When a urologist is the right next step
- Two different PDE5 inhibitors have failed at maximum tolerated dose after adequate trials.
- You want injection therapy, which requires an in-clinic titration.
- You are considering an implant.
- You have penile curvature, pain or a palpable lump — see Peyronie's disease.
- ED following prostate surgery or pelvic radiotherapy.
- Lifelong difficulty maintaining an erection in an otherwise healthy young man, where venous leak is a possibility.
- You want a penile duplex Doppler ultrasound to characterise the cause.
Subspecialty matters
| Focus | What they handle | When you want them |
|---|---|---|
| General urology | Broad — stones, prostate, bladder, some ED | Straightforward second-line treatment |
| Andrology / sexual medicine | Male sexual and reproductive health specifically | Complex ED, hormonal problems, fertility alongside ED |
| Prosthetic urology | Penile implants and revision surgery | You are considering or have an implant |
| Reproductive urology | Male fertility | ED alongside trying to conceive — see ED and fertility |
In the US, the Sexual Medicine Society of North America and the Urology Care Foundation both maintain clinician directories, and academic medical centres usually list subspecialty interests on individual profiles.
Questions worth asking
- What do you think is causing this in my case? Pushes past a reflex prescription.
- What would you do next, and why that rather than the alternatives?
- How many of these procedures do you perform each year? For implants especially, volume correlates with outcomes.
- What is your infection rate, and which device coating do you use? A high-volume implant surgeon will know their own figure.
- What happens if this does not work? Establishing the next step now prevents a wasted six months.
- Will you communicate with my primary care clinician? Someone should be joining up the cardiovascular picture.
- What will this cost me, and what does my insurance require?
What to bring
- Your treatment log — every medication, dose, number of attempts and result.
- A full current medication and supplement list.
- Recent blood results, especially HbA1c, lipids and testosterone.
- Your self-assessment score, ideally before and after treatment.
- A timeline of when the problem started and how it progressed.
- Your specific goal — what would count as a good outcome for you.
- Your partner, if you want them there.
FAQ
Frequently asked questions
Do I need a referral to see a urologist?
Not always clinically, but many insurance plans require one. Check your plan before booking to avoid an unexpected bill.
How do I find one who specialises in ED?
Look for andrology or sexual medicine in their listed interests. Professional society directories and academic centre profiles are the most reliable sources.
Does surgeon volume matter for implants?
Yes. Outcomes and complication rates correlate with how many procedures a surgeon performs. Asking is entirely reasonable and a good surgeon will answer directly.
Should I get a second opinion?
For irreversible surgery, yes — always worth it. A clinician who discourages a second opinion has told you something useful.
Sources
What this is based on
We link to primary sources — clinical guidelines, regulator publications and peer-reviewed research — wherever possible. Links open on third-party sites we do not control.
- [01]American Urological Association. Erectile Dysfunction: AUA Guideline (2018).
- [02]Urology Care Foundation. What is Erectile Dysfunction?.
- [03]National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Erectile Dysfunction.