For millions of men searching for premature ejaculation treatment, the traditional options have included behavioral therapy, topical numbing medications, counseling, and oral medications.

Now, new research is examining a very different approach: hyaluronic acid (HA) injection into the glans penis.

A 2026 randomized controlled trial directly compared glans hyaluronic acid injections with dapoxetine, a short-acting medication used internationally for premature ejaculation.

The results are noteworthy.

Both treatments improved premature ejaculation, but the men treated with glans hyaluronic acid demonstrated significantly greater improvements in ejaculation time, ejaculatory control, sexual function, quality of life, and treatment satisfaction through six months.

For men looking for a premature ejaculation specialist, an alternative to PE medication, or a longer-lasting approach to improving ejaculatory control, this study represents an important development in male sexual medicine.

What Is Premature Ejaculation?

Premature ejaculation (PE) is one of the most common male sexual concerns.

Men with PE may experience:

• Ejaculation sooner than desired
• Difficulty controlling ejaculation
• Very short time between penetration and ejaculation
• Sexual performance anxiety
• Frustration or embarrassment
• Reduced sexual confidence
• Decreased sexual satisfaction
• Relationship or partner distress

The problem is not simply how many seconds or minutes a man lasts.

A successful premature ejaculation treatment should ideally improve ejaculatory control, sexual confidence, sexual satisfaction, and quality of life.

How Is Premature Ejaculation Traditionally Treated?

Men searching for how to last longer during sex or how to stop premature ejaculation will encounter numerous treatments.

Traditional approaches may include behavioral techniques, topical anesthetic creams or sprays, pelvic floor strategies, psychological or sex therapy, and oral medications.

One medication specifically developed for PE is dapoxetine.

Dapoxetine is a short-acting selective serotonin reuptake inhibitor (SSRI) used on demand in countries where it is approved for premature ejaculation.

Medication can be effective for appropriately selected patients, but it does not work for everyone.

This has created increasing interest in non-pill treatments for premature ejaculation.

What Is Hyaluronic Acid Treatment for Premature Ejaculation?

Hyaluronic acid is a naturally occurring substance that is widely used in injectable medical products.

In male sexual medicine, HA has been studied for both penile girth enhancement and, using a different injection technique, premature ejaculation.

For PE treatment, hyaluronic acid is strategically injected into the glans penis.

This is different from HA penile shaft enhancement, which is designed primarily to increase penile girth.

The objective of glans HA injection for PE is to modulate excessive sensitivity of the glans penis.

How Could Glans HA Help a Man Last Longer?

The glans penis contains an extensive sensory nerve supply.

One proposed mechanism of hyaluronic acid injection for premature ejaculation is that the HA creates a physical interface between superficial sensory receptors and external stimulation.

Rather than eliminating penile sensation, the goal is to potentially reduce excessive sensory stimulation while maintaining sexual function.

In appropriately selected patients, this may translate into:

• Delayed ejaculation
• Increased intravaginal ejaculation latency time
• Improved control over ejaculation
• Reduced PE-related distress
• Improved sexual satisfaction

This concept has been investigated for more than two decades, but newer randomized clinical trials are providing increasingly important evidence.

The 2026 Study: Hyaluronic Acid vs. Dapoxetine

A 2026 randomized controlled trial by Torad and colleagues directly compared deep dermal glanular hyaluronic acid injection with oral dapoxetine for men with lifelong premature ejaculation.

This is particularly important because the investigators did not simply compare HA with no treatment.

They compared HA directly with an established pharmacologic treatment for PE.

The study included 60 adult men with lifelong premature ejaculation who had not adequately responded to behavioral therapy.

The men were randomly assigned to one of two groups:

Dapoxetine group: oral dapoxetine 60 mg three times weekly.

Hyaluronic acid group: HA injection into the glans penis.

Patients were evaluated at baseline and again at 1, 3, and 6 months.

What Did the Researchers Measure?

The primary outcome was intravaginal ejaculation latency time (IELT).

IELT measures the time between vaginal penetration and ejaculation and is one of the principal objective measures used in premature ejaculation research.

But the researchers went beyond simply measuring ejaculation time.

They also evaluated:

• IELT — Intravaginal Ejaculation Latency Time
• IPE — Index of Premature Ejaculation
• IIEF-5 — International Index of Erectile Function
• Quality of life
• Patient satisfaction
• Treatment-related adverse events

This is important because PE treatment should not be judged exclusively by a stopwatch.

Ejaculatory control, erectile function, sexual satisfaction, and quality of life matter as well.

What Were the Results?

Both dapoxetine and glans HA treatment produced significant improvements compared with baseline.

However, the improvements were significantly greater in the hyaluronic acid group at 1, 3, and 6 months.

The HA-treated patients demonstrated greater improvement in:

• Intravaginal ejaculation latency time
• Premature ejaculation scores
• Erectile/sexual function measures
• Quality of life
• Patient satisfaction

Patient satisfaction was also consistently higher in the HA group throughout follow-up.

The investigators concluded that deep dermal glanular HA injection was more effective than oral dapoxetine in their study for improving ejaculatory control, sexual function, and quality of life in men with lifelong PE.

Why Is This Study Important?

This randomized trial addresses an important question:

Could selected men with premature ejaculation benefit from a localized treatment rather than relying exclusively on systemic medication?

For many men, PE medication can be effective.

But some patients may dislike having to plan medication around sexual activity, may experience medication-related side effects, or may simply prefer a treatment that does not require taking a pill before intercourse.

Glans HA represents a fundamentally different strategy.

Instead of attempting to modify ejaculation through the central nervous system, HA treatment targets penile sensory input at the level of the glans.

That distinction makes this an especially interesting development in sexual medicine.

What About Side Effects?

No medical treatment is without potential adverse effects.

In the 2026 study, adverse events in the dapoxetine group included:

• Nausea
• Dizziness
• Headache
• Dry mouth

Adverse events associated with glans HA included:

• Temporary injection-site discomfort
• Bruising
• Bullae formation

As with any penile injection procedure, patients should also understand that potential complications can extend beyond those observed in a small clinical trial.

HA injection into the penis requires detailed knowledge of penile anatomy, vascular anatomy, sensory anatomy, tissue planes, and appropriate injection technique.

Is This the First Study of Hyaluronic Acid for Premature Ejaculation?

No.

Research into glans augmentation with hyaluronic acid for premature ejaculation has existed for more than 20 years.

Earlier studies reported improvements in ejaculation latency and patient satisfaction following HA injection.

A randomized placebo-controlled crossover study subsequently compared glans HA injection with saline. At one month, median IELT increased approximately 2.6-fold after HA, compared with approximately 1.1-fold after saline.

More recently, systematic reviews and additional prospective studies have continued to evaluate HA for PE.

The 2026 study adds something particularly valuable to this literature:

a randomized head-to-head comparison between HA and an oral PE medication.

Does This Mean HA Is Better Than Medication for Everyone?

No.

This is an important distinction.

The 2026 trial involved only 60 men, specifically patients with lifelong premature ejaculation that had not adequately responded to behavioral therapy.

The findings are promising, but one randomized trial does not establish that HA should replace medication as the standard treatment for every patient with premature ejaculation.

Larger studies, longer follow-up, standardized injection protocols, and additional head-to-head trials are still needed.

Premature ejaculation is also not a single disease with one cause.

The best treatment depends upon why the patient is ejaculating prematurely.

Lifelong vs. Acquired Premature Ejaculation

Before considering any PE treatment, it is important to determine whether the problem is lifelong or acquired.

A man who has experienced very rapid ejaculation since his earliest sexual experiences may be fundamentally different from a man who previously had normal ejaculatory control and suddenly develops PE later in life.

Acquired premature ejaculation can sometimes be associated with other conditions, including:

• Erectile dysfunction
• Performance anxiety
• Relationship factors
• Prostatitis or pelvic symptoms
• Endocrine or hormonal abnormalities
• Changes in penile sensitivity
• Medication or substance effects

Simply injecting the glans without determining the underlying problem would therefore be inappropriate.

Who Might Consider Glans HA for Premature Ejaculation?

Potential candidates may include appropriately evaluated men with persistent PE who:

• Have lifelong premature ejaculation
• Have excessive glans sensitivity
• Have failed behavioral treatment
• Have inadequate results from conventional PE therapy
• Cannot tolerate medication side effects
• Prefer an alternative to repeated oral medication
• Want to discuss minimally invasive PE treatment options

A consultation should determine whether glans sensitivity actually appears to be an important component of the patient’s premature ejaculation.

Hyaluronic Acid vs. Dapoxetine: Two Very Different Strategies

The comparison is particularly interesting because these treatments approach PE from opposite directions.

Dapoxetine is a systemic medication that acts through serotonin pathways involved in ejaculation.

Glans hyaluronic acid is a localized treatment intended to modify sensory stimulation at the penis.

Neither approach should automatically be considered appropriate for every patient.

The question should not simply be:

“Which treatment is better?”

The more useful question is:

“Which treatment best addresses the mechanism of premature ejaculation in this particular patient?”

Glans HA and Penile Enhancement

There is another potential advantage of glans HA that some patients may find interesting.

Hyaluronic acid can also increase glans circumference and improve glans volume.

This means glans HA occupies a unique position at the intersection of male enhancement and sexual function.

For selected patients, treatment may potentially address both glans aesthetics and excessive penile sensitivity.

This should not be confused with HA penile girth enhancement of the shaft, where filler is distributed in different anatomical planes primarily to increase penile circumference and improve contour.

The two procedures can potentially complement each other, but they have different objectives and require different techniques.

Penile Self-Image, Sexual Confidence, and Premature Ejaculation

This discussion becomes even more interesting when we consider recent research into male genital self-image.

A 2024 study published in Sexual Medicine found a significant association between poorer male genital self-image and premature ejaculation.

Men with PE reported greater dissatisfaction with genital size and function, sexual experiences, and aspects of body image.

This does not mean that penile enlargement cures premature ejaculation.

It does suggest that penile appearance, genital self-image, sexual confidence, performance anxiety, and sexual function can interact in complex ways.

Modern male sexual medicine should therefore consider both function and self-perception.

A New Direction in Premature Ejaculation Treatment

The treatment of premature ejaculation is evolving.

Behavioral therapy and medication remain important options, but emerging treatments are beginning to target the peripheral mechanisms of ejaculation more directly.

Glans hyaluronic acid injection is one of the most interesting of these approaches.

The 2026 randomized trial provides new evidence that, in appropriately selected men with lifelong PE, glans HA may produce meaningful improvements in ejaculation latency, ejaculatory control, sexual function, quality of life, and treatment satisfaction.

It is promising evidence—not the final word.

Looking for a Premature Ejaculation Specialist?

If you are searching for:

premature ejaculation treatment, PE treatment, how to last longer in bed, how to delay ejaculation, premature ejaculation injections, hyaluronic acid for premature ejaculation, glans HA injection, glans enhancement, alternatives to dapoxetine, alternatives to PE medication, nonsurgical premature ejaculation treatment, or advanced male sexual medicine treatments, the first step should be a comprehensive evaluation.

The objective is not simply to make intercourse last longer.

The goal is better ejaculatory control, preserved sensation and erectile function, improved sexual confidence, and greater satisfaction for both the patient and his partner.

Treatment should be individualized based on the type of premature ejaculation, penile sensitivity, erectile function, anatomy, previous treatments, expectations, and overall sexual health.

References

Torad H, Rammah AM, Elahwany A, et al. Randomized controlled trial comparing deep dermal glanular hyaluronic acid injection versus oral dapoxetine in management of premature ejaculation. International Urology and Nephrology. Published online July 20, 2026.

Elahwany A, et al. Hyaluronic acid injection in glans penis for treatment of premature ejaculation: a randomized controlled cross-over study.

Koçak V, Tufan O. Male genital self-image, premature ejaculation, and affecting factors. Sex Med. 2024;12(3).

Additional prospective studies and systematic reviews have evaluated glans hyaluronic acid injection for premature ejaculation, ejaculation latency, patient satisfaction, and sexual-function outcomes.

Medical Disclaimer

This article is provided for educational purposes and does not constitute individual medical advice. Glans hyaluronic acid injection for premature ejaculation is an emerging, specialized treatment and may represent off-label use depending on the HA product, jurisdiction, and indication. Results vary. Potential risks include pain, swelling, bruising, contour changes, nodules, infection, vascular complications, altered sensation, and other adverse events. Current evidence is promising but remains limited, and larger studies with longer follow-up are needed. Patients should undergo evaluation by a physician experienced in male sexual medicine and penile anatomy before considering treatment.

The post Hyaluronic Acid vs. Medication for Premature Ejaculation: What Does the Latest Research Show? appeared first on Valenzuela Urology.

Choosing to undergo penile implant surgery is a life-changing decision. For most men, an inflatable penile prosthesis restores intimacy, confidence, and quality of life.

Unfortunately, not every penile implant delivers the expected result.

Some men experience mechanical failure, while others are disappointed with penile length, pump position, cosmetic appearance, persistent pain, or erectile function. Many have been told that “nothing more can be done.”

That simply isn’t true.

As a urologist specializing in complex penile prosthesis surgery, revision surgery, implant exchange, and reconstruction, I frequently help men who have undergone previous penile implant surgery regain function, improve appearance, and restore confidence.

Why Do Penile Implants Need Revision Surgery?

Modern penile implants are extremely reliable, but no prosthesis lasts forever.

Revision surgery may become necessary because of:

Mechanical Failure

The implant itself can eventually wear out.

Common problems include:

• Fluid leak
• Cylinder leak
• Reservoir leak
• Tubing disconnection
• Lock-out pump malfunction
• Pump that no longer inflates
• Auto-inflation
• Failure to deflate
• Device no longer becoming rigid

Most modern penile prostheses function well for many years, but like any mechanical device, eventual replacement may become necessary.

Unsatisfactory Surgical Outcome

Some patients are unhappy despite a functioning implant.

Common concerns include:

• Loss of penile length
• Poor girth
• High-riding pump
• Pump difficult to locate
• Visible tubing
• Uneven cylinders
• Penile curvature
• Persistent bending
• Floppy glans
• Poor cosmetic appearance
• Difficulty with intercourse

Many of these problems can be corrected with revision surgery.

Implant Infection

Although uncommon, infection remains one of the most serious complications.

Symptoms may include:

• Persistent pain
• Swelling
• Redness
• Drainage
• Fever
• Device exposure

In experienced hands, many infections can be treated using modern salvage techniques.

Device Erosion

Occasionally a cylinder or pump may erode into surrounding tissues.

This requires prompt evaluation by a penile prosthesis specialist.

Implant Malposition

The cylinders or pump may not sit in the optimal position.

Examples include:

• Pump too high
• Pump too low
• Cylinder crossover
• Cylinder displacement
• Distal erosion
• Proximal migration

Correct positioning often significantly improves comfort and function.

Why Revision Surgery Is More Complex Than Primary Penile Implant Surgery

Revision surgery is very different from first-time penile implant surgery.

Previous operations often leave:

• Scar tissue
• Corporal fibrosis
• Tissue contracture
• Altered anatomy
• Previous graft material
• Reservoir scarring
• Infection-related damage

These cases require advanced reconstructive techniques and careful surgical planning.

Not every surgeon performs complex penile implant revisions on a routine basis.

Experience matters.

Common Reasons Patients Travel for Revision Surgery

Many of my patients come from across the country after experiencing:

• Failed penile implant
• Mechanical breakdown
• Multiple prior surgeries
• Loss of penile length
• Poor cosmetic outcome
• Pain with inflation
• Difficulty cycling the implant
• Persistent curvature
• Floppy glans syndrome
• Unsatisfactory pump position
• Penile shortening after implant surgery
• Implant placed by another surgeon

These are often highly specialized cases that benefit from referral to a reconstructive prosthetic urologist.

Advanced Revision Techniques

Depending on your individual situation, revision surgery may include:

Complete Implant Exchange

Replacement of the entire prosthesis with a new device.

Pump Repositioning

Improving comfort and ease of use.

Reservoir Revision

Replacement or relocation of the reservoir.

Cylinder Upsizing

When appropriate, larger cylinders may improve penile length and rigidity.

Corporal Reconstruction

For patients with severe scarring or fibrosis.

Penile Straightening

Correction of persistent curvature associated with Peyronie’s disease.

Penile Length Restoration

Selected patients may benefit from advanced reconstructive procedures designed to maximize penile length while maintaining implant function.

Glans Support Procedures

Correction of floppy glans or distal penile instability when indicated.

Can Penile Length Be Restored?

Loss of penile length is one of the most common reasons patients seek revision surgery.

Although every patient is different, modern reconstructive techniques can often improve:

• Functional length
• Penile girth
• Cosmetic appearance
• Implant positioning
• Overall satisfaction

Your goals, anatomy, and previous surgeries determine which options are appropriate.

Choosing the Right Revision Surgeon

Revision surgery is one of the most technically demanding procedures in prosthetic urology.

When choosing a surgeon, consider:

• Fellowship training
• High-volume penile implant practice
• Experience with complex revisions
• Management of corporal fibrosis
• Expertise in implant salvage
• Experience with Peyronie’s disease reconstruction
• Length restoration techniques
• Reoperative prosthetic surgery

Successful outcomes often depend more on surgical experience than on the implant itself.

What to Expect During Your Consultation

Every revision consultation begins with understanding what happened after your original surgery.

Your evaluation may include:

• Detailed medical history
• Review of prior operative reports
• Physical examination
• Imaging when necessary
• Assessment of implant function
• Evaluation of penile length and anatomy
• Discussion of realistic expectations
• Individualized surgical planning

No two revision surgeries are exactly alike.

You Do Not Have to Live with an Unsatisfactory Penile Implant

If your penile prosthesis no longer works, feels uncomfortable, has lost rigidity, or simply does not meet your expectations, there may be options to improve your outcome.

Whether your implant has developed a mechanical failure, requires replacement, or you are seeking expert revision after previous surgery, specialized reconstructive techniques may help restore function, confidence, and quality of life.

A consultation with an experienced penile prosthesis revision surgeon can help determine the best path forward.

Schedule a Consultation

If you are experiencing:

• Penile implant mechanical failure
• Fluid leak
• Lock-out pump malfunction
• Penile implant revision
• Inflatable penile prosthesis exchange
• Penile implant infection
• Floppy glans after penile implant
• Penile shortening after implant surgery
• High-riding pump
• Penile implant dissatisfaction
• Peyronie’s disease after implant
• Complex penile implant reconstruction

Contact our office to discuss your options. Even if you’ve been told that nothing more can be done, a specialized evaluation may reveal solutions that restore both function and confidence.

The post Penile Prosthesis Revision Surgery: When Your Implant Doesn’t Meet Expectations, There Are Solutions appeared first on Valenzuela Urology.

When testosterone levels drop—a condition often referred to as Low T—it can have significant physical, emotional, and social impacts, affecting overall life quality. Let’s explore how low testosterone affects your health, the symptoms to watch for, and available treatment options.

The Role of Testosterone in the Body

Testosterone is a hormone produced primarily in the testes in men and the ovaries and adrenal glands in women. It regulates key functions, including:

• Development of muscle mass and strength
• Maintenance of bone density
• Red blood cell production
• Fat distribution
• Libido and sexual function
• Mood and cognitive performance

Optimal testosterone levels help maintain a healthy, active lifestyle. When levels decline, either due to aging or medical conditions, the effects can be profound.

Common Symptoms of Low Testosterone

Low testosterone can manifest in various ways, including:

• Physical Symptoms: Fatigue, reduced muscle mass, increased body fat, and decreased bone density.
• Emotional Symptoms: Irritability, depression, anxiety, and difficulty concentrating.
• Sexual Symptoms: Reduced libido, erectile dysfunction, and decreased sexual satisfaction.

These symptoms can lead to a diminished sense of well-being, affecting confidence, motivation, and social relationships.

How Low Testosterone Impacts Health

Muscle Mass and Strength

Testosterone plays a key role in maintaining muscle mass. Low T can lead to muscle loss and reduced strength, making physical activity and daily tasks more challenging.

Bone Density

Low testosterone contributes to reduced bone density, increasing the risk of osteoporosis and fractures, particularly in older adults.

Cardiovascular Health

Studies suggest that low testosterone levels may be linked to an increased risk of cardiovascular disease. Maintaining healthy testosterone levels can support heart health and circulation.

Mood and Cognitive Function

Low T can lead to feelings of depression, anxiety, and brain fog, significantly impacting mental health and daily functioning.

Treatment Options for Low Testosterone

Fortunately, Low T can be managed effectively with the right treatment plan. Options include:

Testosterone Replacement Therapy (TRT)

TRT involves administering testosterone via injections, gels, patches, or pellets to restore hormone levels. This treatment can improve energy, mood, libido, and muscle mass while reducing symptoms like fatigue and depression.

Lifestyle Changes

Adopting a healthy lifestyle can naturally boost testosterone levels. Key strategies include:

• Regular exercise, particularly strength training
• A balanced diet rich in healthy fats, protein, and essential nutrients
• Stress management and adequate sleep

Regular Monitoring

It’s important to monitor testosterone levels regularly, especially if you experience symptoms of Low T. Regular check-ups can help tailor treatments to your individual needs and ensure long-term health.

Low Testosterone Treatment in NYC

Low testosterone can significantly impact your health and quality of life, but with early detection and proper management, you can regain vitality and well-being.

If you suspect you may have Low T, contact Robert Valenzuela, MD at (212) 781-9696 to explore treatment options and take steps toward a healthier, more fulfilling life.

The post How Low Testosterone Affects Your Health and Quality of Life appeared first on Valenzuela Urology.

Penile Implant Options

Penile implants are devices placed inside the penis to allow men with ED, or sometimes Peyronie’s Disease, to have erections and regain sexual function.

In general, there are two types of penile implants: inflatable and semi-rigid.

The inflatable implant has two cylinders, a pump in the scrotum and a reservoir filled with fluid. When an erection is desired, the man presses the pump inside the scrotum which allows the fluid to transfer to the cylinders producing an erection. You are able to control the level of hardness and the erection will not deflate until you press a valve on the pump to return the fluid to the reservoir.

The semi-rigid implant has two firm but flexible rods implanted in the penis. With this one you simply move the penis in place for sexual intercourse and move it back afterward.

Penile Implant Lifespan

Most penile implant devices will last an average of 20 years.

If it should stop working, it can be replaced.

The Benefits of a Penile Implant

Aside from the long lifespan of the device, there are numerous other benefits including:

• They are very durable.
• You are once again in control of your body.
• No one will know you have an implant as it is contained within the body.
• Discretion. You operate the pump when you are ready. There is no waiting like with a pill.
• You can achieve an erection in 15 seconds and keep it as long as you wish.
• The devices do not affect your ability to ejaculate or have an orgasm.
• They do not affect the sensation of the skin on your penis.
• Your partner will not be able to tell any difference between a naturally erect penis and one with a device.
• Over 90% of men are very happy with the results.
• Implanting the device is an outpatient procedure and you go home the same day.
• It will restore your self esteem and confidence.

Contact Dr. Robert Valenzuela at (212) 781-9696 for an evaluation at our urology clinic in Manhattan. Have all your questions answered, and find out if an implant is right for you.

The post How Long Do Penile Implants Last? appeared first on Valenzuela Urology.

How Do You Develop Peyronie’s Disease?

Peyronie’s Disease begins with a build up of scar tissue within the penis. This scar tissue causes the penis to bend, curve, or lose length or girth. This scar tissue, known as plaque, is non-cancerous, does not cause infertility, but does cause pain. It is estimated that the condition goes undetected in up to 23% of men.

The scar tissue may feel like hard flat bumps under the skin or as a band of tissue. It can develop from some trauma or injury to the penis or during sexual intercourse. In addition, family history can play a part.

Signs Of Peyronie’s Disease

It is important to know the early signs of Peyronie’s Disease to get an early diagnosis and be treated.

• With Peyronie’s Disease the penis will bend or curve up, down, or side to side during an erection depending where the scar tissue develops.
• Another type of deformity is a narrowing of the penis and indentions like an hourglass shape. This occurs when the scars go all the way around the penis.
• In most cases the scars will form on the top of the penis causing it to curve upwards. If the scars are near the bottom of the penis, it will bend downward, and if the scars are one the side, the penis can bend side to side. If the scars are on both the top and bottom of the shaft, the penis can be dented or become shorter.
• There may be pain both during an erection and if the penis is in its natural shape.
• It can make an erection difficult and cause ED.

Treatment

How Dr. Valenzuela treats Peyronie’s Disease depends on the severity and stage of the condition.

Stage 1, or the acute stage, is when the first signs appear with this being the optimal time for diagnosis and treatment.  While in the acute stage, Dr. Valenzuela may recommend therapeutic exercises and penile traction to avoid losing any length along with oral medications or injections.

During stage 2, or the chronic stage, the changes stop and they become stable. Sometimes physicians will conduct “watchful waiting” with the patient checking in regularly to decide about treatment. Injections may be performed. Surgical intervention and a penile implant may be recommended if other treatments have been unsuccessful.

Don’t wait to contact Dr. Robert Valenzuela in NYC if you think you are having any early signs of Peyronie’s Disease. Call (212) 781-9696 to schedule a visit.

The post Peyronie’s Disease: Signs And Treatments You Should Know appeared first on Valenzuela Urology.

Common Occurrence

The inability to achieve and maintain an erection for sexual intercourse is the definition of erectile dysfunction, also known as impotence.

How common is erectile dysfunction? It is perfectly normal for men to have at least one incidence of ED in their lifetime. However, it is believed that about 30 million men have ED on a recurring basis. So don’t feel like you are alone or embarrassed to seek treatment from Dr. Robert Valenzuela.

How Men Get an Erection

Getting an erection is all about blood flow. When aroused, your nervous system causes the tissue in the penis to relax allowing blood to flow in. The penis then traps the blood helping to keep it erect until you have an ejaculation.

Although ED is more common in older men, younger generations can be affected too. The good news is whatever is preventing a man from enjoying healthy sex, there are options to treat it.

Possible Causes of ED

Many men think their inability to get an erection is some fault of their own or something missing in their manhood. Forget that.

ED often has more than one single cause. Many conditions can cause blood flow problems, damage nerves, arteries, and muscles which interfere with sexual function.

Underlying Medical Problems

Since erection involves blood flow and arousal, many causes could involve the vascular, endocrine, or nervous system like the following conditions:

• Heart disease
• High blood pressure
• Chronic kidney disease
• Multiple sclerosis (MS)
• Type 2 diabetes
• Atherosclerosis

Once these underlying causes are treated, many times ED is resolved.

Medications

Many medications are linked to ED.

Things like anti-depressants, blood pressure medications, appetite suppressants, prescription sedatives, ulcer medications, and anti-androgens can cause ED.

Your physician may be able to substitute or change dosage.

Lifestyle Behaviors

Here are some things you can control.

• Being overweight, obese, or living a “couch potato” lifestyle.
• Smoking
• Excessive alcohol consumption
• Illicit drug use

All of these behaviors can affect your sexual health. 

Emotional Issues

Problems like depression, anxiety, stress, low self-esteem, or sexual performance anxiety can all affect your ability to get and keep an erection. Any of these can cause or worsen symptoms of ED. 

Treatment Options for ED

The first step is to talk with Dr. Robert Valenzuela to look for any underlying medical conditions that could be causing the ED, medication issues, emotional issues, and discuss your lifestyle. 

There are a variety of methods for treating erectile dysfunction (ED). Dr. Valenzuela can discuss all of these options with you in more detail. All decisions regarding your best option for treating ED should be made between you and your physician, with consideration given to your individual needs and the risks and benefits of each treatment option.

Remember that early intervention and treatment to detect a medical condition causing ED increases your likelihood of reversing it.

The post Is Erectile Dysfunction Permanent? What You Should Know. appeared first on Valenzuela Urology.

What Is Peyronie’s Disease

You might have recently noticed television ads about this issue. It is a condition where a man has an abnormal curve to his penis. You might have a minor curve that does not affect your sex life. However, if you have pain that keeps you from having sex, it’s time to do something about it, because you can.

You’re not alone, since almost a third of men complain they have painful sex.

What About ED?

Peyronie’s Disease and erectile dysfunction seem to occur concurrently. 75% of men with Peyronie’s Disease also experience ED.

For those men who have both Peyronie’s and ED, implanting an inflatable prosthesis can treat both problems.

There are many treatment options for both issues including meds, vacuum devices, injections, suppositories, and penile implants. Implants have been used for over 40 years with great success. An inflatable implant is private and completely undetectable, and your partner does not need to know you have one. In addition, it will not affect your ability to have an orgasm or ejaculate.

Inflatable penile implants have the highest rate of satisfaction of all treatments as reported by men and their partners with 86-90% of patients with both Peyronie’s Disease and erectile dysfunction satisfied with an inflatable penile prosthesis.

Some Additional Benefits Of Inflatable Penile Prosthesis

• Erections will look and feel natural
• Does not change sensation or ability to climax
• Will not affect urination
• Covered by most insurance companies, including Medicare

It’s time to enjoy your sex life again and without pain!!

Talk with Dr. Robert Valenzuela about an inflatable penile implant if you have issues with Peyronie’s Disease and erectile dysfunction. Call (212) 781-9696 to schedule a consultation at our urology clinic in Washington Heights.

The post Can A Penile Implant Correct Peyronie’s Disease? appeared first on Valenzuela Urology.

Over 25,000 penile implants are placed annually in the United States. This procedure has demonstrated a satisfaction rate of up to 93%. Despite this high level of satisfaction, a subset of patients remains dissatisfied with surgical outcomes due to multiple factors. These may include loss of penile length and girth, poor esthetic outcome, poor rigidity, hypermobility of the glans (tip of the penis) herniation of reservoir.

Patient and Partner Satisfaction

Satisfaction is largely due to perception and attitude towards the medical encounter and procedure. This is driven by parameters such as patient expectations, comorbidities, surgical complications or premature device failures and partner’s response to the procedure. Therefore, it is very important to consult a specialist doctor for an accurate diagnosis. Only with specific exams, carried out during the consultation, it is possible to evaluate the presence of fibrosis, loss of size, thinning and curvature.

The function of the implant is to restore rigidity to the penis. Often the placement of the prosthesis is performed without concerns of length preservation or restoration. As surgeons we are concerned with the treatment of the medical condition. The surgeon’s focus is the surgical correction of erectile dysfunction. After the surgery, patients may present with complaints that may lead to decreased satisfaction. These conditions may not be apparent until the patient has recovered and is ready to resume sexual activity.

In this article we will review some of the causes of patient dissatisfaction and the treatment options.

PENILE PROSTHESIS REVISION OR EXCHANGE FOR GIRTH AND LENGTH RESTORATION.

LOSS OF LENGTH (SHORTENING OF THE PENIS)

A common complaint after penile prosthesis implantation is loss of penile length. This has been shown to have a negative impact on overall patient satisfaction. Some studies have shown that the subjective feeling of loss of penile length occurred in over 15% patients.  In fact, the loss of length has been reported to be 1” to 1.75”.

If you have noticed significant loss of length and girth after the placement of a penile prosthesis, in most cases, it is possible to reconstruct the penis to restore or recover length and girth.  Dr. Valenzuela employs a series of techniques that can mediate these conditions. A small midline scrotal incision allows for the removal of the existing implant. He then uses a strategy call Tunica Expansion Procedure or TEP (term developed by Dr. Egydio). TEP allows for stretching of the corpora to recover the largest possible size and diameter of the penis. The length is limited to the maximum stretch of the nerves, vessels, and urethra. This procedure has been shown to restore up to 1.5” in length and girth.

TEP is a series of cuts are made on the capsule of the penis to allow for expansion

TEP for Girth expansion

TEP for length expansion

FLOPPY GLANS (head of the penis)

Another complaint after surgery is hypermobility of the glans or head of the penis when the penis is erect. This can make penetration difficult and even painful. The tips of the cylinders can be palpated and often visible below the glans. This is easily identified by inflating the prosthesis to the maximum and tilting the head of the penis forward and back. Depending on the surgical approach this can result in 5-20% of patients. This condition may result from fibrosis of the cavernosum (tissue inside the penis) These patients tend to low levels of satisfaction with outcome.

CORRECTION OF FLOPPY GLANS

The post implant surgical correction of floppy glans depends on the extent of hypermobility and location of the cylinders. A simple procedure can relocate and fixated the glans directly over the cylinders and eliminate the hypermobility. This procedure can be performed in office under local anesthesia or in the operating room depending on the extent of hypermobility.

1.  A circumcision is created

2. Sutures are then placed to “fix” the glans in place

3. These sutures are then tested for strength

4. The circumcision is then closed

In cases where the cylinders may be too short, fixation of the glans decrease the length of the penis. As a result, we recommend a penile prosthesis exchange and re-sizing of the prosthesis.  At the time of the procedure the penile prosthesis is removed, the corpora are rechanneled to the level of the mid-glans and placement of a larger penile prosthesis. This will help restore penile length and improve esthetic outcome and function.

VISIBLE TUBING OR HIGH RIDING PUMP

Despite having a functional prosthesis, this condition can be very disturbing to the patients. Patient will often avoid sexual encounters due to feeling insecure and embarrassment. Relocation of tubing or pump to maximize esthetic results, can easily be achieved with an outpatient procedure.

Here are some examples of pump placement: 

The pump is high in the scrotum. This makes it more visible due to its location may interfere with sexual activity.

Pump located visible high in the scrotum and at the penoscrotal junction.

Pump low in the scrotum but midline and visible.

In the ideal location the pump should be low in the scrotum, should not interfere with sexual activity and maximize esthetics.

In this case the pump is low in the scrotum, behind the testicles and it is not visible regardless of the angle of the penis

GOALS OF PENILE PROSTHESIS REVISION OR EXCHANGE SURGERY

• Recover axial rigidity and give good penetrative ability.
• Restore girth and length with Tunica Expansion Procedure (TEP).
• Treat the fibrosis that may have appeared after the first surgery.
• Maximize function and esthetics.
• Use national and international protocols to minimize complications
• Rescue a healthy sex life.

Dr. Valenzuela utilizes a series of adjunct procedure to achieve these goals. The choice of prosthesis is made together with the patient, at the time of the consultation, based on a careful evaluation and the needs of the patient. Each case is treated individually, considering the medical condition, lifestyle, personal preference, and cost-effectiveness.

The post PENILE PROSTHESIS REVISION OR EXCHANGE: TREATMENT OPTIONS appeared first on Valenzuela Urology.

Basic Facts About BPH

The prostate gland is a small gland about the size of a walnut located below the bladder and near the urethra. It is an important gland since it produces semen.

It does not cause prostate cancer and is not a risk factor for cancer.

About one out of four men will have uncomfortable symptoms of an enlarged prostate by age 55. By age 80 about half will have symptoms that require treatment.

Some of the most common risk factors besides age include family history, obesity, diabetes, and heart disease. There is other information that there may be factors resulting from rising testosterone and changes in the cellular level in the testes.

The Effects Of BPH

When the prostate gland enlarges, it restricts urine flow due to its proximity to the urethra.

The prostate continues to enlarge until it begins to constrict the ability for a man to urinate.

As men begin to have symptoms of BPH, they may experience the following effects:

• A weak stream
• Difficulty starting and stopping urination
• Urgency
• Frequent feeling of needing to urinate
• Sense that the bladder is not empty
• Getting up several times at night to urinate
• Painful urination and ejaculation

Why BPH Should Be Treated

Some men will have minimal symptoms of benign prostatic hyperplasia at first. When the prostate begins to grow, there is a reduced ability for the bladder to hold urine. In addition, as the prostate grows larger, there can be some serious consequences if a man doesn’t have treatment.

This can lead to a complete blockage of the urethra, kidney damage, the development of both kidney and bladder stones and infections, urinary tract infections, and back up of pressure that damages the kidneys, plus other conditions that can require medical intervention.

Luckily, today there are minimally invasive treatments to open the urethra, drugs to shrink the prostate, and others to relax the muscles. There is no one treatment that is best for all men. There are surgical options as well.

The decision to treat BPH is between the patient and Dr. Robert Valenzuela. This is usually based on a man’s age, his general health and the severity of the symptoms.

The post The Dangers Of Leaving BPH Untreated appeared first on Valenzuela Urology.

First Look At Your Options

There are basically two types of penile implants: bendable and inflatable.

• With bendable implants flexible silicone rods are placed into the erection chambers of the penis. When you want an erection, you manually adjust the rods.
• With an inflatable implant the silicone rods are implanted into the erection chambers which you inflate using a pump hidden in your scrotum.

Talk with Dr. Valenzuela about the pros and cons of both types before you choose which is best for you.

Then Look At The Benefits

Effective And Discreet

The satisfaction rate of men with a penile implant and their partners is between 90 to 95%. In addition, 80 to 90% of those who had a penile implant have no regrets and would have the surgery again.

When you are ready, your erection will be ready in 15 seconds. You can discreetly create your erection when you choose.

You Are In Control

Just like a natural erection, you don’t have to excuse yourself, make plans to have an erection, or wait. As an added bonus, it lasts as long as you want.

Penile Implants Are Safe

The post surgical infection rate of a penile implant is extremely low at approximately 1%. Of course, it is essential to choose an experienced urologist like Dr. Valenzuela to reduce the chances of any complications.

You Can Once Again Be Spontaneous

Your sex life can be fun again without waiting or planning.

Natural Sensations

You still will have natural looking erections and full sensation plus the ability to climax. Your partner will not know you have an implant unless you tell them.

Insurance Coverage

Most insurance companies pay for the device and the surgery, including Medicare.

The post When Is It Time To Consider A Penile Implant For Erectile Dysfunction appeared first on Valenzuela Urology.