One of the most important messages to the public would be that this condition is treatable and that men should seek help if they suffer from erectile dysfunction. To prevent disease, positive, healthy and basic lifestyle choices such as smoking, diet and exercise must be addressed. [146] It is also of paramount importance to aggressively treat existing conditions such as diabetes, obesity and high blood pressure. Erectile dysfunction can be the first symptom of an otherwise silent cardiovascular disease, so a complete cardiovascular assessment should be performed in all patients without an obvious cause of their erectile dysfunction. [22] [67] The pudendal artery clearly illustrates the arterial vascular system of the penis. [81] It is usually reserved for young patients with erectile dysfunction following trauma who are considering revascularization surgery. The anatomy of the pelvic, pudendal and internal penile arteries is carefully studied. The lower epigastric arteries are also being studied for their possible use in the revascularization of the penis. A vacuum constriction device (top) is a cylinder that is placed on the penis. Air is pumped out of the cylinder, which draws blood into the penis and causes an erection. Erection is maintained by pushing a band from the base of the cylinder to the base of the penis. The group can stay in place for up to 30 minutes.
The vacuum device can be used safely to treat most causes of erectile failure. Lack of spontaneity, discomfort and heaviness of the device seem to be the biggest concerns of patients. Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles, and blood vessels. Erectile dysfunction can result from a problem with any of these problems. Similarly, stress and mental health issues can cause or exacerbate erectile dysfunction. Penile revascularization surgery may be considered in a small subset of patients estimated at about 5% of all patients with erectile dysfunction. [125] This is ideally considered for the young patient (under 30 years of age) with erectile dysfunction after pelvic/perineal trauma who has suffered an isolated vascular injury. Arterial insufficiency should be detected by Doppler ultrasound of the penis and then identified on a formal arterogram. Revascularization surgery is performed by anastomosing the inferior epigastric artery to the dorsal artery of the penis or directly to the body cavenosum.
The long-term results are only marginal. Penile biothesiometry is a simple in-office screening test for penile neuropathy using skin threshold sensitivity. The blunt tip of a vibrating probe is placed one after the other on the right and left trees, as well as on the glans. The intensity of the vibrations varies and the patient is asked to indicate when he is just beginning to feel the tip vibrate. The minimum intensity of the probe vibrations that the patient can detect would be its sensitivity to threshold vibrations, which can be compared to normal standards. Five separate readings are performed at each site and the results are averaged; then relative to normal values based on age. [70] Although it does not directly test erectile nerves, it serves as a reasonable, safe and inexpensive office test of the penis for neuropathy. More specific nerve tests can be performed on patients who test positive. [70] [71] [72] It has been suggested that patients with an abnormal biothesiometry test may be somewhat hypersensitive to intratracavernosal injection therapy due to hypersensitivity to denervation, but this has not been confirmed. Neurological causes. There are many neurological (nervous) causes of erectile dysfunction.
Diabetes, chronic alcoholism, multiple sclerosis, heavy metal poisoning, spinal cord and nerve damage, and nerve damage from pelvic surgery can lead to erectile dysfunction. Erectile dysfunction is defined as the persistent inability to achieve or maintain an erection of the penis sufficient for satisfactory sexual performance. The Massachusetts Male Aging Study surveyed 1,709 men between the ages of 40 and 70 between 1987 and 1989 and found that there was an overall prevalence of erectile dysfunction of 52%. It is estimated that more than 152 million men worldwide suffered from erectile dysfunction in 1995. For 2025, the prevalence of erectile dysfunction worldwide is estimated at around 322 million. Various risk factors can contribute to erectile dysfunction, including: Accurate identification and characterization of risk factors are essential for the prevention or treatment of erectile dysfunction. In the past, erectile dysfunction was widely considered to be caused by psychological problems. It is now known that for most men, erectile dysfunction is caused by physical problems that are usually related to the blood supply to the penis.
A lot of progress has been made in the diagnosis and treatment of erectile dysfunction. If these options fail, you may be referred to a urologist who can help you with other non-surgical options, such as vacuum device or injections, or surgical treatment options. If necessary, your doctor can also refer you to a psychologist who specializes in sexual dysfunction. Here are some of the different types and possible causes of erectile dysfunction: Low-intensity shock wave therapy has been shown to be effective, especially in patients with severe erectile dysfunction who do not respond to PDE-5 inhibitors. [130] [131] [132] [133] Its presumed mechanism of action consists of improved cavernous hemodynamics, induction of endothelial cell proliferation and activation of endogenous stem cells, as well as penis revascularization. Shock wave therapy increases angiogenic factors that promote neovascularization, restores smooth muscle activity and attracts stem cells. It also increases vascular endothelial growth factor, neuronal nitric oxide synthase and other similar natural bioactive agents. [134] In other words, its exact mechanism of action is not well understood, but it seems that the effect depends on the dose, with 3,000 pulses per session giving better results than 1,500 or 2,000. [131] Although early results in optimal candidates appear promising, some studies have shown no effect. [135] Meta-analysis of all currently available studies showed that low-intensity shock wave therapy generally provides a clinically significant short-term improvement in erectile stiffness and foctolin, but the lack of long-term data makes it difficult to recommend at this time. [136] Overall, low-intensity shockwave therapy appears to be a reasonable, safe and moderately effective initial therapy for relatively healthy men with mild to moderate erectile dysfunction, with an overall success rate of about 40% after 30 months.
Negative risk factors that limited positive outcomes include advanced age, high blood pressure, smoking, obesity, hyperlipidemia, high levels of ShiM (sexual health inventory for men) prior to treatment, and long-term erectile dysfunction. Low-intensity shock therapy has been shown to be relatively unnecessary in men with severe erectile dysfunction. [137] The treatment is still considered an investigational drug in the United States and is not currently approved by the FDA. Erectile dysfunction can put a couple to the test. Often, men avoid sexual situations because of the emotional pain associated with erectile dysfunction, which makes their partner feel rejected or inadequate. It is important to communicate openly with your partner. Some couples consider seeking treatment for erectile dysfunction together, while other men prefer to seek treatment without their partner`s knowledge. A lack of communication is the main obstacle to finding treatment and can prolong suffering. Loss of erectile capacity can have profound effects on a man. The good news is that erectile dysfunction can usually be treated safely and effectively. Among prostate cancer patients undergoing radical prostatectomy, 85% can expect postoperative erectile dysfunction, compared to an erectile dysfunction rate of only 25% in men who received permanent radiation therapy.
[53] [54] (These data refer to patients who did not have an emergency room prior to their prostate cancer treatment.) Interestingly, the use of robotic surgery in radical prostatectomies did not alter the postoperative incidence of erectile dysfunction.
