SOP Conservative (Medical and Mechanical) Treatment of Erectile Dysfunction

Abstract

Introduction Erectile dysfunction (ED) is the most frequently treated male sexual dysfunction worldwide. ED is a chronic condition that exerts a negative impact on male self-esteem and nearly all life domains including interpersonal, family, and business relationships. Aim The aim of this study is to provide an updated overview on currently used and available conservative treatment options for ED with a special focus on their efficacy, tolerability, safety, merits, and limitations including the role of combination therapies for monotherapy failures. Methods The methods used were PubMed and MEDLINE searches using the following keywords: ED, phosphodiesterase type 5 (PDE5) inhibitors, oral drug therapy, intracavernosal injection therapy, transurethral therapy, topical therapy, and vacuum-erection therapy/constriction devices. Additionally, expert opinions by the authors of this article are included. Results Level 1 evidence exists that changes in sedentary lifestyle with weight loss and optimal treatment of concomitant diseases/risk factors (e.g., diabetes, hypertension, and dyslipidemia) can either improve ED or add to the efficacy of ED-specific therapies, e.g., PDE5 inhibitors. Level 1 evidence also exists that treatment of hypogonadism with total testosterone < 300 ng/dL (10.4 nmol/L) can either improve ED or add to the efficacy of PDE5 inhibitors. There is level 1 evidence regarding the efficacy and safety of the following monotherapies in a spectrum-wide range of ED populations: PDE5 inhibitors, intracavernosal injection therapy with prostaglandin E1 (PGE1, synonymous alprostadil) or vasoactive intestinal peptide (VIP)/phentolamine, and transurethral PGE1 therapy. There is level 2 evidence regarding the efficacy and safety of the following ED treatments: vacuum-erection therapy in a wide range of ED populations, oral L-arginine (3–5 g), topical PGE1 in special ED populations, intracavernosal injection therapy with papaverine/phentolamine (bimix), or papaverine/phentolamine/PGE1 (trimix) combination mixtures. There is level 3 evidence regarding the efficacy and safety of oral yohimbine in nonorganic ED. There is level 3 evidence that combination therapies of PDE5 inhibitors + either transurethral or intracavernosal injection therapy generate better efficacy rates than either monotherapy alone. There is level 4 evidence showing enhanced efficacy with the combination of vacuum-erection therapy + either PDE5 inhibitor or transurethral PGE1 or intracavernosal injection therapy. There is level 5 evidence (expert opinion) that combination therapy of PDE5 inhibitors + L-arginine or daily dosing of tadalafil + short-acting PDE5 inhibitors pro re nata may rescue PDE5 inhibitor monotherapy failures. There is level 5 evidence (expert opinion) that adding either PDE5 inhibitors or transurethral PGE1 may improve outcome of penile prosthetic surgery regarding soft (cold) glans syndrome. There is level 5 evidence (expert opinion) that the combination of PDE5 inhibitors and dapoxetine is effective and safe in patients suffering from both ED and premature ejaculation.

Alprostadil in cream — a new option of treating erectile dysfunctions in diabetic patients

“…The treatment usually requires maximum doses of PDE5 inhibitors. In patients who do not respond to the first-line treatment or in case of whom such a treatment is contraindicated, it is possible to use prostaglandin administered into the urethra, injections to the cavernous bodies, vacuum devices or penile prostheses [4,5,14,15]. Currently, there are no studies confirming the higher efficacy and safety of any of the PDE5 inhibitors.…”

“…Treatment of erectile dysfunction is divided into three categories: oral phosphodiesterase type 5 inhibitors (PDE5i) constituting first-line treatment, alprostadil in injections to cavernous bodies and vacuums, which are the second choice options, as well as third-line treatment which encompasses the surgery with an implantation of penile prostheses of various kinds [2,5,6,8,14,15].…”

“…Pharmacological treatment is traditionally based on oral phosphodiesterase type 5 inhibitors (PDE5i), which is the first-line treatment, and if it is not effective, alprostadil is used for cavernous injection and vacuum devices (second-line treatment) as well as surgical procedures involving implantation of various types of penile prostheses (third-line treatment) (Tab. 1) [2,5,6,8,14,15]. This article will outline the advantages of using alprostadil as a cream for topical use as an effective treatment of erectile dysfunction in diabetic patients.…”

Relationship between Sedentary Lifestyle and Erectile Dysfunction

“…This can lead some to consider the possibility of suicide, because they consider ED a problem of their masculinity (Figueiredo & Schraiber, 2011). In addition to negatively affecting the individual's self-esteem, dysfunction can have serious consequences on other aspects of the subject such as anxiety and social isolation, as well as losses in interpersonal, family and work relationships (Porst et al, 2013;Phé & Rouprêt, 2012).…”

Extraversion and Neuroticism in Sexually Dysfunctional Men Suffering from Erectile Dysfunction and Premature Ejaculation: A Cross-Sectional Study

“…In spite of PE and ED being very different conditions, with different characteristics and etiology, where ED is affected by lifestyle and clearly age-dependent [32] with a steep increase beyond the fifth decade [33][34][35][36] in our literature research we found several papers regarding personality traits and sexual dysfunctions in men, but few studies focused on personality traits and specific sexual dysfunctions like ED and PE (both lifelong and acquired), and on links between such personality traits and dysfunction severity.…”