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Spinal cord traumaMultiple sclerosisDiabetic neuropathyPelvic surgery (prostate, bowel)Parkinson’s diseaseAlzheimer’s diseasePoor Blood Flow

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Prevention of some of the causes that contribute to the development of erectile dysfunction can decrease the chances of developing the problem. For example, if a person decreases their chances of developing diabetes, heart disease, and hypertension, they will decrease their chances of developing erectile dysfunction. Other things like stopping smoking, eating a healthy diet (heart healthy with adequate vitamin intake), and exercising daily may reduce a person's risk. .

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A number of medical treatment options exist for erectile dysfunction include the following:
For venous leak embolization a mixture of Histoacryl and Lipiodol is used by the majority of physicians. In addition, fibered coils may be used to prevent progression of glue from veins with fast outflow.

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Surgical or radiation treatments for prostate cancer, bladder cancer, or prostate enlargement (BPH) can sometimes damage nerves and blood vessels near the penis. Occasionally, the nerve damage is permanent and the patient requires treatment to achieve an erection. Sometimes, surgery causes temporary erectile dysfunction that improves on its own after 6 to 18 months.
Picture of rigid penile implant. Two rigid cylinders have been placed into the penis. This type of implant has no inflation mechanism but provides adequate rigidity to the penis to allow penetration.

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In 2018, the Journal of performance Medicine published a review of 42 studies on ED and depression. Together, the studies included over 192,000 men. The authors reported that men with depression had a 39% increased risk for ED. And men with ED were almost three times more likely to have depression than men who had no trouble with erections.

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Oral pills called phosphodiesterase type-5 inhibitors are the most commonly prescribed medications for ED and include: Viagra (sildenafil) Cialis (tadalafil) Levitra (vardenafil) Stendra (avanafil)

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    If you smoke, talk to your doctor about quitting and whether prescription aids can help you.

    Some/all of these resources are links to external sites, the content on which BAUS accepts no reponsibility for.
    Interpretation of the Data Understanding the Graphs How We Do Risk Analysis Grading of Surgical Complications Privacy Notice for BAUS Audits Cystectomy Nephrectomy Percutaneous Nephrolithotomy (PCNL) Radical Prostatectomy Stress Urinary Incontinence Urethroplasty

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    For an algorithm to facilitate evaluation and treatment of patients with ED, see figure 2.

    Did you know that around 5% of men aged 40, and 15% of men aged 70 have complete erectile dysfunction?
    Patients with organic erectile dysfunction should be examined with color Doppler flow analysis using direct pharmacological stimulation with an intracavernosal injection of 10–20 μg prostaglandin E1. Diagnostic criteria for veno-occlusive dysfunction are a high systolic flow rate >25 cm/s (peak systolic velocity) and a persistent end-diastolic velocity of >5 cm/s 15 min post-injection (rigid phase) with a resistive index <0.75 (7).

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    Vacuum Erection Device is one such external device that is FDA approved and is easy and safe to use. At IASH, we explain step by step procedure for the safe and competent use of this device.

    ED not only affects the sex life of men in a committed relationship. Single men with ED often avoid dating because of the condition.
    High blood sugar levels can damage the nerves that control sexual stimulation. They can also damage blood vessels that provide blood flow to the penis to achieve and maintain an erection.

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    Additionally, surgeries or procedures that target the spinal cord or pelvic area can lead to ED. Radiation therapy to the testicles can also cause impotence.

    Reluctance to seek treatment remains the major barrier to restoring full sexual function for men who have erectile dysfunction.
    All men receiving testosterone replacement need to have periodic measurement of haemoglobin and haematocrit to monitor for erythrocytosis. Feldman HA , Goldstein I , Hatzichristou DG , et al . Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994;151:54–61. Araujo AB , Esche GR , Kupelian V , et al . Prevalence of symptomatic androgen deficiency in men. J Clin Endocrinol Metab 2007;92:4241–7. doi:10.1210/jc.2007-1245 Lindau ST , Schumm LP , Laumann EO , et al . A study of sexuality and health among older adults in the United States. N Engl J Med 2007;357:762–74. doi:10.1056/NEJMoa067423 Shah J . Erectile dysfunction through the ages. BJU Int 2002;90:433–41. doi:10.1046/j.1464-410X.2002.02911.x Mobley D . Early history of inflatable penile prosthesis surgery. Asian J Androl 2015;17:225–9. Roumeguère T , Wespes E , Carpentier Y , et al . Erectile Dysfunction is associated with a high prevalence of hyperlipidemia and coronary Heart Disease Risk European Urology.44:355–9. Klein R , Klein BE , Lee KE , et al . Prevalence of self-reported erectile dysfunction in people with long-term IDDM. Diabetes Care 1996;19:135–41. doi:10.2337/diacare.19.2.135 Larsen SH , Wagner G , Heitmann BL . Sexual function and obesity. Int J Obes 2007;31:1189–98. doi:10.1038/sj.ijo.0803604 McWaine DE , Procci WR . Drug-induced sexual dysfunction. Med Toxicol Adverse Drug Exp 1988;3:289–306. doi:10.1007/BF03259941 Croft H , Settle E , Houser T , et al . A placebo-controlled comparison of the antidepressant efficacy and effects on sexual functioning of sustained-release bupropion and sertraline. Clin Ther 1999;21(4):643–58. doi:10.1016/S0149-2918(00)88317-4 Janeway M , Baum N . Managing the enlarged prostate gland in elderly men. Clinical Geriatrics http://www.consultant360.com/articles/managing-enlarged-prostate-gland-elderly-men. Kumar RJ , Barqawi A , Crawford ED . Adverse events associated with hormonal therapy for prostate Cancer. Rev Urol 2005;7 Suppl 5:S37–S43. Aksam A , Yassin A , Saad F . Testosterone and erectile dysfunction. J Andrology 2008;29. Gades NM , Nehra A , Jacobson DJ , et al . Association between smoking and erectile dysfunction: a population-based study. Am J Epidemiol 2005;161:346–51. doi:10.1093/aje/kwi052 Mobley D , Baum N . Smoking: it’s impact on urologic conditions. Rev Urology 17 2015. Stein RA . Endothelial dysfunction, erectile dysfunction, and coronary heart disease: the pathophysiologic and clinical linkage. Rev Urol 2003;5(Suppl 7):S21–S27. Andersson K , Stief C . Penile erection and cardiac risk: pathophysiologic and pharmacologic mechanisms. Am J Cardiol 2000;86:23–6. doi:10.1016/S0002-9149(00)00887-0 Feldman HA , Johannes CB , Derby CA , et al . Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study. Prev Med 2000;30:328–38. doi:10.1006/pmed.2000.0643 Vlachopoulos C , Ioakeimidis N , Terentes-Printzios D , et al . The triad: erectile dysfunction-endothelial dysfunction-cardiovascular disease Curr Pharm Des. 2008;14:3700–14. Watts GF , Chew KK , Stuckey BG et al . The erectile-endothelial dysfunction nexus: new opportunities for cardiovascular risk prevention. Nat Clin Pract Cardiovasc Med 2007;4:263–73. doi:10.1038/ncpcardio0861 Montorsi F , Briganti A , Salonia A , et al . Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol 2003;44:360–5. doi:10.1016/S0302-2838(03)00305-1 Vlachopoulos C , Rokkas K , Ioakeimidis N , et al . Prevalence of asymptomatic coronary artery disease in men with vasculogenic erectile dysfunction: a prospective angiographic study. Eur Urol 2005;48:996–1003. doi:10.1016/j.eururo.2005.08.002 Mulhall J , Teloken P , Barnas J et al . Vasculogenic erectile dysfunction is a predictor of abnormal stress echocardiography. J Sex Med 2009;6:820–5. doi:10.1111/j.1743-6109.2008.01087.x Hodges LD , Kirby M , Solanki J , et al . The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract 2007;61:2019–25. doi:10.1111/j.1742-1241.2007.01629.x Inman BA , Sauver JL , Jacobson DJ , et al . A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc 2009;84:108–13. doi:10.4065/84.2.108 Ponholzer A , Temml C , Obermayr R , et al . Is erectile dysfunction an indicator for increased risk of coronary heart disease and stroke? Eur Urol 2005;48:512–8. doi:10.1016/j.eururo.2005.05.014 Thompson IM , Tangen CM , Goodman PJ , et al . Erectile dysfunction and subsequent cardiovascular disease. JAMA 2005;294:2996–3002. doi:10.1001/jama.294.23.2996 Banks E , Joshy G , Abhayaratna WP , et al . Erectile dysfunction severity as a risk marker for cardiovascular disease hospitalisation and all-cause mortality: a prospective cohort study. PLoS Med 2013;10:e1001372. doi:10.1371/journal.pmed.1001372 Lewis RW , Fugl-Meyer KS , Corona G , et al . Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med 2010;7:1598–607. doi:10.1111/j.1743-6109.2010.01778.x Yaman O , Gulpinar O , Hasan T , et al . Erectile dysfunction may predict coronary artery disease: relationship between coronary artery calcium scoring and erectile dysfunction severity. Int Urol Nephrol 2008;40:117–23. doi:10.1007/s11255-007-9293-8 Montorsi P , Ravagnani PM , Galli S , et al . Association between erectile dysfunction and coronary artery disease. role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial. Eur Heart J 2006;27:2632–9. doi:10.1093/eurheartj/ehl142 Montorsi P , Ravagnani PM , Galli S , et al . Association between erectile dysfunction and coronary artery disease:matching the right target with the right test in the right patient. Eur Urol 2006;50:721–31. doi:10.1016/j.eururo.2006.07.015 Yassin AA , Saad F . Testosterone and erectile dysfunction. J Androl 2008;29:593–604. doi:10.2164/jandrol.107.004630 Khera M . Androgens and erectile function: a case for early androgen use in postprostatectomy hypogonadal men. J Sex Med 2009;6:234–8. doi:10.1111/j.1743-6109.2008.01159.x Aversa A , Isidori AM , De Martino MU , et al . Androgens and penile erection: evidence for a direct relationship between free testosterone and cavernous vasodilation in men with erectile dysfunction. Clin Endocrinol 2000;53:517–22. doi:10.1046/j.1365-2265.2000.01118.x Wespes E , Amar E , Hatzichristou D , et al . EAU guidelines on erectile dysfunction: an update. Eur Urol 2006;49:806–15. doi:10.1016/j.eururo.2006.01.028

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Some men with erectile dysfunction report having either a partial erection that is unable to sustain sexual intercourse, or the total absence of swelling of the penis. The severity of erectile dysfunction can be assessed using the International Index of Erectile Function (IIEF-5), which uses a questionnaire to grade ED as either mild, moderate or severe.

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Diet rich in vitamins and minerals is essential. Also, you must cut down on junk, caffeine, alcohol, and cigarettes.

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In case of positively confirmed venous-occlusive dysfunction including its morphological demonstration on CT cavernosography, the treatment strategy is occlusion of venous leaks (Box 3). Surgical therapy consists of deep dorsal vein ligation and additional ligation of potential collaterals. However, surgical treatment is rather invasive and usually needs to be performed in an operation room under general anesthesia. Not very encouraging, long-term success rates of surgical ligation of the deep dorsal vein and its collaterals are reported to be ~ 25% (16, 17).

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Finally, Dr Montorsi et al found that severe ED was more common in patients with multivessel coronary involvement as compared with those with single-vessel disease (31% vs 12.5%; p<0.01). They also found a significant inverse relationship between the extent of CVD and IIEF scores.31

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