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Although not fully investigated, restless leg syndrome (RLS) appears also to increase the rates of ED in men.

It is still unclear how treatment for RLS impacts ED. Medications: Certain medications may increase ED rates in men.

It is estimated that medications may be at least partially responsible for 25% of ED cases in men. Some of the most common medications that can cause ED include: antidepressants, sympathetic blockers (clonidine, methyldopa), certain diuretics (water pills), ketoconazole, H2 antagonists (cimetidine, ranitidine), anticholinergics. A variety of other medications are also associated with ED.

Alcohol, cocaine, marijuana, and other drugs also can exacerbate ED symptoms.

Biking/Endocrine/Low Testosterone: Excessive bicycling, endocrine disorders, and low testosterone are also risk factors for ED.

Bicycling places pressure on the perineal nerves, which in excessive amounts, can cause numbness of the penis and impotence.

Others: Other potential causes of ED include systemic sclerosis (scleroderma), Peyronie’s disease (excessive curvature of the penis), past trauma to the penis or pelvis, past surgeries, and prostate cancer treatment. To summarize, there are many different factors that can cause or contribute to ED.

Some of the strongest contributors, such as comorbid conditions, can be modified and controlled with lifestyle changes. Most common however, ED causes are multifactorial and complex.

Our urology team is here to work with you to resolve your ED and improve your sexual function. How We Diagnose ED: As described above, there are many risk factors and causes for ED.

Therefore, our team investigates the potential causes for each patient thoroughly and independently to ensure the best possible outcome.

Our work up for ED may include: Medical and sexual history Physical exam Psychological cvs cialis 5mg price assessment Basic labs. Treatment Options: Treatment options may vary depending on the presumed cause of your ED. Our team will work with and may suggest the following treatments: Oral medications, such as Viagra, Cialis, or Levitra Vacuum devices Penile self-injection therapy Lifestyle modifications Surgical procedures.

Erectile dysfunction (also known as impotence, or ED) is the inability to get and keep an erection firm enough for sex. A practical approach to treating ED —similar to the strategy for most medical issues — starts with a medical history, physical examination and basic lab tests. More extensive testing may be suggested depending on the individual.

If the evaluation indicates that the ED is psychological or emotional in origin, referral to a qualified psychologist, psychiatrist or sexual counselor will be the next step.

If the lab results indicate low testosterone, additional hormone tests will be done to determine the precise cause of the low testosterone, then a treatment aimed at normalizing the levels will be suggested.

If testing shows undiagnosed or poorly controlled diabetes or a risky lipid and cholesterol profile, a referral to another medical professional will be necessary. Although ED treatment is tailored to the individual patient, there are four general paths of treatment for ED: 1.

A healthy lifestyle can “reverse” ED naturally, as opposed to “managing” it.

Since ED can often be considered a “chronic disease,” healthy lifestyle choices can reverse it, prevent it from getting worse, or even prevent it altogether.

Since sexual function is based on many body parts working together, this approach is to nurture every cell, tissue and organ in the body.The goal is to achieve a healthy weight, adopt a healthy diet, exercise regularly, get enough good quality sleep, stop using tobacco, consume alcohol in moderation, and reduce stress.

Aside from general cardio and strength exercises, specific pelvic floor muscle exercises (“man-Kegels”) are beneficial to improve the strength, power and endurance of the penile “rigidity” muscles.

If a healthy lifestyle can be adopted, sexual function will often improve dramatically, as well as overall health improvements. Since many medications have side effects that negatively impact sexual function, a bonus of lifestyle improvement is potentially needing lower dosages or perhaps eliminating medications (blood pressure, cholesterol, diabetes), which can result in further improving sexual function.

It’s my opinion that oral ED medications should be reserved for when lifestyle optimization fails to improve sexual issues.

This may be at odds with some physicians who find it convenient to simply prescribe meds, and with some patients who want a quick and easy fix. However, as good as Viagra, Levitra, Cialis and Stendra may be, they are expensive, have side effects, are not effective for every patient and cannot be used by everyone, as there are medical situations and certain medications that may prevent their use.

In this category, I also include mechanical, non-pharmacological, non-surgical devices, including low-intensity penile shockwave cvs cialis 5mg price therapy, vacuum suction devices, vibration devices and penile traction devices.

Low-intensity shockwave therapy is an exciting new treatment option that uses acoustic energy to cause mechanical stress and microtrauma to erectile

tissues

This stimulates the growth of new blood vessels and nerve fibers and potentially enables penile tissue to regain the ability for spontaneous erection.

Vacuum suction devices are mechanical means of producing an erection in which the penis is placed within a plastic cylinder that is connected to a manual or battery-powered vacuum.

Negative pressure engorges the penis with blood and a constriction band is temporarily placed around the base of the penis to maintain the erection.

80% of men can achieve good rigidity, but many do not continue using the device because of its cumbersome nature.

Venous constriction devices are

used

Men who find these beneficial are usually able to obtain a reasonable quality rigid erection but tend to lose it prematurely. Vibration devices were traditionally employed to provoke ejaculation in men with spinal cord injuries who desired to father children.

Subsequently, they have achieved broader utility and are now also used to facilitate erections in men with ED.

Dual-armed vibratory stimulation of the penile shaft is capable of inducing an erection and ultimately ejaculation. Penile traction devices use mechanical pulling forces to lengthen and/or straighten the penis to manage or prevent penile shortening and angulation. Vasodilator urethral suppositories and penile injections. These are suppositories and injections that increase penile blood flow and induce erections. (Medical urethral system for erection) is a small medicated vasodilator pellet available in a variety of different dosages that is placed within the urinary channel of the penis after urinating.

Absorption occurs through the urethra into the adjacent erectile chambers, inducing increased penile blood flow and potentially an erection.

About 40% of men can achieve rigidity, but it is often inconsistent. Prostaglandin E1 is injected directly into one of the erectile chambers of the penis, resulting in increased blood flow and erectile rigidity. After being taught the technique of self-injection, vasodilator medications can be used on demand, resulting in rigid and durable erections.

A combination of medications can be used for optimal results—one such popularly used combination consists of papaverine, phentolamine and alprostadil, known as “Trimix.” 90% or so of men achieve an excellent response, although many men are reluctant to put a needle into their penis.

Penile prostheses can be life changers for men who cannot achieve a sustainable erection. Surgically implanted under anesthesia on an outpatient basis, they provide the necessary penile rigidity to have intercourse whenever and for however long desirable.

The semi-rigid device is a simple one-piece flexible rod, one of which is implanted within each of the paired erectile chambers.

The penis is bent up for sexual intercourse and down for concealment. The inflatable device is a three-piece unit that is capable of inflation and deflation.

Inflatable inner tubes

are

When the patient desires an erection, he pumps cvs cialis 5mg price the control pump several times, which transfers fluid from the reservoir to the inflatable inner tubes, creating a hydraulic erection that can be used for as long as desired. When the sexual act is completed, the device is deflated via the control pump, transferring fluid back to the reservoir and restoring a flaccid state. Implantica’s Solution, PotencyFlow® Implantica’s PotencyFlow® is subject to further development and approval process. Although Viagra type of drugs has improved the situation for the around 150 million men suffering from Erectile Dysfunction, only 50% are able to use these drugs with a successful result.

PotencyFlow® is designed to treat impotence by hindering blood leakage from the penis during erection.

The most common cause for erectile dysfunction is leakage of blood from the erectile system since pressurized blood causes the erection. Implantica’s PotencyFlow® is designed to help these patients suffering from erectile dysfunction, which occurs when the blood drains too quickly through the veins.

The device, which will use Implantica’s shared wireless energy platform, will be controlled wirelessly by a remote control or a push button under the skin resulting in a smooth chain of events that is expected to lead to a more natural erect penis.

The device is designed to create erection by stimulation followed by restricting

the

The options available today are reconstructive surgery (often with poor long-term result) or a penile implant.

Unlike penile implants, PotencyFlow® will not damage the penile erectile tissue and will therefore be preferred entry procedure especially for patients with some functionality left, having vascular problems. PotencyFlow® is intended to be controlled wirelessly or by a push button under the skin resulting in a smooth chain of events that is

expected

Preventing the leak of the filling blood in the penis will create the possibility for these patients to achieve, and after being stimulated to get erection, keep the erection. Implantica’s solution is expected to be able to help a much larger group of patients than those performing penile implants, due to its additive character. Wireless control is designed to enable activation of erection in a controlled and discrete way. PotencyFlow® is expected to temporarily restrict the blood flow and leave the corpus cavernosum undamaged – unlike current penile implants.

Because PotencyFlow® method of treatment is designed to only be active during a short period of time, the risk of complications is likely reduced.

Erectile Dysfunction (ED) can be defined as ‘the inability to achieve an erection satisfactory for sexual intercourse.

Satisfaction is determined by both patient and partner, making ED a ‘couple’s disease’.

The degree of ED can range from a total inability to achieve an erection, an inconsistent ability to do so, or a tendency to sustain only brief erections. The World Health Organization specifies a three-month minimum duration of symptoms to establish the diagnosis.

Approximately 5% of 40-year-old men and 15-25% of 65-year old men suffer from complete ED. The penis has two chambers called the corpora cavernosa, which run the length of the organ and are filled with spongy tissue. The corpora cavernosa are surrounded by a membrane called the tunica albuginea.

The spongy tissue contains smooth muscles, fibrous tissues, spaces, veins and arteries.

The urethra runs along the underside of the corpora cavernosa in the corpus spongiosum and is the channel for

urine

An erection is a complex, involuntary, neuropsychological, hormone-mediated, vascular event, which begins with both sensory and mental stimulation.

Impulses from the brain and local nerves cause the muscles of the corpora cavernosa to relax, which allows rapid blood flow to fill the spongy chambers, thus creating pressure in the corpora cavernosa and expanding the penis. An erection is sustained when the tunica albuginea helps trap the blood within corpora cavernosa, but is reversed when the muscles in the penis contract, which stops the inflow of blood and opens the outflow channels. Usually, oral drugs are the

first

Penile injection has been used as a second line treatment for over a decade.

It has a higher success rate than drug treatment, but it is not generally considered a popular form of treatment with patients because of the need to administer regular self- injection into the corpora cavernosa of the penis. Following urination, a small pellet is inserted approximately an inch deep into the urethra via an applicator at the tip of the penis.

The method is just slightly easier to self-administer than injections and it also suffers from the lack of spontaneity. Patients generally have tried both drugs and other treatments before they are considered suitable for third line treatment.

The use of drugs like Viagra and new competitors producing implants have caused a rapid increase in the use of penile implants. In some cases, surgery is used to repair damaged arteries and tie off veins.

The most common method is penile venous reconstructive surgery, also called venous ligation. This is a method used when the blood drains out too quickly through the veins. If this occurs, the veins that drain the penis may be tied off, however, because new veins develop over 1-2 years time and again cause leakage of blood from the erected penis, this method has not been very successful in the long run.