Author: Dr. Osterberg
Comprehensive Evaluation and Advanced Treatment Options
Erectile dysfunction (ED) and Peyronie’s disease are common urologic conditions that can significantly affect a man’s sexual health, confidence, and quality of life. At Urology Austin, we provide a confidential, comprehensive evaluation and individualized treatment plans using the latest evidence-based therapies.
Many men are hesitant to seek care, but both conditions are highly treatable—especially when addressed early by one of our urologists.
Erectile Dysfunction (ED)
What Is Erectile Dysfunction?
Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient enough to have satisfying sexual intercourse. It is one of the most commonly untreated medical disorders in the US, with roughly 30 million men reporting problems achieving or maintaining an erection. Yet, only 10% of men ever seek treatment or ask about options. Erectile dysfunction is associated with depression, loss of self-esteem, and anxiety. It can also be associated with chronic medical conditions such as high blood pressure, high cholesterol, and diabetes.
Common Causes of ED
ED may result from one or more of the following:
- Cardiovascular disease and poor blood flow
- Diabetes and metabolic syndrome
- Hormonal imbalances, including low testosterone
- Neurologic conditions
- Side effects of medications
- Psychological factors such as stress, anxiety, or depression
- Lifestyle factors, including smoking and obesity
Because ED is frequently linked to overall health, proper evaluation is essential.
Peyronie’s Disease
What Is Peyronie’s Disease?
Peyronie’s disease occurs when fibrous scar tissue (plaque) forms within the penile tissue, leading to penile curvature, deformity, pain, or shortening. In some men, Peyronie’s disease can also cause erectile dysfunction. This is because the plaque will restrict blood flow to the penis.
Symptoms of Peyronie’s Disease
- Curvature or bending of the penis
- Penile pain, especially with erections
- Palpable penile plaque or nodules
- Penile shortening or narrowing
- Difficulty with sexual intercourse
Peyronie’s disease typically progresses through an active phase, when pain and curvature may worsen, followed by a stable phase, when symptoms plateau. In some cases the plaque will resolve altogether, but in others a persistent curvature exists. Evaluation during the active phase is encouraged, as well as during the stable phase.
Treatment Options for Erectile Dysfunction
Lifestyle and Risk Factor Modification
- Exercise and weight management
- Smoking cessation
- Optimizing cardiovascular and diabetic control
Oral Medications
PDE5 inhibitors are first-line therapy for many men. Cialis (Tadalafil), Levitra (Vardenafil), and Viagra (Sildenafil) work by selectively inhibiting an enzyme in the penis called Phosphodiesterase V (PDE V), a chemical that takes away the erection. They are all in a family of medication called PDE5 inhibitors. Ultimately, they work by increasing levels of cyclic GMP, which allows for increased penile blood flow. There are subtle differences between the medications available; however they all work in a similar fashion.
Advanced ED Therapies
In men who are dissatisfied with their response to oral phosphodiesterase 5 inhibitors, another treatment option are penile injections, also known as
- intracavernosal injections (ICI).
CaverjectTM or EdexTM (Alprostadil) or TriMix – Papaverine, Phentolamine, and Alprostadil can be injected directly into the side of the penis and produces an erection. The medication dilates the arteries of the penis and allows blood to flow in. An erection occurs anywhere from 5 to 15 minutes after injection. The most common side effect of injection therapy is an aching feeling in the penis that will ultimately go away with time. Occasionally, ICI may cause a painful, sustained, prolonged erection, known as priapism. Priapism (a rigid erection for more than 4 to 8 hours) requires immediate medical attention, but is easily reversed when treated early.
- Low Intensity Shock Wave Therapy (LiSWT)
Low-Intensity Shockwave Therapy uses gentle acoustic (sound) waves applied to the penis and surrounding tissue. The shockwaves stimulate blood vessel growth (angiogenesis), and thereby improve blood flow to erectile tissue. They may help repair damaged blood vessels. This is generally best suited for men with mild to moderate ED with a vascular underlaying cause.
Surgical Options
For men with severe or refractory ED, penile prosthesis implantation offers a reliable, long-term solution with high satisfaction rates.
Treatment Options for Peyronie’s Disease
Observation and Monitoring
Men with mild curvature and preserved sexual function may be managed conservatively.
Non-Surgical Therapies
- Penile traction therapy is a device that counter bends the area of curvature. Men who wear this device for more than 1 hour per day, can see up to 20 degrees improvement in curvature over 12 weeks.
- Intralesional injections, including collagenase (Xiaflex®) for appropriate candidates – Xiaflex is the first (and currently only) FDA-approved treatment proven effective for Peyronie’s disease in men with a palpable plaque and a curvature deformity of 30 degrees or greater at the start of the treatment. Xiaflex is an enzyme produced by the bacterium Clostridium histolyticum, which breaks down collagen.
Surgical Treatment
Surgery is considered once the disease is stable and curvature interferes with sexual activity:
- Penile plication procedures
- Plaque incision or excision with grafting
- Penile prosthesis placement for men with both Peyronie’s disease and erectile dysfunction
Treating ED and Peyronie’s Disease Together
These conditions frequently coexist. In particular, as plaque develops in the penis to cause Peyronies Disease and curvature, the same plaque is restricting blood flow during an erection. Thus, PD and ED often go hand in hand. Please remember to discuss this with your urologist.
When to See a Urologist at Urology Austin
You should seek evaluation if you experience:
- Persistent erectile dysfunction
- Penile curvature or pain that affects your ability to have sex
- Changes in sexual function
- Symptoms affecting intimacy or quality of life
Early evaluation allows for more treatment options and improved results.
In Summary
Our goal is to restore function, confidence, and quality of life through evidence-based, personalized treatment plans. Both conditions are not normal, and the first step toward seeking treatment is scheduling a consultation today to discuss your options.
Urology Austin has many locations close to home. Visit our locations page and schedule your appointment today.
Explore More Expert Insights on Urologic Health
Visit our Patient Webinar page or our YouTube channel to learn from Urology Austin’s trusted providers and take a more active role in your health.
