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Erectile dysfunction.

¹North Shore Private Hospital, Sydney, NSW. cmcmahon@mail.usyd.edu.au

The Medical Journal of Australia

|January 10, 2001

Summary

Erectile dysfunction (ED) treatments include oral sildenafil and intracavernosal injections (ICI). Alprostadil ICI is effective for ED, while oral sildenafil efficacy varies by ED severity and cause.

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Area of Science:

Urology
Pharmacology

Background:

Erectile dysfunction (ED) is a prevalent condition often managed with pharmacological interventions.
Treatment options include oral medications, transurethral methods, and intracavernosal injections (ICI).
Patient cardiovascular status and fitness for sexual activity are crucial pre-treatment considerations.

Purpose of the Study:

To review the efficacy and safety of pharmacological treatments for erectile dysfunction.
To compare different drug delivery methods for ED management.

Main Methods:

Review of existing evidence, including Level II evidence, on ED pharmacological treatments.
Analysis of drug efficacy based on delivery method (ICI, transurethral, oral) and patient-specific factors.

Main Results:

Alprostadil ICI is a first-choice treatment for ED, effective in 72.6% of men with low risk of priapism and fibrosis.
Transurethral alprostadil is less effective than ICI, yielding rigid erections in only 10% of men.
Sildenafil efficacy is reduced in severe vasculogenic ED, diabetes-related ED, and post-prostatectomy.
Papaverine ICI carries a high risk of cavernosal fibrosis and priapism, recommended only for refractory cases.

Conclusions:

Intracavernosal alprostadil is a highly effective treatment for erectile dysfunction.
Oral sildenafil is effective, but its success depends on the severity and cause of ED.
Transurethral alprostadil and papaverine ICI have limitations and higher risks that must be considered.

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