Organic Impotence: Next-Line Treatment After VED and Alprostadil-Based Therapy Has Not Achieved Sufficient Erection

Clinical Scenario

This protocol is for men with impotence of organic origin who have already attempted non-surgical therapies and have not achieved erections sufficient for successful intercourse.

Prior Therapy — Failure Condition

The preceding treatment line consisted of a vacuum erection device (VED), intraurethral alprostadil, or intracavernosal injection (ICI) of alprostadil — alone or combined with papaverine, phentolamine, and/or atropine. Escalation to this protocol is triggered when that therapy failed to achieve the goal: erection sufficient for successful intercourse.

Next-Line Approach (Partial Overview)

When the above non-surgical measures have been exhausted without adequate response, a surgical intervention is the recognised next step. The complete structured protocol — including candidate selection and procedural considerations — is available in the full regimen.

Instant Access to Structured Evidence-Based Regimens

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.
Penile prosthetic surgery should not be performed in the presence of systemic, cutaneous, or urinary tract infection.

View source ↗