CLINICAL GUIDELINES PANEL ON ERECTILE DYSFUNCTION - SUMMARY REPORT ONTHE TREATMENT OF ORGANIC ERECTILE DYSFUNCTION

Purpose: The American Urological Association convened the Clinical Gui delines Panel on Erectile Dysfunction to analyze the literature regard ing available methods for treating organic erectile dysfunction and to make practice recommendations based on the treatment outcomes data. M aterials and Methods: The panel searched the MEDLINE data base for all articles from 1979 through 1994 on treatment of organic erectile dysf unction and meta-analyzed outcomes data for oral drug therapy (yohimbi ne), vacuum constriction devices, vasoactive drug injection therapy, p enile prosthesis implantation and venous and arterial surgery. Results : Estimated probabilities of desirable outcomes are relatively high fo r vacuum constriction devices, vasoactive drug injection therapy and p enile prosthesis therapy. However, patients must be aware of potential complications. The outcomes data for yohimbine clearly indicate a the rapy with marginal efficacy. For venous and arterial surgery, based on reported outcomes, chances of success do not appear high enough to ju stify routine use of such surgery. Conclusions: For the standard patie nt, defined as a man with acquired organic erectile dysfunction and no evidence of hypogonadism or hyperprolactinemia, the panel recommends 3 treatment alternatives: vacuum constriction devices, vasoactive drug injection therapy and penile prosthesis implantation. Based on the da ta to date, yohimbine does not appear to be effective for organic erec tile dysfunction and, thus, it should not be recommended as treatment for the standard patient. Venous surgery and arterial surgery in men w ith arteriolosclerotic disease are considered investigational and shou ld be performed only in a research setting with long-term followup ava ilable.