Management of erectile dysfunction in phosphodiesterase type 5 inhibitor nonresponders

Despite the effective use of phosphodiesterase type-5 inhibitors, a considerable number of patients fail initial attempts to manage erectile dysfunction with these medications. We reviewed the literature describing recent advances and future directions, and propose new regimens to manage nonresponders.

Patient education, psychological interventions, lifestyle changes and treatment of comorbidities are associated with improved erectile function. The administration of testosterone replacement combined with phosphodiesterase type-5 inhibitors promotes beneficial effects on erectile function in hypogonadal men. Combination of two different phosphodiesterase type-5 inhibitors at the same time is a promising approach, especially in individuals with more severe forms of erectile dysfunction, without increasing the incidence of adverse events. Although intracavernosal injection and penile prosthesis implantation are traditional and established therapeutic options to restore erectile function in refractory cases. Recent advances in medicine have expanded the therapeutic panorama, with emerging regenerative approaches, showing promising potential to restore erectile function.

The choice of the best strategies should be individualized according to the preferences of the patient and his sexual partner based on the advantages and disadvantages of the various options. Therefore, shared decision-making with the patient is strongly encouraged.