title: Time course and predictors of use of erectile dysfunction treatment in a Veterans Affairs medical center.
abstract: The objective of this study was to define the pattern and time course of use of ED treatments in a Veterans Affairs (VA) medical center and to identify clinical or demographic variables that are associated with the use of second- or third-line ED treatments. We identified 702 men treated for ED at the Greater Los Angeles Veterans Affairs between 2007 and 2013. We extracted demographics, Charlson co-morbidity score, pertinent surgical/medication history as well as use of ED treatments from medical records. On multivariate analysis, age over 65 (OR 1.83, 95% CI: 1.31-2.56) and Charlson co-morbidity score of 1 (OR 1.77, 95% CI: 1.13-2.77) and 2+ (OR 2.07, 95% CI: 1.28-3.36) were significantly associated with use of medicated urethral suppositories for erection (MUSE)/intracorporal injections (ICI) compared with PDE5i/erection devices. Across all men who used second- or third-line treatments, median time until receiving MUSE was 0.6 years and median time until receiving ICI/implant was 2 years. We conclude that men who will ultimately use more invasive ED treatments, such as men with more co-morbidities, tend to have a prolonged treatment course. This information may be incorporated into a shared decision-making model for more efficient treatment of ED.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: R I
authors.initials: RI
authors.lastname: Clavijo
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Daskivich
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
authors.forename: L
authors.initials: L
authors.lastname: Kwan
authors.affiliation: Kaiser Permanente, Anaheim, CA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Bassett
authors.affiliation: Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Keller
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.|Greater Los Angeles Veterans Affairs Medical Center, Los Angeles, CA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Bennett
mesh_terms: D000367:Age Factors; D000368:Aged; D007172:Erectile Dysfunction / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010410:Penile Erection / Q000187:drug effects*; D019935:Penile Implantation; D015917:Penile Prosthesis; D058986:Phosphodiesterase 5 Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D058986:Phosphodiesterase 5 Inhibitors