[Erectile dysfunction. Review and current status of diagnosis and therapy].

A rational concept of the diagnostic evaluation and treatment of erectile dysfunction (ED) is based on the corpus cavernosum drug test (CCDT) employing in combination with penis Doppler sonography. A positive CCDT with erection within 10 minutes indicates psychogenic or neurogenic ED, which is treated with sexual therapy of intracavernous (self)injection (ICI, ICSI). An erection after 10-30 minutes and pathological Doppler sonographic findings document a hemodynamically relevant penile blood flow disturbance which is treated with papaverine administered by ICI or ICSI. A negative CCDT with normal Doppler findings correlates with venous insufficiency as the cause of ED. On the basis of the results of drug cavernosography the indication for venous or penile prosthetic surgery is established. Depending on the pathological Doppler sonographic findings, in negativ CCDT the surgical treatment comprises prosthesis implantation or, in suitable cases, revascularization procedures.