Erectile dysfunction (ED) means a man cannot get or keep an erection firm enough for sexual intercourse. He may have decreased interest in sex. 

Physical factors can cause erectile dysfunction, including:

• Certain medications
• Clogged blood vessels 
• Diabetes
• Heart disease
• High blood pressure
• High cholesterol
• Injury
• Obesity
• Peyronie's disease (scar tissue in the penis) 
• Substance abuse
• Surgery

Psychological factors can also cause erectile dysfunction, including:

• Anxiety 
• Depression
• Relationship issues
• Stress

Our compassionate team of urologists can diagnose your erectile dysfunction by reviewing your medical and psychological history, performing a physical exam and doing a series of laboratory tests.

Your diagnosis process may include:

• Blood tests
• Cardiac evaluation to rule out heart disease
• Psychosocial (psychological and social) evaluation 
• Testosterone measurements
• Thyroid function tests
• Ultrasound of penis
• Urinalysis (urine tests) 

We work with you to find the best possible treatment plan. Through our caring approach to your health, we find the right way to handle your ED.  

Erectile dysfunction may be treated with:

• Injection therapy
• Lifestyle changes
• Medications 
• Penile implants 
• Psychological therapy and stress management
• Vacuum devices for the penis to get an erection 

Symptoms of low testosterone in men may include a combination of the following: 

• Diminished volume of semen
• Erectile dysfunction
• Fatigue or decreased energy
• Inability to reach orgasm
• Increased body fat or inability to lose weight
• Low libido (sex drive)
• Low sperm count
• Low bone density
• Mood changes
• Reduced muscle mass
• Smaller or softer testicles

The causes of low testosterone in men can vary greatly and may include the following:

• Andropause (male menopause) due to natural aging
• Chronic (ongoing) diseases, such as diabetes 
• Hormonal disorders
• Injury or infection of the testicles
• Nutritional deficiencies
• Obesity
• Treatment for testicular cancers
• Use of illegal drugs (including marijuana)

To diagnose low testosterone, we perform a physical examination and review all of your symptoms. We may order tests to check hormone levels, including testosterone and estrogen. 

Our team may recommend other tests, including:

• Urinalysis (urine test) 
• Sperm count
• Prostate-specific antigen (PSA) test to check for prostate cancer (blood test)
• Hematocrit test (measures red blood cells, which are fewer when testosterone is low) 

In addition to affecting quality of life, mental health and intimacy, low testosterone can also impact chronic (ongoing) health conditions. Recent research suggests that men with low testosterone are at a higher risk of developing diabetes, osteoporosis (bone condition) and heart disease.

Treatments for low testosterone involve replacing the hormone in the body. Testosterone replacement therapy is considered a life-long treatment option. We carefully monitor men taking testosterone to make sure hormone levels are stable and check for side effects.

Testosterone may be replaced in the body using:

• Gel, cream or patches applied to the skin
• Injections
• Long-acting supplements
• Medications to stimulate natural testosterone production
• Nasal spray
• Oral tablets and capsules 

Men treated with testosterone have a higher risk of developing enlarged prostate symptoms or urinary tract infection symptoms. Increasing testosterone levels can also affect mood.

Those who have kidney, liver or heart problems may increase their risk of edema (fluid retention) by taking testosterone. Testosterone can also make sleep apnea (breathing problems during sleep) worse. Testosterone may also decrease fertility (the ability to have children). Testosterone treatments are not usually recommended for men who have been treated for prostate or breast cancer. It can also increase the risk of blood clots, heart attack and stroke. 

Common causes of male infertility include:

• Cancer treatments 
• Chronic (ongoing) health conditions, such as diabetes 
• Exposure to certain environmental factors like chemicals 
• Genetics
• Infections such as STDs 
• Physical injuries 
• Problems with the genitals or sperm 

After performing a physical exam and asking about your medical history, our caring team discusses your concerns about infertility and makes suggestions to help you conceive a child. We may order additional tests for diagnosis, including: 

• Blood tests
• Genetic tests 
• Hormone tests
• Imaging tests, such as ultrasounds  
• Semen analysis tests 
• Testicular biopsy (take a sample of tissue) 
• Urine tests 

Infertility treatments may include:

• Electroejaculation (procedure to collect sperm using an electric probe) after a spinal cord injury 
• Lifestyle changes 
• Intra-abdominal robotic vasal (vessel) reconstruction for men with an injury to the vas deferens (duct that moves sperm) from prior hernia repair surgery
• Medications 
• Microsurgical Epididymal Sperm Extraction or MESA (retrieving sperm through a surgical incision)
• Percutaneous Epididymal Sperm Aspiration or PESA (retrieving sperm without a surgical incision)
• Retrograde ejaculation treatment (fixing ejaculation so sperm does not enter bladder)
• Retrieving sperm in men who have no sperm in their ejaculate
• Robotic micro-TESE (Testicular Sperm Extraction)
• Robotic vasectomy reversal
• Robotic vasoepididymostomy (reversing a vasectomy)
• Robotic vasosvasostomy (reversing a vasectomy)
• Sperm cryopreservation (preserving sperm by freezing)
• Vasal reconstruction for congenital obstruction (repair blockages)  
• Vibratory ejaculation (procedure to collect sperm using vibrations) after a spinal cord injury 

Robotic-Assisted Vasectomy Reversal

We use the da Vinci robotic platform to complete a vasectomy reversal. Robotic assistance improves the accuracy of the procedure. The robots enhance the medical skills of our talented surgeons who control them.
 
Using robotic assistance to do the procedure has benefits, including:

• Eliminating the surgeon's non-essential movements
• Enhancing magnification
• Motion scaling (converting a surgeon's large movements into smaller ones to improve accuracy)
• Reducing surgeon fatigue

Common causes of pain include having: 

• Hernia surgery 
• Infections
• Kidney removal
• Scrotal or pelvic trauma
• Vasectomy

We work with you to lower or eliminate your chronic pain. Our compassionate urologists understand these are difficult conditions to treat and take the time to find the right treatment for you. Our mission is to provide the most innovative and reliable treatment options available to help you manage your condition. 

Your treatment options include:

• Acupuncture 
• Antibiotics 
• Botox injections 
• Nerve blocks 
• Oral anti-inflammatory medications
• Pelvic floor (muscles that support the bladder, bowel and genitals) rehabilitation therapy 
• Robotic-assisted surgery