Surgery for Erectile Dysfunction: Current Indications and Future Perspectives

In most cases, a curative treatment is lacking for erectile dysfunction and a symptomatic treatment has to be undertaken. Symptomatic treatment is usually given in a stepwise manner, that is, from a less aggressive to a more aggressive approach. Less aggressive approach would be oral drug therapy, a second step would be local pharmacotherapy (intracavernosal or transurethral) and the last option would be surgical treatment with the implant of penile prosthesis. Only in a few occasions vascular surgery may be the solution for an arterial blockage or a venous leakage, in these cases the aim is curative and the urologist should be aware of this possibility. Penile implants offer a dependable way of restoring erections in virtually all motivated patients. The satisfaction rate among both patients and partners using these devices is high—in the range of 90%. Advances in technology have reduced the infection rate and increased the mechanical reliability of these products. Vascular surgery is less predictable than implant surgery and cases need to be carefully selected, but when selection is appropriate, successful outcomes are expected.