Salvage of sildenafil failures referred from primary care physicians

Purpose: Sildenafil citrate is an effective first line agent for most causes of erectile dysfunction. Primary care providers (PCPs) write the majority of these prescriptions and most failures of sildenafil therapy are subsequently referred to urologists for alternative therapies. Often it is concluded that the drug is ineffective when in actuality the failure is do to inadequate patient education. We examined patients referred from PCPs who were nonresponders to sildenafil therapy and attempted to convert them to responders through reeducation. Materials and Methods: In a 2-year period 253 sildenafil nonresponders were evaluated by the same urologist (GNS). Patient reeducation consisted of viewing a brief videotape, personal instruction and detailed instruction sheets for the patient and his partner. Outcome measures were obtained through patient self-reporting of the Sexual Health Inventory for Men and a global assessment question. Responders were identified as those who answered positively latter or had a statistical improvement in the score of the former. Results: Of the 253 patients reeducated 17 were excluded due to contraindications. Of the remaining nonresponders 41.5% achieved salvage with reeducation. Incorrect administration accounted for 81% of the failures. Average time with the physician was 12 minutes and 94% of the patients continued to respond at 26 months. Conclusions: Approximately 40% of patients with sildenafil failures referred from PCPs can be converted to responders through reeducation. Incorrect drug administration was the most common reason for correctable failure. Reeducation can be done in an efficient manner. New package materials may improve sildenafil outcomes and compliance.