Erectile Dysfunction

We understand that erectile dysfunction is much more than a physical condition. The psychological and emotional aspects of erectile dysfunction can also be distressing. This may make discussing erectile dysfunction a difficult or embarrassing experience.

Although it may feel uncomfortable to take that first step and see a doctor, there are many treatments available today that can restore erectile function, allowing patients to return to sexual activity.

Conservative treatment often begins with pills (such as “the blue pill,” Viagra and Cialis) and penile injections. But, what happens if pills and injections don’t work for you? At The Institute for Advanced Reconstruction, we may be able to restore erectile function by performing a minimally invasive nerve transfer procedure.

Understanding Erectile Dysfunction

Erectile dysfunction (ED), also known as impotence, is a common male sexual dysfunction defined as an inability to achieve or sustain an erection. If you are affected by ED, know that you are not alone. It is estimated that one in every ten men will suffer from long-term ED at some point during his lifetime.

ED is often a symptom of another underlying condition. Male sexual arousal is a complex process that involves the brain, hormones, emotions, nerves, muscles and blood vessels. Erectile dysfunction can result from a problem with any of these. Some of the common causes of ED include:

  • Heart Disease
  • High Cholesterol
  • Obesity
  • Certain Prescription Medications
  • Trauma
  • Treatments for Prostate Cancer
  • Clogged blood vessels (atherosclerosis)
  • Diabetes
  • Emotional Disorders (Stress, Anxiety, Depression)
  • Alcoholism or Substance Abuse
  • Surgeries in the Pelvic Region

A common treatment option used for complete remission of localized prostate cancer is a radical prostatectomy. Unfortunately, this operation carries a risk of postoperative complications including ED. Although great advances have been made in surgical techniques and devices, the prevalence of ED after prostatectomy remains a major postoperative complication. The effects of radiotherapy for the treatment of prostate cancer can also contribute to ED.  40% of men report ED symptoms after radiotherapy, and half of all men use erectile aids thereafter.

What is our treatment approach for Erectile Dysfunction?

At The Institute for Advanced Reconstruction, we believe that patients should explore all conservative ED treatment methods before considering surgery. As mentioned above, many men with ED will experience improvements when taking medications such as Viagra and Cialis. These medications improve blood flow to the penis and make developing an erection easier. Penile injections and penis pumps may also be used to achieve an erection in men with erectile dysfunction.

When pills and injections don’t work, a penile prosthesis may be considered. Implantation of a penile implant may require complex surgery and is irreversible. If the implant is removed, other treatment for ED will not be successful.

Before proceeding with a penile prosthesis, we offer patients a minimally invasive nerve transfer procedure to permanently restore erectile function.

What are the causes of Erectile Dysfunction that we treat?

The procedure that we offer at The Institute for Advanced Reconstruction addresses erectile dysfunction caused by nerve damage or interruption. We may be able to treat erectile dysfunction resulting from a prostatectomy, prostate radiation, pelvic surgery, pelvic trauma or diabetes. In addition, we may be able to treat idiopathic erectile dysfunction (unknown cause).

What procedure do we offer?

At The Institute for Advanced Reconstruction, we perform a genitofemoral to cavernous nerve transfer to restore erectile function (see figures). A “nerve transfer” is a standard surgical technique that utilizes a healthy, functioning nerve, connecting it to an unhealthy, injured nerve, in order to restore the function in the injured nerve.

What is the recovery like after this procedure?

Treatment for Erectile Dysfunction

This minimally invasive procedure is usually performed on an outpatient basis. Patients are often able to return to work within one week. Full recovery from this surgery usually takes around six weeks.

What are the potential benefits of this procedure?

Following the procedure, nerve regeneration is expected to occur in less than a year before the desired erection is possible, but each case is unique. The standard of treatment for ED often focuses on short-term solutions however; our surgical option offers a long-term solution to ED.

You may be a candidate if you…

  • Are over 18 years old and otherwise healthy
  • Have a history of spontaneous erectile function prior to prostatectomy, prostate radiation, pelvic surgery, trauma or diabetes
  • Experienced a loss of erectile function after prostatectomy, prostate radiation, pelvic surgery, trauma or being diagnosed with diabetes
  • Are within 18 months of the onset of Erectile Dysfunction symptoms
  • Are willing and capable to proceed with surgery and follow-up appropriately
  • Are free from tobacco use, alcoholism and other forms of substance abuse

Please contact The Institute for Advanced Reconstruction if you are interested in learning more about this procedure.

References

Tal R, Alphs HH, Krebs P, Nelson CJ, Mulhall JP. Erectile function recovery rate after radical prostatectomy: a meta-analysis. J Sex Med. 2009;6(9):2538–2546.

Chung E, Brock G. Sexual rehabilitation and cancer survivorship: a state of art review of current literature and management strategies in male sexual dysfunction among prostate cancer survivors. J Sex Med. 2013;10 Suppl 1:102–111.

Fode M, Ohl DA, Ralph D, Sønksen J. Penile rehabilitation after radical prostatectomy: what the evidence really says. BJU Int. 2013;112(7):998–1008.

Alemozaffar M, Regan MM, Cooperberg MR, et al. Prediction of erectile function following treatment for prostate cancer. JAMA. 2011;306(11):1205–1214.

Erectile Dysfunction. Cleveland Clinic Website. https://my.clevelandclinic.org/health/diseases/10035-erectile-dysfunction. Accessed June 25, 2018.



Have More Questions?

For more information please contact our Lymphedema Coordinator, Pam Maddox 732-741-0970 ext. 147.

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