UROLOGY CLINIC
RO-BOOST
We use state-of-the-art medical equipment to provide effective and safe treatments.
We use state-of-the-art medical equipment to ensure safe and effective treatments.
RO-BOOST applies a multidisciplinary approach in the evaluation and treatment of male health conditions, integrating specialists from complementary fields to achieve optimal therapeutic outcomes.
Erectile Disfunction
It is a treatable medical condition.
At RO-BOOST, we are dedicated to providing our patients with the latest solutions to treat erectile dysfunction.
What is Erectile Dysfunction (ED)?
The diagnosis of erectile dysfunction (impotence) refers to the constant or recurrent inability to achieve or maintain an erection long enough to sustain sexual intercourse. It can occur at any age, but it is more commonly diagnosed in older men. Sexual dysfunction does not affect only a man’s sex life. 'The value of proper evaluation and management of the diagnosis of erectile dysfunction has implications not only for affected individuals and their partners, but also for society as a whole. The management of erectile dysfunction encompasses aspects related to physical and mental health, to addressing or failing to address this sexual dysfunction, to the management of associated diseases, as well as its socioeconomic burden,' says Dr. Bogdan Gusanu, Senior Urology Specialist.
Diagnosed as such, erectile dysfunction is considered a disease of the 20th and 21st centuries—not because it was only recently discovered, but because its mechanisms have now been well understood and several effective therapies have been developed.
There are several major causes that ultimately lead to erectile dysfunction, but it has been concluded that there is practically no single type of erectile dysfunction; rather, all cases have multiple triggering factors in varying proportions.
This medical condition is of major importance for human health, with implications that go beyond treating the patient who occasionally presents with a problem of seemingly non-vital magnitude. The value of proper evaluation and management of ED refers to and has implications not only for the affected individuals and their partners, but also for society as a whole. The management of ED encompasses aspects related to physical and mental health, the approach or failure to address this sexual dysfunction, the management of associated diseases, as well as its socioeconomic burden.
The management of erectile dysfunction has evolved into a mature clinical discipline over the past decades, thanks to continuous progress in basic science, epidemiology, clinical research, and health services research within this dynamic field.
The fundamental principles of ED management, based on the highest clinical standards of ethics, quality, safety, and cost-effectiveness, are now well accepted by the scientific and clinical community in sexual medicine. Epidemiological studies of this well-researched sexual problem estimate a general prevalence of ED among adult men (over the age of 20) to be between 10% and 20% worldwide, with most studies reporting a rate closer to 20%.
It is recognized that there is an age-related correlation in the prevalence of ED, with a global prevalence of 1% to 10% in men under 40 years old, up to 15% in men aged 40–49, 30% in men aged 50–59, 40% in men aged 60–69, and 50% to 100% in men in their 70s and 80s.
It is estimated that in 1995 there were more than 152 million men affected by ED, with a projected prevalence of approximately 322 million men with ED by 2025. This trend persists regardless of race/ethnicity or geographic region. Current data have also confirmed that the prevalence of ED increases in the presence of comorbid medical conditions, including type 2 diabetes, obesity, cardiovascular disease, hypertension, dyslipidemia, depressive disorders, and prostate conditions/benign prostatic hyperplasia (prostate adenoma), as well as in the presence of unhealthy lifestyle habits (excessive tobacco and alcohol use, sedentary lifestyle). It is also well known that 25% of all ED cases occur as a side effect of commonly used medications for conditions such as hypertension, depression, and certain forms of cancer. In addition to its associations with other diseases (comorbidity), ED is recognized for its negative impact on quality of life, reduced occupational productivity, and increased healthcare resource utilization.
Since adequate erection requires a well-functioning vascular system, ED has also been found to be an early indicator of future cardiovascular, myocardial, and cerebrovascular disease. Thus, ED itself serves as a true clinical barometer of men’s overall health, and efforts aimed at improving its management are also pursued with a view to disease prevention, health promotion, and quality of life improvement.
The primary goal of ED management is to guide it toward an individualized approach, allowing the patient or couple to make an informed choice of preferred therapy for sexual fulfillment, based on a solid understanding of all treatment options, following an in-depth discussion with the treating physician. The current approach recognizes that patients vary in their acceptance of sexual disorders and in their willingness to continue prescribed treatment. Their decisions appropriately reflect individual preferences, needs, and expectations regarding management options. Clearly, there has been a consistent preference for the least invasive treatment methods.
RECOGNIZING THE SEXUAL PROBLEM YOU ARE FACING AND OVERCOMING THE HESITATION TO CONSULT A SPECIALIST DOCTOR ARE ESSENTIAL
Symptoms
We are not wrong in saying that any man—absolutely any man—may experience a so-called sexual failure at some point in his life. It may happen when he is more tired or stressed, after consuming more alcohol, or after smoking excessively one day. Not every isolated failure should be alarming. However, if through normal self-evaluation he notices that these failures begin to increase and repeat with a frequency that affects his sex life, then that is the moment when he truly needs to see a urologist to identify the causes and receive a correct diagnosis.
A medical check-up is necessary when:
- an erection cannot be achieved regardless of the type of stimulation (sexual intercourse or masturbation)
- the erection is not firm enough to initiate sexual intercourse
- the erection cannot be maintained for the entire duration of sexual intercourse
Any of these symptoms persisting for more than three months requires a specialist medical check-up.
CAUSES
Organic:
- vascular (arterial or venous)
- neurogenics
- anatomical
- endocrinological
Psychogenic:
- generalized (primary lack of libido or age-related decrease)
- situational (related to the partner, specific conflict situations, or psychopathological states)
Mixt:
It is important to mention that in all cases, ED does not have a single mechanism, but rather one that predominates (organic or psychogenic), with varying degrees of interference.
Vascular causes of ED represent a major segment in the etiology of this condition, due to the fact that the mechanism of erection is primarily vascular. The physical support of the erection phenomenon is represented by the integrity of the penile vascular network, specifically the normal reactivity of the arterial and venous blood vessels of the penis. Since the size of these vessels is relatively small, even minor changes in vascular caliber can cause serious difficulties with achieving an erection. Various pathological conditions (hypertension, diabetes mellitus, hypercholesterolemia) that reduce the caliber of blood vessels in many internal organs inherently affect the penile blood vessels as well, decreasing the normal arterial flow required for a viable erection.
For this reason, an important step in evaluating a patient with ED is determining the condition and quality of the penile blood vessels (mainly the cavernous arteries, through which arterial blood enters the two corpora cavernosa in increased volume during an erection).
The evaluation of this parameter is carried out primarily through a penile Echo Doppler ultrasound, which will determine whether the flow in the cavernous penile arteries is sufficient and whether the penile veins respond appropriately to maintain an adequate amount of blood in the corpora cavernosa during an erection.
Currently, patients with vasculogenic ED have available remedies including pharmacological methods (oral or local medications) as well as invasive surgical methods.
The medications available on the market belong to the group of so-called phosphodiesterase type 5 (PDE5) inhibitors, such as Viagra, Cialis, and Levitra, which, through a local penile vasodilatory mechanism, allow an adequate erection if taken about one hour before sexual activity. However, this method is associated with certain drawbacks, such as significant side effects (headache, blurred vision, dizziness, facial flushing), the contraindication of combining with nitrate-containing medications used for angina, and, not infrequently, the lack of responsiveness of the body to these vasodilators, which renders the administration ineffective.
Other groups of medications can be self-administered by patients via penile injection before sexual activity, in order to induce artificial vasodilation to facilitate an erection. However, many patients are hesitant to inject themselves due to legitimate concerns about possible accidents during administration (perforation of a major artery leading to uncontrollable bleeding, urethral perforation, or the creation of an abnormal connection between a penile artery and vein, causing a prolonged, painful erection—priapism—which can sometimes even endanger life).
Invasive surgical methods (penile revascularization surgeries or implantation of inflatable penile prostheses) also present significant drawbacks (high costs, aesthetic shortcomings).
DIAGNOSIS
Early recognition of symptoms and the first visit to a urologist are an important first step for the patient. The diagnosis of erectile dysfunction includes:
- physical examination of the genital organs
- medical history of the condition
- blood tests – these can detect the presence of other conditions such as diabetes or heart disease, and also determine the level of male hormones, which play an essential role in the development of the reproductive system
- urine tests
- performing a Doppler ultrasound – allows visualization of blood circulation in the penis
- psychological evaluation – to determine whether erectile dysfunction is caused by an underlying psychological disorder
Given the relatively high percentage of cardiovascular comorbidity, patients with ED are recommended to undergo a complete medical evaluation initially, with stratification of cardiovascular risk as high, medium, or low. Patients classified as high risk include those with unstable or refractory angina, a recent history of myocardial infarction, certain arrhythmias, or uncontrolled hypertension. For these patients, sexual activity with any ED therapy should be postponed until cardiac status is stabilized. Often, in the evaluation of the initial causes of ED, the urologist will collaborate interdisciplinarily with other specialties such as endocrinology, neurology, cardiology, psychiatry, etc.
The urologist is responsible for correctly establishing the diagnosis, the severity of ED (mild, moderate, severe), and the classification of its origin (psychogenic, organic, mixed), as well as for completing a personalized assessment questionnaire for the ED patient. This helps determine the criteria mentioned above, as well as other psycho-social parameters related to the condition.
During the initial evaluation, standard testing of important blood parameters is recommended, such as blood glucose, cholesterol and its fractions, sex hormones (testosterone), thyroid hormones, and pituitary hormones, in order to identify possible triggering and potentially treatable causes of ED.