Salvage Strategies for Nonresponders to Phosphodiesterase-5 Inhibitor Treatment for Erectile Dysfunction in the Aging Male

Abstract

This article reviews contemporary treatment strategies for the aging male who does not demonstrate a satisfactory response to first-line oral phosphodiesterase-5 inhibitor agents for erectile dysfunction. More than half of men aged 40–70 years are unable to attain or maintain a penile erection sufficient for satisfactory sexual performance, with the prevalence of erectile dysfunction climbing to more than 75% among those aged over 70 years. However, the aging male may fail to respond to or express dissatisfaction with oral on-demand treatment. Clinically effective phosphodiesterase-5 inhibitor salvage strategies include patient re-education, lifestyle changes, correction of risk factors, dose adjustment, agent switching, androgen replacement and/or psychosexual or relationship counseling. Important new data supporting the safe and efficacious use of daily phosphodiesterase-5 inhibitor dosing schedules are reviewed. If required, progression to second- and third-line treatments is appropriate for most men, and may include intracavernous penile injections, vacuum erection devices, multimodality therapy or implantation of a penile prosthesis.