Who to refer
- PDE5 failures and CIs only
- Those with penile deformity (ask patient to bring photos of erect penis to OPA)
- For those with ED and hypogonadism (Testosterone below normal range) refer to endocrine dept. for consideration of supplementation
- Vitaros/ Caverject/ Muse therapy undertaken in Urology OPA in the absence of a specialist ED clinic currently.
Primary Care Workup
- Incidence of ED is approximately proportional to age, ie. 60% of 60y olds, with half that number severely affected. ED aetiology is usually a combination of organic and psychological causes.
- ED itself is a cardiovascular risk factor conferring a risk equivalent to a current moderate level of smoking (HR 1.46)
- The pro-active management of ED in the cardiovascular patient provides an ideal and effective opportunity to address other cardiovascular risk factors
- Mainstay of contemporary treatment is with PDE5i that can be instigated in primary care.
- Medical & psychosexual hx. Examination to include penile deformity?, BP and gross neuro exam, peripheral vascular exam.
- 1st line ( Majority of patients): HbA1c and lipids
- 2nd line: only if PDE-I failure or other signs of hypogonadism: 1st line bloods&Testosterone (sample taken before 11am)
- 3rd line: If 2nd line testosterone low (<8)- repeat Testosterone ( sample pre 11am) 1month later & Prolactin, FAI, SHBG, FSH, LH
Management prior to referral:
- Modifiable lifestyle changes
- Consider changing drugs associated with ED
- Psychosexual counselling where relevant (RELATE)
- Beware CI, concomitant nitrate use
Insertion of penile prosthesis is not routinely commissioned by NHS Kernow
Vacuum pumps can be purchased from reputable medial suppliers, see www.sexualadviceassociation.co.uk/pump
For prescribing guidance please see link: https://cks.nice.org.uk/erectile-dysfunction#!prescribinginfosub:4
All PDE5i similar efficacy overall, individual responses vary
Try Viagra & Cialis & Levitra at maximum dose x8 each drug taken 1-2x/week before declaring failure
Where PDEi successful subsequently titrate down dose
NICE CKS Erectile Dysfunction. July 2020 https://cks.nice.org.uk/erectile-dysfunction
Peninsula Pathology NHS Network Testing for Erectile Dysfunction, May 2021
Mr Mathialagan Murugesan, Consultant Urologist, RCHT
Mr Christopher Blake, Consultant Urologist, RCHT
Dr Bridgitte Wesson, GP Lead Urology
Date of Review: 14/06/2021
Next Review Due: 14/06/2022