A urologist is a medical doctor who has completed an additional five years of surgical training and has chosen to specialize in the branch of medicine called urology.

Urology involves the diagnosis and treatment of diseases and disorders of the male reproductive organs and the urinary tract of both men and women. The urinary tract consists of the kidneys, the bladder, the ureters and the urethra.

Men and women may consult a urologist about urinary tract problems, such as kidney stones, bladder infections and difficult or painful urination.

Men who have problems with the prostate gland may be referred by their general practitioners to urologists for more sophisticated diagnosis and treatment, possibly including prostate biopsy and transurethral resection of the prostate (TURP).

Some urologists have a subspecialty in male reproductive and sexual health. These specialists deal with male infertility problems, such as low sperm count and sperm abnormalities. They perform vasectomies and diagnose and treat erectile and ejaculatory dysfunction.

Specializing in Sexual Health

Urologists have an awareness of psychological factors that may contribute to or be responsible for erectile and ejaculatory problems. Often they have a collaborative relationship with certified sex therapists, and may refer patients to therapists when no organic causes of sexual dysfunction can be found.

It is important for a male with sexual or reproductive concerns to seek a urologist who identifies himself as specializing in sexual health.

Sexual Health Treatments

Treating Erectile Dysfunction or Impotence

One of the most common male sexual problems a urologist treats is erectile dysfunction, or impotence. Erectile dysfunction is the consistent failure to obtain or maintain an erection rigid enough to achieve penetration.

An initial visit to a urologist for a sexual concern, including impotence, typically begins with a detailed medical and sexual history, followed by a complete physical exam.

Additional tests may or may not be necessary, depending on the information obtained from the initial evaluation. Such tests may include blood tests for hormone levels and cholesterol and lipid levels, penile blood flow studies, or sleep monitoring.

Penile blood flow is assessed by means of an ultrasound examination whereby the actual condition of the blood vessels and blood flow within the penis can easily and painlessly be checked.

For sleep monitoring, a simple, non-invasive device called a snap gauge is worn on the penis during sleep for two to three nights. The purpose of the snap gauge is to determine if erections are occurring throughout the night, as is normally expected.

Research has shown that during a phase of sleep known as rapid eye movement (rem sleep), men without erectile difficulties become partially or fully erect approximately every 88 minutes. These data can help in diagnosing the underlying cause of the impotence. Additional studies are occasionally recommended to measure nerve impulses and pressure changes within the penis, items that are instrumental to erectile functioning.

Urologists treat impotence according to the information obtained through these diagnostic tests. Medical treatments include hormone replacement therapy for cases of hormone deficiency, and oral medications in cases of mild to moderate erectile dysfunction.

If these treatments fail to produce desired results, alternative therapies may be offered. One such treatment is penile self-injection. A single drug (Prostaglandin) or a combination of three drugs (Prostaglandin, Papaverine and Phentolamine) is injected into the chambers of the penis to produce an adequate erection within minutes.

This method works in approximately 75 percent of patients, but the drugs are only effective when used in injection form. The injections are given at the base of the penis, with an extremely fine needle for minimal discomfort. Penile self-injection is the most prevalent form of treatment because of its relative simplicity, effectiveness, and patient satisfaction. Complications are rare and usually preventable.

Other Treatments Urologists Use

Another urological treatment for erectile dysfunction is known as a Vacuum Erection Device (VED). This external device pulls blood into the penis by means of negative pressure, or suction. The blood is then trapped in the penis by a rubber compression ring at the base of the penile shaft. If not properly used, complications can arise.

Some patients use the VED satisfactorily; many, however, discontinue its use, reporting diminished sensation along the penile shaft, difficulty with ejaculation, or the experience of the penis "flopping" at its base.

Urologists can also treat impotence by means of penile implants. Implants are a surgical procedure in which a hydraulic penile prosthesis is inserted completely within the body, allowing patients the flexibility to have an erection at any time and for any length of time simply by inflating the prosthesis. This Federal Drug Administration (FDA) approved procedure has received high marks for reliability and patient satisfaction.

As with the choosing of any medical doctor, the patient should choose a urologist who is board certified and with whom he feels comfortable.

If seeking help for a sexual dysfunction or infertility, be sure to ask if your urologist specializes in this area. If he does not, seek a second opinion from someone who does before proceeding with any treatment.

Copyright 2002 Sinclair Intimacy Institute

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