Erectile dysfunction or impotence is present in 12-19% of Spanish men between 25 and 70 years of age, but in diabetic patients it reaches values of 30-50%. Age is another related factor; it is present in 2% at 40 years of age, 6.7% at 50, 18.4% at 60, 27% at 70 and 75% at 80.
Apart from age, the most frequent causes are cardiovascular, endocrine, neurological, prostatic diseases, Peyronie’s disease and the consumption of drugs, tobacco and alcohol.
- Diagnosis is fundamental. It is carried out with an adequate clinical history oriented to determine the most probable cause, a general physical examination to objectify the presence of spontaneous erection, a blood test, imaging studies and finally, neurological studies, if necessary.
- The treatment is related, in the first place, to the causes that originate the dysfunction and to the degree of severity of the same, being necessary to consider other factors, such as efficacy, adverse effects, acceptance by the patient and his partner, psychological effects, possible reversibility and economic cost.
It goes through various phases and progresses according to the response:
- First: it would include the adequate control of possible concomitant diseases, the review of the pharmacological treatments to which the patient is subjected, since in many occasions they aggravate impotence. In addition to the modification of harmful habits, such as the consumption of alcohol or tobacco, promoting, in addition, a healthy lifestyle. In this phase we have oral drugs, such as sildenafil, tadalafil and vardenafil. These are very effective and well tolerated.
- Second: when there is little or no response or it is impossible to use oral drugs, we include intracavernous treatment with vasoactive substances, such as prostaglandin E1 or alprostadil. Other forms of administration of alprostadil are through the urethra, by means of gel or capsule. Vacuum devices can also be used in this second stage. This is a method with low adherence in our country and little used.
- Third: If the previous treatments fail, the implantation of penile prostheses in the corpora cavernosa is considered.
Therefore, its indications are:
- Non-response to oral medical treatment or non-tolerance due to side effects, contraindications or dissatisfaction.
- No response or discomfort to intracavernous or intraurethral injections.
- Definitive solution to your problem.