Objective To assess the effectiveness of a progressive local treatment protocol for erectile dysfunction (ED) in patients after undergoing radical retropubic prostatectomy (RRP) for prostate cancer. Patients and Methods The study included 85 patients (mean age 59.5 years, range 50±75) with ED after RRP. Treatment was offered in four progressive phases, with patients passing to the next phase only if they failed the previous one: in phase I patients used a vacuum erection device; in phase II, sildena®l; in phase III, intracorporal injection; and in phase IV, intracorporal injection plus the vacuum erection device. The patients were followed for 1 year. Results Of the 85 patients, 78 (92%) responded to the vacuum erection device (with an erection suf®cient for vaginal penetration), but only 11 (14%) agreed to continue with it at home. Of the remaining 74 patients, 69 with no contraindications were given sildena®l and 14 (20%) had a positive response. Sixty patients were then treated with intracorporal injection and 51 (85%) had a positive response; four of the nine failures in phase III responded to intracorporal injection plus vacuum therapy. Five patients failed all four protocols. After 1 year of follow-up, 76 of the 80 patients were successfully continuing treatment at home; seven (9%) used the vacuum erection device, 11 (14%) sildena®l, 54 (71%) intracorporal injection and four (5%) intracorporal injection plus the vacuum erection device. Conclusion Overall, this progressive treatment method gave a positive response in 80 of the 85 patients (94%). After 1 year of follow-up, 76 of the 80 patients (95%) continued to respond well. Of all the methods used, intracorporal injection was the most effective for ED after RRP.

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The aim was to evaluate the effectiveness of a progressive program, starting with simple methods and, when not effective, moving to more complex methods, to treat erectile dysfunction (ED) in patients with diabetes mellitus. A total of 284 diabetic patients with ED entered into a 6-phase program starting with sildenafil citrate (Viagra). Those with contraindications, side effects, or negative response (erection insufficient for vaginal penetration) were switched to the vacuum erection device (VED), and then progressively (for failures) to intracavernous injection (ICI), sildenafil citrate þ ICI, ICI þ VED, and penile prosthesis. Patients were followed for 2 y. Of the 284 patients 276 patients were eligible for sildenafil citrate and 147 (53.3%) responded positively, but 25 (9.1%) patients stopped it soon due to adverse effects. Of 162 patients (129 nonresponders, eight noneligible for the sildenafil and 25 patients who dropped out due to adverse effects), treated with VED, 114 (70.4%) responded well, however, only 19 (11.7%) patients agreed to continue its use. Of the remaining 143 patients (nonresponders, noneligible for the previously mentioned treatments and patients who dropped out due to adverse effects), 103/143 (72%) responded to ICI, 27/40 (67.5%) to sildenafil þ ICI, and 9/13 (69.2%) to ICI þ VED. Four patients received a penile implant. At the 2 y follow-up, 81 of 284 patients who entered the study (28.5%) were still responding to sildenafil, seven (2.5%) to VED, 113 (39.8%) to ICI, 24 (8.5%) to sildenafil þ ICI, two (0.7%) to ICI þ VED; 15 (5.3%) had a penile implant. In all 17 (6%) patients reported spontaneous erections, 11 (3.9%) stopped the treatment due to family reasons and 14 (4.9%) failed the treatment. In conclusion, the progressive treatment program for ED seems to be very effective for diabetic patients, yielded a complete response for short-term and 91.2% rate of success at the end of 2 y follow-up.