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The medical and surgical treatment of erectile dysfunction: a review and update
The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Aug  2020 (Vol.  27, Issue  43, Pages( 28 - 35)
PMID: 32876000


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    Erectile dysfunction (ED) is a common condition affecting more than 3 million men in the United States every year. Given the prevalence of severe co-morbidities associated with ED, the clinician must take a thorough history and conduct a diagnostic exam accordingly. The clinician should consider that every man who presents with ED is unique with regards to his symptoms, degree of stress, associated health conditions, sexual relationship quality, and sociocultural context. The clinician determines an appropriate treatment plan that is aligned with the patient's and his partner's priorities and values, adopting a shared decision-making process. The clinician must possess sufficient knowledge of all available treatment modalities and be able to offer to all treatment options that are not contraindicated, regardless of invasiveness or irreversibility, as potential first-line treatments.


    Current medical and surgical treatment options in ED, including novel and innovative therapeutic options, were reviewed.


    There are a variety of treatment options for the management of ED, both medical and surgical. The most commonly considered medical treatment option is phosphodiesterase type 5 inhibitors (PDE5i), which has been proven successful in up to 65% of men with ED. Other treatment options, such as vacuum erection device or intracavernosal injection therapy using vasodilator medications, should be considered in men who have contraindications or are non-responders to PDE5i. Surgical treatment of ED using penile implants has undergone multiple improvements over the years with low device failure and infection risks providing an effective and satisfying treatment alternative. Other therapies, such as penile vascular surgery, extracorporeal shock wave therapy, and intracavernosal stem cell therapies, are novel and should be considered investigational due to lack of evidence supporting their long term safety and efficacy.


    The management of ED requires considerations of all aspects of the patient's health and involvement of the patient and his partner in the decision-making process. Patients should be informed of all available treatment options and be able to choose the option that is most aligned with their condition, goals, and risk tolerance. There are medical and surgical therapeutic options available in the management of ED, all supported with the best level of evidence. Novel therapeutic options are promising; however, randomized controlled trials with long term follow up periods and larger sample sizes are needed to support their safety and efficacy.