3rd Annual Jefferson Urology Symposium: Men’s Health Forum

© The Canadian Journal of Urology TM : International Supplement, August 2020 The medical and surgical treatment of erectile dysfunction: a review and update Serkan Karakus, MD, Arthur L. Burnett, MD The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA KARAKUS S, BURNETT AL. The medical and surgical treatment of erectile dysfunction: a review and update. Can J Urol 2020;27(Suppl 3):28-35. Introduction: 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 examaccordingly. 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 clinicianmust 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. Materials and methods: Current medical and surgical treatment options in ED, including novel and innovative therapeutic options, were reviewed. Results: 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. Conclusions: 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. KeyWords: sexual dysfunction, phosphodiesterase 5 inhibitors, vacuumerection device, intracavernosal injection, penile prosthesis Address correspondence to Dr. Arthur L. Burnett, The James Buchanan Brady Urological Institute, Johns Hopkins School of Medicine, 600 NorthWolfe Street, Marburg 407, Baltimore, MD 21287-2101 USA Introduction Erectile dysfunction (ED) is not an uncommon condition that has a significant impact on the quality of life of men and their partners worldwide. Over 150 million men globally were affected by ED based on estimations in 1995, and this number is predicted to reach approximately 322 million by 2025. 1 The reason for the increase in the global prevalence of EDis believed 28 to be due to the increased prevalence of associated risk factors such as the global aging population, obesity, sedentary lifestyle, cardiovascular diseases, diabetes, depression, and BPH. 2-4 ED prevalence is usually underestimated inmany developing countries because help-seeking is rare among men with ED due to its associated stigma, and it is a non-life-threatening condition. However, previous research indicated that the presence of ED is a predictor of cardiovascular disease (CVD), dementia, and all-cause mortality. 5,6 The most common underlying mechanism of ED is vascular, and symptoms of ED may precede a CVD event by up to 5 years, and the degree of ED correlates with the severity of CVD. 7