Skip to main content
SpringerLink
Log in

Urologic/Clinical Treatment of Erectile Dysfunction

  • Chapter
Management of Sexual Dysfunction in Men and Women

  • 2220 Accesses

Abstract

The treatment of erectile dysfunction (ED) employs a step-wise algorithm to achieve an optimal response. Treatment is progressive, with the initial use of oral pharmacotherapy, and becomes more invasive if initial therapies fail. Vacuum erection devices (VEDs) and intraurethral or intracavernosal vasoactive agents comprise second-line treatments. Comorbid conditions, such as hormonal deficiencies and cardiovascular disease, should be identified and managed concurrently using lifestyle modification or medical therapies. For refractory ED, penile prosthetic surgery is available for appropriate patients, resulting in high satisfaction rates. Addressing psychosocial factors contributing to ED can maximize treatment efficacy.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. Eur Urol. 2010;57:804–14.

    Article  PubMed  Google Scholar 

  2. Lewis RW, Fugl-Meyer KS, Corona G, et al. Definitions/epidemiology/risk factors for sexual dysfunction. J Sex Med. 2010;7:1598–607.

    Article  PubMed  Google Scholar 

  3. Pourmand G, Alidaee MR, Rasuli S, et al. Do cigarette smokers with erectile dysfunction benefit from stopping?: a prospective study. BJU Int. 2004;94:1310–3.

    Article  PubMed  Google Scholar 

  4. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291:2978–84.

    Article  CAS  PubMed  Google Scholar 

  5. Glina S, Sharlip ID, Hellstrom WJ. Modifying risk factors to prevent and treat erectile dysfunction. J Sex Med. 2013;10:115–9.

    Article  PubMed  Google Scholar 

  6. Gupta BP, Murad MH, Clifton MM, et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2011;171:1797–803.

    Article  PubMed  Google Scholar 

  7. Mozaffarian D, Wilson PW, Kannel WB. Beyond established and novel risk factors: lifestyle risk factors for cardiovascular disease. Circulation. 2008;117:3031–8.

    Article  PubMed  Google Scholar 

  8. Jacob BC. Testosterone replacement therapy in males with erectile dysfunction. J Pharm Pract. 2011;24:298–306.

    Article  PubMed  Google Scholar 

  9. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2010;95:2536–59.

    Article  CAS  PubMed  Google Scholar 

  10. Karazindiyanoglu S, Cayan S. The effect of testosterone therapy on lower urinary tract symptoms/bladder and sexual functions in men with symptomatic late-onset hypogonadism. Aging Male. 2008;11:146–9.

    Article  CAS  PubMed  Google Scholar 

  11. Shamloul R, Ghanem H, Fahmy I, et al. Testosterone therapy can enhance erectile function response to sildenafil in patients with PADAM: a pilot study. J Sex Med. 2005;2:559–64.

    Article  CAS  PubMed  Google Scholar 

  12. Fabbri A, Giannetta E, Lenzi A, et al. Testosterone treatment to mimic hormone physiology in androgen replacement therapy. A view on testosterone gel and other preparations available. Expert Opin Biol Ther. 2007;7:1093–106.

    Article  CAS  PubMed  Google Scholar 

  13. Wang C, Nieschlag E, Swerdloff R, et al. Investigation, treatment, and monitoring of late-onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. Eur Urol. 2009;55:121–30.

    Article  PubMed  Google Scholar 

  14. Montague DK, Jarow JP, Broderick GA, et al. Chapter 1: The management of erectile dysfunction: an AUA update. J Urol. 2005;174:230–9.

    Article  PubMed  Google Scholar 

  15. Goldstein I, Lue TF, Padma-Nathan H, et al. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil study group. N Engl J Med. 1998;338:1397–404.

    Article  CAS  PubMed  Google Scholar 

  16. Carson CC. Phosphodiesterase type 5 inhibitors: state of the therapeutic class. Urol Clin North Am. 2007;34:507–15.

    Article  PubMed  Google Scholar 

  17. Dunn ME, Althof SE, Perelman MA. Phosphodiesterase type 5 inhibitors’ extended duration of response as a variable in the treatment of erectile dysfunction. Int J Impot Res. 2007;19:119–23.

    Article  CAS  PubMed  Google Scholar 

  18. Viagra (sildenafil) package insert. 2013.

    Google Scholar 

  19. Vardenafil (Levitra) package insert. 2013.

    Google Scholar 

  20. Staxyn (vardenafil ODT) package insert. 2013.

    Google Scholar 

  21. Tadalafil (Cialis) package insert. 2013.

    Google Scholar 

  22. Rajfer J, Aliotta PJ, Steidle CP, et al. Tadalafil dosed once a day in men with erectile dysfunction: a randomized, double-blind, placebo-controlled study in the US. Int J Impot Res. 2007;19:95–103.

    Article  CAS  PubMed  Google Scholar 

  23. Porst H, Kim ED, Casabe AR, et al. Efficacy and safety of tadalafil once daily in the treatment of men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia: results of an international randomized, double-blind, placebo-controlled trial. Eur Urol. 2011;60:1105–13.

    Article  CAS  PubMed  Google Scholar 

  24. Burke RM, Evans JD. Avanafil for treatment of erectile dysfunction: review of its potential. Vasc Health Risk Manag. 2012;8:517–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  25. Bella AJ, Brant WO, Lue TF, et al. Non-arteritic anterior ischemic optic neuropathy (NAION) and phosphodiesterase type-5 inhibitors. Can J Urol. 2006;13:3233–8.

    PubMed  Google Scholar 

  26. Kendirci M, Tanriverdi O, Trost L, et al. Management of sildenafil treatment failures. Curr Opin Urol. 2006;16:449–59.

    Article  PubMed  Google Scholar 

  27. Mohee A, Bretsztajn L, Eardley I. The evaluation of apomorphine for the treatment of erectile dysfunction. Expert Opin Drug Metab Toxicol. 2012;8:1447–53.

    Article  CAS  PubMed  Google Scholar 

  28. Eardley I, Donatucci C, Corbin J, et al. Pharmacotherapy for erectile dysfunction. J Sex Med. 2010;7:524–40.

    Article  CAS  PubMed  Google Scholar 

  29. Padma-Nathan H, Goldstein I, Klimberg I, et al. Long-term safety and efficacy of oral phentolamine mesylate (Vasomax) in men with mild to moderate erectile dysfunction. Int J Impot Res. 2002;14:266–70.

    Article  CAS  PubMed  Google Scholar 

  30. Teloken C, Rhoden EL, Sogari P, et al. Therapeutic effects of high dose yohimbine hydrochloride on organic erectile dysfunction. J Urol. 1998;159:122–4.

    Article  CAS  PubMed  Google Scholar 

  31. Costa P, Potempa AJ. Intraurethral alprostadil for erectile dysfunction: a review of the literature. Drugs. 2012;72:2243–54.

    Article  CAS  PubMed  Google Scholar 

  32. 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.

    Article  CAS  PubMed  Google Scholar 

  33. Mydlo JH, Volpe MA, Macchia RJ. Initial results utilizing combination therapy for patients with a suboptimal response to either alprostadil or sildenafil monotherapy. Eur Urol. 2000;38:30–4.

    Article  CAS  PubMed  Google Scholar 

  34. Linet OI, Ogrinc FG. Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group. N Engl J Med. 1996;334:873–7.

    Article  CAS  PubMed  Google Scholar 

  35. Perimenis P, Konstantinopoulos A, Perimeni PP, et al. Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction. Asian J Androl. 2006;8:219–24.

    Article  CAS  PubMed  Google Scholar 

  36. Dinsmore WW, Wyllie MG. Vasoactive intestinal polypeptide/phentolamine for intracavernosal injection in erectile dysfunction. BJU Int. 2008;102:933–7.

    Article  CAS  PubMed  Google Scholar 

  37. Porst H. Current perspectives on intracavernosal pharmacotherapy for erectile dysfunction. Int J Impot Res. 2000;12 Suppl 4:S91–100.

    Article  PubMed  Google Scholar 

  38. Brison D, Seftel A, Sadeghi-Nejad H. The resurgence of the vacuum erection device (VED) for treatment of erectile dysfunction. J Sex Med. 2013;10:1124–35.

    Article  PubMed  Google Scholar 

  39. Raina R, Agarwal A, Ausmundson S, et al. Early use of vacuum constriction device following radical prostatectomy facilitates early sexual activity and potentially earlier return of erectile function. Int J Impot Res. 2006;18:77–81.

    Article  CAS  PubMed  Google Scholar 

  40. Canguven O, Bailen J, Fredriksson W, et al. Combination of vacuum erection device and PDE5 inhibitors as salvage therapy in PDE5 inhibitor nonresponders with erectile dysfunction. J Sex Med. 2009;6:2561–7.

    Article  PubMed  Google Scholar 

  41. John H, Lehmann K, Hauri D. Intraurethral prostaglandin improves quality of vacuum erection therapy. Eur Urol. 1996;29:224–6.

    CAS  PubMed  Google Scholar 

  42. Holloway FB, Farah RN. Intermediate term assessment of the reliability, function and patient satisfaction with the AMS700 Ultrex penile prosthesis. J Urol. 1997;157:1687–91.

    Article  CAS  PubMed  Google Scholar 

  43. Zermann DH, Kutzenberger J, Sauerwein D, et al. Penile prosthetic surgery in neurologically impaired patients: long-term followup. J Urol. 2006;175:1041–4 (discussion 1044).

    Article  PubMed  Google Scholar 

  44. Montague DK. Penile prosthesis implantation in the era of medical treatment for erectile dysfunction. Urol Clin North Am. 2011;38:217–25.

    Article  PubMed  Google Scholar 

  45. Mulcahy JJ. Penile prosthesis infection: progress in prevention and treatment. Curr Urol Rep. 2010;11:400–4.

    Article  PubMed  Google Scholar 

  46. Hellstrom WJ, Montague DK, Moncada I, et al. Implants, mechanical devices, and vascular surgery for erectile dysfunction. J Sex Med. 2010;7:501–23.

    Article  PubMed  Google Scholar 

  47. Kawanishi Y, Kimura K, Nakanishi R, et al. Penile revascularization surgery for arteriogenic erectile dysfunction: the long-term efficacy rate calculated by survival analysis. BJU Int. 2004;94:361–8.

    Article  PubMed  Google Scholar 

  48. Aung HH, Dey L, Rand V, et al. Alternative therapies for male and female sexual dysfunction. Am J Chin Med. 2004;32:161–73.

    Article  PubMed  Google Scholar 

  49. Aydin S, Ercan M, Caskurlu T, et al. Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction. Scand J Urol Nephrol. 1997;31:271–4.

    Article  CAS  PubMed  Google Scholar 

  50. Sugimori H, Yoshida K, Tanaka T, et al. Relationships between erectile dysfunction, depression, and anxiety in Japanese subjects. J Sex Med. 2005;2:390–6.

    Article  PubMed  Google Scholar 

  51. Althof SE, Wieder M. Psychotherapy for erectile dysfunction: now more relevant than ever. Endocrine. 2004;23:131–4.

    Article  CAS  PubMed  Google Scholar 

  52. Melnik T, Soares BG, Nasello AG. The effectiveness of psychological interventions for the treatment of erectile dysfunction: systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med. 2008;5:2562–74.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, University of California, San Diego, San Diego, CA, USA

    Nishant Patel M.D. & T. Mike Hsieh M.D.

Authors
  1. Nishant Patel M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Mike Hsieh M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to T. Mike Hsieh M.D. .

Editor information

Editors and Affiliations

  1. Chief, Division of Male Reproductive Medicine and Surgery; Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA

    Larry I. Lipshultz

  2. Assistant Professor; Division of Male Reproductive Medicine and Surgery; Center for Reproductive Medicine; Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA

    Alexander W. Pastuszak

  3. Department of Obstetrics and Gynecology; George Washington University; School of Medicine and Health Sciences, The Center for Vulvovaginal Disorders, Washington, District of Columbia, USA

    Andrew T. Goldstein

  4. Psychiatric Center Copenhagen; Institute of Clinical Medicine; University of Copenhagen, Sexological Clinic, Copenhagen, Denmark

    Annamaria Giraldi

  5. Weill Medical College Cornell University; Co-Director, Human Sexuality Program; The New York Presbyterian Hospital; Founder, MAP Education and Research Fund, Clinical Professor of Psychiatry, Reproductive Medicine and Urology, NEW YORK, New York, USA

    Michael A. Perelman

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media New York

About this chapter

Cite this chapter

Patel, N., Hsieh, T.M. (2016). Urologic/Clinical Treatment of Erectile Dysfunction. In: Lipshultz, L., Pastuszak, A., Goldstein, A., Giraldi, A., Perelman, M. (eds) Management of Sexual Dysfunction in Men and Women. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-3100-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4939-3100-2_7

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-3099-9

  • Online ISBN: 978-1-4939-3100-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation