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Feature Article

Erectile dysfunction. Part 1: investigation and management

Chris G McMahon, Chelsea N McMahon

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Abstract

Effective treatment of erectile dysfunction involves early diagnosis and prompt management. With early intervention, erectile function can be improved by treating comorbid disease, identifying and correcting risk factors, counselling patients on psychosocial issues and using several effective medical and surgical therapies.

Key Points

  • Erectile dysfunction (ED) is a common condition and can usually be managed pharmacologically with oral phosphodiesterase-5 (PDE5) inhibitor drugs or self-administered intracorporal injections.
  • The cardiovascular status of the patient and his overall fitness for renewed sexual activity should be assessed before initiation of treatment for ED.
  • PDE5 inhibitor drugs are effective in 65 to 70% of men with ED.
  • The efficacy of PDE5 inhibitor drugs is related to the extent and severity of ED, with significantly reduced efficacy shown in patients with severe vasculogenic ED, diabetic ED and ED after radical prostatectomy.
  • Alprostadil is the first choice of drug in patients treated with intracorporal injections. It is effective in 70% of men with ED and is associated with a low risk of priapism and penile fibrosis.

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