The UNC Center for Male Erectile Dysfunction has expertise in all aspects of male erectile dysfunction diagnosis and its medical and surgical treatment. We provide clinical evaluation, as well as radiographic, ultrasound, and nocturnal penile tumesence studies. Medical and surgical procedures for the treatment of male erectile dysfunction include the latest in medical management, as well as penile prosthesis implantation, penile vascular procedures, and genital reconstructive techniques.
Treatment begins with a shared-decision making approach with the patient to determine the effect of ED on the patient’s and partner’s quality of life. If treatment is desired, an evaluation of the man’s cardiac risk may be recommended. If the patient is considered high risk for a cardiac event, then formal cardiac evaluation is warranted prior to beginning therapy. Lifestyle modifications are first-line treatment options. These include weight loss, tobacco cessation, and medical management of any associated conditions (HTN, DM, dyslipidemia). Additionally, any medications that may contribute to ED should be altered, if possible (beta blockers, diuretics).
Medical treatment of ED began with intracavernosal injection agents in the 1980’s. Medications include prostaglandin E1, papaverine, and phentolamine. Later in the 1980’s, intraurethral suppositories of alprostadil were approved (MUSE). In 1998, sildenafil was approved as the first phosphodiesterase type 5 inhibitor and revolutionized ED therapy. Since then, tadalafil and vardenafil have been approved in the US. These medications increase the erectile response to normal sexual stimulation. Common side effects include headache, flushing, nasal congestion, and vision changes (blue tint). These are all mild and temporary.
Surgical treatment of ED is for men who have failed conservative measures. Placement of an inflatable penile prosthesis (IPP) is a very important consideration for patients who have failed oral therapy or who don’t want to continue injection therapy. An IPP is the most common procedure performed for ED with very high success and satisfaction rates. Developed in 1973, penile implants have now been on the market for over 40 years. IPP is the best long-term solution for severe ED, as the erection feels natural to the patient and his partner, it functions anytime one chooses, and is maintained as long as desired. Covered by Medicare and most private insurance carriers, an IPP is an outpatient operative done with general or spinal anesthesia. Performed through a small hidden scrotal incision, a penile implant is invisible in your body while producing a completely natural erection and sexual experience. Sensation, orgasm, ejaculation, and urination are unaffected. The IPP has the highest success rate of all the treatments for Peyronie’s disease and erectile dysfunction, and over 90% of men and their partners are satisfied after the procedure.