Erectile dysfunction is primarily a disease, for many men an extremely serious, when you want to have sex, but there is no possibility. Or, in scientific terms, it is lack of maintenance of an erection. That is erection does not just have to arise, but also it should be at an appropriate level, sufficient for implementation or fulfillment of sexual intercourse. The term erectile dysfunction used to be often referred to as impotence and believed that it was entirely acceptable. However, now the term «erectile dysfunction» is used most often and this, in our opinion, is absolutely correct. Diagnosis of erectile dysfunction in urology can be established only if a disorder is present in patient for 3 or more months. But there are exceptions to this rule – this is the presence of severe concomitant pathology when during surgery all neurovascular bundles associated with the prostate are removed. For example, radical prostatectomy performed at prostate cancer. Similar changes are observed at adenomectomy performed by perineal access.
Erectile Dysfunction Types
All types of erectile dysfunction can be divided into two large groups:
The latter group unites all urological diseases, vascular and neurogenic pathologies. Vascular disorders can be arteriogenic and venogenous. Among urological diseases, chronic prostatitis should be noted, which for a long time does not cause patients any trouble. The first symptoms of prostatitis are the appearance of accelerated ejaculation and a decrease in potency. Long-existing urethritis and chronic prostatitis also support inflammation of the urogenital tract in men, contribute to the appearance of symptoms of weak potency and erectile dysfunction.
In addition, this group includes all severe endocrine diseases, including primary and secondary hypogonadism. Severe somatic diseases, such as diabetes, chronic renal and hepatic insufficiency lead to erectile dysfunction of mixed genesis. Patients in this group undergo spermogram that confirms a combination of severe endocrine disorders and sexual infections.
To establish diagnosis – erectile dysfunction requires a patient’s consent. Only the patient will be able to fully understand the state of his sexual health. The first-line drugs for potency increase are inhibitors of phosphodiesterase-5 (PDE-5) (Viagra, Levitra, Cialis). The duration of use and dosage of the drug in each case is selected individually by the urologist. First of all, the doctor must establish genesis of erectile dysfunction, which helps to eliminate the cause of the disease and prescribe adequate therapy. It is generally accepted to conduct a questionnaire of patients with the purpose of assessing a state of erection.
Currently, a sufficiently large number of questionnaires have been developed, which are used by urologists and sex therapists in their practice. Careful collection of anamnesis is simply necessary to determine possible factors for the development of erectile dysfunction (smoking, alcoholism, overweight, concomitant diseases, medications are taken, etc.). Often, a diagnosis of psychogenic disorders requires joint consultation of urologist and psychiatrist. All patients with ED undertake blood tests, with a determination of glucose (or glycated hemoglobin), total testosterone, prolactin and lipid profile of blood (cholesterol, high and low-density lipoproteins, triglycerides and atherogenicity index); dopplerography of the penis and pre-prostatic venous plexus to identify vascular erectile dysfunction.
At suspicion of neurogenic ED, electromyography of the penis is performed. Use of Doppler and electromyographic method is possible only with the use of a vasoactive substance – prostaglandin E1 (PGE1), which allows to model erection with the help of pharmacological preparation.
Treatment of erectile dysfunction should be started in stages, by moving from non-invasive to invasive methods. Clinics now have extensive experience in the treatment of various forms of erectile dysfunction. The absolute rule of treatment is the elimination of harmful factors leading to a breakdown in erection (smoking, obesity and sedentary lifestyle).
At first stage of treatment of potency disorders, PDE-5 (Levitra, Cialis, and Viagra) inhibitors are prescribed, which are available in the form of pills. Sildenafil (or Viagra) is the first drug of this group, synthesized by specialists of pharmaceutical company «Pfizer» in 1993 for the treatment of ischemic heart disease. But when testing Viagra, a side effect of the drug, which consisted in the appearance of persistent erection, was noticed. Thus, the history of the treatment of erectile dysfunction was created. These drugs are effective in 80 – 85% of patients with ED. At primary and secondary hypogonadism androgen therapy is indicated.
At the second stage, with insufficient effectiveness of PDE-5 inhibitors, second-line drugs are given by intracavernous administration of PGE1 10 – 15 minutes before sexual intercourse. This drug improves potency and can also be applied intraurethral. In this case, there is a risk of developing priapism (painful erection lasting for more than 5 hours). Therefore, this technique is used at first only under the supervision of a doctor. Vacuum technique – LOD-therapy is quite safe, but its effectiveness is estimated in 20 – 30% of patients.
At the third stage, if the above methods are ineffective, surgical methods for treating erectile dysfunction are used.
There are two principal types of surgical treatment of impotence:
- vascular surgery (revascularization of the penis by lower hypogastric artery, ligation of deep dorsal vein of the penis);
- falloprosthesis, with the use of semi-rigid prostheses, which constantly imitate erection.
For the last 5 years, hydraulic prostheses have been widely used, which are more functional and convenient to use. They allow you to bring the penis into a state of erection only at the time of sexual intercourse, which, of course, is more natural for patients psychologically. Indications for prosthetics of the penis are severe forms of vasculogenic erectile dysfunction, cavernous fibrosis and endocrine forms of impotence.