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Erectile Dysfunction

Medical Treatment

R. Taghavi MD

Professor of Urology

Mashhad University of Medical Sciences

March 2012

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Introduction

Erectile dysfunction (ED , impotence) and

premature ejaculation (PE) are two main

complaints in male sexual medicine.

EAU guidelines for ED or impotence march 2011

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Erectile dysfunction

- Is a common worldwide

- ED is a symptom, not a disease. Some men may

not be properly evaluated or receive treatment

for an underlying disease or condition that may

be causing ED.

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Erectile dysfunction

- Is a common worldwide

- ED is a symptom, not a disease. Some men may not be properly evaluated or receive treatment for an underlying disease or condition that may be causing ED.

ED shares several risk factors with

cardiovascular disease

Lifestyle modification (intensive exercise and

a decrease in BMI) can improve erectile

function

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Treatment of ED

Primary goal

Is to determine the etiology of the disease

and treat it when possible

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Treatment of EDPrimary goal

Is to determine the etiology of the disease and

treat it when possible

Treat the symptom “ED” alone

ED is a symptom, not a disease

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Treatment of ED

As a rule, ED can be treated successfully with

current options, but can not be cured exceptions:

- Psychogenic ED

- Post-traumatic arteriogenic ED in young patients

- Hormonal causes e.g.hypogonadism,hyperprolactinemia

Which can be potentially cured with specific treatment

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Curable causes of EDHormonal causes

Testosterone deficiency:

- Primary testicular failure

- Secondary to pituitary/hypothalamic causes

Testosterone replacement therapy is effective

- IM , oral and transdermal

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Curable causes of EDHormonal causes

Testosterone replacement

Contraindications = Men with:

- History of prostate carcinoma

- Symptoms of prostatism

Caution:

- DRE+PSA before testosterone therapy

Monitor:

- Clinical response

- Development of hepatic or prostatic disease

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Curable causes of ED

Testosterone replacement

Men with coronary artery diseases no

contraindication, however, the hematocrite

level should be monitored and a close

adjustment of testosterone may be

necessary, specially in CHF

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Curable causes of EDPsychosexual counseling therapy

For patients with a significant psychological

problem

Psychosexual therapy alone or with another

therapeutic approach

Takes time and has had variable results

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Treatment of EDUnknown cases of ED

Three lines

First-line therapy

Second-line therapy

Third-line therapy (penile prostheses)

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Treatment of ED

First-line therapy

Oral pharmacotherapy

Topical pharmacotherapy

Vacuum constriction devices “VCD”

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Treatment of ED

Second-line therapy

Patients not responding to oral drug with

high success rate of 85%

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Treatment of EDSecond-line therapy

1. Intracavernous injections

- Monotherapy “Alprostadil PGE1”

- Combination therapy:

* Papaverine + Phentolamine

* Papaverine + Phentolamine + PGE1

2. Intraurethral alprostadil “PGE1”

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Treatment of EDOral pharmacotherapy

Mechanism action

The PDE5 enzyme hydrolyses cyclic

guanosine monophosphate (cGmp) in the

cavernosum tissue of the penis.

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