Reflexions on 50 Years of Sexual Medicine in Urology Focusing on Male Sexual Dysfunctions

Abstract

Diagnosis and therapy of male sexual dysfunctions made enormous progress over the last 50 years. Starting with the development of hydraulic penile implants in 1973 meanwhile several effective and well-tolerated conservative treatments such as the PDE-5 inhibitors avanafil, sildenafil, tadalafil and vardenafil, transurethral PGE1 (MUSE) and self-injection therapy with a variety of vasoactive drugs like alprostadil, papaverine/phentolamine (bimix), PGE1/papaverine/phentolamine (trimix/triple drug) or VIP (aviptadil)/phentolamine-Invicorp) have been developed for the treatment of ED. More recently Li-ESWT has provided impressive results both in PDE-5i responders and non-responders and partly also in Peyronie's disease. Regarding premature ejaculation (PE) meanwhile with oral dapoxetine and topical lidocaine/prilocaine spray two effective treatment options are officially available which may be combined in men with severe PE and with PDE-5 inhibitors in men with PE and ED. Hormonal disorders such as hypogonadism, hyperprolactinemia and thyroid disorders may be linked to male sexual disorders and successfully treated with T-substitution, prolactin inhibitors or thyroid specific medications.Whereas vascular surgery for ED such as deep dorsal vein ligation/resection or arterial revascularization procedures dominated the 80ies and 90ies last century they have been considered outdated and are replaced in severe ED of organic etiology by the modern new three piece inflatable penile implants whose high technical standard meanwhile provide 10 years survival rates of about 70 %.