The Most Recent Treatment Options for Erectile Dysfunction

By Carl Capelouto, M.D.

Erectile dysfunction (ED) affects millions of American men. The effects of ED can be psychologically devastating, not only to the man but also to his partner as well. In particular, the damage to the self-esteem of both partners can be extremely troubling and damaging to the relationship. But the expert urologists at Georgia Urology are equipped to tack on the task to bring back confidence to all of our patients.

Happy patient discusses erectile dysfunction treatment options with Georgia Urology physician.

How Can Georgia Urology Help with Erectile Dysfunction?

At Georgia Urology, the management and treatment of ED is a major component of our practice and our physicians are among the leaders in the care of these patients. Many patients and their partners are often embarrassed to discuss such an intimate problem. Our providers strive to help our patients with these problems in a caring and supportive environment.

Goal-directed therapy is the mainstay of management. We will provide the least involved therapy that gets the patient back to successful erectile function. Let’s discuss the current options for therapy and briefly touch on a possible exciting new development in the treatment of ED.

Treatments for Erectile Dysfunction

Unless you have lived on another planet for the past 15 years, you have heard of the oral medications available for ED. Viagra, Cialis, Levitra, and Stendra are all members of the same family of medications called PDE inhibitors. These medications trigger the relaxation of arterial smooth muscle in the penis, leading to arterial dilation and venous constriction resulting in an erection.

These medications are effective in about 70% of men in restoring successful erectile function. Side effects are usually mild and include flushing, headache, and/or mild gastritis. Rare side effects include hearing loss, vision loss, and a prolonged erection lasting more than a few hours. In my 20 years of prescribing these medications, I have never seen these more serious side effects and I have prescribed these medications to thousands of patients.

These medications have traditionally been very expensive are rarely covered by insurance drug plans. Recently, Sildenafil, which is the same as Viagra, went off-label in the 20 mg dose. Georgia Urology has a direct pathway to the distribution of Sildenafil, and we are able to offer these pills to our patients for about a dollar a pill.

Vacuum erection devices (VED) have been commercially available for over 40 years. They consist of a closed-end plastic cylinder and a vacuum pump that is either hand or battery-operated. They are generally reliable, non-invasive, relatively easy to use, and inexpensive. They do require some degree of manual dexterity. The disadvantages are that they are not indiscreet being rather bulky, lead to a hinge-like erection (due to only getting the visible part of the penis erect), and can be painful in many patients.

Intracavernosal injections have also been available for 30 years. This treatment involves using a very small insulin-type needle to inject a vasoactive substance directly into the penile erectile tissues. This is a highly successful treatment (>70%) and is mainly used as the next option when patients fail oral medications.

The first injection is done by the provider where the patient or his partner is taught to do subsequent injections on their own. Complications include pain, fibrosis, and prolonged erections. Side effects are uncommon and this is a very successful option once we get the patient past the fear of penile injection, which in reality are no more painful than an injection in any other part of the body.

These medications are also rarely covered by providers but, due to its purchasing power of over 50 providers, Georgia Urology is able to provide these medications through our in-house compounding pharmacy provider at substantial cost savings over traditional pharmacies.

Penile implant surgery has been performed by the specialists at Georgia Urology for decades. The surgery is performed on properly selected patients has very high satisfaction rates. It is mainly used when all the previously mentioned options have been unsuccessful. The surgery is performed through a very small incision in the scrotum and is entirely self-contained.

There are no exposed components and the erection looks and feels natural to the patient and his partner. The modern implants allow for not only an excellent erection but also a normal appearance in the deflated state. If you failed pills and injections, a penile implant is probably the best option to consider if you want to have a more normal and spontaneous sexually functioning.

Finally, Georgia Urology is currently evaluating low-intensity shock-wave therapy (LISWT) for erectile dysfunction. Already widely used in Europe, this treatment appears successful in improving erectile function in about 60% of patients. The responses appear to be best in patients who are taking medications and less successful in more severe types of ED. It appears safe with minimal side effects and very little discomfort.

If you or your loved one is struggling with Erectile Dysfunction, then contact the experts at Georgia Urology at 678-284-4053. We’ll be able to evaluate which one of the treatment options described above are best for you.