The treatment choice of elderly patients with erectile dysfunction

The aim of this study was to determine treatment preference, commitment to choice of therapy, and the influence of physical disability on treatment choice in a geriatric group of males with erectile dysfunction (E.D.) of various etiologies. Eighty-nine patients aged 65 to 83 years (mean 69.5 years) were assessed and followed at our erectile dysfunction clinic from July 1991 to September 1996. Etiology of ED was based on clinical assessment. Available treatment options included oral medications, vacuum devices, injection therapy, penile prostheses, sex counseling and testosterone when indicated. Median follow-up since initial consultation was 9 months (range 1 to 63 months). Data was retrieved in a retrospective fashion from chart review and selective telephone follow-up. Clinical assessment yielded the following distribution of etiologies: vasculogenic (57.2%), neurogenic (7.9%), hormonal (1.1%), psychogenic (2.2%), and multifactorial (32.6%). The most popular initial treatment choices were injection therapy (30.3%), vacuum device (27.0%), and oral medication (20.2%). Of the 84 patients who chose to be treated, 34 (40.5%) elected to switch to a different form of therapy after a median time of 7.5 months (range 1 week to 63 months). Five patients tried a third form of therapy and two proceeded to a fourth. The remaining patients have continued with their original choice for a median time of 7 months (range 1 to 63 months). A greater drop-out rate (78%) amongst those who initially chose oral medication was statistically significant when compared to drop-out rates for injection therapy (48%) and vacuum devices (29%), p = 0.044 and p = 0.005, respectively. Significant physical disabilities in eight patients did not appear to influence their treatment selection. In conclusion, the elderly are a unique group of patients who are more likely to have an organic etiology to their erectile dysfunction. When they do present with erectile dysfunction, they are inclined to pursue treatment. The choices made by this group of men did not differ from impotent men in general. When unsatisfied with one form of therapy they were inclined to pursue an alternative treatment. A significant physical disability did not preclude a therapeutic choice.