Practical management of erectile dysfunction

Intracavernous pharmacotherapy has become the mainstay of medical treatment of erectile failure in our genitourinary clinic. Papaverine and phentolamine are used in combination as the first line agent and prostaglandin E 1 (PGE 1 ) is being used for non‐responders or those patients where papaverine plus phentolamine is inappropriate. Therapy is effective in producing erections sufficient for sexual intercourse in approximately 70–80% of cases. Priapism and corporeal fibrosis represent the most important side effects. Patient education regarding injection technique and drug usage is vital with regular clinic visits to detect development of fibrotic complications and for continued patient support. Trained medical staff must be available should priapism develop. Those patients who fail to respond to intracavernous pharmacotherapy are offered a vacuum constriction device. Selected patients may be referred to Urology for further management of erectile failure or to specialist counselling services for psychosexual therapy.