title: Implants, mechanical devices, and vascular surgery for erectile dysfunction.
abstract: BACKGROUND
  The field of erectile dysfunction (ED) is evolving and there is a need for state-of-the-art information in the area of treatment. Aim. To develop an evidence-based, state-of-the-art consensus report on the treatment of erectile dysfunction by implants, mechanical devices, and vascular surgery.
  
  
  METHODS
  To provide state-of-the-art knowledge concerning treatment of erectile dysfunction by implant, mechanical device, and vascular surgery, representing the opinions of 7 experts from 5 countries developed in a consensus process over a 2-year period.
  
  
  METHODS
  Expert opinion was based on the grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.
  
  
  RESULTS
  The inflatable penile prosthesis (IPP) is indicated for the treatment of organic erectile dysfunction after failure or rejection of other treatment options. Comparisons between the IPP and other forms of ED therapy generally reveal a higher satisfaction rate in men with ED who chose the prosthesis. Organic ED responds well to vacuum erection device (VED) therapy, especially among men with a suboptimal response to intracavernosal pharmacotherapy. After radical prostatectomy, VED therapy combined with phosphodiesterase type 5 therapy improved sexual satisfaction in patients dissatisfied with VED alone. Penile revascularization surgery seems most successful in young men with absence of venous leakage and isolated stenosis of the internal pudendal artery following perineal or pelvic trauma. Currently, surgery to limit venous leakage is not recommended.
  
  
  CONCLUSIONS
  It is important for the future of the field that patients be made aware of all treatment options for erectile dysfunction in order to make an informed decision. The treating physician should be aware of the patient's medical and sexual history in helping to guide the decision. More research is needed in the area of revascularization surgery, in particular, venous outflow surgery.
authors.affiliation: Tulane University School of Medicine, Department of Urology, New Orleans, LA 70112, USA. whellst@tulane.edu
authors.forename: Wayne J G
authors.initials: WJ
authors.lastname: Hellstrom
authors.forename: Drogo K
authors.initials: DK
authors.lastname: Montague
authors.forename: Ignacio
authors.initials: I
authors.lastname: Moncada
authors.forename: Culley
authors.initials: C
authors.lastname: Carson
authors.forename: Suks
authors.initials: S
authors.lastname: Minhas
authors.forename: Geraldo
authors.initials: G
authors.lastname: Faria
authors.forename: Sudhakar
authors.initials: S
authors.lastname: Krishnamurti
mesh_terms: D001163:Arteriovenous Anastomosis; D007172:Erectile Dysfunction / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D019935:Penile Implantation / Q000379:methods*; D010413:Penis / Q000098:blood supply / Q000601:surgery; D010549:Personal Satisfaction; D014618:Vacuum; D014656:Vascular Surgical Procedures / Q000379:methods*