Sustaining the Cure

Abstract

Oral pharmacotherapy fails to provide an adequate erection in approx 30 to 35% of all patients tried on this initial therapy, and at higher rates in those patients who have diabetes mellitus and those who have had radical pelvic cancer surgery. In those patients with initial success from oral pharmacotherapy, there have been few reports of complete tachyphylaxis, although many who are started on lower doses initially feel that they obtain better results from the oral therapy by increasing to the higher dose recommended for use. Dropout rates owing to intolerable side effects are rare with all of the phosphodiesterase inhibitors. Occasionally, some users of oral therapy cannot afford to continue the use of the oral agents and prefer a more economical treatment for their erectile dysfunction (ED). Vacuum therapy provides such a solution. Certainly, penile prostheses are less economical for such patients. If there is a progression of disease—such as Peyronie’s disease of a severe nature, or more fibrosis of sinus smooth muscle, such as that associated with diabetes mellitus—then a penile prosthesis may become the next step in therapy for the patient with ED.