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What Is The Right Course Of Treatment Suffering From ED Since 25 Years?

Posted on 5 days ago

Question: Dr,
I have been suffering from ED since 25 years . I am now 51 years old . I have been doing the rounds of urologists and doctors and am fed up as urology so far has offered me very little. No doubt the Tadalafil and Sildenafil have helped over the years . But I have to take higher and higher doses and the desired outcomes are becoming lesser.
Recently I got a penile doppler done and Angio CT pelvic (attached)
All blood tests were also done.
Glycosylated Haemoglobin(Glyco Hb/HbA1c)---5.70
Fasting Blood Sugar(FBS) --97
Sex hormone binding globulin(SHBG)-- 43.64
Liver Profile -normal
Lipid Profile(mini) -normal HDL/cholo ratio 4.05
Prostate specific Antigen(PSA) Total plu --all normal but FPSA/TPSA ratio 0.18
Thyroid Profile Total T3 T4 TSH -normal
Testosterone Total -- 606
Free Testosterone ---9.50 (is this on low side)
Estradiol --48.21
Prolactin.--47.81
Vitamin D --8.00-have started D3 60000
IGF-1 -- 123
Dr,
I have 4 questions:
1.Urologists are divided on the cure. Some say penile implant is the only way out. Other one says ESWT + daily tadalafil 5 + vaccum pump + cernos gel + baithaks. Looking st the angio and doppler what do you suggest?
2.My prolactin has been increasing from 29 ng/ml on 9th March to 47 on 30th March . I have started Cabogline 0.25 twice a week or would Bromocriptine be the drug of choice?
3.I don’t want to try ESWT conclude it does not work or has to be done every year and then go for implant finally. Pl give me your honest views
What is the right course of treatment?

Answered by Dr. Dr. P. T. Patil (12 hours later)

Brief Answer:
Penile implant would be the best option .

Detailed Answer:
Thanks for query .

Based on the facts and relevant reports that you have posted you seem to have been facing problem of Erectile Dysfunction since 25 years and have been using medicine like Cialis but have not been achieving hard erection to be unable to enjoy sex.

In view of the Ct angiography and Penile Doppler Scan which clearly revealed Arterial Insufficiency being the cause of your ED due to diseased arteries that play important role in achieving erection all other modalities of treatment will not help to increase arterial blood flow to penis which is the basic process to get erection .In such situation I would suggest to consult qualified and experienced Urologist who is routinely doing this surgery .Since you are in XXXXXXX I will recommend Dr Rupin Shaha who is world renowned Urologist and XXXXXXX in the field of Penile Implant Surgery .

As regards your query about increased Prolactin levels i find it to be irrelevant your Ed being due to Vasulogenic in nature .You may stop taking medications for the same .

Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (28 hours later)

Dr, Thanks a lot for the correct road ahead.
Would implant lead to loss of sensation in sex?
I am taking Cab 0.5 since 2 weeks--is it ok if I abruptly stop?
Even if I do go in for ESWT, would I have to do sessions yearly? I feel the whole treatment at best will give only feeble erections and sildenafil may still be needed. Am I kind of right?
Dr, how can I try pt141--hw do I procure it in XXXXXXX

Thanks n regards

Answered by Dr. Dr. P. T. Patil (19 hours later)

Brief Answer:
Penile implant will not cause loss of sexual sensation .

Detailed Answer:
Hello

Thanks for follow up .

Penile implant does not cause loss of sex sensation .

You can stop Cab 0.5 .

Since the mother arteries are diseased . ESWT will not be of much help you in getting erection .

Thanks and Regards.
Dr Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. P. T. Patil (2 days later)

Dr,
One last question --my research shows that in XXXXXXX mostly malleable implants are used largely for the cost convenience . Is it true then that I should try for a malleable, as Drs are more faimliar and experienced in that surgery. I dont want to go in for 3 piece and then have problems .
Kindly guide

Answered by Dr. Dr. P. T. Patil (3 hours later)

Brief Answer:
Malleable implants are very easy to use

Detailed Answer:
Hello
Thanks for follow up
Malleable penile implants are very user friendly ,convenient and economical and can be easily replaced ( if needed)
Thanks and Regards
Dr Patil

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar