Treatment of Organic Impotence When VED, Intraurethral, and Intracavernosal Therapies Have Failed
For men with impotence of organic origin whose prior non-surgical treatments did not achieve a penile erection sufficient for successful intercourse, a structured next-line protocol is available. This page summarises the clinical scenario and provides access to the complete evidence-based regimen.
Previous treatment line — failure condition
The prior line involved one or more of the following approaches:
- Vacuum erection device (VED) with vacuum limiter
- Intraurethral alprostadil pellet (dose titrated in office)
- Intracavernosal injection (ICI) of alprostadil as monotherapy
- ICI of papaverine plus phentolamine
- ICI of alprostadil plus papaverine plus phentolamine
- ICI of alprostadil plus papaverine plus phentolamine plus atropine
Goal not reached: Penile erection sufficient for successful intercourse.
Next-line approach — partial overview
When the therapies listed above have not achieved the required goal, the protocol moves to a surgical intervention involving a penile implant procedure. The full decision pathway, candidacy criteria, and sequenced regimen are available via the link below.
Goal: Penile erection sufficient for satisfactory sexual performance
References
DOI: 10.1016/j.juro.2018.05.004
- Men with ED should be informed regarding the treatment option of penile prosthesis implantation, including discussion of benefits and risks/burdens.
- Prosthesis implantation has been performed successfully in men from the general ED population as well as in men from a variety of special populations.
- Penile prosthesis surgery should not be undertaken if the man has evidence of systemic or cutaneous infections or if he has a urinary tract infection.
- Men and their partners should be thoroughly counseled regarding the benefits and potential risks of this treatment to ensure appropriate choice of device, realistic post-operative expectations, and potential for high satisfaction.
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