For Patients

Erectile Dysfunction and Andrology

Erection problems are common in men as they get older, but there are a range of options available to improve the quality of erections. The simplest treatment for impotence is medication which is successful in up to 70% of men. If tablets are not effective, or cannot be prescribed because of other health problems, then there are alternatives, both surgical and non-surgical. At Newcastle Urology we also offer surgery to correct penile curvature (including Peyronies disease).

Penile injections for erectile dysfunction (impotence)

What does the procedure involve?

Self-injection of alprostadil (Caverject®) into the penis to produce an erection sufficient for intercourse

What are the alternatives to this procedure?

Tablets, vacuum erection devices, penile implants, MUSE, psychosexual counselling, no treatment

What should I expect before the procedure?

Penile injections do not require any form of anaesthetic and are usually performed in the andrology clinic (Urology Treatment Suite) under the supervision of a Nurse Specialist. The Nurse Specialist will demonstrate the technique and will make sure you are comfortable with the procedure. The technique of penile injection produces the most natural form of erection for a man with impotence.

What happens during the procedure?

You will insert the needle into the side of the penis with a sharp thrust, pushing it in to its full depth. This may be slightly painful but a firm and rapid thrust improves or minimises the pain of needle insertion. You may experience a slight pricking sensation on injection which is not unusual. If there is severe pain, stop the injection immediately and seek medical advice if the pain does not settle within 30 minutes.

What happens immediately after the procedure?

When the contents of the syringe have been injected, remove the needle and use your finger or thumb to put gentle pressure on the injection site for a few minutes. Gently massaging the penis a few times between thumb and finger will help distribute the drug throughout the penis. A satisfactory erection should be achieved within 10 minutes. The Nurse Specialist will adjust the dose as necessary depending on the response to treatment.

Are there any side-effects?

You may experience pain or discomfort at the time of injection, and you can develop bruising at the injection site. Some men (5%) may develop bending of the penis on erection following repeated injections. Some men may not be able to get an erection with injections – the overall success rate is approximately 80%.

What should I expect when I get home?

Your erection may last anything from 5 minutes to 2 hours. If your erection lasts more than 4 hours or becomes very painful, you should attend the Emergency Admission Suite at Freeman Hospital immediately so that you can receive treatment to stop the erection.

What else should I look out for?

You may develop a small bruise under the skin of the penis at the site of injection. This is nothing to worry about and will disappear by itself over the next few days.

Are there any other important points?

You should not use this technique for obtaining erections more than 3 times in any one week and injections should not be used more than once in any one day. More frequent injections risks damage to the erectile tissue of the penis (which can make you impotent again). If the dose of drug produces no erection, you should contact the Nurse Specialist who will arrange for you to be re-assessed in the Andrology Clinic.

Who can I contact for more help or information?

Sister Judith Heckels, on (0191) 213 7001.

Useful Website

www.Caverject.com

Penile straightening (Nesbit or Lue operation)

What does the procedure involve?

This is a procedure to correct curvature of the penis during erection. It is a suitable treatment option for men whose penis is too bent to permit penetration. Surgery will not normally be performed without a period of observation of at least 12 months to ensure that the curvature is not progressing.

What are the alternatives to this procedure?

In men who also have erectile dysfunction (impotence) then insertion of a penile prosthesis (implant) may be more appropriate.

What should I expect before the procedure?

You will usually be admitted on the same day as your surgery. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, and your named nurse. You will change into a gown and you will be pushed to the operating room on a trolley. The anaesthetist will then put you to sleep, usually by an injection in the back of your hand.

What happens during the procedure?

The curvature will be confirmed by an artificial erection and then corrected by placing stitches to shorten the opposite side to the curvature (Nesbit procedure) or by placing a collagen graft to the scarred area (Lue procedure).

What happens immediately after the procedure?

You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home. Absorbable stitches are normally used which do not require removal. You will usually be able to go home on the same day as the operation.

Are there any side-effects?

There will be some shortening of the penis (1-3cm), especially with Nesbit procedure but less likely with the Lue procedure, in addition to the shortening already produced by the disease itself. As a consequence there can be dissatisfaction with the cosmetic or functional result. There will be temporary swelling and bruising of the penis and scrotum which can last for several days. A circumcision may need to be performed during surgery – this happens in approximately 10%.

There may still be some residual curvature, but the aim of the operation is to straighten the penis sufficient for intercourse. Curvature may recur at a later stage.

There is a risk of nerve injury with temporary or permanent numbness of the head of the penis (glans) – this is more likely after a Lue procedure. There is also a risk of developing impotence after surgery. The risk is higher (up to 40%) in men having a Lue procedure.

What should I expect when I get home?

You may return to work when you are comfortable enough and your GP is satisfied with your progress. You should abstain from sexual intercourse for a minimum of 8 weeks to allow complete healing.

What else should I look out for?

If you develop a high temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP as you may have developed a wound infection and require antibiotics.

Are there any other important points?

A follow-up outpatient appointment will be arranged for you 3 months after the operation. You will receive this appointment either whilst you are on the ward or shortly after you get home.

Insertion of Penile Prosthesis for Erectile Dysfunction

What does the procedure involve?

This procedure involves insertion of artificial implants (prostheses) into the penis to allow men to achieve erections for sexual intercourse. Penile prostheses are usually reserved for men who have tried and failed other medical treatments such as tablets, injections, vacuum devices or pellets.

It may also be used in men with other conditions in which erections have been affected, such as following priapism (prolonged, painful erections) or Peyronie’s disease (curvature of the penis). The entire device is implanted into the body and is not otherwise visible.

What are the alternatives to this procedure?

Although surgery is reserved for patients who have tried other treatments, you should discuss the merits of any treatment which you may not have tried with your surgeon. You may not be suitable for certain treatments, as a result of specific medical factors.

What should I expect before the procedure?

You will usually be admitted on the day of your operation. It is a good idea to have a shower or bath at home before coming to the Freeman. After admission, you will be seen by members of the medical team which will include the Consultant, the anaesthetist, and your nurse. You will change into a gown and you will be pushed to the operating room on a trolley. The anaesthetist will then put you to sleep, usually by an injection in the back of your hand.

What happens during the procedure?

A catheter will be inserted through the penis into your bladder at the start of the operation. The prosthesis may be either a malleable (self-bending) one or an inflatable one which requires mechanical pump activation. Although not all patients are suitable for both types, this will have been discussed in detail with you before the procedure. The incision is usually made at the junction of the penis and scrotum. A second incision may be used to insert the balloon reservoir, which is part of the inflatable prosthesis, into the abdomen. Although this can be done through the first incision, your surgeon may feel is safer to perform this through a separate incision, especially if you have had previous abdominal surgery.

What happens immediately after the procedure?

If an inflatable prosthesis has been used, it may be left in the inflated position overnight to reduce the risk of bleeding, but will be deflated before you are discharged home. You may experience discomfort for a few days after the procedure but painkillers will be given to you to take home. Absorbable stitches are normally used which do not require removal.

The catheter will usually be removed on the morning following surgery. Once the you are passing urine normally, you will be able to go home. You may have a wound drain (to prevent any collection of blood at the operation site) which will also be removed on the morning following surgery.

The average hospital stay is 1 day after surgery. When you are discharged, you will be asked not to inflate the prosthesis for 6 weeks. You will be asked to return to the Andrology Clinic where we will teach you to inflate and deflate it (this is known a “cycling” the prosthesis). Sexual intercourse is not advisable for at least 6 weeks after the operation.

Are there any side-effects?

Most procedures have a potential for side-effects. You should be reassured that, although all these complications are well-recognised, the majority of patients do not suffer any problems after a urological procedure.

There will be temporary swelling and bruising of the penis lasting several days. The risk of infection is 2-3% and this may require removal of the whole device. There can be nerve injury with temporary or permanent numbness of the head of the penis. There may be mechanical failure of the device (this can occur many years later) requiring further surgery. This may involve replacement of all or part of the device. Rarely, there can be injury to the bowel or bladder during insertion of the balloon component within the abdomen. Erosion of the prosthesis can occur rarely – this is where a part of the device may break out of its normal position and appear at another site.

What should I expect when I get home?

There will be marked swelling on the penis and scrotum for a few days. This may last up to 10 days and will then subside but do not be alarmed because it is expected.

What else should I look out for?

If you develop a high temperature, increased redness, throbbing or drainage at the site of the operation, please contact your GP or ward 1 at Freeman.

Are there any other important points?

A follow-up appointment in the Andrology Clinic will generally be arranged approximately 6 weeks after the operation. You will receive this appointment either whilst you are on the ward or shortly after you get home. You will also receive an appointment for the Consultant’s clinic 3 months following surgery.