Contemporary intracavernous pharmacotherapy for erectile dysfunction in the aging male

Abstract

With the introduction of phosphodiesterase type-5 inhibitors as a first-line, oral treatment for erectile dysfunction, intracavernous injection of vasoactive agents is regarded as a secondary therapy for most patients. However, clinicians evaluating the aging male must be aware of this important group of safe and effective therapies, since patients may be more appropriately treated for their erectile dysfunction with intracavernous prostaglandin E-1, papaverine or phentolamine (alone or in combination) owing to the presence of absolute contraindications to phosphodiesterase type-5 use, a failure to respond to these agents or patient preference. Ongoing research continues to define new options for the intracavernous treatment of erectile dysfunction, including gene transfer therapy. These efforts will probably result in the introduction of novel therapies with greater efficacy, tolerability and a more rapid onset of action, as an ever-expanding number and combination of agents is investigated. Until then, contemporary intracavernous vasoactive treatments will continue to successfully restore erectile function among patients with diverse erectile dysfunction etiologies and a variety of comorbidities.