Treatment Options for Erectile Dysfunction in Patients Failing Oral DrugTherapy

Oral drug therapy is the first line treatment for erectile dysfunction. Efficacy of oral drugs does not exceed 70%, while drop-out rate is high. Therefore, salvage strategies and second/third line treatment options are necessary to restore erectile function in such patients. The article reviews currently available data and comment on key issues that urologists address on their every day clinical practice. In order to do so, a literature-based critical presentation on the current methodological problems on definition of treatment failure, treatment outcome assessment and alternative therapeutic options was made. Emphasis was given in identifying truly non-responders, as proper instructions for oral drug administration and psychosexual counselling may reverse a substantial number of non-responders to responders. Medication, clinical and patient/partner related issues have been identify that may lead to treatment failure. Treatment outcome assessment based not only on quality of erectile response, but also on side effects profile and patient satisfaction is recommended. Treatment options for truly non-responders include intracavernosal injections, combination thera-pies, and penile prosthesis. Management strategy however, must identify patient and partner needs and expectations and involve them in the decision-making