Erectile dysfunction

Erectile dysfunction is the inability to achieve or maintain an erection (impotence). It is a common problem that increases with age. There are many causes for erectile dysfunction including medical conditions (such as diabetes, high blood pressure, obesity and vascular disease), psychological causes (anxiety, depression and relationship problems), surgery (bowel and prostate surgery) and trauma.

There are a number of ways to treat erectile dysfunction, depending on the cause and the severity. These include medications, vacuum penile pump devices, injections into the penis and surgery (insertion of penile prosthesis).

Insertion of penile prosthesis:

This surgical procedure is used in men who are unable to gain an erection with other methods. A device made up of two balloon cylinders is inserted into the penis and attached to a pump device that is placed in the scrotum. When the pump is activated the cylinders in the penis fill to produce an erection.

Peyronie’s disease

Peyronie’s disease is a condition where thick plaques of tissue form in the deep layers of the penis. This thickened tissue doesn’t expand normally during an erection, causing curving of the erect penis and sometimes pain and erectile dysfunction. The cause of Peyronie’s disease is not fully understood, but it may be related to trauma (including repeated minor trauma) and is commonly found in association with other conditions such as Dupuytren’s contractures.

In the first year after developing Peyronie’s disease the condition can change; it can improve by itself, remain the same or worsen. For this reason, your Urologist will not consider surgery in the first year of symptoms to allow the condition to stabilize. If after a year the erections are too curved to allow for sexual intercourse an operation may be required. The most common procedures used are a Nesbit procedure or a penile prosthesis, depending on whether there is erectile dysfunction present. Your Urologist will discuss which procedure is appropriate in your circumstances.

There are a number of non-surgical treatments that have been used for Peyronie’s disease, including medications, injections into the scar tissue and penile traction (extender) devices. Unfortunately, non-surgical treatments are not very successful in the longer term.

Penile plication (Nesbit procedure):

This procedure involves placing deep stitches in the penis on the opposite side to the curve to straighten it. This procedure will result in some loss of penile length, but has a low risk of damaging the nerve supply of the penis.

Excision of scar and grafting:

In this procedure the thickened plaque of abnormal tissue is removed and a patch (graft) is placed to repair the area. This technique preserves the length of the penis, but runs a higher risk of damage to the penile nerves that are located in the same area as most plaques.

Penile prosthesis:

A device with a balloon pump is inserted into the penis and scrotum to allow the patient to achieve a straight erection. This procedure is only necessary in men who have penile curvature and erectile dysfunction.

Penile Cancer

Penile cancer is a rare condition that is usually detected when a lump or red patch is seen on the penis. It is more common in older men, men who are not circumcised and smokers.

Diagnosis:

If there is a red patch on the penis that doesn’t go away in a few weeks or a lump, a biopsy may be required. If the biopsy suggests a cancer, further tests such as a CT scan and an MRI scan will be arranged.

Treatment:

Treatment of penile cancer will depend entirely on the size and location of the tumour. Your Urologist will outline the appropriate options for your case.

Foreskin Problems

Tight foreskin (Phimosis):

A phimosis is a narrowing or scarring of the opening of the foreskin that prevents the foreskin from retracting back over the head (glans) of the penis. This can cause a number of problems including painful erections, tearing with erections, difficulties passing urine and the inability to clean under the foreskin. Rarely the foreskin may get stuck beneath the head of the penis causing swelling and pain (paraphimosis) – this requires emergency treatment.

Circumcision:

A circumcision is an operation to remove the foreskin, then the skin edges are repaired with dissolving stitches. This is performed with a general anaesthetic as a day case.

Tight frenulum:

The frenulum is a band of tissue on the underside of the head of the penis that connects to the shaft. If this band of tissue is very short it can be stretched during erections, resulting in tearing and bleeding during intercourse.

Frenuloplasty: A frenuloplasty is a minor procedure where the tight band of tissue is divided horizontally and closed with dissolving stitches in an up and down manner. This lengthens the frenulum to prevent stretching. This is a day case procedure that is carried out with a brief general anaesthetic or sedation.