Contemporary management of erectile dysfunction

Erectile dysfunction (ED) is common with aging. Formerly ED treatment was offered mainly by urologists, but the approval and widespread use of phosphodiesterase inhibitors has enabled primary care clinicians to provide targeted ED treatment. Although large, multicenter clinical trials have shown efficacy and safety with these drugs, they are ineffective in 30-35% of men, may cause sideeffects, and do not improve the underlying pathology. A thorough understanding of erectile physiology and causes of ED and a comprehensive treatment plan addressing all contributing factors may be more effective than pharmaceutical management and may improve aspects of psychological and physical health beyond erectile problems.

The American Journal of the Medical Sciences, 1995

with aging, which resulted in little attention being given to sexual behavior and treatment of sexual dysfunctions in the older population. However, in the current era it is known that as life expectancy improves, both men and women are seeking to preserve their sexuality into old age. While the appreciation of sexuality persists with aging, a decline in sexual activity is typically seen with, and can be attributed to both general health problems as well as specific sexual dysfunctions. In a large US study, the proportion of males who were sexually active declined from 83.7% in the age group 57-64 years to 38.5% in the age group 75-85 years . In a smaller pilot study in a cohort of 50 patients with a mean age of 81 years, Smith et al. reported that the main reason for being sexually inactive in older men was erectile dysfunction (ED), the condition defined as the persistent inability to attain and maintain penile erection sufficient for sexual intercourse . It is likely the most thoroughly studied sexual dysfunction in men and the most common sexual complaint of men presenting to their healthcare providers . The advent of safe oral therapy for the treatment of ED has brought attention to the disease and likely results in increased treatment-seeking behavior, also in the aging male. Despite the overwhelming success of these oral phosphodiesterase-5 inhibitors (PDE5I), the demand for pharmacotherapeutic and surgical options for ED continues to rise as a result of the increased proportion of elderly in the population as well as the increasing recognition that approximately one

Drugs, 2006

The Journal of Urology, 2003

The Third International Conference on the Management of Erectile Dysfunction: Linking Pathophysiology and Therapeutic Response, co-chaired by Ajay Nehra and William D. Steers was held July 26 -27, 2002, in McLean, Virginia. The conference was designed for an invited expert clinical faculty who wished to expand their knowledge and contribute new information and perspectives regarding the management of erectile dysfunction (ED). The goals of the conference were to review and discuss implications of pathophysiological differences in disease for different patient groups, discuss new opportunities for using oral therapies for the treatment of ED, review research, preclinical and clinical information related to treatment of specific patient groups, and discuss prevention strategies.

Mayo Clinic Proceedings, 2006

Most men older than 60 years experience some degree of erectile dysfunction (ED). The physiology of erections is complex, with contributions from hormonal, vascular, psychological, neurologic, and cellular components. ED is strongly associated with cardiovascular risk factors, and this fact plays a major role in the prevention and treatment of ED. In this article, we review the evaluation of ED in terms of history, physical examination, and common laboratory studies. Additionally, we review major considerations when prescribing phosphodiesterase type 5 inhibitors and other medical treatments, including intraurethral alprostadil, penile injection therapy, and testosterone replacement. Proc. 2006;81(3):385-390 BPH = benign prostatic hyperplasia; cGMP = cyclic guanosine monophosphate; ED = erectile dysfunction; LH = luteinizing hormone; PDE = phosphodiesterase; PDE-5 = PDE type 5; PSA = prostate-specific antigen

2016

Erectile dysfunction (ED) is the inability to achieve and maintain an erection sufficient for satisfactory sexual intercourse. It is the most frequent sexual dysfunction in elderly men and its prevalence increases with age. Ever since ED was recognized as a real health problem, several treatment options became available and some of them proved to be very efficient. PDE5 inhibitors are the mainstay treatment of ED. However, other treatment options such as intracorporal injections, surgery, vacuum devices and prosthesis are also available for patients who are unresponsive to PDE5 inhibitors. Since none of the treatment options available so far has proven ideal, research in the field of sexual medicine continues. The aim of this paper is to review the most advances in the treatment of ED.

Journal of Sexual Medicine, 2008

Drugs, 2005

Journal of Sexual Medicine, 2010

Pharmacotherapy is the usual initial therapy for most men with erectile dysfunction. Aim. To review the current data relating to the efficacy, tolerability and safety of drugs used in the treatment of men with erectile dysfunction. Methods. A critical review of the literature relating to the use of pharmacotherapeutic agents was undertaken by a committee of eight experts from five countries, building on prior reviews. Main Outcome Measures. Expert opinion and recommendations were based on grading of evidence-based literature, internal committee dialogue, open presentation, and debate. Results. Almost all currently available evidence relates to sildenafil, tadalafil, and vardenafil. Phosphodiesterase type 5 (PDE5) inhibitors are first-line therapy for most men with erectile dysfunction who do not have a specific contraindication to their use. There is no evidence of significant differences in efficacy, safety, and tolerability between the PDE5 inhibitors and apomorphine. Intracavernosal injection therapy with alprostadil should be offered to patients as second line therapy for erectile dysfunction. Intraurethral alprostadil is a less effective treatment than intracavernosal alprostadil for the treatment of men with erectile dysfunction. Conclusions. PDE5 inhibitors are effective, safe, and well-tolerated therapies for the treatment of men with erectile dysfunction. Apomorphine, intracavernosal injection therapy with alprostadil, and intraurethral alprostadil are all effective and well-tolerated treatments for men with erectile dysfunction. We recommend some standardization of the assessment of psychosocial outcomes within clinical trials in the field of erectile dysfunction. Eardley I, Donatucci C, Corbin J, El-Meliegy A, Hatzimouratidis K, McVary K, Munarriz R, and Lee SW. Pharmacotherapy for erectile dysfunction. J Sex Med 2010;7:524-540. Key Words. Pharmacotherapy; Erectile Dysfunction; PDE5 Inhibitors of action and relevant basic science before moving on to an evidence-based review of the clinical data.

Revista da Associação Médica Brasileira

The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient. Erectile dysfunction is the recurrent and persistent inability of having and/or maintain a sufficient penile erection for satisfactory sexual intercourse. It is considered a disease that impairs psychosocial health and quality of life. By means of the PICO methodology, each clinical question was structured, using the following descriptors: (P) Patients with erectile dysfunction, (I) Injectable treatment associated with PDE5i, penile revascularization, use of a penile implant, (O) Adverse events/ International index of erectile function. We performed a systematic review of the literature for each clinical question, with no time restriction, in the MEDLINE database, using 59 papers to answer all the questions. The details about the methodology and the results are set out in Appendix I.