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Surgery For ED

Surgery usually has one of three goals:

• to implant a device that can cause the penis to become erect
• to reconstruct arteries to increase blood flow to the penis
• to block off veins that allow blood to leak from the penile tissues

Implanted devices, known as prostheses, can restore erection in many men with ED.

Malleable implants usually consist of paired rods, which are inserted surgically into the corpora cavernosa. The user manually adjusts the position of the penis and, therefore, the rods. Adjustment does not affect the width or length of the penis.

Inflatable implants consist of paired cylinders, which are surgically inserted inside the penis and can be expanded using pressurized fluid (see Figure 3). Tubes connect the cylinders to a fluid reservoir and a pump, which are also surgically implanted. The patient inflates the cylinders by pressing on the small pump, located under the skin in the scrotum. The pump causes fluid to flow from a reservoir residing in the lower pelvis to two cylinders residing in the penis. Inflatable implants can expand the length and width of the penis to some degree. They also leave the penis in a more natural state than malleable implants do when not inflated.

Once a man has either a malleable or inflatable implant, he must use the device to have an erection. Possible problems with implants include mechanical breakdown and infection, although mechanical problems have decreased in recent years because of technological advances.

With an inflatable implant, an erection is produced by squeezing a small pump implanted in the scrotum. The cylinders expand to create the erection.

Surgery to repair arteries can reduce ED caused by obstructions that block the flow of blood. The best candidates for such surgery are young men with discrete blockage of an artery because of an injury to the groin or fracture of the pelvis. The procedure is usually unsuccessful in older men with widespread blockage.

Surgery to veins that allow blood to leave the penis usually involves an opposite procedure-intentional blockage. Blocking off veins, called ligation, can reduce the leakage of blood that diminishes the rigidity of the penis during an erection. However, experts have raised questions about the long-term effectiveness of this procedure, and it is rarely done.

Tips for Getting a Good Sleep

Stick to a sleep schedule. Go to bed and wake up the same time each day. As creatures of habit, people have a hard time adjusting to altered sleep patterns. Sleeping later on weekends will not fully make up for the lack of sleep during the week and will make it harder to wake up early on Monday morning.
Exercise is great, but not too late in the day. Try to exercise at least 30 minutes on most days but not later than five or six hours before bedtime.
Avoid caffeine and nicotine. Coffee, colas, certain teas and chocolate contain the stimulant caffeine and its effects can take as long as eight hours to wear off fully. Therefore, a cup of coffee in the late afternoon can make it hard to fall asleep at night. Nicotine is also a stimulant, often causing smokers to sleep only very lightly. In addition, smokers often wake up too early in the morning because of nicotine withdrawal.
Avoid alcoholic drinks before bed. Some people think having an alcoholic "nightcap" will help induce sleep, but alcohol robs the body of deep sleep and REM sleep, keeping sleep in the lighter stages. After drinking, people also tend to wake up in the middle of the night when the effects of the alcohol ware off.
Avoid large meals and beverages late at night. A light snack is okay, but a large meal can cause indigestion that interferes with sleep. Drinking too many fluids at night can cause frequent awakenings to urinate.
If possible, avoid medicines that delay or disrupt your sleep. Some commonly prescribed heart, blood pressure or asthma medications, as well as some over-the-counter and herbal remedies for coughs, colds or allergies, can disrupt sleep patterns.
Do not take naps after 3 PM. Naps can help make up for lost sleep, but late afternoon naps can make it harder to fall asleep at night.
Relax before bed. Do not over schedule the day so that no time to unwind. A relaxing activity, such as reading or listening to music, should be part of any bedtime ritual.
Take a hot bath before bed. The drop in body temperature after getting out of the bath may help induce sleepiness and the bath can help relax and slow down.
Have a good sleeping environment. Get rid of anything that might distract from sleep, such as noises, bright lights, an uncomfortable bed or warm temperatures. People sleep better if the temperature in the bedroom is on the cool side.

Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least 30 minutes each day. If possible, wake up with the sun or use very bright lights in the morning. Sleep experts recommend that an hour of exposure to morning sunlight helps people who are having trouble falling asleep.
Do not lie in bed awake. It is more helpful to get up and do some relaxing activity until the body feels sleepy. The anxiety of not being able to sleep can make it harder to fall asleep.
See a doctor if there is a serious problem sleeping.