Erectile Dysfunction

There are a range of treatments for this condition, all of which are available at this clinic. They are:

• Tablets – ie Sildenafil (Viagra), Vardenafil (Levitra) or Tadalafil (Cialis). Approximately 80% of men with ED will get a good response to these medications.
• Intra-cavernosal injection therapy: Following a test-dose and demonstration, this is a self-administered injection that is highly effective in patients who do not respond to tablet therapy.
• Vacuum erection device therapy: A minimally invasive and successful method of treatment in those happy to use this advice. Better for those in stable relationships.
• Surgery: The mainstay of surgical treatment for this condition is the penile implant, or prosthesis. Typically these are inserted for men in whom all other modalities of treatment have failed or are unsuitable. These include Peyronie’s disease, following radical prostatectomy / pelvic surgery, vascular problems or priapism.
• Either an inflatable or flexible device is inserted under anaesthetic, and these devices lead to a reliable erection and high patient satisfaction rates. Devices have improved in recent years and infection rates are down to 2-5%. The operation involves an overnight stay and a catheter overnight.

Penile implants (or prostheses) are devices used as a last-resort treatment option for men with end-stage erectile dysfunction, where other treatments have failed. Such severe ED can be associated with diabetes, Peyronie’s disease, following radical prostatectomy or other pelvic surgery, pelvic fracture or priapism.

The use of penile prostheses has increased since the advent of PDE5 inhibitors, presumably due to increased awareness of the disease and treatment options, but also due to recent technical advances improved reliability of devices. They are a highly effective form of treatment for the motivated patient (and partner) who has failed or is not suitable for other forms of therapy.

The results of surgery at high-volume centres are excellent (93% 5-year survival of devices), and satisfaction rates high among patients (up to 89%) Infection rates have fallen to around 2%, and there have been no infections or implants removed in Winchester over the last 3 years. Despite this, relatively few patients in the UK are offered this treatment option by the NHS, and statistically, men in other European countries and North America are significantly (X1000) more likely to receive such treatment when required.

Penile prostheses are available as malleable or inflatable devices, and the choice of implant depends on a number of factors – such as patient preference, other medical conditions, the presence of scarring and cost. Malleable implants are simpler devices, easier and quicker to insert, and have a lower risk of mechanical complications. On the other hand, inflatable devices offer a more natural and concealable result and are generally more popular as a result.

Patients are carefully counselled beforehand to ensure suitability for the procedure and undergo thorough pre-assessment to exclude other urological problems, urinary infection etc. The operation takes between one and two hours, requires a tube in the bladder (catheter) overnight, and involves a one-night stay in hospital. Patients do not find the procedure particularly painful, and barring any problems complete healing will have occurred by around 6 weeks