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Andrology

Fertility: in collaboration with the Gynecology Service, diagnostic study and infertility treatment.


Erectile dysfunction: It is defined as erectile dysfunction the incapacity to produce and maintain an erection long enough for a satisfactory sexual relationship. It is a very common pathology, especially after the 5th and 6th decade of life. Existing information and its disclosure has encouraged patients to consult doctors about a subject, which was considered taboo years ago.


The most frequent cause has a vascular origin and it is associated to the same risk factors of other localizations: tobacco, hypertension, hypercholesterolemia, stress… Another frequent cause is psychological: patients, frequently young, with erectile dysfunction associated with marital problems, stress, etc.


MOSTLY USED TREATMENTS ARE:


  • Correction of risk factors: Smoking cessation, revision of the vascular risk factors, right diet… After this step, the beginning of a specific treatment will be considered, and it will consist on: Pharmacological oral treatment: The appearance of Sildenafil (VIAGRA) in 1998 has been a real revolution on the treatment of this disease. There are different active pharmacological ingredients with differentiated posology suitable for most of the patients, with almost just one contraindication of certain cardiopathies with a specific treatment.
 
    • Topical treatment/Oral route treatment: after the preliminary assessment phase.  In addition, there are topical treatments (creams) that even allow combinations with other treatments
 
    • Intracavernous therapy: Today it can be considered the second step of the treatment, applicable if the previous treatment has failed. It consists on the administration of prostaglandin E1 on the penis via an intracavernous injection. Very high efficiency. Detailed information and medical consultation eliminate initial apprehensions and provide great confidence on the penis intracavernous injection therapy treatment.
 
    • Vacuum device: It can also be considered as a second step treatment after the failure of the pharmacological treatment. Through the device, there is a negative pressure on the penis with induration because of the arrival of venous blood.
 
    • Surgical treatment: It consists on the last therapeutic step and it is applied when there is a failure of the previous treatments. It consists on the implantation of a mechanical penile prostheses. The device consists of three components which allow an activation (erection) and deactivation (relaxation) providing a high quality erection. Intracarvenous collocation provides total discretion without any external evidence.. Introduction is carried out with regional or general anesthesia and it requires a hospital admission no longer than 24-48 hours.
 
  • Psychological evaluation: It is said that there are no proper erectile dysfunctions by themselves, that means that although there is an organic origin, the added psychological component needs a complementary treatment. Therefore, in all cases the appropriate psychological/ sexual support will be valued for the patient and his couple.

  •  Other genital pathologies:

– Premature ejaculation

    – Penile curvature
    – Peyronie’s disease: Unknown cause, it consists on the appearance of a fibrosis / calcification on the penis which will be related to different levels of penile curvature and erectile dysfunction.

– Medical treatment: There is no evidence of efficiency of any of the existing treatments. XIAFLEX, a drug for intra-plaque injection with discussed results but which could partially stop penile incurvation. Some factors, such as its high price, its application via an injection directly to the plaque and the possibility of severe complications (fracture of the penis) limit the use of this medication.

– Surgical treatment: For the correction of the penile incurvation, which can even hinder the penetration.