The urologist/andrologist is the specialist responsible for diagnosis and treatment of health problems related to the genitourinary tract, and his or her participation in comprehensive care for a patient with erectile dysfunction (ED) is fundamental and often indispensable. The urologists/andrologists should characterize the origin of ED because of their knowledge and familiarity of all diagnostic tests and second- and third-line therapy. The origin of ED is important to determine for various reasons, such as young people suitable for etiologic treatment, medicolegal reasons, or patients' wishes for a better understanding of their condition. A review of the diagnostic tests available as well as indications for second- and third-line therapy is presented. The close relationship between ED and urological disorders, such as benign prostatic hyperplasia, prostate cancer and their treatments, and renal failure, in association with penile conditions like Peyronie's disease, priapism, and possible androgen deficiency in men older than 50 years, places the urologist at the center of integrated treatment of male ED.
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Lue TF . Erectile dysfunction. N Engl J Med 2000; 342: 1802–1813.
Siegel T et al. The development of erectile dysfunction in men treated for prostate cancer. J Urol 2001; 165: 430–435.
Potosky AL et al. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study. J Natl Cancer Inst 2000; 92: 1582–1592.
Talcott JA, Clark JA, Stark PC, Mitchell SP . Long-term treatment related complications of brachytherapy for early prostate cancer: a survey of patients previously treated. J Urol 2001; 166: 494–499.
Martin E, Bennett A . Iatrogenic causes of impotence. In: Bennett A (ed). Impotence: Diagnosis and Management of Erectile Dysfunction. WB Saunders: Philadelphia, 1994, p 135.
Baniel J et al. Sexual function in 131 patients with benign prostatic hyperplasia before prostatectomy. Eur Urol 2000; 38: 53–58.
Martin-Morales A et al. Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfuncion Erectil Masculina Study. J Urol 2001; 166: 569–574, discussion 574–575.
Martin-Morales A . Lower Urinary Tract Symptoms (LUTS) and erectile dysfunction in a population-based survey. Data from the EDEM study. Int J Impot Res 2001; 13: S39.
Sengor F et al. Neodymium:YAG visual laser ablation of the prostate: 7 years of experience with 230 patients. J Urol 2002; 167: 184–187.
Chen J et al. Erectile dysfunction following Nd-YAG visual laser-assisted prostatectomy (VLAP). Int J Impot Res 1998; 10: 45–48, discussion 48–49.
Stoner E . Three-year safety and efficacy data on the use of finasteride in the treatment of benign prostatic hyperplasia. Urology 1994; 43: 284–292, discussion 292–294.
Giuliano F . Recommendations of the First International Consultation for the Treatment of Erectile Dysfunction. Available at http://www.ahc-net.at/uprima/ed/del_5.htm. Accessed 2003.
Rodríguez-Vela L, Gonzalvo A . Historia clínica y manejo inicial de la disfunción eréctil. In: Saenz de Tejada I, Allona A (ed). Erección, eyaculación y sus trastornos. Fomento Salud: Madrid, 1997, p 65.
Morales A, Heaton JP . Hormonal erectile dysfunction. Evaluation and management. Urol Clin N Am 2001; 28: 279–288.
Prostate-specific antigen (PSA) best practice policy. American Urological Association (AUA). Oncology (Huntingt) 2000; 14: 267–272, 277–268, 280 passim.
Woolf SH . Screening for prostate cancer with prostate-specific antigen. An examination of the evidence. N Engl J Med 1995; 333: 1401–1405.
Rodríguez-Vela L, Gonzalvo APG . Evaluación inicial del paciente impotente. Manejo diagnóstico y terapéutico. In: Rodríguez-Vela L, Rioja LA E (ed). Actualización en Andrología. Pulso: Barcelona, 2000, p 321.
Karacan I, Howell J . Use of nocturnal penile tumescence in diagnosis of male erection dysfunction. In: Tanagho E, Lue T, McClure R (ed). Contemporary Management of Impotence and Infertility. Williams and Wilkins: Baltimore, MD, 1988, p 95.
Morales A, Harris C, Condra M, Heaton J . Validation of visual sexual stimulation in the etiological diagnosis of impotence. In J Impot Res 1990; 2: 109.
Roselló M . Rigidometría de Inflexión Digital, Rigiscan y Eco-doppler en el diagnóstico de la disfunción eréctil. In: Rosello M (ed). Ultimos avances en el diagnóstico de la disfunción eréctil. Cuasba: Palma de Mallorca, 1996, p 179.
Rao DS, Donatucci CF . Vasculogenic impotence. Arterial and venous surgery. Urol Clin N Am 2001; 28: 309–319.
Pescatori ES, Hatzichristou DG, Namburi S, Goldstein I . A positive intracavernous injection test implies normal veno-occlusive but not necessarily normal arterial function: a hemodynamic study. J Urol 1994; 151: 1209–1216.
Rodríguez-Vela L, Gonzalvo A, Pascual D, LA R . Disfunción Eréctil. Acta Urol Españ 2002; 26: 667–690.
Nehra A, Moreland RB . Neurologic erectile dysfunction. Urol Clin N Am 2001; 28: 289–308.
Sarramon JP, Bertrand N, Malavaud B, Rischmann P . Microrevascularisation of the penis in vascular impotence. Int J Impot Res 1997; 9: 127–133.
Padma-Nathan H, Giuliano F . Oral drug therapy for erectile dysfunction. Urol Clin N Am 2001; 28: 321–334.
Zippe CD et al. Role of Viagra after radical prostatectomy. Urology 2000; 55: 241–245.
Hong EK, Lepor H, McCullough AR . Time dependent patient satisfaction with sildenafil for erectile dysfunction (ED) after nerve-sparing radical retropubic prostatectomy (RRP). Int J Impot Res 1999; 11: S15–S22.
Zelefsky MJ, McKee AB, Lee H, Leibel SA . Efficacy of oral sildenafil in patients with erectile dysfunction after radiotherapy for carcinoma of the prostate. Urology 1999; 53: 775–778.
Potters L et al. Potency after permanent prostate brachytherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2001; 50: 1235–1242.
Turk S et al. Erectile dysfunction and the effects of sildenafil treatment in patients on haemodialysis and continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 2001; 16: 1818–1822.
Barrou B et al. Early experience with sildenafil for the treatment of erectile dysfunction in renal transplant recipients. Nephrol Dial Transplant 2003; 18: 411–417.
Prieto Castro RM et al. Treatment with sildenafil citrate in renal transplant patients with erectile dysfunction. BJU Int 2001; 88: 241–243.
Dula E, Bukofzer S, Perdok R, George M . Double-blind, crossover comparison of 3 mg apomorphine SL with placebo and with 4 mg apomorphine SL in male erectile dysfunction. Eur Urol 2001; 39: 558–563, discussion 564.
Levine LA, Dimitriou RJ . Vacuum constriction and external erection devices in erectile dysfunction. Urol Clin N Am 2001; 28: 335–341.
Porst H . The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. J Urol 1996; 155: 802–815.
Rodríguez-Vela L, Moncada Irribarren I, Gonzalvo A . Tratamiento de la disfuncion eréctil mediante farmacoterapia intracavernosa. Acta Urol Espan 1998; 22: 291–319.
Montague DK, Angermeier KW . Penile prosthesis implantation. Urol Clin N Am 2001; 28: 355–361.
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Martin-Morales, A., Rodríguez-Vela, L., Meijide, F. et al. Specific aspects of erectile function in urology/andrology. Int J Impot Res 16 (Suppl 2), S18–S25 (2004). https://doi.org/10.1038/sj.ijir.3901239
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