About Impotence

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If you are suffering from impotence, then you’re not alone. In fact, more than 30 million American men of all ages suffer from impotence. Impotence, or Erectile Dysfunction (ED), is defined as a man’s inability to gain or maintain an erection adequate for the completion of sexual intercourse. In other words, ED has nothing to do with sexual desire, orgasm, or ejaculation. Nor does it have anything to do with “machismo.”

ED is a common disorder, but effective treatment of it requires uncommon medical skills. Very few physicians are trained to diagnose and treat ED, which means that they often prescribe popular oral medications such as Viagra®, without knowing the true cause(s) of a patient’s condition. Medication is most effective for men with mild to moderate impotence. In truth, only 65% of all men with ED will have satisfactory long term results from oral medication, such as Viagra.

ED can be temporary, sporadic, or long lasting. Causes can be medical, hormonal, emotional … even nutritional. Often, ED is an unfortunate side effect of prescription drugs, particularly those taken for high blood pressure or ulcers. Drugs or alcohol can often make ED worse. Men with diabetes commonly develop ED. (Many times, diabetes is first diagnosed after a man visits his physician because of his ED.) Radiation therapy or surgery (prostatectomy) to treat prostate cancer will usually cure the cancer, but will often cause impotence—and incontinence.

Urologists specializing in sexual health can help men realize a more fulfilling sexual life. Whether the problem is physical or psychological, the sooner the patient acts, the sooner he and his partner will enjoy renewed intimacy.

Understanding The Male Anatomy

There are three chambers in the normal penis: two inter-connected erectile chambers called the corpora cavernosa, which occupy the bulk of the penis, and the urethra, a tube through which either urine or semen is carried from the body. Each erectile chamber is made of sponge-like tissue which fills with blood during arousal. When a man becomes aroused, blood vessels in the penis enlarge, allowing blood to flow into the chambers at seven times the normal rate. As the chambers enlarge, they squeeze the small veins of the penis, trapping the blood, expanding and hardening the penis for penetration during sexual intercourse.
Normally the penis maintains the erection until ejaculation is completed. Then, the nerve centers, which began the process of erection, reverse the action and allow the blood to flow out—returning the penis to its soft, flaccid state.

Many factors (mental and physical) cause and maintain an erection. Nerve signals, blood vessel responses, and a fine balance of chemicals all play a part. It’s not surprising that ED can occur in so many men, especially given the normal effects of age on the male body.
Find much more detailed information about the causes and treatments of ED in our book, Ending ED, written by the leading urologists of the Institute for Urologic Excellence. To order a copy of Ending ED, click here.

Your Satisfaction

Because the physicians of the Institute for Urologic Excellence are specialists in the diagnosis and treatment of ED, the time from a patient’s initial phone call to a solution for his ED may be as short as one week. IUE physicians are the leading authorities on the latest treatments of ED and always strive to provide the least invasive and most practical way to eliminate impotence from your life.

As Institute for Urologic Excellence (IUE) physicians, we have a special interest in the treatment of ED; it is the primary focus of our clinical practices. Our patients enjoy a high success rate based on our correct diagnosis of the cause of each patient’s ED. Only after the cause of the ED is accurately determined is an appropriate treatment recommended.

Treatment Options

Our primary concern is your health and satisfaction. While the Institute for Urologic Excellence is the world leader in the latest surgical treatment for Erectile Dysfunction, we strive to provide the least invasive and most practical way to eliminate ED from your life. We are patient advocates.

Often, patients may only need counseling, oral medication, or a medical device to solve the problem. But if surgical treatment is required, the trained physicians of the IUE can put an end to your ED. Treatment options are discussed in detail in our comprehensive book, Ending ED. To order a copy, click here.

Diagnosing ED — what to expect at your IUE consultation

A complete medical history and physical examination will be conducted during your visit. The physician will perform a digital rectal exam, which can diagnose an enlarged prostate, Benign Prostatic Hyperplasia (BPH). While the prostate has no actual function in erection, enlargement of the prostate may inhibit erectile activity by interfering with nerve impulses and blood flow. Many patients’ erections improved significantly after surgical correction of their enlarged prostates.

ED can be caused by metabolic and hormonal abnormalities. Blood tests can determine conditions that may interfere with normal erectile function. For example, excess production of the hormone prolactin can lower testosterone levels, which can diminish libido, the sexual urge. Testosterone, prolactin, and other hormone levels will be measured. Other laboratory tests that may be performed include:

CBC: A Complete Blood Count measures the red and white blood cells present in the blood and is used to evaluate the general health of the patient. High cholesterol and triglyceride levels may indicate arteriosclerosis, which can contribute to poor blood flow to the penis. Abnormal blood sugar readings can indicate diabetes mellitus, a condition which also interferes with blood circulation.

Liver and Kidney Function: Liver and kidney disease can create hormonal imbalances. Liver function tests involve analysis of enzyme and serum creatinine levels, which are indicators of kidney efficiency.

Thyroid Function Tests: Abnormal thyroid function can be associated with ED.

Urinalysis: Urine is analyzed for protein (albumin), sugar (glucose), and hormone (testosterone) levels that may indicate a kidney disorder, diabetes, or testosterone deficiency.

Estrogen, FSH and LH: these tests are useful if a hormonal cause is suspected.
A variety of tests have been developed that enable us to accurately diagnose the cause of a patient’s ED. Your physician will determine which, if any, are required for your situation.

Cystoscopy: Cystoscopy is an examination of the lower urinary tract with a tiny telescope. The urethra, prostate, and bladder are examined for irregularities which may contribute to ED. Cystoscopic examination is important prior to beginning impotence therapy because easily corrected conditions, such as urethral stricture, prostatic obstruction, or bladder infection, will cause unnecessary complications if not treated prior to beginning the ED therapy.

Penile Doppler Flow Studies: The Penile Doppler Flow Study is a non-invasive study done with sophisticated ultrasound equipment. The Penile Doppler Flow Study is used to evaluate blood flow, venous leakage, signs of arteriosclerosis, and scarring or calcification of erectile tissue.

Penile Nerve Function: Neurogenic impotence can be studied through the use of a bulbocavernosus reflex latency time study. This series of tests measures the integrity of nerve roots in the tailbone, and are used to determine if there is sufficient nerve sensation in the penis.

Nocturnal Penile Tumescence (NPT) Monitoring: It is normal for a man to have from one to five erections, lasting for 20-30 minutes each, during the dream stage of sleep, known as rapid eye movement (REM), sleep. An absence of erectile activity can indicate a problem with blood supply to the penis.

Penile Biothesiometry: This test uses electromagnetic vibration to evaluate sensitivity and nerve function in the glands and shaft of the penis.

Vasoactive Injection: Prostaglandin E1, which causes arterial dilation and/or smooth muscle relaxation, is injected into the penis. These injections normally produce an erection lasting about 20 minutes. If an erection does not occur, it is an indication that either the arteries feeding the penis are obstructed, or that severe vein leakage in the penis is occurring.

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