Erectile Dysfunction Treatment
Intracavernosal Drug Therapy
In 1982 the notable Dr. Virag reported that male erection could be produced by injecting papaverine into the internal vessels of the penis. Now injection therapy has become one of the more routine forms of treating erectile dysfunction. Several agents are used, either together or separately.
Unlike a normal erection, detumescence does not occur following a man's ejaculation - it takes place when he medication has been metabolized in the penis or has passed into the systemic circulation. The most commonly used drugs are prostaglandin E1 and papaverine, all of which increase arterial blood flow into the penis.
Unfortunately there are numerous possible side effects including pain, nausea, hypotension, headache, fainting, priaprism, and penile scarring with deformity.
However, the positive side is that firm erections lasting up to one hour or more can be achieved with this therapy. Caution! if any man happens to develop an erection that persists for more than three hours, he must speak to a urologist or report to a hospital emergency department urgently. Prolonged erections can cause penile damage and deformtiy.
Intraurethral Prostaglandin E1 (Muse)
Prostaglandin E1 comes as a suppository pellet which is placed in the urethra and produces erections in two-thirds of men. Side effects are not uncommon, with pain and scarring are the most common. Some reports suggest up to 5% of men are affected in this way. Prostaglandin E1 can be harmful to pregnant women and must should not be used with pregnant spouses or partners.
The now-famous Vacuum Erection Device (VED) consists of a clear cylinder placed over the penis and a hand- or battery-operated pump which is used to remove air from the cylinder, creating a partial vacuum which helps to draw blood into the penile cavernosa. A "constrictor band" is used to hold the blood in place, and this must be worn during intercourse. A high number of men - say 70% - have satisfactory erections with VEDs.
So-called Venous Flow Controllers (VFCs) are used when a man's inability to keep an erection is due to venous leakage; in other words, the body's inability to trap blood in the penis. VFCs reduce the blood which can flow out of the penis, thereby helping to maintain a man's erection.
Penile arterial bypass surgery, which is like coronary artery bypass surgery, has been available for over 20 years. But the success of this surgery depends very much on the skill of the surgeon and the age of the patient: young patients with focal arterial lesions resulting from trauma are the most successful group.
Venous ablation surgery is rarely successful and thus is rarely attempted. but there may be a case for trying it when a young man has never had a decent erection, or has undergone pelvic trauma, or has previously had penile surgery for priapism.
Penile implant surgery (the implantation of a prosthesis) became popular in the 1970s when manufacturers developed semi-rigid and inflatable prostheses. The implants are fitted in day surgery - or at most an overnight stay - and are concealed in the pelvic or scrotal region. Most men recover in approximately a week.
Non-Hydraulic or Semi Rigid Prostheses
Said to be a simple, inexpensive, easy, full girth, and flexible prosthesis, the main problem with them is one which many men find challenging: the fact that the prosthesis cannot increase in length or girth. This type of prosthesis has a high success rate.
Mechanical semi-rigid prostheses use a cable for tumescence and detumescence. This is a more complex type of implant.
The single piece malleable prosthesis (known as the AMS Dynaflex) has a pump in the distal section and a reservoir on the proximal section. There are several disadvantages: the prosthesis can be hard to operate, produces rigidity which may not be sufficient for patient satisfaction, and protrudes when the man is naked.
A superior two-piece prosthesis (such as the Mentor Mark II and AMS Ambicor) consist of a pair of cylinders connected to a reservoir pump housed in the scrotum. This can be helpful in men who have undergone previous abdominal surgery and formed scars. But because the reservoir can hold only a small amount of fluid, the device may not be adequate to achieve maximum penile circumference and length.
Finally, there is the three-piece of fully inflatable penile prosthesis. This prosthesis is most like a normal erection. It increases both girth and length with inflation and appears normal.