Influence of cause on choice of therapy in 174 patients with erectile dysfunction.

In 174 impotent patients consistent application of modern diagnostic methods, including dynamic color duplex sonography, pharmacocavernosography, nocturnal penile tumescence monitoring and psychological exploration, led to invasive therapy in 38 and to self-injection therapy in 76. Analysis of patients who received penile implants and those who performed self-injection did not show an important effect of etiology of impotence on the choice of treatment. Therefore, if penile vascular surgery is excluded, diagnostic procedures can be limited to a simplified goal-directed panel. Once psychogenic impotence is excluded through nocturnal penile tumescence monitoring, application of vasoactive drugs serves only to select patients to be considered for self-injection therapy. Implant surgery will be reserved for patients who fail to respond to any drug applied.