Diagnosis of erectile dysfunction (impotence) in Maria-Hilf Hospital Krefeld

About the department

The Department of Andrology at the Maria-Hilf Hospital Krefeld provides the full range of medical services in its area of competence. The department provides consultation, diagnosis, and treatment of diseases of the male reproductive system. The department's team of doctors focuses on men with erectile dysfunction, infertility, varicocele, penile curvature, and testosterone deficiency syndrome. The healthcare facility provides medical care to patients with andropause (male menopause), which is a complex of age-related changes in the functioning of the male reproductive system. The department's team of andrologists successfully performs vasectomy for men who do not plan to have children in the future and microsurgical vasovasostomy when a man wishes to restore his reproductive function after undergoing sterilization. The department's specialists have exceptional experience in the field of non-invasive correction of penile curvature. They perform local injections of enzyme medications over a certain period of time, which enables the restoration of the normal position of the penis. Patients receive medical care in accordance with current clinical protocols and recommendations of the European Association of Urology (EAU). The Head Physician of the department is Dr. med. Christian Leiber-​Caspers.

One of the most common diagnoses in the daily clinical practice of physicians is erectile dysfunction (impotence). This pathological condition impairs the ability to achieve or maintain the erection necessary for full sexual intercourse. Normal erection is an important component of a man's full life, which is a reflection of his physical and psychological state. Patients with erectile dysfunction often suffer from neuroses, apathy, and depression. They have problems in relationships and develop complexes. During the initial appointment, the andrologist conducts a clinical examination and asks the patient about his complaints, the characteristics of his lifestyle, and other things important for the upcoming treatment. At the diagnostic stage, the department's specialists are faced with the task of determining the cause of the development of erectile dysfunction. This disease may be associated with diabetes mellitus, arterial hypertension, hyperlipidemia, genital traumatic injuries, postoperative conditions after a prostatectomy, neurological diseases, endocrine disorders, neuroses, and depressive disorders. Smoking and excessive alcohol consumption also negatively affect men's health.

A diagnostic protocol for suspected erectile dysfunction includes corpus cavernosography of the penis, penile Doppler ultrasound scanning, ultrasound scanning of the endocrine glands, blood and urine tests, and a testosterone test. A comprehensive diagnosis often includes psychotherapeutic testing. With the diagnostic results in hand, the department's specialists develop a personalized treatment regimen for the patient, which may include medication, psychotherapy, vacuum therapy, and/or surgery. A surgical procedure is a last-line treatment and is indicated only when conservative therapy fails. The department's andrologists specialize in hydraulic and flexible penile prosthesis implantation surgery. Prior to surgery, the patient is fully informed about the upcoming procedure, postoperative recovery, and expected results.

The department's team of andrologists is highly qualified in the diagnosis and treatment of male infertility. This diagnosis is made when it is impossible to conceive a child for 1 year, subject to regular sexual activity and the absence of reproductive health problems in the partner. The main method of diagnosing male infertility is a spermogram. This test allows the qualitative, quantitative, and morphological characteristics of the sperm to be assessed. Treatment tactics depend on the type of male infertility. There can be secretory (develops due to impaired spermatogenesis processes), excretory (due to the difficulty of sperm passage through the vas deferens), autoimmune (due to the production of antisperm antibodies that prevent natural conception), combined (due to several factors of infertility), and idiopathic (the conception of a child does not occur due to unknown reasons, subject to satisfactory reproductive health indicators) male infertility. In many cases, the problem of male infertility can be solved with the help of drug therapy: the patient is prescribed drugs to normalize the quantitative and qualitative parameters of the spermogram. If the results of a spermogram reveal serious abnormalities, for example, the absence of sperm in the semen (azoospermia), their complete immobility (asthenozoospermia), and the presence of a large number of non-viable sperm or the absence of live ones (necrozoospermia), conservative treatment is ineffective. In such cases, the department’s andrologists recommend the use of assisted reproductive technologies. Surgical treatment may be an option of choice for the elimination of urological diseases that prevent the conception of a child. For example, the department performs operations for varicocele, ejaculatory duct obstruction, cryptorchidism, etc.

Of particular clinical interest to the department's medical team is the correction of penile curvature. This pathological condition causes not only aesthetic but also physical discomfort, interferes with a full sexual life, and potentially threatens the development of erectile dysfunction. Penile curvature can be congenital or acquired. The only effective method of restoring the normal anatomical shape of the penis in patients with the congenital form of the disease is surgery. For the treatment of the acquired form of the pathology (Peyronie's disease), the department's doctors have an effective non-invasive treatment method, namely local collagenase injections. Injection therapy is performed on an outpatient basis at intervals of 4 weeks. The required number of injections is determined by the attending physician based on the patient's individual clinical data. The department is one of the few medical facilities in Germany that specializes in this type of treatment. The department's team of andrologists has extensive experience in this field and demonstrates excellent results.

The department's range of medical services includes the following:

• Diagnostics and treatment of erectile dysfunction
  • Drug therapy
  • Hydraulic and flexible penile prosthesis implantation surgery
• Diagnostics and treatment of male infertility
  • Drug therapy
  • Surgeries for varicocele, ejaculatory duct obstruction, cryptorchidism, and other urological diseases that prevent the conception of a child
• Diagnostics and correction of penile curvature
  • Non-invasive treatment of Peyronie's disease with local collagenase injections
  • Surgical procedures to correct penile curvature
• Diagnosis and treatment of andropause (male menopause)
  • Drug therapy
• Diagnosis and treatment of testosterone deficiency syndrome
  • Drug therapy
• Microsurgical varicocelectomy for varicocele
• Vasectomy (one of the types of male contraception) and vasovasostomy to restore reproductive function in men after sterilization
• Medical care for gender dysphoria
  • Hormone therapy with male hormones for women after sex reassignment surgery
  • Male-to-female sex reassignment surgery
• Other medical services