[Is the recommended treatment for erectile dysfunction effective for men over age 65?]

To evaluate the recommended erectile dysfunction treatment algorithm for men over age 65.

Between 2004 and 2006, 334 men were treated for ED at our institution, of whom 64 were greater than 65 years old (19.2%). Medical history, ED treatments and patients' satisfaction were reported. The first line therapy was PDE 5 inhibitors except after radical prostatectomy, followed by intracavernous injections (ICI). When conservative treatments failed, penile prosthesis was proposed. Mean follow up was 23.7 months.

Mean age was 69.2 years (65-81). Aetiology of ED was organic in 85.9% (39.1% after radical pelvic surgery) and partially drug induced in 45.8%. With PDE 5 inhibitors, the mean success rate was 26.5 and 7.1% after radical pelvic surgery. Because of cost, 30.8 % of satisfied patients stopped PDE 5 inhibitors. Mean ICI success rate was 60.4% but 34.5% of satisfied men interrupted them. Finally, 14% of patients were successfully treated by PDE 5 inhibitors and 29.7% by ICI. Penile prosthesis was implanted in 12 patients (18.7%) with a mean success rate of 83.3%. No successful ED treatment was found in a third of patients.

PDE 5 inhibitors after 65 were found to be less successful as envisaged. This study points out the probable inadequacy between the patients' expectations and the therapeutic options, including socioeconomic terms.