Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-26T15:09:03.510Z Has data issue: false hasContentIssue false

Chapter 39 - Medical and Surgical Management of Erectile Dysfunction

from Section 5 - Medical and Surgical Management of Issues of Male Health

Published online by Cambridge University Press:  06 December 2023

By
Mohit Khera  and
Skyler Howell
Edited by
Douglas T. Carrell ,
Alexander W. Pastuszak  and
James M. Hotaling
Douglas T. Carrell
Affiliation:
Utah Center for Reproductive Medicine
Alexander W. Pastuszak
Affiliation:
University of Utah
James M. Hotaling
Affiliation:
Utah Center for Reproductive Medicine
Get access

Summary

Erectile dysfunction (ED) is a complex, multifactorial disease caused by multiple factors including difficulty with erection initiation, arterial filling, and occlusion to maintain turgor. It may be a manifestation of poor overall health or specific medical conditions. Treatment of underlying causative conditions may resolve ED. Medical treatment options for ED include oral medications, such as phosphodiesterase type-5 inhibitors, as well as locally acting agents and nonsurgical devices. Locally acting agents include alprostadil, which may be administered by intracavernosal injection, intraurethral suppository, or topical cream, as well as other intracavernosal injection agents. Vacuum erection devices are available. Surgical management options for ED include penile prosthesis placement or vascular surgery. Penile prostheses may be malleable or inflatable. Arterial vascular surgery has shown some efficacy in ideal candidates, but venous surgery is not recommended. Treatment options that are currently being studied and show promise include low-intensity extracorporeal shockwave therapy and regenerative treatments such as stem cells and platelet-rich plasma.

Keywords

men’s healtherectile dysfunctionEDED treatmentPDE-5 inhibitor
Type
Chapter
Information
Men's Reproductive and Sexual Health Throughout the Lifespan
An Integrated Approach to Fertility, Sexual Function, and Vitality
 , pp. 308 - 314
Publisher: Cambridge University Press
Print publication year: 2023

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Banner, LL, Anderson, RU. Integrated sildenafil and cognitive-behavior sex therapy for psychogenic erectile dysfunction: a pilot study. J Sex Med. 2007;4:1117–1125.CrossRefGoogle ScholarPubMed
Hsu, C, Sandford, B. The Delphi technique: making sense of consensus. Pract Assess Res Eval. 2007;12:1–8.Google Scholar
Burnett, AL, Nehra, A, Breau, RH, et al. Erectile dysfunction: AUA Guideline. J Urol. 2018;200:635–638.CrossRefGoogle ScholarPubMed
Kovac, JR, Labbate, C, Ramasamy, R, et al. Effects of cigarette smoking on erectile dysfunction. Andrologia. 2015;47:1087–1092.Google Scholar
Bolona, ER, Uraga, MV, Haddad, RM, et al. Testosterone use in men with sexual dysfunction: a systematic review and meta-analysis of randomized placebo-controlled trials. Mayo Clin Proc. 2007;82:20–28.CrossRefGoogle ScholarPubMed
Spitzer, M, Basaria, S, Travison, TG, et al. Effect of testosterone replacement on response to sildenafil citrate in men with erectile dysfunction: a parallel, randomized trial. Ann Intern Med. 2012;157:681–691.CrossRefGoogle ScholarPubMed
Kim, JW, Oh, MM, Park, MG, et al. Combination therapy of testosterone enanthate and tadalafil on PDE5 inhibitor non-responders with severe and intermediate testosterone deficiency. Int J Impot Res. 2013;25:29–33.Google Scholar
Alhathal, N, Elshal, AM, Carrier, S. Synergetic effect of testosterone and phophodiesterase-5 inhibitors in hypogonadal men with erectile dysfunction: a systematic review. Can Urol Assoc J. 2012;6:269–274.Google Scholar
Gruenwald, I, Shenfeld, O, Chen, J, et al. Positive effect of counseling and dose adjustment in patients with erectile dysfunction who failed treatment with sildenafil. Eur Urol. 2006;50:134–140.Google Scholar
Kim, ED, Seftel, AD, Goldfischer, ER, et al. A return to normal erectile function with tadalafil once daily after an incomplete response to asneeded PDE5 inhibitor therapy. J Sex Med. 2013;11:820–830.Google Scholar
Carson, CC, Hatzichristou, DG, Carrier, S, et al. Erectile response with vardenafil in sildenafil nonresponders: a multicentre, double-blind, 12-week, flexible-dose, placebo-controlled erectile dysfunction clinical trial. BJU Int. 2004;94:1301–1309.Google Scholar
Salonia, A, Adaikan, G, Buvat, J, et al. Sexual rehabilitation after treatment for prostate cancer – part 1: recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med. 2017;14:285–296.CrossRefGoogle ScholarPubMed
Mahmood, J, Shamah, AA, Creed, TM, et al. Radiation-induced erectile dysfunction: recent advances and future directions. Adv Radiat Oncol. 2016;1:161–169.Google Scholar
Weyne, E, Castiglione, F, Van der Aa, F, et al. Landmarks in erectile function recovery after radical prostatectomy. Nat Rev Urol. 2015;12:289–297.Google Scholar
Salonia, A, Adaikan, G, Buvat, J, et al. Sexual rehabilitation after treatment for prostate cancer – part 2: recommendations from the Fourth International Consultation for Sexual Medicine (ICSM 2015). J Sex Med. 2017;14:297–315.Google Scholar
Nehra, A, Jackson, G, Miner, M, et al. The Princeton III consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012;87:766–778.Google Scholar
Pomeranz, HD. The relationship between phosphodiesterase-5 inhibitors and nonarteritic anterior ischemic optic neuropathy. J Neuroophthalmol. 2016;36:193–196.Google Scholar
Pottegard, A, Schmidt, SA, Olesen, AB, et al. Use of sildenafil or other phosphodiesterase inhibitors and risk of melanoma. Br J Cancer. 2016;115:895–900.Google Scholar
Michl, U, Molfenter, F, Graefen, M, et al. Use of phosphodiesterase type 5 inhibitors may adversely impact biochemical recurrence after radical prostatectomy. J Urol. 2015;193:479–483.CrossRefGoogle ScholarPubMed
Loeb, S, Folkvaljon, Y, Robinson, D, et al. Phosphodiesterase type 5 inhibitor use and disease recurrence after prostate cancer treatment. Eur Urol. 2016;70:824–828.Google Scholar
Shabsigh, R, Padma-Nathan, H, Gittleman, M, et al. Intracavernous alprostadil alfadex is more efficacious, better tolerated, and preferred over intraurethral alprostadil plus optional actis: a comparative, randomized, crossover, multicenter study. Urology. 2000;55:109–113.CrossRefGoogle Scholar
Padma-Nathan, H, Hellstrom, WJ, Kaiser, FE, et al. Treatment of men with erectile dysfunction with transurethral alprostadil. Medicated Urethral System for Erection (MUSE) Study Group. N Engl J Med. 1997;336:1–7.CrossRefGoogle ScholarPubMed
Williams, G, Abbou, CC, Amar, ET, et al. Efficacy and safety of transurethral alprostadil therapy in men with erectile dysfunction. MUSE Study Group. Br J Urol. 1998;81:889–894.CrossRefGoogle ScholarPubMed
Padma-Nathan, H, Yeager, JL. An integrated analysis of alprostadil topical cream for the treatment of erectile dysfunction in 1732 patients. Urology. 2006;68(2):386–391.Google Scholar
Mehrotra, N, Gupta, M, Kovar, A, Meibohm, B. The role of pharmacokinetics and pharmacodynamics in phosphodiesterase-5 inhibitor therapy. Int J Impot Res. 2007;19(3):253–264.Google Scholar
Anaissie, J, Hellstrom, WJ. Clinical use of alprostadil topical cream in patients with erectile dysfunction: a review. Res Rep Urol. 2016;8:123–331.Google Scholar
Khayyamfar, F, Forootan, SK, Ghasemi, H, et al. Evaluating the efficacy of vacuum constrictive device and causes of its failure in impotent patients. Urol J. 2013;10:1072–1078.Google Scholar
Chen, J, Mabjeesh, NJ, Greenstein, A. Sildenafil versus the vacuum erection device: patient preference. J Urol. 2001;166:1779–1781.Google Scholar
Kramer, AC, Schweber, A. Patient expectations prior to Coloplast Titan penile prosthesis implant predicts postoperative satisfaction. J Sex Med. 2010;7:2261–2266.CrossRefGoogle ScholarPubMed
Mulcahy, JJ, Carson, CC 3rd. Long-term infection rates in diabetic patients implanted with antibiotic-impregnated versus nonimpregnated inflatable penile prostheses: 7-year outcomes. Eur Urol. 2011;60:167–172.Google Scholar
Serefoglu, EC, Mandava, SH, Gokce, A, et al. Long-term revision rate due to infection in hydrophilic-coated inflatable penile prostheses: 11-year follow-up. J Sex Med. 2012;9:2182–2186.Google Scholar
Nehra, A, Carson, CC 3rd, Chapin, AK, et al. Longterm infection outcomes of 3-piece antibiotic impregnated penile prostheses used in replacement implant surgery. J Urol. 2012;188:899–903.Google Scholar
Mirheydar, H, Zhou, T, Chang, DC, et al. Reoperation rates for penile prosthetic surgery. J Sex Med. 2016;13:129–133.Google Scholar
Enemchukwu, EA, Kaufman, MR, Whittam, BM, et al. Comparative revision rates of inflatable penile prostheses using woven Dacron® fabric cylinders. J Urol. 2013;190:2189–2193.Google Scholar
Levine, LA, Rybak, J. Traction therapy for men with shortened penis prior to penile prosthesis implantation: a pilot study. J Sex Med. 2011;8:2112–2117.Google Scholar
Canguven, O, Talib, RA, Campbell, J, et al. Is the daily use of vacuum erection device for a month before penile prosthesis implantation beneficial? A randomized controlled trial. Andrology. 2017;5:103–106.CrossRefGoogle ScholarPubMed
Pahlajani, G, Raina, R, Jones, S, et al. Vacuum erection devices revisited: its emerging role in the treatment of erectile dysfunction and early penile rehabilitation following prostate cancer therapy. J Sex Med. 2012;9:1182–1189.Google Scholar
Tsambarlis, PN, Chaus, F, Levine, LA. Successful placement of penile prostheses in men with severe corporal fibrosis following vacuum therapy protocol. J Sex Med. 2017;14:44–46.Google Scholar
Hakky, TS, Suber, J, Henry, G, et al. Penile enhancement procedures with simultaneous penile prosthesis placement. Adv Urol. 2012;2012:314612.Google Scholar
Chew, KK, Stuckey, BG. Use of transurethral alprostadil (MUSE) (prostaglandin E1) for glans tumescence in a patient with penile prosthesis. Int J Impot Res. 2000;12:195–196.Google Scholar
Mulhall, JP, Jahoda, A, Aviv, N, et al. The impact of sildenafil citrate on sexual satisfaction profiles in men with a penile prosthesis in situ. BJU Int. 2004;93:97–99.Google Scholar
Pryor, MB, Carrion, R, Wang, R, et al. Patient satisfaction and penile morphology changes with postoperative penile rehabilitation 2 years after Coloplast Titan prosthesis. Asian J Androl. 2016;18:754–758.Google Scholar
Munarriz, R, Uberoi, J, Fantini, G, et al. Microvascular arterial bypass surgery: longterm outcomes using validated instruments. J Urol. 2009;182:643–648.CrossRefGoogle ScholarPubMed
Dabaja, AA, Teloken, P, Mulhall, JP. A critical analysis of candidacy for penile revascularization. J Sex Med. 2014;11:2327–2332.Google Scholar
Gruenwald, I, Appel, B, Kitrey, ND. Shockwave treatment of erectile dysfunction. Ther Adv Urol. 2013;5(2):95–99.CrossRefGoogle ScholarPubMed
Sokolakis, I, Hatzichristodoulou, G. Clinical studies on low intensity extracorporeal shockwave therapy for erectile dysfunction: a systematic review and meta-analysis of randomised controlled trials. Int J Impot Res. 2019;31:177–194.CrossRefGoogle ScholarPubMed
Yiou, R, Hamidou, L, Birebent, B, et al. Safety of intracavernous bone marrow-mononuclear cells for postradical prostatectomy erectile dysfunction: an open dose-escalation pilot study. Eur Urol. 2016;69:988–991.Google Scholar
Al Demour, S, Jafar, H, Adwan, S. Safety and potential therapeutic effect of two intracavernous autologous bone marrow derived mesenchymal stem cells injections in diabetic patients with erectile dysfunction: an open label phase I clinical trial. J Urol Int. 2018;101:358–365.Google Scholar
Chung, E. A review of current and emerging therapeutic options for erectile dysfunction. Med Sci (Basel). 2019;7(9):91.Google ScholarPubMed
Patel, D, Pastuszak, A, Hotaling, J. Emerging treatments for erectile dysfunction: a review of novel, non-surgical options. Curr Urol Rep. 2019;20:44.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×