INTRODUCTION
The primary goal in the treatment strategy of a patient with Erectile Dysfunction (ED) is to determine the aetiology (vascular, neurological, hormonal, psychogenic) of the disease and treat it when possible, and not to treat the symptom alone. It is clear that ED may be associated with modifiable or reversible factors, including lifestyle or drug-related factors, which may be modified prior to, or together with, the employment of specific therapeutic operations. ED can be treated successfully today with current treatment options. Besides efficacy and safety, patients and partner satisfaction, as well as other quality of life items, are important endpoints when assessing treatment options.
FIRST LINE THERAPY
The first-line therapy for ED is oral pharmacotherapy. Among the drugs we can orally use on first approach we have some natural substances
(as Yohimbine, used as an aphrodisiac for almost a century), or actual drugs (Viagra®, Cialis®, Levitra®),which if appropriately used, are effective within 30-60 minutes from administration and can improve erections in over 70-80% of men with ED. Each of these drugs has its indications and its side-effects. Therefore ED-oral drugs must be carefully prescribed and monitored by a specialist.
SECOND LINE THERAPY
Patients not responding to ED-oral drugs may be offered the so called intracavernous therapy with high success rates of 85%. Intracavernous administration of vasoactive drugs was the first medical treatment for ED more than 20 years ago. Alprostadil (Caverject®, Viridal®) is the first and only drug approved for intracavernous ED treatment. It is necessary to perform a microinjection into the penis with this drug and then the erection appears after 5-15 minutes and lasts according to the dose injected. These drugs as well as those given orally, have the goal to treat and improve the circulation as well as the function of the penis. These penile microinjections can be used alone or together with Vacuum constriction Devices (devices which provide passive engorgement of the penis in conjunction with a constrictor ring placed at the base of the penis to retain blood within the penis). An office-training programme (one or two visits) is required for the patients to learn the correct injection process. After at home the patient can use intracavernous therapy not only to achieve a temporary erection to have sex, but also to continue the rehabilitation of the penile circulation (cavernosal gym).
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