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Feature Article

Erectile dysfunction Part 2: Managing men unresponsive to PDE5 inhibitors

Chris G McMahon, Chelsea N McMahon

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Abstract

Erectile dysfunction (ED) is a common medical condition affecting men worldwide. The introduction of phosphodiesterase-5 (PDE5) inhibitors has changed the ED treatment paradigm and decreased the use of more invasive options. However, many men will fail to respond to an adequate trial of a PDE5 inhibitor.

Key Points

  • Of men with ED, 30 to 35% will fail to respond to treatment with a phosphodiesterase-5 (PDE5) inhibitor.
  • The most common cause of initial PDE5 inhibitor failure is inadequate patient education or a failure to optimise the dosage.
  • Severe penile vascular disease, unrecognised hypogonadism, uncorrected comorbid disease, vascular risk factors and psychosocial factors are also associated with initial PDE5 inhibitor failure.
  • Initial PDE5 inhibitor failure is almost universal after a radical prostatectomy.
  • Treatment with self-administered intracorporal injection therapy, a vacuum constriction device, combination therapy or a penile prosthesis is likely to help men who fail to respond to PDE5 inhibitor therapy.

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