Treatment for erectile dysfunction at AKUH

Erectile Dysfunction (ED) is a rarely spoken condition among the men although it is fairly common as 10 to 15 percent of men under 40 years and 76 per cent of those between 50 and 70 years of age suffer from ED. Prof. Ahmed Yousef, a Consultant Urologist at the Aga Khan University Hospital, Nairobi, answers some questions regarding the condition and why more men are opting for penile implants.

What is Erectile Dysfunction?

Erectile Dysfunction (ED) is when a man is unable to have an erection, or is unable to sustain the erection long enough to have sex. This can result from a psychological problem (lack of arousal), or a physical problem (reduced blood flow to the penis, or a nerve not functioning properly).

What diseases can cause ED?

ED can be caused by one of several medical conditions. These include diabetes, hypertension, prostate cancer, kidney disease, obesity, venous leaks and neurological problems such as Parkinson's disease, Alzheimer's and Multiple Sclerosis (MS). Use of some medications and injuries resulting from an accident can also cause ED.

What treatment options are there for ED?

ED that is a result of a medical condition is easily treated by dealing with the medical condition e.g. Diabetes. Depending on the cause and severity of the ED and any underlying health conditions, there are various treatment options.  If the ED is not severe, simple steps like quitting smoking, exercising, losing weight, reducing alcohol intake and stress can help to deal with the condition. For more severe cases, drug therapy, or a penile implant are the other options.

How does the medications treatment work?

Most of the medications work to enhance a natural chemical in the body that relaxes the muscles in your penis. The goal of this medication is to increase response to sexual stimulation by increasing the blood flow in the penis allowing the person to get an erection. It is important to consult the doctor before taking any of these medications.

What is a penile implant?

A penile implant (or penile prosthesis) is a discrete device that is placed into a man's penis and is designed to help him get an erection. The implant is usually used when there is a clear medical cause for ED and when the problem is unlikely to resolve, or improve naturally, or with other medical treatments. The prosthesis can last for 15-20 years.

How many types of implants are available for this procedure?

There are two different penile implants that are available today. The three piece inflatable penile implant is popular as it produces a more natural erection and the two piece malleable penile implant which uses bendable rods. Both types are custom fitted to the body to allow the man to have a satisfactory erection for sexual intercourse.

How do penile implants work?

Both implants involve surgically placing devices.  For the inflatable ones, a cylinder is placed in the penis, a fluid filled container in the abdomen and a pump in the scrotum. These allow the man to control when and how long he has an erection. The malleable rods are implanted into the shaft of the penis to keep the penis firm, but bendable. Once implanted the sensitivity and ability to ejaculate should not be affected.

How long does the theatre procedure take?

The procedure is done under general, or spinal anesthesia. A small incision is made and the implants are inserted. The patient can be discharged after one day with medication for pain and instructions not to have intercourse for three to six weeks. During the review visit, the doctor counsels the patient on how to use the implant as complications can arise if used aggressively.

How will the patient benefit from a penile implant?

The treatment is discreet as the implant is not visible (the sexual partner cannot tell it exists). The recovery time is short averaging four to six weeks. Once implanted, the man can have sex whenever he wants instead of having to plan in advance. Patients treated with a penile implant appear to be significantly more satisfied than those treated with ED medication, or other treatment options. Looking at the long-term, it is also more cost-effective than medication.

Does the procedure have any side effects?

As with any surgery, there are some minor risks associated with the penile implant procedure including pain, anesthesia reactions and infection. These are dealt with by the doctor using medication. Mechanical problems can occur with the device if the patient fails to follow instructions provided on the usage.

If I get an implant, will the sensation be the same as before I got ED?

After implantation of a penile prosthesis, you will have the same sensation, orgasm and ejaculation as you had before you got erectile dysfunction

How will the erection change after this procedure?

Yes. You will have a strong erection like when you were in your teen ages and the satisfaction rate will be around 95- 97 % for you and your partner.

Being a foreign object put in my body, are there some reactions and how safe is it?

The prosthesis is made of a special alloy which is completely safe for the patient and also accepted by the body tissue. However, some precautions have to be taken after the operation to prevent infection of the prosthesis but generally it is completely save

Once they put the implant, do you stop taking the medicines?

After implantation, you will stop to take the medication for inducing erection and the penis will be ready any time without any prior preparation for sex. This means that you can have unplanned sex any time lasting the intercourse for as long as you like with your partner.

What counselling is offered to patients after this treatment to minimize abuse?

As much as penile implants have a lot of advantages in treating a wide variety of patients, we have to take care of some counseling. For instance;

• You have to avoid abnormal/frequent sex practice as this is viewed as abuse

• You have to control your diabetes to prevent infections

• Some patients have to be cleared by the cardiologist to qualify for a penile implant.

What are the tell-signs of severe ED?

To know the degree of erectile dysfunction you have, you will need to visit a specialist who will give you a questionnaire to evaluate your erection. We also have some blood test you can do as well as a Penile Doppler ultrasound which will determine the degree of erection affection. Results obtained from the tests will determine the course of treatment depending on the severity.

By Prof. Ahmed Yousef, a Consultant Urologist at Aga Khan University Hospital, Nairobi

This article was first published in Business Daily on February 25, 2022