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At our Sexual Medicine Program at Weill Cornell Medicine, 3-piece inflatable penile prostheses are the most commonly implanted.

Three-piece inflatable implants have paired cylinders, a small scrotal pump, and a large-volume fluid reservoir (which is placed behind the abdominal wall muscles).

Prior to surgery, it is important that all patients receive appropriate education concerning the operative procedure and its associated risks and benefits.

We also insist on all patients reading device literature and viewing a device video prior to committing to the procedure.

Ensuring that the patient has realistic expectations prior to proceeding with implant surgery is essential to ensuring high postoperative satisfaction profiles. Patients are advised that the prosthesis will allow them to achieve a rigid erection on demand and will have no effect on their libido and will not lengthen their penis. Patients are


informed of infection rates (1-3%) and rates of re-operation second to device malfunction (15% within 8 years). Penile implants offer the patient a very high level of satisfaction with spontaneity, consistency, and rigidity. You can request an appointment to see a ED treatment provider in NYC via our online form at any time. If you'd like to learn more about each of our providers that specialize in Erectile Dysfunction, please review the Physicians & Faculty profiles listed at the bottom of this page.

Our urologist faculty practice in New York City, and are experts in ED treatments including penile prosthesis surgery as well as non-surgical solutions.

The Most Recent Treatment Options for Erectile Dysfunction. Erectile dysfunction (ED) affects millions of American men.

The effects of ED can be psychologically devastating, not only to the man but also to his partner as well. In particular, the damage to the self-esteem of both partners can be extremely troubling and damaging to the relationship.

But the expert urologists at Georgia Urology are equipped to tack on the task to bring back confidence to all of our patients. How Can Georgia Urology Help with Erectile Dysfunction? At Georgia Urology, the management and treatment of ED is a major component of our practice and our physicians are among the leaders in the care of these patients. Many patients and their partners are often embarrassed to discuss such an intimate problem. Our providers strive to help our patients with these problems in a caring and supportive environment.

Goal-directed therapy is the mainstay of management. We will provide the least involved therapy that gets the patient back to successful erectile function.

Let’s discuss the current options for therapy and briefly touch on a possible exciting new development in the treatment options for erectile dysfunction.

Unless you have lived on another planet for the past 15 years, you have heard of the oral medications available for ED. Viagra, Cialis, Levitra, and Stendra are all members of the same family of medications called PDE inhibitors. These medications trigger the relaxation of


smooth muscle in the penis, leading to arterial dilation and venous constriction resulting in an erection.

These medications are effective in about 70% of men in


successful erectile function. Side effects are usually mild and include flushing, headache, and/or mild gastritis. Rare side effects include hearing loss, vision loss, and a prolonged erection lasting more than a few hours. In my 20 years of prescribing these medications, I have never seen these more serious side effects and I have prescribed these medications to thousands of patients.

These medications have traditionally been very expensive are rarely covered by insurance drug plans.

Recently, Sildenafil, which is the same as Viagra, went off-label in the 20 mg dose.

Georgia Urology has a direct pathway to the distribution of Sildenafil, and we are able to offer these pills to our patients for about a dollar a pill. Vacuum erection devices (VED) have been commercially available for over 40 years. They consist of a closed-end plastic cylinder and a vacuum pump that is either hand or battery-operated.

They are generally reliable, non-invasive, relatively easy to use, and inexpensive. The disadvantages are that they are not indiscreet being rather bulky, lead to a hinge-like erection (due to only getting the visible part of the penis erect), and can be painful in many patients. Intracavernosal injections have also been available for 30 years. This treatment involves using a very small insulin-type needle to inject a vasoactive substance directly into the penile erectile tissues.

This is a highly successful treatment (>70%) and is mainly used as the next option when patients fail oral medications.

The first injection is done by the provider where the patient or his partner is taught to do subsequent injections on their own. Complications include pain, fibrosis, and prolonged erections.

Side effects are uncommon and this is a very successful option once we get the patient past the fear of penile injection, which in reality are no more painful than an injection in any other part of the body. These medications are also rarely covered by providers but, due to its purchasing power of over 50 providers, Georgia Urology is able to provide these medications through our in-house compounding pharmacy provider at substantial cost savings over traditional pharmacies.

Penile implant surgery has been performed by the specialists at Georgia Urology for decades.

The surgery is performed on properly selected patients has very high satisfaction rates.

It is mainly used when all the previously mentioned options have been unsuccessful. The surgery is performed through a very small incision in the scrotum and is entirely self-contained.

There are no exposed components and the erection looks and feels natural to the patient and his partner. The modern implants allow for not only an excellent erection but also a normal appearance in the deflated state.

If you failed pills and injections, a penile implant is probably the best option to consider if you want to have a more normal and spontaneous sexually functioning. Finally, Georgia Urology is currently evaluating low-intensity shock-wave therapy (LISWT) for erectile dysfunction.

Already widely used in Europe, this treatment appears successful in improving erectile function in about 60% of patients. The responses appear to be best in patients who are taking medications and less successful in more severe types of ED. It appears safe with minimal side effects and very little discomfort. If you or your loved one is struggling with erectile dysfunction or if you have any more questions about the treatment options for erectile dysfunction, then contact the experts at Georgia Urology.

We’ll be able to evaluate which one of the treatment options described above are best for you.

Erectile Dysfunction can be described as erection that is not sufficient to achieve or maintain the desired performance for a satisfactory sexual experience. Men suffering from low testosterone will often complain of weak erections, or the lack of morning erections, or the inability to maintain an erection.

Sometimes ED can be due to psychosomatic issues and this can lead to vasoconstriction ED which can have many causes, testosterone deficiency can be one of them but not the only reason for it and testosterone on its own does not always improve erectile dysfunction. Medications called PDE5 inhibitors like (tadalafil(cialis®), or sildenafil(viagra®) can help relax


smooth muscle in the


by vasodilating those blood vessels causing you to achieve an


. Having erectile dysfunction is actually very common around there are estimated to be around 15-30 million men who suffer from it. As you age erectile dysfunction becomes more common and on average 15-25% of men over the age of 65 experience problems maintaining an erection. Unable to get an erection with stimulation Weak or soft erections Short lasting erections lead to unsatisfactory sexual experience Change in Angle of erection Penis has decreased sensitivity (feels like you are wearing 5 condoms) Erections are less girthy. There are many men suffering from ED in the world, and the reasons behind ED are wide and varied. Below we have listed the more common causes for suffering from ED. Cardiovascular disease affecting the flow of blood to the penis Nerve damage affecting the penis Smoking, alcohol abuse, lack of exercise Diabetes High Blood Pressure Certain medications including SSRIs, and beta-blockers Stress Depression Performance Anxiety- Psychosomatic Low Testosterone Hormone imbalance Damage to the penis Peyronie’s disease (plaques causing a curvature of the penis) Nerve Sleep disorders or sleep apnea Damage to pelvic area Obesity High cholesterol Kidney disease Anxiety Loss of Penile Sensitivity and erections due to excessive aromatisation inhibition Stress. Testosterone PDE5 Inhibitors Prostaglandin Analogues injected into the penis before sexual activity (alprostadil, caverject) Prostaglandin Analogues inserted into the urethra with insertion device (aloprostadil Muse device) PRP-Platelet Rich Plasma Treatment (unapproved use) Stem Cells- (unapproved use as not approved by regulatory agencies but data to demonstrate effectiveness in small studies) Bremelanotide , sold under the brand name Vyleesi e for women(unapproved use and difficult to titrate) also can improve sexual desire (libido). Shockwave therapy at clinic The Rocket- home shockwave therapy device (pending approval, CE) PDE5 inhibitors and low testosterone.

If you have low testosterone and you have tried viagra and cialis, chances are it may not have worked for you. PED5 inhibitors work best with an adequate amount of free testosterone. Some men who have tried PDE5s like cialis or viagra who are unable to maintain a desired erection with testosterone alone will often dismiss adding a PDE5 to treatment because of treatment


in the past when they have had low testosterone. As mentioned earlier PDE5s work best when there is an optimal amount of testosterone present.

So you may want to reconsider and ask your doctor if adding a PDE5 is right for you. ED can be caused by several factors as described above, if you would like us to check your testosterone levels please


the form below to get in touch with us. Erectile dysfunction, which is also known as impotence, is the inability to achieve and/or maintain an erection.

It is a common condition that affects millions of men; it is estimated that half of men in the UK aged between 40 and 70 have erectile dysfunction to some degree, but it can affect men of all ages.

Although the risk does increase with age, erectile dysfunction shouldn’t be seen as a consequence of ageing.

There are many causes for erectile dysfunction ranging from underlining health conditions (high blood pressure, diabetes and high cholesterol), hormonal problems, previous surgery and injury through to psychological problems such as anxiety, depression and relationship issues. It is important to get an accurate diagnosis and identify the cause in order for the appropriate treatment or procedure to be recommended. An erection is a direct result of increased blood flow into your penis.

This blood flow is stimulated by sexual thoughts and arousal, or direct contact with your penis.

When a man becomes sexually aroused, all the muscles in the penis relax, allowing the blood flow to increase into the penile arteries. The blood then fills the two chambers that are inside the penis, called the Corpora Cavernosa. When these chambers fill with blood, the penis becomes rigid and erect.

The erection ends when the muscles finally contract, and the blood can flow back out the penile veins.

Giulio Garaffa, an award-winning Consultant Uro-Andrologist with over 20 years’ international medical experience in this field. Mr Garaffa has a global reputation for his excellence in urology and andrology and is one of the leading experts in the fields of erectile dysfunction, congenital penile curvature, complex penile reconstruction, phalloplasty, Peyronie’s disease, male infertility and microsurgery. + You have trouble maintaining an erection during sexual acts OR. If you experience any of these symptoms for more than 2-3 months, speak to your doctor. To determine if you have erectile dysfunction, your doctor will inquire about your symptoms and your health history. They will do tests if necessary to determine whether or not those symptoms are caused by an underlying health issue. This may include a physical exam, blood pressure work, and examination of your penis and testicles. This may also include a rectal exam to check on your prostate. If surgery is needed, your doctor will go over the best method for you and give you your options. The most common oral medications prescribed in patients with erectile dysfunction are Sildenafil, Tadalafil and Vardenafil.

All these medications help to enhance erections and therefore do not trigger automatic erections as injections instead do. Therefore sexual stimulation is necessary for these medications to work.

The most common side effects of these medications are headache, facial blushing, upset stomach and mild temporal visual effects (only for Sildenafil).In most cases, the side effects are minor and tend to reduce with time.

Therefore only very few patients decide to discontinue the treatment due to sildenafil 25 mg tablet price side effects.

Approximately 40% of men at the age of 50 suffer from erectile dysfunction and this prevalence increases around 10% each decade. Although prevalence of erectile dysfunction increases with age, erectile dysfunction should not be seen as an inevitable consequence of ageing. Erectile dysfunction can be subdivided in psychogenic and organic. Psychogenic erectile dysfunction, which is more common in younger men, cannot trace his origin to a physical problem or disease and is due to performance anxiety.

Organic erectile dysfunction is much more common than psychogenic erectile dysfunction and in most cases the causes can be easily identified. Once identified, proper treatment can be recommended to help patients return to a satisfying sexual life. Organic erectile dysfunction is usually caused by an injury (to the brain, spinal cord, peripheral nerves or arteries), by a disease (diabetes, high blood pressure or high cholesterol), by an operation (prostate gland removal, urinary bladder removal, surgery to the rectum, spinal surgery) and by substance abuse (tobacco, drugs, alcohol and some medications). A thorough examination and history taking is necessary to understand the nature of erectile dysfunction. Patients with psychogenic erectile dysfunction may be further investigated with a nocturnal penile tumescence test to confirm that the nocturnal erections are preserved.

The confirmation of the presence of normal nocturnal erections excludes the presence of an organic cause of erectile dysfunction and the patients should be therefore reassured and offered psychosexual counselling.

When organic erectile dysfunction is suspected and an underlying cause is not obvious from the examination and history, efforts should be made towards the identification of any underlying condition, since erectile dysfunction may represent the first sign of diffuse cardiovascular disease.

A prompt identification of any of the cardiovascular risk factors such as


, high blood pressure and high cholesterol levels is paramount to set up an adequate treatment plan and prevent further progression of the cardiovascular disease. The Doppler Ultrasound scan of the penis is a relatively simple investigation but it provides very important information on the blood supply to the penis. The management of the patient with erectile dysfunction is tailored to the underlying cause of erectile dysfunction and to patients’ preferences.

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