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What Are The Diseases and Risk Factors Associated With Erectile Dysfunction?



Diagnosis

In the diagnosis of Erectile Dysfunction, the patient is questioned about his complaints, risk factors, previous operations, use of medications and concomitant diseases. It is asked if there are morning erections. Patients are questioned in terms of psychological reasons such as depression and anxiety.

Detailed physical examination is performed (penis, testicles and prostate are evaluated). Some laboratory tests (testosterone, LH, FSH, prolactin, thyroid hormones, fasting blood sugar, cholesterol) may be requested from the patients. If necessary, further tests (penile Doppler ultrasonography) can be performed. 

Treatment

Firstly, it is recommended to bring under control modifiable risk factors with lifestyle changes. Daily exercises and weight control, regulation of fasting blood sugar, cholesterol, triglyceride values, and chronic diseases such as hypertension and diabetes should be brought under control. Psychotherapy option should be considered in erectile dysfunction caused by psychological factors.

The first and most common method of treatment is oral medications such as sildenafil, vardenafil, avanafil and tadalafil. It has side effects such as headache, muscle pain, nasal congestion and facial flushing. It is recommended that patients who use nitrates for heart disease do not use these medications.

In cases where oral medications are insufficient, options such as injection into the penis, use of a vacuum device and ESWT  treatment can be used. In cases where these treatments do not help or are not suitable for the patient, penile prosthesis surgery can be performed with high success rates. 

Types of Penile Prosthesis

There are 2 types, inflatable and malleable. 

Malleable (One-piece) Prosthesis: Two semi-rigid cylindrical pieces, left and right, are surgically placed inside the penis. It is malleable. The most important disadvantage of it is that it is constantly hard and felt from the outside.

Its advantage is that it has low risk of mechanical breakdown and is easy to use. 

Inflatable (2 or 3-piece) Prosthesis: These are the 3-piece penile prostheses, which are the most widely used in the world and provide the closest result to the natural appearance. It consists of 2 silicone prostheses placed in the penis, a reservoir placed in the abdomen next to the bladder (where the fluid is stored) and a pump placed next to the testicles.

There are connections between these 3 pieces with thin tubes. Through these tubes, the patient sends the water in the reservoir into the silicone prosthesis by pressing the pump and the penis becomes hard. After the sexual intercourse, the patient sends the liquid in the prosthesis back to the reservoir by pressing the pump and the penis becomes soft. In other words, the 3-piece prosthesis, the patient can harden and lower his penis whenever he wants. 

Penile Prosthesis Complications:

  • The most important complication is prosthesis infection. With the use of antibiotic-coated prostheses, infection can be seen at a rate of 2%.
  • There is a risk of mechanical failure. However, if it fails, it can be replaced.
  • After prosthesis surgery, a decrease of 1-2 cm can be experienced in the thickness and size of the penis.
  • In the long term, rare complications such as prosthesis coming out of the skin and passing into the urinary tract may also occur.

Penile prosthesis pre and post-operative surgery

Before the surgery: Your medical history, previous surgeries, diseases, medications you use and previous treatments for erectile dysfunction are questioned by your doctor. Urological examination is performed in terms of suitability for prosthetic surgery. Diabetic patients should have their blood sugar levels under control. Those who use blood thinners should stop their medication under the control of a doctor or a treatment suitable for surgery should be started instead. On the day of the operation, the genital area is shaved and antibiotic treatment is given.

Penile prosthesis surgery: It is performed with general anesthesia or regional (spinal) anesthesia. The operation time is usually 1 hour. During the surgery, a catheter is placed in the urinary tract and a surgical drain is placed on the wound site. Both of them are taken the next day. The hospital length of stay is 1-2 days. 

After the surgery: Antibiotics and painkillers should be used.After the surgery, the penile prosthesis is left semi-inflated and remains like this until 1 week after you go to the doctor's control.You will be taught to operate the pump by your doctor and you will be asked to inflate and deflate until the day you have sexual intercourse.You are allowed to take a bath 1 week after the surgery.

The stitches do not need to be removed as they will dissolve by themselves.After the penile prosthesis, sexual intercourse is allowed after 6 weeks.There may be slight pain and swelling in the penis and scrotum for 1-2 weeks after the surgery. Again, heavy exercises and heavy lifting should be avoided for 6 weeks after the surger. 

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