Treatment Options for Erectile Dysfunction in Patients Failing Oral Drug Therapy

Abstract

Oral drug therapy is the first line treatment for erectile dysfunction. Efficacy of oral drugs does not exceed 70%, while drop-out rate is high. Therefore, salvage strategies and second/third line treatment options are necessary to restore erectile function in such patients. The article reviews currently available data and comment on key issues that urologists address on their every day clinical practice.In order to do so, a literature-based critical presentation on the current methodological problems on definition of treatment failure, treatment outcome assessment and alternative therapeutic options was made.Emphasis was given in identifying truly non-responders, as proper instructions for oral drug administration and psychosexual counselling may reverse a substantial number of non-responders to responders. Medication, clinical and patient/partner related issues have been identify that may lead to treatment failure. Treatment outcome assessment based not only on quality of erectile response, but also on side effects profile and patient satisfaction is recommended. Treatment options for truly non-responders include intracavernosal injections, combination therapies, and penile prosthesis. Management strategy however, must identify patient and partner needs and expectations and involve them in the decision-making. #

Treatment-Seeking Behavior of Erectile Dysfunction Patients in Europe: Results of the Erectile Dysfunction Observational Study

“…The International Index of Erectile Function erectile function domain (IIEF-EF) score, which was collected only at the baseline visit, was used to define the severity of ED. Specifically, ED was classified as severe (score 1-10), moderate (score [11][12][13][14][15][16], and mild (17)(18)(19)(20)(21)(22)(23)(24)(25), with an IIEF-EF score of 26 or greater indicating normal erectile function [22,23].…”

“…In spite of the availability of efficacious treatments, it has been estimated that only about 10% of men with ED seek help [16], and that 30-60% of those who do seek medical care discontinue their treatment [17][18][19]. Despite the fact that only a few patients are seeking help for ED and treatment discontinuation is common, there are few studies exploring help and treatment-seeking behavior, as well as reasons for treatment discontinuation [17,18,20,21]. Little is known, therefore, about the characteristics of patients who use ED therapy in normal clinical practice or the use of ED treatments in this setting.…”

A Mathematical Model of Penile Vascular Dysfunction and Its Application to a New Diagnostic Technique

“…Still, in about 30% of the patients affected with ED, the pharmacological modalities fail. 24 There is no single test that will accurately provide vascular assessment of arterial inflow and adequacy of the veno-occlusive mechanism. Moreover, some of the tests are invasive, for example, angiography and cavernosography.…”

Erectile response with vardenafil in sildenafil nonresponders: a multicentre, double‐blind, 12‐week, flexible‐dose, placebo‐controlled erectile dysfunction clinical trial

“…There is currently no simple and generally accepted definition of failure of ED therapy, because the disorder is complex and subjective. Hatzimouratidis and Hatzichristou [20] recently proposed criteria for identifying true nonresponders to oral PDE‐5 inhibitor therapy. First, they recommend an evaluation of the patient's previous use of oral therapy, including the timing of dosing and sexual activity, the use of sexual stimulation to achieve erection, and the possibility of food and drug interactions.…”

“…Ultimately, the present study was designed to determine whether men who were not responsive to sildenafil, in the opinion of themselves and their physician, could achieve successful intercourse by using an alternative PDE‐5 inhibitor. While a patient may be considered as truly unresponsive to sildenafil if re‐trial after proper counselling and instruction fails [20], with the availability of three oral PDE‐5 inhibitors for treating ED, it is reasonable for a patient to wish to consider an alternative drug.…”