The incapability to reach or maintain an erection to perform sexual intercourse is known as impotency or erectile dysfunction. Erectile dysfunction may occur right after surgery to remove the prostate, regardless of the fact that the surgical technique is performed that by sparing the nerve that controls erection.
Erectile dysfunction may attain its severity depending upon the type of surgical technique, stage of cancer, or skill of the surgeon. Recovery from erectile dysfunction may occur within the first year following the nerve-sparing technique. Reported data revealed 66% erectile dysfunction rate in case of nerve-sparing prostatectomy as compared to 75% for non-nerve sparing surgery within a year of surgery. Erectile dysfunction usually begins gradually following radiation therapy within about six months of the treatment. Radiation therapy has some common complications associated with it, including Erectile dysfunction, however, its occurrence may decrease with the application of more sophisticated treatments, such as intensity-modulated radiotherapy (IMRT), radioactive seed implants (brachytherapy), or 3-D conformal radiotherapy. Erectile dysfunction desire may occur approximately two to four weeks following hormone therapy, which is due to the testosterone-reducing action of the drugs. Although the mechanism of action is similar, oral drugs such as Viagra, Levitra and Cialis has little differences in the chemical makeup. Testosterone replacement raises man's sexual desire, thereby improving erectile dysfunction. Injections into the penis can be an effective treatment procedure in case drugs for oral erectile dysfunction fail for patients who underwent surgery or have received radiation therapy for prostate cancer. Erection can be regained in approximately 60% to 80% men with the application of injection treatments. A penis pump or a vacuum pump is a device with a hollow tube that can be kept over the penis.
In this treatment procedure, a suppository is placed into the urethra (urinary tube) with the help of a plastic applicator. This technique is applicable if the patient did not recover A fromA  erectile dysfunction within a year of cancer treatment and at the same time nonsurgical techniques have failed or was unacceptable. Erectile Dysfunction Shock Wave Therapy: It is a revolutionary, new modality of non-surgical treatment. A surgical specialty that deals with disturbances of the urinary organs for males and females (the bladder and kidneys) and reproductive organs for males including the prostate. A doctor who specializes in diseases of the urinary organs in females (the bladder and kidneys) and the urinary (bladder, kidneys, and prostate) and sex organs in males.
Though unlikely, still Erectile function recovery after a non-nerve-sparing surgery is possible. Application of erectile dysfunction drug or vacuum devices after the healing of the body from surgery may improve the quality of erections and rapid return of normal sexual function. This may result in infertility, although most men are diagnosed with prostate cancer at old ages.

These minor variations affect the way of function of the medications, such as how quickly it may start its effect and wears off. This therapy is generally not recommended for patients having testosterone levels at the lower of the normal range.
The procedure may have fewer side effects, including the development of scar tissue or occasional pain from any of the drugs applied for injection therapy. The drug alprostadil that relaxes muscle of the erection chamber, thereby permitting blood flow into the penis is present in the suppository that travels to the erection chamber.
Penile implant, or prosthesis, is quite an effective therapy to treat erectile dysfunction in many men, butA  does require surgery to place the implant into the penis. Initially, patients should be advised to control every clinical abnormality or life-style factor associated with a higher risk of erectile dysfunction.
This is a hand- or battery-powered device which quite easy to operate and associated with low risk of problems. Semirigid or expansive penile implants are safe and effective treatment technique for many men with erectile dysfunction. If this device is a suitable treatment for the sufferer then his doctor may recommend a specific model by which the patient can make sure that it A is approved by the Food and Drug Administration (FDA), suits the need, A and manufactured by a reputable organization. It has some disadvantages since surgical procedures can cause infection or mechanical failure, which may requireA  re-operation and removal of the prosthesis. Vacuum-constriction devices that are available in some magazines and sex ads may not be safe or effective for use.
However, some men and their partners are quite satisfied with these techniques and the rate of success is almost 95%. In addition, patients with poor manual dexterity, poor visual acuity or morbid obesity, or those in whom a transient hypotensive episode may have a deleterious effect (e.g. Finally, patients with serious psychiatric disorders or patients who might misuse or abuse this therapy should be excluded from treatment.The first phase of the pharmacological erection program consists of dose titration of the drug or mixture used for injections. Patients are placed in the sitting position on the examination couch during each injection and kept in this position for 30 min.
Systemic blood pressure is recorded as baseline in the event of syncope, and to check for hypertension. The right side (lateral aspect) of the penis is cleansed with an alcohol swab.The first injection is then performed with a very small amount of either the drug or the mixture.
The needle is inserted by a quickjab up to the hilt of the needle so that the tip of it reaches the centre of the right corpus cavernosum. Injections must not be performed on the dorsal and ventral aspect of the penis, to avoid damage to the dorsal neurovascular bundle of the penis and the urethra, respectively.Immediately after injection, the base of the penis is squeezed firmly between the right thumb and index finger, while the accessible portion of the penis is massaged for up to 5 min by squeezing it laterally along the length of the shaft between the left thumb, and index and middle fingers, thus distributing the drug throughout the pendulous shaft. Patients are then left alone to watch an erotic video and they are invited to masturbate without ejaculation to optimize sexual stimulation. The dose of the injected drug or mixture is considered adequate when it produces an erection equal to 50–75% of the maximal erectile response reported by the patient.If a patient reaches a maximal rigid erection during the titration phase in the clinic, a lower dose is suggested for home use as the erectile effect induced by the drug or mixture during sexual activity is usually greater than that observed under laboratory conditions.

If the first injection does not produce a satisfactory erectile response (that is, less than 50% of the maximal potential response), the patient is re-injected after at least 24 h and the dose is slightly increased.
If after the injection a fullrigid erection persists for longer than 1 h, 20–40 ?g of adrenaline is injected intracorporeally to obtain complete detumescence.
Appropriate electrocardiographic and blood pressure monitoring are used during this procedure.Patients are contacted by telephone the next day to verify persistence of detumescence. After the appropriate dose of the drug or mixture has been determined, patients watch the thorough demonstration of both a conventional insulin syringe and an automatic selfinjection system (Disetronic pen®; Medis, Milan, Italy) with which multiple injections can be performed, thus avoiding the maneuvers needed before each injection performed with the insulin syringe (preparation of the syringe, needle and appropriate amount of the drug).
The pen consists of a capsule that is screwed together with the adaptor after inserting the filled glass cartridge. The needle is then screwed into the adaptor.The glass cartridge consists of a rubber piston and a conus in front, which is closed with a cap. To fill the cartridge, the pull rod is screwed into the thread of the rubber piston and, after removing the cap, the needle is stuck upon the conus. At our clinic the cartridge is filled with a four-drug vasoactive mixture, which is described in detail below. Astheaverage volume of mixture used at each injection by our patients is below 0.2 ml, every cartridge has a drug load that is usually enough for 8–10 injections. We supply 29-gauge needles for injections.To prepare the pen for injection, the adaptor is first removed from the capsule. The full glass cartridge is then inserted into the capsule with the conus pointing forward.
The needle cap is pulled out and, while the pen with the needle is held pointing upwards, the knob is pressed slowly until it reaches the top.Some drops of liquid should come out, but if this does not occur the knob is turned clockwise for approximately 2–3 clicks and is slowly pressed until it stops. To inject the drug, the needle is inserted into the corpus cavernosum and the pen knob is gently depressed until it stops.
Two models of this system are currently available, which differ only in the volume (20 or 50 ?l) of liquid released with every click of the knob.
We currently use 20 ?l for pure psychogenic and neurogenic patients, and 50 ?l for vasculogenic cases.Patients are instructed to limit injection use to three times a week, with no more than one injection in any 24-h period. Patients are then warned to return immediately to the emergency room if erection persists for longer than 3 h. Patients are also told to refrigerate the drug or mixture, if it contains prostaglandin E1, and to examine the drug or solution for changes in color or the formation of a precipitate.Patients are reassessed once a month for the first 2 months, and subsequently every 3 months.
At each follow-up visit, injection frequency, duration and consistency of erections, and patient satisfaction are recorded. Penile ultrasonography is performed to verify any clinical findings on digital palpation of the penis.

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