# Choosing a Urologist for ED

> Not every urologist specialises in sexual medicine, and for second- and third-line treatment the difference in outcomes is real. Here is how to find the right one and what to ask.

- **Source:** ED Treatment Guides (https://www.edtreatmentguides.com/guides/choosing-a-urologist)
- **Last updated:** 2025-11-18
- **Type:** guide
- **Topic:** When treatment stalls

## Key points

- Urology is broad. The relevant subspecialties here are **andrology** and **sexual medicine**, and for implants, **prosthetic urology**.
- For implant surgery, surgeon volume correlates with outcomes. Asking how many they do a year is a fair and important question.
- Ask about infection rates directly. A surgeon who does a lot of these will know their own number.
- You do not always need a referral, but your insurance may. Check before booking.
- Bring your treatment log. It is what determines whether you leave with a plan or another prescription.

## 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](https://www.edtreatmentguides.com/treatments/penile-injections), which requires an in-clinic titration.
- You are considering an [implant](https://www.edtreatmentguides.com/treatments/penile-implants).
- You have penile curvature, pain or a palpable lump — see [Peyronie's disease](https://www.edtreatmentguides.com/causes/peyronies-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.

> **For a first presentation, primary care is usually right**
>
> A GP or primary care clinician can assess cardiovascular risk, order the bloods and start first-line treatment — which is what most men need. Urology is for when that pathway has been exhausted or when there is a structural problem.

## 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](https://www.edtreatmentguides.com/guides/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

1. **What do you think is causing this in my case?** Pushes past a reflex prescription.
2. **What would you do next, and why that rather than the alternatives?**
3. **How many of these procedures do you perform each year?** For implants especially, volume correlates with outcomes.
4. **What is your infection rate, and which device coating do you use?** A high-volume implant surgeon will know their own figure.
5. **What happens if this does not work?** Establishing the next step now prevents a wasted six months.
6. **Will you communicate with my primary care clinician?** Someone should be joining up the cardiovascular picture.
7. **What will this cost me, and what does my insurance require?**

> **Signals to walk away from**
>
> A clinic that leads with shockwave or PRP packages before discussing established treatments; one that sells a course of six sessions up front; one that cannot cite published evidence for what it is recommending; or one that discourages a second opinion. See [shockwave vs PRP](https://www.edtreatmentguides.com/compare/shockwave-vs-prp).

## 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](https://www.edtreatmentguides.com/tools/ed-self-assessment), 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.

> **Tip**
>
> The treatment log is the thing that changes the appointment. It is also frequently what insurance requires to authorise second- and third-line treatment, so it does double duty.

## 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

- American Urological Association. [Erectile Dysfunction: AUA Guideline](https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline) (2018)
- Urology Care Foundation. [What is Erectile Dysfunction?](https://www.urologyhealth.org/urology-a-z/e/erectile-dysfunction-(ed))
- National Institute of Diabetes and Digestive and Kidney Diseases. [Treatment for Erectile Dysfunction](https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/treatment)

## Related pages

- [What to Do When ED Medication Doesn't Work](https://www.edtreatmentguides.com/guides/when-medication-fails)
- [Penile Implants: The Definitive Treatment, and Why It Is Last](https://www.edtreatmentguides.com/treatments/penile-implants)
- [Penile Injections (Alprostadil, Trimix): The Most Reliable Non-Surgical Option](https://www.edtreatmentguides.com/treatments/penile-injections)
- [Peyronie's Disease: Curvature, Pain and ED](https://www.edtreatmentguides.com/causes/peyronies-disease)

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_This page is general health information, not medical advice. It cannot account for your own history, medications or risk factors. Talk to a licensed clinician before starting, stopping or changing any treatment._

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