Lack of diagnostic tools to prove erectile dysfunction: Consequences for reimbursement?

Purpose: Oral medications for treatment of erectile dysfunction may drastic ally increase health care expenses. Therefore, reimbursement for treatment will be limited in many countries. Proof of erectile dysfunction on an indi vidual basis may be required. We determine whether erectile dysfunction can be proved by pharmacostimulation tests. Materials and Methods: We prospectively evaluated 77 consecutive patients w ith a median age of 54 years (range 25 to 75) who presented with previously untreated erectile dysfunction, assessment included patient reported semiq uantitative data on sexual erections (rigidity, ability for vaginal intromi ssion, duration), standard clinical and laboratory tests, and intracavernou s injection test and color duplex sonography with 10 mu g. intracavernous p rostaglandin El. Data were compared on the basis of the most important comp laint, namely whether vaginal intromission was impossible, feasible only wi th manual assistance or possible but not long enough for satisfactory sexua l performance. Results: Of the 77 patients 36 (47%) were unable to perform vaginal intromi ssion, 28 (37%) needed manual help and 13 (17%) had erections sufficient fo r penetration but were not satisfied with sexual performance. Patient repor ts were reliable as shown by the significant correlation of items (r = 0.77 ) and significant discriminating power among categories for penetration (an alysis of variance p <0.001), In contrast, clinical response to intracavern ous pharmacostimulation and flow parameters assessed by color duplex sonogr aphy could not discriminate among the groups. Conclusions: Erectile dysfunction could not be defined by pharmacostimulate d erections but relevant erectile dysfunction was honestly reported. New an d reliable tests for clinical assessment are required to support the applic ation for reimbursement of treatment expenses for erectile dysfunction.