What does Prof. Alessandro Natali?

These are the uro-andrological clinical fields in which Prof. A. Natali practices his profession both from the medical and surgical point of view


Erectile Dysfunction

What is Erectile Dysfunction?

Erectile Dysfunction (ED) is more common than one might think. In Italy it has an emerged prevalence of 12.8%, but it is hypothesized that the percentage of men affected by the problem that does not address the doctor is the same. For a total, therefore, of over 25% of men suffering from various degrees, in terms of severity, of this disorder.

Through a complete medical examination that foresees a careful general and specific anamnesis as well as the subsequent performance of blood chemistry and specific physical tests and psychological evaluations, it will be possible to determine the root cause of the problem, to arrive to a diagnosis and prepare a treatment that will restore in correctly the sexual life of the man.

The medical definition of ED is the inability to obtain and / or maintain an erection sufficient to have a satisfying sexual intercourse. Physical and / or psychological factors come into play in the determinism of this problem.

The bad daily habits and the low quality of life style (smoking, alcohol and drug use, sedentariness, stress, obesity) are important risk factors for ED. Then can be associated real diseases and / or pathological situations that involve, over time, problems of erection. Just remember:

  • Hypertension
  • Diabetes
  • Depression
  • Anxiety
  • Benign Prostatic Hypertophy
  • Cardiovascular diseases
  • Endocrinopathies
  • Chronic sleep disorders
  • Hypercholesterolemia, Hypertriglyceridemia

Without forgetting that many common and chronic use of drugs (antihypertensives, anxiolytics, antidepressants), often without adequate medical supervision, can have as side effect ED.

How is Erectile Dysfunction diagnosed?

The patient's medical and sexual history must be thoroughly examined and a specific fisical examination performed to evaluate the penis, the testicles and the prostate, and to look for possible circulatory, hormonal and nervous system problems.

Laboratory tests usually include routine blood sampling, hormone tests, as well as a cardiological evaluation if not previously performed. Furthermore, if during the andrological examination important psychological, relational and / or behavioral factors inherent to the sexual problem emerge, the support of a psycho-sexologist could prove useful.

Often the prescription of a particular ultrasound diagnostic examination called dynamic penile ecocolordoppler is important. With this examination, through a microinjection in the corpora cavernosa at the base of the penis of a vasodilating substance, called Alprostadil, one can establish the level of efficiency of the penile vascularization. An ultrasound may also be useful for assessing kidney, bladder, prostate and testicles.

How is Erectile Dysfunction treated?

Once the diagnosis has been made with the above findings, the therapeutic approaches may include specific treatments for erection with drugs to be taken by mouth, called phosphodiesterase type 5 inhibitors (PDE5-Is).

These drugs can be used both as a daily intake, usually in the evening before bedtime, regardless of sexual activity, for certain periods of time (4-6 months), or when needed at the time of sexual intercourse. These drugs are now available in the form of tablets to be swallowed or dissolved in the mouth, depending on the needs of the patients.

If necessary, it is associated with pharmacological treatment psycho-sexual counselling. Recently the use of low frequency shock waves (LI-ESWT) it became in handy in the first step of ED' treatment.

This is an absolutely atraumatic treatment, which can also be repeated cyclically, which through the process of so-called "noeoangiogenesis" leads to an improvement in the vascularization of the penis. This type of therapy may also be associated with the use of oral medications. If this first therapeutic step, which generally solves 70-80% of the problems, is not sufficient, the International Guidelines on ED foresee the use, as second therapeutical step, of local drugs such as Alprostadil with tranglandular or transurethral administration modality through gels or creams , or intracavensosa with microinjections at the base of the penis. The third therapeutical step is, in selectede cases, the penile prosthesis implantation,.


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