If a response to PDE5i is demonstrated, patients can continue with PDE5i alone; if there is no response, injection therapy is continued. Another study suggested that nightly Fildena (50 to 100 mg) can markedly increase the return of spontaneous erections after bilateral nerve-sparing radical prostatectomy. The study concluded that on-demand vardenafil had a greater success rate (34.5%) for restoration of erections when compared with nightly dosing (25%).
However, like many treatments for ED, this option presents adverse effects that deter its use, including pain, penile fibrosis, and priapism. This treatment option is successful and is used regularly for ED and penile rehabilitation. Self-injection therapy, as the term implies, uses a needle to inject medication directly into the base or side of the penis.
Alprostadil is a prostaglandin E1 (PGE1) that creates a vasodilatory effect on the blood vessels of the penis. However, they are often abandoned as a treatment option because of adverse effects, such as infection, cavernosal fibrosis, penile discomfort, bruising or numbness, or various mechanical failures of the device. These devices are a good option for many patients because they are a one-time expense and can be used in conjunction with a PDE5i to help maintain and sustain an erection.
Once an erection is achieved, an elastic tension ring is placed at the base of the penis to help maintain the erection. The tube is placed over the penis, which creates a vacuum that pulls blood into the penis. Patients should be stable on their α-blocker therapy before using an oral PDE5i.
Some patients uncomfortable with injection to penis. Alternative in patients failing PDE5i and/or vacuum erection device. May be less effective in men with diabetes or after some treatments for prostate cancer.
Numerous treatment options for ED are available for patients with cancer. ED TREATMENTS FOR PATIENTS WITH CANCER. All patients had a normal Doppler ultrasound 12 months after treatment of testicular cancer, and there were no differences in hemodynamics between those men with and without hypogonadism.
Of patients with seminoma, 66% were treated with radiation therapy; 79% with nonseminomatous germ cell tumor received chemotherapy, 18% underwent primary retroperitoneal lymph node dissection, and 20% underwent postchemotherapy retroperitoneal lymph node dissection. In a larger study, Gulino et al 29 looked at ED after glansectomy for locally confined carcinoma of the penis in 42 patients. Although their numbers were small (n = 6), they noted 50% reported normal erections but described intercourse as not very enjoyable” and were dissatisfied with their sex life.
Of patients who did use erectile aids, 32.9% maintained their preoperative erectile function score. Spontaneous erections in the nerve-sparing group variably returned over 12 months. They noted a statistically significant increase in penile end-diastolic velocity (suggesting a veno-occlusive dysfunction), which was improved significantly after 12 months in the nerve-sparing group.