Erectile dysfunction treatment options

There are numerous erectile dysfunction treatment options, from least to most invasive, all with various amounts of success.

Lifestyle Changes are the first-in-line treatment option for erectile dysfunction. Managing erectile dysfunction involves:

• Decreasing stress
• Improving diet and nutrition
• Losing weight
• Controlling diabetes
• Decreasing consumption of alcohol
• Avoiding the use of illicit drugs and smoking

Also available are psychogenic treatments in which the patient may be seen by a sex therapist.

Medications to treat erectile dysfunction are primarily focused on increasing blood flow to the erectile tissue. Change of medication or adjustments is sometimes necessary over time depending on the body’s response.

• Hormone replacement, particularly testosterone
• Oral pills (ex: Viagra, Cialis, Levitra, Stendra)
• Penile injection therapy (ex: Tri-Mix); these injections are placed straight into the penis
• Urethral gels or pellets, which can be placed either on the head of the penis or placed through the urethra or the opening of the penis

Vacuum Erection Devices are devices which basically look like a hollow cylinder. The patient places the penis into the tube and presses a button, and from vacuum suction the penis becomes turgid and sometimes rigid enough for penetration.

Penile Implant Surgery is done in the operating room using non-inflatable and inflatable penile prosthesis or implants. This hydraulic device is placed in the penis, and by squeezing a pump, it allows water to engorge the penis and develop an erection that is satisfactory for intercourse. Overnight, a man can achieve and maintain an erection whenever he chooses to do so. This represents an excellent durable option.

Regenerative Therapies that exist today are stem cell therapy, platelet rich plasma (PRP), and shockwave therapy. Stem cells and PRP injections represent exciting avenues for the future but are not ready for primetime, as it stands today in urology, showing insufficient evidence of efficacy and safety for erectile function.

Shockwave therapy is a newer technique in which we are able to increase the ability of a man to maintain an erection and reproduce the erections of prior days without the need for any additional therapies. Evidence supports the use in select patients who are younger with mild to moderate erectile dysfunction, those who are non-diabetics, and patients who would like to avoid pills or are either non-responders or partial responders to PDE5 inhibitors or pills such as Viagra, Cialis, and those who were intolerant to pills. There is a difference between what is called radial acoustic vs. focal shockwave therapy. Acoustic or GAINSWave® therapy doesn’t have as much pressure, last as long, or penetrate the tissue as much as real shockwave therapy.