Erectile Dysfunction / Peyronie’s Disease

Half of men over the age of 40 will have some problems with erectile dysfunction (ED), and the prevalence increases with age. The good news is that there are many treatment options available for you.

There are many causes of ED. The men most at risk include smokers, men with diabetes, heart disease or high blood pressure. Often erectile dysfunction is an initial sign of more serious problems, so it is imperative that you see your doctor. Heart disease and other issues may need to be ruled out. The evaluation for ED is easy, and you have already started the hardest part, which is talking to a doctor about your problem. If you are looking at this website, you have probably spent months or years with the disease, and something has finally motivated you to see what can be done.

When you come in to see your urologist you should understand a couple of things. First, this is what he does all day long, and nothing will surprise him. Second, we can help you. In other words, we can get you an erection, it just depends on what treatments you wish to pursue to get there. The evaluation will be a detailed history and physical exam to evaluate for things like heart and blood vessel disease, and a blood test to evaluate you for low testosterone. A physical exam will be completed to make sure that there is no evidence of Peyronie’s disease (scarring in the penis). After that, the conversation turns to action. How can we fix this?

No matter how you get to our office, whether you are diabetic, have a spinal cord injury, or have history of prostate cancer, there are 4 choices for treatment. Initially, pills such as Viagra are offered. Most men that come in have already tried these medications at least once. And for some, they work well. If however, you have tried them 4 or more times, and there has been little effect, or an unreliable result, you may want to consider other options. Some men cannot tolerate these medications due to side effects or interactions with other medications.

Another choice is a vacuum erectile device (VED). A VED is an external device that can bring blood flow into the penis, and create an erection. It works well, but takes practice. The advantages are that it is cost effective and that there are no side effects. The problem is that it can be cumbersome and not very spontaneous. In our experience, very few men find this to be a reliable solution.

Injections of medications (Trimix/Alprostadil) can help men that have all types of ED. Often times when presented with the idea of injecting a needle into the base of the penis, patients start to shake their heads in disbelief. “You want me to inject a needle WHERE?.” However, for the motivated couple this can be a very straightforward solution. The medication works by opening up blood vessels that promote an erection. If you decide to try injections, you will receive a test injection in the office. You are encouraged to bring your partner for this visit so that you can both hear the instructions. If you decide that you would like to try the injections, then a prescription is given, and you are sent home to try it on your own. The most important thing to understand, is that most couples will require at least 6 -10 tries before they find the correct dose and correct technique. In other words, expect some trial and error in the early going. The good news is that pills like Viagra can cost $30 or more per pill, injections usually cost $2-3 per dose.

For the patient that is unable to have success with injections, pills or vacuum pumps, a penile implant can be considered. An implant is a device that is placed during a 40 minute procedure under a general anesthetic, and will allow you to have erections at any time. The advantages are spontaneity, and an erection that is totally reliable. The disadvantages are that you have to go through a procedure and a period of 6 weeks of healing before you can use the device. The satisfaction rates for penile implant surgery is very high, but it is only a decision that can be made after a detailed discussion with your urologist and your partner. Dr. Neeb has extensive training and experience with penile implant surgery.

Please call to schedule a consult and we will review your options and find a solution that works for you and your partner. If you would like a copy of the book “Ending ED and Incontinence”, please contact our office and one will be mailed to you.

Symptoms: Men will occasionally have a preceding event, such as sexual trauma like bending of the penis during intercourse, or an actual penile fracture. More often, men will start to notice pain with erections, or a palpable abnormality (lump) along the shaft of the penis. This is often associated with a curve or a bend that can be mild or severe. It can also cause erectile dysfunction, and shortening of the penis.

Evaluation: A complete history and physical examination, and evaluation of the timing and severity of the disease will be undertaken. It is very helpful if the patient brings a picture of the erect penis on their smartphone so that the severity of the curvature can be assessed, as it is difficult to appreciate, and sometimes for the patient to describe. In some cases, a Doppler ultrasound of the penis is required for evaluation of the blood vessels and the Peyronie’s plaque.

Treatment: If the curvature is mild, or not bothering you, a wait-and-see approach may be adequate. In a small percent of cases, the Peyronie’s disease may improve spontaneously. If the curvature is severe enough, and the timing of the disease is appropriate for intervention, treatment with Xiaflex may be recommended. Xiaflex is a medicine that is injected directly into the offending plaque, which can help to destroy the plaque and allow healing of the tissue. Xiaflex is the only FDA approved medication for Peyronie’s disease, and was approved January of 2014. Dr. Neeb was the first urologist in the area to use this revolutionary medicine on appropriately selected patients.

• There are a number of off label drugs that can also be used for Peyronie’s disease such as verapamil.
• There is no known benefit to taking oral drugs such as vitamin E or colchicine for this disease. There is no known benefit to over the counter combination supplements for this disease.
• In some cases, if the patient has good erectile function, surgery to correct the curvature can be considered.
• In patients who have both Peyronie’s disease, and significant erectile dysfunction, a penile implant is usually recommended.

Your doctor will discuss the evaluation and treatment options of this disease with you at your appointment. It is helpful if you bring a photo of the erect penis on your phone or digital camera both from above and from the side to your initial visit.