Penile Prosthesis

Penile implants are the last resort for severe Erectile Dysfunction, they are medical devices designed to help men with severe erectile dysfunction achieve an erection. They are considered a last resort when all other conservative treatment options, such as oral medications, penile injections, or vacuum erection devices, have been tried and proven unsuccessful. Common indications include organic ED, for instance, due to diabetes or vascular diseases, Peyronie’s disease, and traumatic injuries.

Erectile Dysfunction - Causes

Erectile dysfunction is characterized by the inability to achieve a proper erection of the penis during sexual intercourse. This is one condition most men experience but hardly discuss, probably due to embarrassment. However, ED is relatively common, affecting approximately 20-30% of men at some point in their lives, with its prevalence increasing with age.

On the bright side, ED is treatable, and there is a solution for every man.

The following article deals with causes, treatment options, and advanced solutions for ED, such as penile prosthesis.

What is Erectile Dysfunction?

Erectile dysfunction is the inability to achieve or maintain an erection of the penis sufficient for satisfying sexual intercourse. It is not a disease but a symptom that may signify serious physical or psychological disorders.

ED may be temporary or chronic and can affect not only sexual health but also one’s self-esteem and relationship with others.

Causes of ED

The causes of ED fall into two main categories: physical and psychological.

Physical Causes:

Vascular diseases: Reduced blood flow due to atherosclerosis, or narrowing of the arteries, is a leading cause.

Diabetes mellitus: High blood sugar levels can cause damage to nerves and blood vessels, leading to ED.

Hormonal imbalance: It includes low testosterone or any other hormonal imbalance that can have an effect on the erectile functions.

Side effects of some medications: These are drugs for blood pressure problems, antidepressants, and sedatives.

Unwholesome lifestyle habits: A man who smokes excessively and drinks coupled with no exercises increases the chances of getting the problem.

Psychological Causes Stress and anxiety:

Performance anxiety and chronic stress interfere with erection.

Depression: Mental health issues tend to lower libido and disturb function.

Relationship problems: Problems in the partnership may act as both a cause and a result of ED.

Erectile Dysfunction - Diagnosis

Diagnosis is made upon thorough medical history, physical examination, and laboratory tests. The physician may evaluate blood flow, nerve function, and hormone levels.

Ultrasound may be employed to examine penile blood vessels in certain instances.

When to see a doctor:

If ED has lasted for over three months or is causing a severe impact on your quality of life, it would be best to consult with a urologist. Sometimes ED can also point to other health conditions, such as cardiovascular disease; therefore, it is not an issue that should be ignored.

Erectile Dysfunction - Other Treatments

The treatment of ED has to do with the root causes and therefore involves a number of approaches.

Medications: PDE-5 inhibitors such as Sildenafil (Viagra) or Tadalafil (Cialis) improve blood flow to the penis and are therefore often the first-line treatment.

Hormone therapy: Testosterone replacement can be effective in those cases where low testosterone is diagnosed.

Psychotherapy: Psychological counseling is quite effective for addressing stress, depression, or relationship problems.

Lifestyle Modifications

Weight loss and healthy diet: Weight loss decreases the excess weight and hence improves the general health and erectile function. A diet rich in fruits, vegetables, whole grains, and healthy fats will keep your blood vessels healthy.

Exercise: The regular flow of blood from physical activity improves blood circulation and vascular health.

Cessation of smoking and alcohol: Stopping these habits can go a long way in improving erectile performance.

Stress management: Yoga and meditation are some of the practices that can help manage mental stress

Regular check-ups: Early detection and management of conditions such as heart diseases and diabetes can prevent ED.

Mechanical Devices

Vacuum pumps: These draw blood into the penis, which enables an erection.

Constriction rings: These maintain blood flow and prolong the erection.

Conservative Medical Treatment

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Ureterorenoscopy (URS, RIRS)

Technological improvements in ureteroscopy have been quite significant over the last years, making this procedure much more refined and less invasive. With the help of equipment having rapidly decreasing diameters, complemented by specialized grasping forceps and laser lithotripsy, it is now possible to treat stones rapidly and safely.

A special optical instrument, either rigid or flexible, with a diameter ranging from 2 to 4 mm, depending on the size of the working channel, is passed under visual control through the urethra and bladder and then advanced into the ureter. Sometimes, the opening to the ureter needs dilation, and with X-ray guidance, the procedure can be monitored effectively.

Local injection of a contrast agent during ureteroscopy is very useful in visualizing the ureteral pathway and detecting obstructions. In instances where the path of the ureter is quite tortuous, a guidewire or very thin catheter may be passed through the working channel for easier guidance of the instrument. Ureteroscopy is primarily used for stone removal, where the stone is fragmented under direct vision. This may be done with specialized stone probes like mechanical-pneumatic, electromagnetic, electrohydraulic, ultrasound, or laser. The fragmented pieces are either naturally flushed out or extracted with the help of forceps or a retrieval basket.

After the procedure, a ureteral stent is commonly placed to prevent swelling of the ureter and its opening. This JJ or Double-J catheter needs to be removed after some time. If there is impaired bladder emptying, a urethral catheter can also be placed.

PCNL

Percutaneous nephrolithotomy (PCNL or PNL) is an endoscopic procedure that is used as a minimally invasive surgery for the removal of large kidney stones.

Uses of PCNL in the treatment of nephrolithiasis include kidney stones larger than 1.5 cm, lower calyx stones over 10 mm, kidney stones that are resistant to treatment after extracorporeal shock wave lithotripsy (ESWL), and calyceal stones with calyceal neck stenosis. Technological advances in miniaturization, such as Mini-PNL, have reduced the morbidity associated with PCNL, expanding its indications instead of ESWL.

PCNL depends very heavily on technical advances in equipment and the expertise of the surgeon for good results with fewer complications.

The kidney stone is punctured through the skin from outside, under the guidance of ultrasound and X-ray, and then fragmented under videoendoscopic vision using a laser before suctioning.

During this operation, an optical device called a nephroscope, about 4 to 9 mm in diameter, is introduced into the kidney through an access channel created. When stones are visible, the surgeon will break them with a laser. The fragments are either flushed out, suctioned, or retrieved by forceps and a retrieval basket. X-ray fluoroscopy is used intraoperatively to guide the procedure and ensure the kidney is as stone-free as possible. A temporary nephrostomy catheter is placed inside the renal collecting system and used to drain urine into a collection bag.

ESWL

Extracorporeal Shock Wave Lithotripsy (ESWL) is a urologic technique developed in Germany in 1982 that enables the fragmentation of urinary stones through shock waves. It is a noninvasive treatment where shock waves generated outside the body are used to break down stones into fragments small enough to pass naturally through the urinary system.

ESWL is mainly indicated for small to medium renal calculi and proximal ureteral stones. After stone fragmentation, small residual fragments usually remain in the kidney or ureter. Adequate hydration is essential to help flush out these fragments. These fragments may be excreted several days or up to several weeks after the procedure, depending on their initial size and location. Regular urological check-ups should also be conducted during this period. In the event of pain or fever, immediate urological evaluation is necessary.

In some cases an additional DJ Stenting maybe necessary to avoid renal colic after the procedure.