symptoms of erectile dysfunction include:

  1. Problem getting an erection.
  2. Diminished interest in sex.
  3. Difficulty maintaining a firm enough erection for sexual intercourse.

It’s important to speak with your doctor if you are experiencing any of these symptoms, particularly if they last 2 or more months. The doctor will determine if there is an underlying condition to your ED and whether or not treatment is necessary.

Medical history and physical exam

At Advanced Urology Institute, we usually begin with a medical history and physical exam so we can find the reasons for your ED. Erectile dysfunction can be due to stress, fatigue, anxiety, low testosterone, physical problems or other factors. When we take your medical history, we will ask you questions about your health and the symptoms you are experiencing. Then we perform tests to determine whether your symptoms have an underlying cause.

You should expect a physical examination where the doctor listens to your lungs and heart, measures your blood pressure and examines your penis and testicles. We also frequently recommend a rectal exam for checking your prostate. Likewise, urine or blood tests may be necessary to rule out conditions with similar symptoms.

Who needs treatment?

When making a diagnosis for erectile dysfunction, problems such as premature ejaculation and low libido are not considered. We basically focus on your failure to have or maintain a steady erection. Since most men have ED at one point or another in their lives, the most useful factor when determining whether or not to offer treatment is the frequency of your problem. From a medical standpoint, an erectile dysfunction occurring as often as 20 percent of the time isn’t considered a major concern. However, ED that occurs 50 percent or more of the time is likely to have an underlying psychological or physical cause and warrants treatment.

ED medications

For most men, the treatments offered for erectile dysfunction are quite similar. In most cases successful treatment depends on effective treatment of the underlying causes. At times it may even be necessary to use a combination of treatments. At Advanced Urology Institute, we often begin with medications, giving drugs such as Cialis (tadalafil), Stendra (avanafil), Caverject (alprostadil), Viagra (sildenafil), Levitra (verdenafil) or Androderm (testosterone). These drugs increase the blood flow in the penis and will help you to achieve an erection. The fact that some of these drugs now have generic forms means prices have gone down and most men can afford to use them when appropriate.

Pumps and injections

In some cases, treatment for erectile dysfunction may involve the use of vacuum constriction devices (erection pumps). These are mechanical or automatic devices that help men to achieve erection by increasing blood flow to the penis. Basically, an erection pump consists of a cylinder with a pump attached directly to the end of the penis. After the pump has made the penis bigger, a constriction band or ring is attached to the other end of the penis to keep the erection comfortably in place for at least 30 minutes. The main advantage of these devices is that no invasive or surgical procedures are involved. When it’s appropriate, we recommend these devices for our patients and make arrangements so that they are ordered and sent to them.

For some men with erectile dysfunction, we may recommend penile injections. It’s often amusing talking about penile injections with men, but they are very effective in treating ED. With a sharp needle that’s too small to cause much discomfort, medications such as papaverine hydrochloride, prostaglandin E-1 or phentolamine are injected into the penis tissue to stimulate an erection. When used, papaverine injection relaxes muscles of the arterial wall, dilates the vessels and increases blood flow; phentolamine blocks nerve signals for muscle contractions and promotes muscle relaxation; while prostaglandin E-1 relaxes penile muscles resulting in an erection. Once we prescribe any of these penile injections, we show you how the injection is done — the process is simple, not painful, and up to 90 percent of the patients are able to do it on their own after it’s explained to them.

Surgical treatment of erectile dysfunction

If these options don’t work, then we may recommend surgical treatment of erectile dysfunction. Surgery can be used to implant a prosthetic device into the penis that causes an erection; reconstruct penile arteries to increase blood flow and facilitate an erection; or block off the veins in the penis to allow blood to leave the penis, which helps in maintaining an erection. At Advanced Urology Institute, we usually discuss surgery as an option for treating ED with our patients before recommending it to them. We do a lot of penile implants and penile reconstruction operations and offer several other treatments for erectile dysfunction.

Is erectile dysfunction affecting your relationship? At AUI, we offer several effective treatments for the condition, including medications, pumps, penile injections and surgery. Talk with us about your condition and find help in getting it effectively treated. We are committed to providing treatment that restores sexual health and satisfaction to men with erectile dysfunction. For more information on how we treat ED, visit the “Advanced Urology Institute’” site

The Effectiveness of Erectile Dysfunction Treatments

Worried about your inability to get or maintain an erection? Stop worrying and visit your doctor for an open and honest chat. A urologist can help you find safe and effective treatment of erectile dysfunction that will enable you to approach any future dates with your partner with confidence. Urologists are experts in treating erectile dysfunction and other genitourinary issues, so do not be anxious about such a visit. In fact, you will be surprised to find that your doctor is probably seeing up to a half dozen men with ED every week.

Oral ED Medications

The first choice of treatment for ED is usually oral medications called phosphodiesterase inhibitors type 5 (PDEi-5). These drugs include the first-generation agents such as sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis), together with second-generation agents like mirodenafil (Mvix), iodenafil (Helleva), udenafil (Zydena) and avanafil (Stendra). With the drugs providing a normal, natural erection in 80-95 percent of men as long as there is sexual stimulation, they are the best option for many men with ED. They also deliver high efficacy rates and favorable safety levels.

Transurethral and Intracavernosal Injections

If you are unresponsive to oral drugs, your doctor will review your treatment and consider other options. The urologist may consider a transurethral injection with a drug called alprostadil. The doctor may go for this option if your penile nerves have been compromised and you need to bypass the neurological pathways responsible for an erection. Another option may be an intracavernous injection of papaverine, phentolamine, PGE1 or vasoactive intestinal peptide (VIP). The injections are a good treatment choice with 91-96 percent success rates and proven safety. These drugs may be combined for better efficacy.

Vacuum Constriction Devices

Vacuum erection devices also may be considered. But these are commonly offered to elderly patients who may only want occasional sexual intercourse. Younger men do not like these devices because of the unnatural feeling of the erections and the mechanical procedure necessary to produce the erections. You should discuss this option with your doctor and find out if the devices are ideal for you.

Surgical Therapies

When medical therapies fail, your urologist may recommend surgery. Surgical procedures are often the last option because of the cost, non-reversibility and invasiveness involved. There are two kinds of surgery for men with ED: penile prosthesis and penile revascularization. In penile prosthesis, the urologist inserts an inflatable or semi-rigid implant into the penis tissue. The success rate of penile prosthesis is 97 percent, but the implant must be replaced every 8-15 years. Penile revascularization is a surgical procedure to repair either venous ligation or arterial stenosis. Explore surgery with your doctor if the other options fail to work for you, but be sure to understand what is involved before you make a decision.

Non-Specific Interventions

Erectile dysfunction treatments may be accompanied by other interventions. For instance, psychotherapy is a noninvasive and highly effective intervention that is often combined with other therapies for a better success rate. Likewise, your urologist may recommend lifestyle modifications, such as increased physical activity, dietary changes, moderate alcohol consumption or a decision to stop smoking in order to improve your ED symptoms and minimize cardiovascular risk. If tests show that you have low testosterone, your doctor may recommend testosterone replacement therapy before you use ED-specific medications. If you are a younger, healthier man, testosterone therapy may just be what you need for enhanced sexual desire and harder erections.

At Advanced Urology Institute, we have established a multidisciplinary, compassionate and patient-centered approach to the treatment of erectile dysfunction. We prioritize the needs and expectations of our patients during treatment, educating them and providing a supportive environment that ensures shared decision-making. We also conduct meticulous follow-ups to identify any changes in the relationships, health and emotional status of our patients to optimize the efficacy of our treatments. If you are experiencing bothersome and embarrassing ED, visit one of our urologists for help. Get more information on the treatment of erectile dysfunction at the “Advanced Urology Institute” site.

What is an Erectile Dysfunction? with Dr. James E. Renehan

Erectile dysfunction (ED) is a man’s inability or difficulty to get or keep erections that are firm enough to enable sexual intercourse.

While occasional ED is very common in men, particularly during times of stress, depression or fatigue, frequent ED can really ruin a man’s life. For instance, some men with erectile dysfunction may avoid contact with their partners for fear that they will have trouble satisfying them sexually in the bedroom while others may get into a complete emotional and psychological meltdown.

Forms of erectile dysfunction

According to Dr. James E. Renehan of Advanced Urology Institute, erectile dysfunction can take a variety of forms. For example, some men may be unable to get an erection under any circumstance, while other men with ED may occasionally get an erection. In other men, getting an erection is possible but the erections are not strong enough for satisfying sexual intercourse.

“Erectile dysfunction does not mean that you are infertile,” says Dr. Renehan. “In fact, the majority of the men having difficulties with getting an erection are still quite capable of achieving an orgasm and getting children. ED just means that you cannot consistently get or sustain an erection.”

What are the symptoms of erectile dysfunction?

You could be suffering from ED if you frequently have:

  1. Difficulty getting an erection.
  2. Trouble sustaining an erection throughout sexual intercourse or during sexual activities.
  3. Diminished interest in sex.

However, there are also a number of factors related to erectile dysfunction, such as:

  1. Premature ejaculation.
  2. Difficulty achieving orgasm even after ample stimulation (anorgasmia).
  3. Delayed ejaculation.

Experiencing such symptoms for 2 or more months may indicate that you have erectile dysfunction. So it is important to speak with your urologist to determine if you have a sexual disorder.

“Men should know that erectile dysfunction is not in the head,” says Dr. Renehan. “You will not simply get an erection by stimulation, as 80 percent of all cases of ED are usually caused by treatable physical disorders, such as high blood pressure, high cholesterol or diabetes. So make sure you visit your doctor for advice.”

Causes of erectile dysfunction

Erectile dysfunction may have several possible causes, including both physical disorders and emotional problems. The most common causes are:

  1. Diabetes
  2. Obesity (being overweight)
  3. Smoking, alcohol use or drug abuse
  4. Hypertension
  5. Cardiovascular disease
  6. Hyperlipidemia
  7. Injuries
  8. Stress, anxiety or relationship problems
  9. Damage from surgery or cancer treatment
  10. Increased age

Because there are many possible causes of erectile dysfunction, it is important to work with a urologist so that any underlying medical conditions are identified and treated.

Diagnosis of erectile dysfunction

When you visit your urologist, you will be asked questions related to your symptoms, health history, emotional and physical problems. You also should expect a physical examination in which the doctor will listen to your lungs and heart, examine your penis and testicles and measure your blood pressure. The doctor may order various tests to determine whether you have an underlying disorder, such as blood and urine tests. A rectal examination may be requested to check your prostate.

Treatment of erectile dysfunction

The treatment chosen by your doctor will depend on the type of symptoms and any underlying causes for the dysfunction. At times, a combination of treatments may be necessary. The most common treatments for ED include:

  1. Medications: The doctor may prescribe medications to improve blood flow to the penis and improve ED symptoms. The drugs commonly indicated include Alprostadil (Caverject), Avanafil (Stendra), Sildenafil (Viagra), Tadalafil (Cialis), Testosterone (Androderm) and Vardenafil (Levitra).
  2. Talk Therapy: If it is established that the erectile dysfunction is caused by psychological factors such as stress, depression, anxiety or post-traumatic stress disorder, the urologist may recommend that you see a therapist. Working with the therapist, you will attend several sessions in which you will be helped to recover from stress, anxiety, subconscious conflict or negative feelings around sex. A relationship counselor also may be called upon if the ED is affecting your relationship.
  3. Alternative Treatments: Treatments such as prostatic massage, acupuncture, yoga and pelvic floor exercises also may improve your condition. Likewise, lifestyle and diet changes, such as regular exercise, losing weight, lowering your blood pressure and avoiding cigarettes and alcohol can be recommended to help you overcome erectile dysfunction.
  4. Surgery: When medications and exercises fail to work, the urologist may perform a surgery to correct any problems in the penis or to add a penile implant. Penile implants help to generate spontaneous and controlled erections.

Erectile dysfunction is treatable

Most cases of erectile dysfunction are treatable. At Advanced Urology Institute, we have helped thousands of men to improve their symptoms and regain their confidence through compassionate, multidisciplinary, patient-centered treatment approaches. Depending on your condition, we will administer the right medications or treatments to ensure that you achieve an erection and be able to have satisfying sexual intercourse. Come and discuss your symptoms with us so we can fix your problem. For more information on help with erectile dysfunction, visit the “Advanced Urology Institute” site.

New Treatment Options for Erectile Dysfunction

Statistically, 50 percent of all men experience erectile dysfunction (ED) at some point of their life, with the risk of ED increasing with age. Roughly 30 million men in the United States suffer from ED, a condition that causes frustration and the breakdown of marriages and self-confidence.

Evolution of Erectile Dysfunction Treatments

Over the years, the medical management of erectile dysfunction has evolved greatly. For instance, before oral phosphodiesterase inhibitors (PDESi) like Cialis, Standra, Viagra, Levitra and related medications were introduced, doctors could administer one of only two effective treatments for erectile dysfunction: surgical penile revascularization and implantation of a penile prosthesis.

The emergence of Viagra and related oral drugs for ED ushered in a new age of non-invasive treatment of the condition. These drugs relax the muscles in the penis and increase blood flow, allowing patients to have an erection. However, while these drugs are helpful for many men, they are not safe for men with high blood pressure, severe liver disease, kidney disease, or who take nitrate drugs. The drugs also come with side effects such as a runny or stuffy nose, dizziness, fainting and blurred vision. Because of these limitations, doctors have continuously looked for new treatment options for erectile dysfunction.

New Treatment Options

New treatment options for ED include:

  1. Injection therapy: Drugs such as alprostadil (sold under the names Edex, Caverject and Prostin VR) and the suppository-form of alprostadil (sold as MUSE) are currently available to patients. Alprostadil causes expansion of blood vessels and increased blood flow to the penis, enabling patients to get erections.
  2. Extracorporeal shock-wave therapy (ESWT): Also called acoustical wave therapy or linear shockwave therapy, ESWT uses high-frequency acoustical waves for treatment of the root cause of ED. During treatment, the waves are used to open and repair blood vessels in the penis. The therapy improves blood flow in the penis by creating new blood vessels or rejuvenating existing ones, which in turn increases the patient’s ability to get an erection.
  3. Melanocortin activators: These drugs stimulate erection by acting through the central nervous system. For instance, the drug PT-141 is effective in stimulating erection when given through the nose to men with mild-to-moderate non-medical (emotional or psychological) erectile dysfunction.
  4. Topiglan: This is a cream that is applied to the penis. Topiglan contains alprostadil, the same drug that is injected or applied as suppository by men with ED.
  5. Uprima (apomorphine): Working to stimulate the secretion of the brain chemical dopamine, Uprima heightens sexual interest and increases sensations. It comes in tablet form that easily dissolves under the tongue. However, because of its major side effects of nausea and vomiting, research is still going on to find a nasal spray alternative that causes less nausea but is equally effective.
  6. Gene therapy: The therapy delivers genes that help generate proteins or products that can replace those that are not functioning well in the penile tissues of men with ED. While experimental use of gene therapy has reported tremendous success, regulatory approval and the public’s acceptance of the therapy may still take some time.

If you are suffering from erectile dysfunction, consider your options carefully. Talk to your urologist openly. Effective treatment of ED can improve your quality of life, ability to maintain intimate relationships and boost your self-esteem. At Advanced Urology Institute, we are always improving our range of treatment options to give the very best to our patients. When you visit our urology center in Florida, you can be sure that you will have a broad range of treatment options, including the very latest, for erectile dysfunction. For more information on diagnosis and treatment of erectile dysfunction, visit the “Advanced Urology Institute” site.

Erectile Dysfunction, A Common, but Treatable Condition in Men – Dr Matthew Merrell

Video: Erectile Dysfunction, A Common, but Treatable Condition in Men – Dr Matthew Merrell


Erectile dysfunction (impotence) affects approximately 30 million men. This common problem can be a sign of a health condition that needs treatment such as poorly controlled diabetes or cardiovascular disease. Contact a urologist now and get treatment as soon as possible. [Read Full Article…]

Why did Dr. Evan Fynes choose urology?

KEY TAKEAWAYS:

  • Dr. Evan Fynes, a urologist in Port Orange, FL, chose urology as his specialty due to the diversity of cases and the daily challenges it offers.
  • Patient interaction is one of Dr. Fynes’ favorite aspects of his work, as it allows him to build relationships and better understand his patients’ needs.
  • Dr. Fynes finds great fulfillment and reward in helping patients overcome their urological problems and improve their quality of life.

Dr. Evan Fynes, a urologist in Port Orange, FL, has a passion for his work and a deep appreciation for the variety and patient interaction that comes with practicing urology. In this article, we will explore the factors that led Dr. Fynes to choose urology as his specialty and how his work positively impacts patients’ lives.

The Path to Urology

Dr. Fynes grew up in Toledo, Ohio, and completed his undergraduate and medical education, as well as his six-year urologic residency, at the University of Toledo. Early on in his training, Dr. Fynes was encouraged by a friend who was a urology resident to explore the field of urology. He quickly found that he enjoyed the diversity of cases and the daily challenges that came with the specialty. From kidney stones and enlarged prostates to kidney cancer, every day brought something different to his work.

Patient Interaction

One of the aspects of urology that Dr. Fynes particularly enjoys is the patient interaction. He values the opportunity to develop relationships with his patients, often bonding over shared interests, such as football. This rapport allows him to better understand his patients’ concerns and provide tailored treatment plans to address their specific needs.

Making a Difference in Patients’ Lives

Dr. Fynes finds great fulfillment and reward in helping patients overcome their urological problems. Whether it’s removing a kidney stone or vaporizing prostate tissue to enable a patient to urinate without a catheter, he takes pride in the positive impact his work has on patients’ lives. Their gratitude and satisfaction make his efforts worthwhile and further solidify his passion for the field of urology.

Advanced Urology Institute

Dr. Evan Fynes is a part of the Advanced Urology Institute, the largest urology practice in Florida. The institute is dedicated to providing the highest quality of care for their patients through the use of state-of-the-art technology and evidence-based treatment approaches. By choosing the Advanced Urology Institute for your urological needs, you can trust that you are receiving the best possible care from highly skilled and experienced professionals.

TRANSCRIPTION:

I never met an unhappy urologist. They all seemed to really like what they did for a
living and were really enthusiastic about their job.
Hello, Dr. Evan Fynes. I’m a urologist with Advanced Urology Institute. I’ve been down
here in Florida about 15 months now. I came down from the great state of Ohio. I grew
up in northwest Ohio, Toledo, Ohio. I went to school at the, basically did all my training
in Toledo. Went to undergrad, med school, and then did a six-year urologic residency
at the University of Toledo. Urology really caught my interest early on in my training.
I had actually a good friend that was a urology resident, and he told me to kind of check
out urology. And so when I really looked into it, I mean, I really liked the diversity of
the cases. Every day you’re doing something different, whether it’s kidney stones, somebody
with a large prostate, to taking out or removing kidneys because of kidney cancer. You never
knew what you were going to do that day. It was a wide variety.
One of the favorite things I like about my work is just patient interaction. A lot of
times when I initially talk about a patient, they’ll walk in with a Pittsburgh Steelers
hat on, and the first 10 minutes of my conversation is talking about football. And so I really
enjoyed the patient interaction of getting to know somebody, developing that relationship
with somebody, and then trying to help them with their problem. From that, when you get
to help them with their problem and basically correct their situation, whether it’s removing
a kidney stone or they have a catheter in and you take away their, you know, vaporize
their prostate tissue and they’re able to pee on their own, they’re very satisfied with
having that catheter out. It does give you a sense of fulfillment and reward that
you’ve helped somebody, and they’re usually very grateful.

REFERENCES:

Penile Prosthesis – Very High Satisfaction Rate

Video: Low Testosterone – Urologists Treat The Whole Patient



This procedure has a success rate of about 90%-95% five years after insertion. Most men rate the erection as shorter than their natural one. A penile prosthesis does not change the sensation on the skin of the penis or the ability to reach orgasm or ejaculate. Contact a urologist who knows this procedure. [Read Full Article…]

What Causes Erectile Dysfunction and How Can It Be Treated? Dr. Dinesh S. Rao Explains

KEY TAKEAWAYS:

  • Erectile dysfunction is a common issue, affecting half of all men over the age of 40.
  • Various factors can contribute to erectile dysfunction, including aging, low hormone levels, smoking, alcohol use, and vascular disease.
  • A wide range of treatment options is available, from oral medications to surgical interventions, and the Advanced Urology Institute offers comprehensive care for patients with erectile dysfunction.

The Prevalence of Erectile Dysfunction

Dr. Dinesh S. Rao, a respected urologist in Ocala, FL, explains that erectile dysfunction (ED) is a common issue faced by many men, particularly those over the age of 40. In fact, half of all men over 40 experience some degree of erectile dysfunction. Despite its prevalence, many patients feel hesitant or embarrassed to discuss the issue with their healthcare providers.

Causes of Erectile Dysfunction

Erectile dysfunction can be caused by various factors. Some well-known causes include smoking and alcohol use. However, other factors, such as aging, low hormone levels, and vascular disease, can also contribute to ED. Dr. Rao emphasizes that heart disease and high cholesterol can have a profound effect on erections, further highlighting the importance of addressing underlying health issues.

Treatment Options for Erectile Dysfunction

When treating erectile dysfunction, Dr. Rao and his team at the Advanced Urology Institute screen for basic causes and attempt to reverse them where possible. They also offer a wide range of treatment options to suit each patient’s unique needs. These include:

  • Oral medications: Common medications, such as Viagra, Levitra, and Cialis, are often the first line of treatment for erectile dysfunction.
  • Mechanical devices: Vacuum erection aids can help those who do not tolerate oral medications.
  • Injectable therapies: Available at local pharmacies, these treatments are another option for those who cannot take oral medications. Dr. Rao’s team teaches patients how to administer injectable therapies safely and effectively.
  • Surgical interventions: Penile implantations are an option for patients who have not found success with other treatments.

Advanced Urology Institute: Comprehensive Care for Erectile Dysfunction

The Advanced Urology Institute, the largest urology practice in Florida, is dedicated to providing comprehensive care for patients with erectile dysfunction. Dr. Dinesh S. Rao and his team of skilled urologists work closely with each patient to determine the most effective treatment options, ensuring the best possible outcomes.

TRANSCRIPTION:

Many of my patients have erectile dysfunction and many of them are afraid to bring it up. There’s always some hesitation or embarrassment involved. There’s a feeling that it’s just me or there’s something wrong with me. The interesting thing is, and many people don’t know, that half of all men over the age of 40 have erectile dysfunction. So it’s extremely common, not uncommon. And there’s many, many different causes. 

Some of the things I think a lot of people are aware of, things like smoking and alcohol use, but also just aging, low hormone levels, and vascular disease apply to erectile dysfunction. If you have some element of heart disease or high cholesterol, it can make a profound effect on erections. When people come in with that problem, we screen for the basic causes and see if we can reverse some of those things, but there’s also many different types of treatments available. So we certainly have all of the different available here in our practice. Some of the most basic things include medicines, medications that people have probably heard of, things like Viagra or Levitra or Cialis. There’s also mechanical devices like vacuum erection aids that can help in people who don’t tolerate those types of medicines. We have injectable therapies that are also available and they’re available to local pharmacies and we teach people how to use them. And we even do surgeries, things like penile implantations for people who don’t succeed with other options.

REFERENCES:

What is Erectile Dysfunction? by Dr. Richard Roach

A man may have Erectile Dysfunction if he had failed to have an erection, or may have inconsistent ability to achieve an erection and lastly he can only sustain an erection briefly. Contact a urologist now and get treatment for this condition as soon as possible. [Read Full Article…]

What is Erectile Dysfunction? by Dr.Andy Sher

​Erectile dysfunction (impotence) affects approximately 30 million men. This common problem can be a sign of a health condition that needs treatment such as poorly controlled diabetes or cardiovascular disease. Contact a urologist now and get treatment for this condition as soon as possible. [Read Full Article…]