Update on erectile dysfunction treatment for aging men

Recent epidemiological studies clearly indicate that the incidence of erectile dysfunction increases with age. Thus, healthcare professionals managing the aging population should be prepared to properly diagnose and manage erectile dysfunction. There is no doubt that the introduction of type 5 phosphodiesterase inhibitors (PDE5Is) has revolutionized the management of erectile dysfunction. Currently, in the absence of contraindications, all three available PDE5Is, namely sildenafil, tadalafil and vardenafil are first line therapy for erectile dysfunction. Clinicians should be aware of the potential adverse events associated with the use of PDE5Is when counselling patients. Other adjunctive and second/third-line therapies for erectile dysfunction, including intracavernosal injection, transurethral application of medication, testosterone replacement therapy, vacuum construction device, sex therapy and penile prosthesis, have been used long before PDE5Is were available and continue to serve as safe and efficacious forms of erectile dysfunction management, even in cases that are refractory to PDE5Is. Clinicians should thus be aware of these various forms of management to help patients select the most appropriate forms of therapy for their erectile dysfunction. (C) 2008 Elsevier Masson SAS. All rights reserved.