A. Preservative Treatment
If the man taking medicines that cause erectile dysfunction he should talk to his doctor to stop taking them.
Patients with hypogonadal should be treated with testosterone preparations while those with hyperprolactinemia should take bromocriptine
First -line treatment
This treatment include phosphodiesterase inhibitors (PDE5 inhibitors) and apomorphine. In hosphodiesterase inhibitors include sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). These medicines should be taken after a full investigation of the patient by the Andrology and initial dosage will depend on the patient’s age and other history
These medicines shouldn’t be taken immediately after fatty food (exception is tadalafil), since in this way reduced their activity.
Also patients who take these drugs is important to know that:
1. PROHIBITED TO TAKE THEM WITH NITRITE. If someone is already taking phosphodiesterase inhibitor and has retrosternal pain should be given directly to other drug substance and not nitrite. Nitroglycerin will be given 24h after administration sildanafilis and vardenafil and tadalafil after 48h.
2. Coadministration with antihypertensive can cause a drop in pressure, usually not significant.
3. Coadministration with a- blockers may cause orthostatic hypotension.
Side effects that may occur during treatment are the following:
• Visual disturbances
• Myalgia – Pain
Apomorphine and is first line drug that is given to patients where the administration of phosphodiesterase inhibitors is contraindicated and in those with psychogenic etiology erectile dysfunction. The dose is 2-3mg sublingual, acts on the central nervous system and can cause dizziness, vertigo, headache and vomiting.
Second -line treatment
As second -line treatment of erectile dysfuction means the injection method with vasodilating substances which they use when prior failure of the use of phosphodiesterase inhibitors.
By “Papaverine” refer to corpus (ie within the corpora cavernosa of the penis) injections. The substances used for this purpose is alprostadil (caverject) and the combination of papaverine, phentolamine and alprostadil. These substances act in blood vessels and cause increased blood flow to the corpus, and therefore erection. The most serious side effect that can cause is priapism, who dealt with intracavernous injection of phenylephrine. It should be noted that treatment with intracavernosal injections involves patients with skill, since after their initial training will be the ones who will carry out their own treatment.
3rd line therapy
This treatment consists of placing papaverine intent. The penile filler are two types: with pump (hydraulic) and without pump (not hydraulic). The hydraulic filler consist of a pair of bar apparatus, a pump and a reservoir, made of silicone elastomer. The patient whenever wants to have an erection, pressing the pump delivers fluid, which fills the cylinders where are placed in the corpus cavernosum and an erection is achieved. When you finish having sex, pressing again the pump, the fluid returns to the reservoir and achieved flaccid penis.
When, however, recommend penile prosthesis? Penile prosthesis recommended in the following situations:
1. Organic etiology erectile dysfunction as third -line therapy
2. Lack of response in other treatment or non- acceptance.
3. In fully informed patient
The penile revascularization procedures are divided into arterial and venous.
1. A new < 45 years without predisposing factors and vascular
2. Localized damage to the penile arteries traumatic etiology
The surgeries were widespread although previously longer applicable to specific cases because studies show that high rates followed by relapses.