RECOVERY OF SPONTANEOUS ERECTILE FUNCTION AFTER NERVE-SPARING RADICAL RETROPUBIC PROSTATECTOMY WITH AND WITHOUT EARLY INTRACAVERNOUS INJECTIONS OF ALPROSTADIL: RESULTS OF A PROSPECTIVE, RANDOMIZED TRIAL

Pharmacotherapeutic advances in the treatment of erectile dysfunction

An estimated 20 million to 30 million American men have erectile dysfunction (ED). The past 2 decades of research defining erectile physiology and investigating the pathogenesis of ED have led to the recognition of a predominantly vascular basis for organic male sexual dysfunction. These scientific advances have laid the foundation for the advent of pharmacotherapies. The Food and Drug Administration approval of intracavernosal, intraurethral, and oral pharmacotherapeutics for ED has revolutionized non-surgical management of this condition. The primary care physician is faced with the challenges of diagnosis and treatment of ED, as well as referral of patients to urologists. In this article, erectile physiology and pathophysiology are reviewed, and pharmacotherapeutics are classified and discussed by their mechanisms of action and the means of administration. A thorough understanding of these new therapeutic options is key to the accurate diagnosis and successful treatment of ED and maximal patient satisfaction and care.

Current concepts in the management of post‐radical prostatectomy impotence

Erectile dysfunction after radical retropubic prostatectomy has a multifactorial aetiology, including both neurogenic and vasculogenic factors. Postoperative potency is improved with preservation of the neurovascular bundles in a nerve-sparing procedure. Preoperative and intraoperative identification and preservation of accessory pudendal arteries may also improve postoperative potency rates. The early institution of treatment with intracavernous alprostadil appears to improve postoperative potency rates. Treatment with newer therapeutic agents, such as Sildenafil and Invicorp, are both efficacious and well tolerated.