This protocol addresses men with impotence of organic origin whose erections remain insufficient for satisfactory sexual performance despite a structured course of oral therapy and lifestyle measures. A specific set of second-line interventions is indicated at this point.
The preceding treatment line — lifestyle modifications (diet changes, increased physical activity) combined with oral PDE5 inhibitors (sildenafil, tadalafil on demand, tadalafil once daily, vardenafil, or avanafil) titrated to optimal dose — did not achieve the goal of penile erection sufficient for satisfactory sexual performance. This protocol is the defined next step after that failure.
Penile erection sufficient for successful intercourse.
The protocol covers both device-based and direct pharmacological delivery options — including a vacuum erection device and approaches that deliver medication locally — each selected and individually titrated. The complete set of options, the selection algorithm, and all dosing guidance are contained within the full protocol.
DOI: 10.1016/j.juro.2018.05.004