New Advances in Management of Erectile Dysfunction

Abstract

E D is very common among aging men, and it has a variety of possible etiologies, including combinations of factors. When evaluating patients with ED, it is important to obtain a full history, which will usually reveal the etiology of ED and the potential cardiovascular risk associated with taking medications from the PDE-5 inhibitor class. Sudden-onset ED and the persistence of nocturnal erections should alert physicians to the possibility of psychogenic ED. Physical examination should focus on the genitals and may include a neurological evaluation in addition to the routine overall exam. Evaluation of hormone status is the most important part of laboratory studies for ED, but blood glucose and cholesterol tests should also be performed to identify underlying conditions. Most ED evaluations do not require invasive tests, but the clinician must be familiar with the indications and identify the need for further evaluations and investigations. An ICI pharmacotest is a first line option to evaluate penile vascular function. In the setting of an abnormal ICI test a penile blood flow study with CDDS should be the mainstay of ED testing. Additional testing with DICC or penile angiography is only rarely needed and should proceed only when surgery is being planned. Modern treatment of ED been revolutionized by the worldwide availability of the three PDE5 inhibitors (sildenafil, tadalafil, vardenafil) for oral use, which are associated with high efficacy and safety rates, even in difficult-to-treat populations (e.g. diabetes mellitus, radical prostatectomy). Patients should be encouraged to try all three inhibitors and to develop their own opinions. They will choose the compound perceived by them to the best efficacy, as well as considering other features such as time of onset, duration of action, window of opportunity and their own individual experience with side-effects.