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Medical Management - ED

  • Time
  • Psychotherapy and Sexual Counseling
  • Hormonal Therapy
    Delivery sytems:
    • Intramuscular route
    • Testoderm; applied solely to scrotal skin
    • Androderm; applied to any skin surface
    • Transdermal
  • Pharmacological Therapy
    Oral Agents:
    • Peripherally acting drugs, i.e., sildenafil citrate
    • Centrally acting drugs, i.e., phentolamine, yohimbine, apomorphine, and trazadone.
    • Intraurethral and transdermal agents
  • Intracavernous Injection Therapy
    • Combination of papaverine and/or phentolamine or PGE, by direct injection into the corpora to initiate an erection
    • A worrisome side effect of injection therapy is corporal fibrosis, which has been reported after papaverine injections and may occur (although less frequently) after prostaglandin therapy. Priapism occurs occasionally and usually responds to intracorporal pharmacotherapy with u-adrenergic agents such as ephinephrine, norepinephrine, ephedrine, or phenylephrine
    • Other experimental intracavemosal agents include VIP, moxisylyte, CG-RP, linsidomanine and sodium nitroprusside, and some newer phosphodiestrase inhibitors

Other Therapeutic Options

  • Neurostimulation.
  • Vacuum erection device
  • Corporal dilation and gene therapy

References

  • Batra AK, Lue TF: Physiology and pathology of penile erection. In: Bancroft J, ed. Annual Review of Sex Research. Iowa, Society for the Scientific Study of Sex, 1990, vol. 1, pp 251-263.
  • DeGroat WC, Booth AM: Neurol control of penile erection. In: Maggi CA, ed. The Autonomic Nervous System. Nervous control of urogenital system. London, Harwood, 1993, pp 415-513.
  • Dinsmore W, Evans C: ABC of sexual health: Erectile dysfunction. Br Med J 318:387-390, 1999.
  • Eid JF, Dutta TC: Vacuum constriction devices for erectile dysfunction: A longterm, prospective study of patients with mild, moderate, and severe dysfunction. Urology 54:891-893: 1999.
  • Goldstein 1: Current status of surgical correction of vasculogenic impotence. In Lytton B, Catalona WJ, Lipshultz LL eds. Advances in Urology, vol. 7, St. Louis, Mosby, 1994, p 155.
  • Arterial revascularization procedures. Semin Urol 4:252, 1986.
  • Hashmat AI, Rehman J: In: Hashmat, Das S, eds. The Penis. Philadelphia, Lea and Febiger, 1993.
  • Hellstrom, WJG ed: The Handbook of Sexual Dysfunction. San Francisco, The American Society of Andrology, 1999.
  • Iacono F, Barra S, DeRossa G: Microstructral disorders of tunica albuginea in patients affected by impotence. Ear Urol 26:233-239, 1994.
  • Kirby RS, Carson C, Webster GD, eds: Diagnosis and Management of Male Erectile Dysfunction. London, Oxford, Butterworths-Heinneman, 1991. Krane RJ, Siroky MB, Goldstein I, eds: Male Sexual Dysfunction. Boston, Little Brown, 1983.
  • Laumann E, Paik A, Rosen R: Sexual dysfunction in the United States. JAMA 281:537-544, 1999.
  • Lawless C, Cree J: Oral medications in the management of erectile dysfunction. JAm Board Fam Pract 11:307-314, 1998.
  • Lewis R, Barrett DM, eds: Problems in Urology, Impotent Man. Philadelphia, Lippincott, 1991, vol. 5.
  • Lewis RW; Long term results of penile prosthethesis implantations. Urol Clin North Am7:381-401, 1995.
  • Lewis RW: Arteriovenous surgeries: Do they make any sense? In: Lue TF, ed. World Book of Impotence. London, Smith-Gordan, 1992, pp 199-220.
  • Lue TF: Intracavernous drug administration: Its role in diagnosis and treatment of impotence. Semin Urol 2:100-106, 1990.
  • Luc TF: Editorial comment. J Urol 152:1661, 1994.
  • Lugg J, Rajfer J: Drug therapy for erectile dysfunction. A UA Update Series, vol. 15, lesson 36, 289-296, 1996.
  • Melman A, Gingell JC: The epidemiology and pathophysiology of erectile dysfunction. J Urol 161:5-11, 1999.
  • Masters WH, Johnson VE: Human Sexual Inadequacy. Boston, Little Brown, 1970. Montague DK: Editorial: Medical therapies for erectile dysfunction. J Urol 162:732, 1999.
  • Montague DK: The current status of penile prosthesis. A UA Update Series, vol. 8, lesson 29, 226-231, 1987.
  • Montague DK, ed: Disorders of Male Sexual Function. St. Louis, Mosby, 1987. Newman HF, Northrup JD: Problems in male organic sexual physiology. Urology 21:443-450, 1983.
  • Padmanathan H, Shabsigh R: Sildenafil citrate (Viagara): A review. A UA Update Series, vol. 18, lesson 35, 273-280, 1999.
  • Reidl CR, Plas E, Engelhardt P, Daha K, Pfluger H: Iontophoresis for the treatment of Peyronie's disease. J Urol 163:95-99, 2000.
  • Shabsigh R, Fishman IJ, Toombs BD, Skolkin M: Venous leaks: Anatomical and physiological observations. J Urol 146:1260-1265, 1991.
  • Steers W: Erectile dysfunction. AUA News May/June 25, 1999.
  • Stief GS, Jonas U: Editorial: After the gold rush: Advancing research based care for patients with erectile dysfunction. J Urol 159:120-121, 1998.
  • Van Arsdalen KN, Wein AJ, Hanno PM, Malloy RT: Erectile failure following pelvic trauma: A review of pathophysiology, evaluation, and management, with particular reference to the penile prosthesis. J Trauma 24:579-585, 1984.
  • Walsh P, Retik A, Vaughan E, et al: Campbell's Urology, 7th ed. Philadelphia, Saunders Company, 1998.
  • Wagner G, Green R: Impotence. New York, Plenum, 1981. Zilbergeld B: Male Sexuality. New York, Bantam, 1978. Zorgniotti AW Lefleur RS: Auto-injection of the corpus cavernosum with a vasoactive drug combination of vasculogenic impotence. J Urol 133:39-41, 1985.