Erectile Dysfunction
Erectile dysfunction (ED) affects an estimated 30 million men in the United States and is a common sequela of radical prostatectomy, pelvic radiation, vascular disease, diabetes, and neurological injury. Management follows a stepwise approach — from least to most invasive — with treatment selection guided by severity, etiology, patient and partner preference, and comorbid conditions. All options below are reversible except the penile implant.
5 of 5 treatments
| Treatment | Category | Invasiveness | Notes |
|---|---|---|---|
| PDE5 Inhibitors | Oral Pharmacotherapy | Non-invasive | First-line therapy for most patients with ED. Sildenafil, tadalafil, vardenafil, and avanafil enhance nitric oxide–mediated smooth muscle relaxation; require intact neurogenic stimulation. Tadalafil 5 mg daily is used for penile rehabilitation post-prostatectomy. |
| Vacuum Erection Device (VED) | Mechanical | Non-invasive | Negative pressure draws blood into the corpora; a constriction ring maintains erection. Effective in 60–90% of patients. No systemic side effects; useful for penile rehabilitation post-prostatectomy and in patients who cannot tolerate PDE5 inhibitors. |
| Intraurethral Alprostadil (MUSE) | Intraurethral | Minimally Invasive | Medicated urethral system for erection (MUSE) delivers alprostadil (PGE1) pellet transurethrally. Absorbed via corpus spongiosum; efficacy ~40–65%. Useful when systemic absorption of PDE5 inhibitors is contraindicated or insufficient. |
| Intracavernosal Injections (ICI) | Injectable | Minimally Invasive | Direct injection of vasoactive agents (alprostadil alone or Trimix — papaverine/phentolamine/alprostadil) into the corpus cavernosum. Efficacy 70–90%; independent of neurogenic stimulation. Gold standard pharmacotherapy for post-prostatectomy ED when oral agents fail. |
| Penile Implant | Surgical | Surgical Implant | Inflatable penile prosthesis (IPP) or malleable rod implanted into the corpora cavernosa. Definitive treatment; highest satisfaction rates of any ED therapy (92–98%). Indicated after failure of or inability to use non-surgical options. Precludes future spontaneous erections. |