Organic Impotence in Testosterone Deficiency When Prior ED Device and Injection Therapies Have Not Achieved Satisfactory Erection
This protocol applies to men with impotence of organic origin and confirmed testosterone deficiency who did not achieve an erection sufficient for successful intercourse after an adequate trial of second-line device-based and local therapies.
Testosterone deficiency confirmed by morning serum total testosterone below 300 ng/dL, with the presence of corresponding symptoms and signs, in a man presenting with organic impotence.
A trial of second-line therapies — including vacuum erection device (VED) with vacuum limiter; intraurethral alprostadil pellet; or intracavernosal injection (ICI) approaches (alprostadil monotherapy; papaverine plus phentolamine; alprostadil plus papaverine plus phentolamine; or alprostadil plus papaverine plus phentolamine plus atropine) — did not achieve the target of penile erection sufficient for successful intercourse. This protocol describes the next clinical step after that failure.
The evidence-based approach at this stage involves a surgical intervention. The complete regimen — including procedural details, device considerations, and the full counselling requirements — is available in the structured protocol below.
Penile erection sufficient for satisfactory sexual performance.
References
DOI: 10.1016/j.juro.2018.05.004
- Serum total testosterone should be measured in all men with ED to determine if testosterone deficiency (TD), defined as total testosterone <300 ng/dL with the presence of symptoms and signs, is present.
- 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.