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Title: THREE TREATMENT CALLED EQUALLY EFFECTIVE FOR ERECTILE DYSFUNCTION ,  Geriatrics, 0016867X, Jan97, Vol. 52, Issue 1

Section: WHAT’S NEW

Source: American Urological Association

Three treatment options for erectile dysfunctionappear to be equally effective and safe, according to new American Urological Association (AUA) treatment guidelines.

“The therapeutic armamentar-ium for treating erectile dysfunction has greatly increased over the past two decades. Primary care physicians can help their patients with impotence problems by explaining the causes and various treatments available,” Jack McAninch, MD, president of the AUA, told GERIATICS.

The guidelines (see table) apply to the “standard patient.” He is a man who develops erectile dysfunction after a well-established period of normal function and whose dysfunction is primarily organic rather than psychological. He has no evidence of hypogonadism or hyperprolactinemia. According to the guidelines:

• Vacuum constriction devices use a plastic cylinder that fits over the penis and a pump to create a vacuum, which causes an erection. They have no serious side effects when used properly. For safety and efficacy, men using such a device should receive individual instruction on its use. Only devices available by prescription should be used.
• Penile injection therapy involves injection of vasoactive drugs into the corpora cavernosa to expand the arteries, relax penile tissue, and permit increased blood flow into the erection chambers. A firm erection is produced within 5 to 15 minutes of injection. If an erection lasts more than 4 hours, patients should be told to contact their physician.
• Penile implants consist of a prosthetic device implanted inside the penis to make it rigid. Once the prosthesis is implanted, the patient can create an erection at will. The guidelines advise physicians to obtain the concurrence of a psychiatrist or psychologist before providing implants to men with psychogenic erectile dysfunction.

According to the panel, the benefits of the oral medication yohimbine have been modest, with a pronounced placebo effect. Men who would benefit from yohimbine cannot be accurately identified before treatment. The panel also cites venous and arterial surgery as having unpredictable results and low reported success rates.

Physicians can order the guidelines and a patient guide from the AUA’s Health Policy Department at (410)223-4310 or its Fax Information Line at (410)223-4367. Ask for document #4504.

The following chart reads as follows: 
	
Row 1: TREATMENT 
	
Row 2: ADVANTAGES 
	
Row 3: DISADVANTAGES 
	
Vacuum constriction devices 
	
        Reliable and safe with no serious side effects when
          reputable prescription devices are used properly
        Patients can discontinue and try another treatment 
	
        Lovemaking must be interrupted
        Numbness or coldness of the penis and/or discomfort when
          ejaculating may occur 
	
Penile injection therapy 
	
        Tends to produce firm erection
        Easy to do with practice and usually painless
        Patients can discontinue and try another treatment 
	
        1 to 8% chance of prolonged erection, which can cause
          injury to the penis
        May cause scar tissue to form in the penis 
	
Penile prostheses 
	
        High rates of patient satisfaction
        Allows patient to create an erection whenever he wishes
        No change in skin sensation or ability to have an orgasm 
	
        Once a device is implanted, it is difficult to choose a
          different option; removal requires another operation
        Mechanical failure is possible, as are complications
from
          surgery

* Options are for the standard patient with organic erectile dysfunction

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