Abstract
This article reviews contemporary treatment strategies for the aging male who does not demonstrate a satisfactory response to first-line oral phosphodiesterase-5 inhibitor agents for erectile dysfunction. More than half of men aged 40–70 years are unable to attain or maintain a penile erection sufficient for satisfactory sexual performance, with the prevalence of erectile dysfunction climbing to more than 75% among those aged over 70 years. However, the aging male may fail to respond to or express dissatisfaction with oral on-demand treatment. Clinically effective phosphodiesterase-5 inhibitor salvage strategies include patient re-education, lifestyle changes, correction of risk factors, dose adjustment, agent switching, androgen replacement and/or psychosexual or relationship counseling. Important new data supporting the safe and efficacious use of daily phosphodiesterase-5 inhibitor dosing schedules are reviewed. If required, progression to second- and third-line treatments is appropriate for most men, and may include intracavernous penile injections, vacuum erection devices, multimodality therapy or implantation of a penile prosthesis.
Financial disclosure
WOB: Eli Lilly Inc.: Meeting Participant/Lecturer; AMS, Coloplast, TIMM: Consultant/Advisor. GBB: Consultant/Advisor, Meeting Participant/Lecturer, or owns stock: Pfizer, Lilly, Bayer, GSK, Schering. TFL: Consultant/Advisor, Investigator, or Scientific Study/Trial: Biopharm GmbH, GSK/Schering-Plough, Eli Lilly Inc., Pfizer Inc., Sanofi Aventis. RGG: Consultant/Advisor: Triton Pharma. AJB: Eli Lilly Inc.: Consultant/Advisor and Meeting Participant/Lecturer; Pfizer Inc.: Consultant/Advisor and Meeting Participant/Lecturer.
Notes
Numeric score in brackets.
Data taken from Citation[10].
PDE5-I: Phosphodiesterase type 5 inhibitor.
Data taken from Citation[26–28].