Treatment of
Erectile Dysfunction
Treatment options for erectile dysfunction (ED) include a range of approaches, including lifestyle modifications, medications, devices, therapies, and surgery.
Lifestyle modifications: Lifestyle changes can have a significant impact on erectile function. These may include quitting smoking, reducing alcohol consumption, maintaining a healthy weight through diet and exercise, and managing stress.
Oral drugs: The release of the known drugs to treat the problem, the phosphodiesterase type 5 inhibitors (sildenafil, tadalafil, vardenafil and avanafil) was the first major therapeutic step 25 years ago. These drugs are extremely effective and safe.
Phosphodiesterase type 5 (PDE5) inhibitors includes sildenafil (ViagraTM), tadalafil (CialisTM), vardenafil (LevitraTM), and avanafil (SpedraTM) and their generics. All of them enhance the action of nitric oxide, a natural chemical in the body that relaxes the muscles in the penis, increasing blood flow and facilitating erections. It should be noted that drugs treat only the symptom and not the disease. As the disease progresses, after some years, the response to the drugs decreases.
Intraurethral and Intravesical Medications: Alprostadil gel, a prostaglandin E1 analog (VitarosTM) or by penile injection (CaverjectTM). These drugs help dilate blood vessels and improve blood flow to the penis, making erections easier.
Shockwaves: Low-intensity Shockwaves Therapy (LiST) has been recommended by the European Association of Urology (EAU) as a first-line treatment for vascular erectile dysfunction. This recommendation is based on growing evidence from clinical studies indicating that LiSTs may improve erectile function by promoting neovascularization and tissue regeneration in the penis, thus addressing underlying vascular problems.
LiSTs involve the application of low-intensity shock waves to the penile tissues, usually delivered over a series of sessions over several weeks. LiST stimulate the release of growth factors and promote the formation of new blood vessels, enhancing blood flow to the penis and improving erectile function.
Vacuum Erection Devices (VED): These devices consist of a vacuum tube that fits over the penis and creates negative pressure, pumping blood into the penis and causing an erection. A clamping ring is then placed at the base of the penis to maintain the erection.
Penile prostheses: In cases where other treatments have failed or if there are anatomical or physiological reasons that prevent other treatments, surgical insertion of penile implants may be considered. There are two main types: inflatable implants, which allow for manual erection control, and semi-rigid implants, which maintain firm stability but can be bent into a more “hidden” position.
Psychotherapy and Counseling: For men with psychological issues such as performance anxiety or relationship issues, psychotherapy and counseling are particularly beneficial. Modern sexology uses various techniques that can help address the underlying psychological factors. It should be noted that these treatments are also valuable for men with organic erectile problems. When combined with treatments such as oral drugs, they improve the result and recovery time.
Hormone replacement therapy: Testosterone replacement therapy (TostranTM and TestogelTM testosterone gel or NebidoTM injections) may be considered in cases of low testosterone contributing to erectile dysfunction. However, it is necessary to carefully monitor hormone levels and consider possible risks and side effects.
Vascular surgery: In selected cases of young men where vascular insufficiency is of traumatic etiology, surgical procedures such as penile revascularization or arterial bypass surgery improve penile blood flow.
Treatment for erectile dysfunction should be individualized based on the underlying cause, the patient’s overall health, preferences, and response to previous treatments. A collaborative approach involving urologists and mental health professionals is essential to optimize outcomes.
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A highly successful interactive educational program (webinar) on Regenerative Medicine in Andrology was organized on 16/10/2023 by the European Society of Sexual Medicine. It was attended by Urologists from 35 countries.
The International Regenerative Medicine conference was held in Belgrade with great success, with the participation of scientists from all specialties. All the newest developments in Regenerative Medicine were presented.
