An evaluation of a clinical care pathway for the management of men with nonorganic erectile dysfunction Journal Article
| Authors: | Jenkins, L. C.; Hall, M.; Deveci, S.; Guhring, P.; Parker, M.; Nelson, C. J.; Mulhall, J. P. |
| Article Title: | An evaluation of a clinical care pathway for the management of men with nonorganic erectile dysfunction |
| Abstract: | Introduction: There exists little literature on the outcomes of the medical management of men with erectile dysfunction (ED) with no overt organic etiology. Aim: This study was conducted to assess the outcomes of men with nonorganic ED treated medically. Methods: All patients had normal hormone profiles and vascular assessment. All were given a trial of a phosphodiesterase type 5 inhibitor (PDE5i). If no improvement was experienced, intracavernosal injection (ICI) therapy was administered. All patients were encouraged to seek a consultation with a mental health professional. Main Outcome Measure: Patient demographics, medical comorbidities, hormone and hemodynamics assessments, and change in International Index of Erectile Function scores of patients were recorded. Results: 116 men with a mean age or 38 ± 19 (range 16−57) years were studied. 21% had mild ED, 47% had moderate ED, and 32% had severe ED. 21% had seen a psychiatrist. 81% of patients responded to PDE5i with a penetration hardness erection on follow-up (mean duration of 7 ± 3 months postcommencement of PDE5i). However, only 68% of these were capable of a consistently good response. The mean Erectile Function domain score on PDE5i for the entire group improved from 18 ± 11 to 22 ± 6 (P = .01), and for PDE5i responders it was 27 ± 4 (P < .001). 28% of men (22 PDE5i failures and 10 with a mixed response to PDE5i) attempted ICI, all obtaining consistently functional erections. At a mean time point of 11 ± 5 months, 83% of those responding to PDE5i had ceased using PDE5i due to a lack of need. 11% of those using ICI continued to use them 6 months after starting ICI; the remainder had been transitioned back to PDE5i. Of the 29 patients in the latter subgroup, 66% were no longer using PDE5i consistently due to a lack of need. Clinical Implications: Not all men with nonorganic ED respond to PDE5i initially and many of those who respond do so only intermittently; such patients are potentially curable, using erectogenic pharmacotherapy for erectile confidence restoration, most men are capable of being weaned from drug therapy. Strengths & Limitations: The strengths of the study are the large number of patients and the use of serial validated instruments to assess erectile function outcomes. As a weakness, despite normal hormone and vascular assessments, the diagnosis of nonorganic ED is still a presumptive one. Conclusion: Medical management of nonorganic ED utilizing the process of care model results in cure in a large proportion of such patients. The transient use of ICI in some patients permits successful PDE5i rechallenge. Jenkins LC, Hall M, Deveci S, et al. An Evaluation of a Clinical Care Pathway for the Management of Men With Nonorganic Erectile Dysfunction. J Sex Med 2019;16:1541–1546. © 2019 International Society for Sexual Medicine |
| Keywords: | adolescent; adult; controlled study; treatment outcome; treatment response; major clinical study; drug tolerability; treatment duration; drug megadose; follow up; prospective study; demography; cohort analysis; retrospective study; population research; comorbidity; testosterone blood level; drug dose titration; erectile dysfunction; testosterone; phosphodiesterase v inhibitor; sildenafil; tadalafil; vardenafil; international index of erectile function; intracavernosal injections; pde5 inhibitor; human; male; priority journal; article; nonorganic erectile dysfunction |
| Journal Title: | Journal of Sexual Medicine |
| Volume: | 16 |
| Issue: | 10 |
| ISSN: | 1743-6095 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2019-10-01 |
| Start Page: | 1541 |
| End Page: | 1546 |
| Language: | English |
| DOI: | 10.1016/j.jsxm.2019.07.013 |
| PUBMED: | 31444103 |
| PROVIDER: | scopus |
| PMCID: | PMC6956862 |
| DOI/URL: | |
| Notes: | Source: Scopus |
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22Deveci -
600Mulhall -
387Nelson -
2
Hall -
63
Jenkins II
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