Therapeutic management of erectile dysfunction: The AFU/SFMS guidelines

Area of Science:

• Urology
• Sexual Medicine
• Evidence-Based Medicine

Background:

• Erectile dysfunction (ED) is a prevalent sexual disorder.
• A lack of recent evidence-based guidelines for ED management exists in France.

Purpose of the Study:

• To establish practice guidelines for the therapeutic management of erectile dysfunction.
• To provide healthcare professionals with evidence-based recommendations for ED treatment.

Main Methods:

• Systematic review of publications in PubMed/Medline® from January 1999 to October 2023.
• Attribution of evidence levels to conclusions for each clinical question.
• Development and grading (A-C) of recommendations based on conclusions and expert arguments.

Main Results:

• Phosphodiesterase 5 inhibitors (PDE5I) are recommended as first-line treatment (A).
• Combination therapies, including PDE5I with alprostadil, are options for severe or refractory ED.
• Mechanical therapies like vacuum therapy and low-intensity shockwave therapy are suggested, alongside surgical options like penile implants and revascularization surgery for specific cases.

Conclusions:

• ED management requires a personalized approach.
• A stepwise treatment strategy is recommended, starting with PDE5I and progressing to other modalities as needed.
• Comprehensive management includes educational interventions, lifestyle modifications, and addressing comorbidities.