Medical Treatment Of Erectile Dysfunction Research Articles

Major adverse cardiovascular events related to phosphodiesterase 5 inhibitors: analysis of real-life data from Eudra-Vigilance database.

Phosphodiesterase 5 inhibitors (PDE5i) are the standard medical treatment for erectile dysfunction. Aim of our study was to evaluate the rate of major adverse cardiovascular events (MACE) reported during PDE5i treatment based on Eudra-Vigilance (EV) reports. EV database is the system for managing and analyzing data on suspected adverse reactions to medicines which have been authorized or being studied in clinical trials in the European Economic Area. MACE are defined as non-fatal stroke, non-fatal myocardial infarction, non-fatal congestive heart failure, revascularization after aorto-coronary graft bypass and cardiovascular death. We recorded the number of MACE for sildenafil, tadalafil, vardenafil, avanafil per category and severity until 1st July 2023. Pooled Relative Risk (PRR) was used to compare data between drugs. Overall, 951 MACE events were reported. Most of them were observed in younger patients <65 years old (452/951 events, 48%). Overall, 377/8939 (4%) MACE events were observed for sildenafil, 221/5213 (4%) for tadalafil, 50/1029 (4%) for vardenafil and no events for avanafil. No significative differences were reported comparing sildenafil and tadalafil (PRR 0.71-0.99, IQR 0.61-1.35, P>0.05), neither sildenafil vs. vardenafil (PRR 0.68-0.79, IQR 0.43-1.55, P>0.05), neither tadalafil vs. vardenafil (PRR 0.77-0.95, IQR 0.64-1.30. P>0.05) even when compared for age. Comparison between different classes of age showed MACE were more frequent in patients younger than 65 years old taking sildenafil and tadalafil when compared to patients older than 85 years old (PRR 0.02-0.11. IQR 0.01-0.40. P<0.01) and when compared to patients in 65-85 class of age (PRR 0.02-0.12, IQR 0.01-0.95, P<0.01). Real life data is consistent with MACE related to PDE5i. PDE5is are infrequently (<5%) associated with MACE. However, risk seems higher in younger patients, particularly for sildenafil (452/951 events, 48%). Clinicians should consider these data when prescribing PDE5i especially in young patients.

(164) Potential Savings with Use of Cost Plus Pharmacy for Medical Treatment of Erectile Dysfunction

Abstract Introduction With its stated goal “to end ridiculous drug prices,” the Mark Cuban Cost Plus Drug Company (MCCPDC) launched in January 2022 with over 100 generic prescription drugs available to be mailed directly to patients without the involvement of health insurance. To promote drug cost transparency, all drugs are priced at the cost to manufacture the drug with a 15% administrative markup, a $3 pharmacist fee, and a $5 shipping fee. Prior research has focused on the theoretical savings MCCPDC could offer if Medicare purchased drugs at MCCPDC prices with studies reporting a potential $3.3 billion in savings for Medicare. Prescription drug spending is continuing to rise in the United States and providers are increasingly considering patient’s out-of-pocket costs. MCCPDC touts a transparent, consistent pricing model, but it is unclear if this pricing model will actually translate to cost savings for patients. Objective We sought to analyze if Mark Cuban Cost Plus Drug Company (MCCPDC) can offer savings directly to patients compared with other mail-order pharmacies, local pharmacies (based on zip code of our urology clinic) and with patients using health insurance to fill prescriptions for their sildenafil, vardenafil and tadalafil. Methods Out of the approximately 100 generic drugs available on MCCPDC website, we analyzed the 3 drugs that are prescribed to treat erectile dysfunction. We analyzed drug prices of 30 and 90-day prescriptions at the same dose of each medication. Using Good Rx prescription drug search engine, we compared the drug prices of the cheapest mail order and local in person pharmacies near our zip code. We also included prices for the recently started telemedicine company Roman. To compare if MCCPDC could offer savings to patients using health insurance to fill their prescriptions, we extracted the out-of-pocket drug costs for patients from the 2020 Medical Expenditure Panel Survey (MEPS; a national survey that compiles data from both the pharmacy and the survey respondent to determine the exact cost of each prescription filled during that year) and the 2020 Medicare Part D spending data. Medicare Part D spending data was used to estimate the out-of-pocket cost for each medication, which is approximately a 25% copayment for Medicare prescriptions. Results MCCPDC offered the lowest direct-to-consumer price on sildenafil and tadalafil 90-day prescriptions (Table 1). MCCPDC saved patients approximately $10 per sildenafil and tadalafil prescription compared with the next cheapest option. We found additional, although smaller, savings at 30-day prescriptions for sildenafil and tadalafil. MCCPDC was not the cheapest option for vardenafil. Compared with Roman, MCCPDC offered cheaper prescriptions for sildenafil and tadalafil by over $300 and $900, respectively. Conclusions MCCPDC can offer significant cost savings to patients, especially considering the high number of sildenafil and tadalafil prescriptions each year. The transparency and consistency in pricing with MCCPDC can be utilized by providers when counseling patients on medical therapy options for erectile dysfunction. Disclosure No.

Efficacy and Safety of Different Modalities for Treatment of Erectile Dysfunction in Chronic Renal Failure Patients

Background Erectile dysfunction has been found to be significantly more common in men with chronic kidney disease (CKD) than in the general population. Objective of the Study Detection of the safest and most effective medical treatment of erectile dysfunction(ED) in chronic renal failure patients. Patients and Methods . This study was conducted at Ain Shams University Hospitals with a sample size of 60 patients: 15 patients per group. We assessed the improvement in the erectile function through assessment of IIEF (International Index of Erectile Function) score and EHS (Erection Hardness Scale) score pre- and post-administration of the drugs used in the study (oral sildenafil, oral vardenafil, oral tadalafil and intracavernosal injection of alprostadil). Results There is a statistically significant increase in IIEF score post-administration of the drugs used in this study with p value of &amp;lt; 0.001 and a mean difference of 6.92. The mean score of IIEF pre-administration of the drugs used was 8.13 and post-administration was 15.05. There is also a statistically significant difference in EHS score with p value of &amp;lt; 0.001 and mean difference of 1.4. The mean score of EHS pre-administration of the drugs was 1.22 and post-administration was 2.62. From the four drugs used in this study, Alprostadil showed the highest improvement in IIEF and EHS scores. The study also showed a negative correlation between age, duration of haemodialysis and serum creatinine with erectile function. In addition, there was a statistically significant decrease in pre- and- post-treatment IIEF and EHS scores in diabetic cases than in the non-diabetic cases. Conclusion There is high incidence of ED in CKD patients. The drugs used in the study showed improvement in the erectile function with mild side effects. Alprostadil had the best IIEF and EHS scores amongst the four drugs.

Stem Cell Therapy for Erectile Dysfunction: A Step towards a Future Treatment.

Background: The improvement of absent or partial response in the medical treatment of erectile dysfunction (ED) has led to the development of minimally invasive new treatment modalities in the field of regenerative medicine. Methods: A literature review on stem cell therapy for the treatment of ED was performed. We searched for the terms "erectile dysfunction" and "stem cell therapy" in PubMed and Clinicaltrials.gov. Literature searching was conducted in English and included articles from 2010 to 2022. Results: New treatment modalities for ED involving stem cell therapy are not only conceived with a curative intent but also aim to avoid unnecessary adverse effects. Several sources of stem cells have been described, each with unique characteristics and potential applications, and different delivery methods have been explored. A limited number of interventional studies over the past recent years have provided evidence of a safety profile in their use and promising results for the treatment of ED, although there are not enough studies to generate an appropriate protocol, dose or cell lineage, or to determine a mechanism of action. Conclusions: Stem cell therapy is a novel treatment for ED with potential future applications. However, most urological societies agree that further research is required to conclusively prove its potential benefit.

Inflammatory biomarkers may predict response to phosphodiesterase type 5 inhibitor treatment in patients with erectile dysfunction.

In this study, we aimed to evaluate the clinical utility of the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio (LMR), and monocyte/high-density lipoprotein cholesterol ratio (MHR) in predicting response to a phosphodiesterase type 5 inhibitor (PDE5i) when used as the first-line medical treatment of erectile dysfunction (ED). This study prospectively included 185 patients who were diagnosed with ED and started PDE5i treatment. After PDE5i treatment, 107 (57.8%) patients with an International Index of Erectile Function-5 (IIEF-5) score below 22 were assigned to Group 1, and 78 (42.2%) patients with an IIEF-5 score of 22 or above were assigned to Group 2. The outcome measures of the study were demographic characteristics and inflammation markers between the groups. The mean IIEF-5 change after PDE5i treatment was 6.1±4.2 points in Group 1 and 11.5±3.2 points in Group 2 (p=0.001). The mean age was 54.6±9.2 years in Group 1 and 47.8±10.3 years in Group 2 (p<0.001), and the median fasting blood glucose values of Groups 1 and 2 were 105 (36) mg/dL and 97 (23) mg/dL, respectively (p=0.010). The LMR and MHR values were 2.39±0.23 and 13.8±7, respectively, for Group 1, and 2.03±0.22 and 17±6.6, respectively, for Group 2 (p=0.044 and p=0.002, respectively). On multivariable analysis, younger age and increased MHR were independent predictors of benefit from PDE5i treatment. This study showed that only MHR as an inflammatory biomarker was an independent predictor for response to PDE5i in the treatment of ED. Also, several factors were predictive of treatment failure.

Impact of antiangiogenic treatment on the erectile function in patients with advanced renal cell carcinoma.

We longitudinally assessed erectile function as well as the willingness to use pro-erectile treatment in a cohort on AAT for advanced RCC. Thirty-seven patients with advanced RCC completed the five-item version of the International Index of Erectile Function (IIEF-5) and other interview items before (T0) and 12weeks into therapy (T12) with AAT. Patients were further asked if they were willing to use and pay out-of-pocket for on-demand treatment with phosphodiesterase-5-inhibitors (PDE-5i). Statistical analysis was performed using nonparametric hypothesis testing. The IIEF-5 score at T12 was significantly decreased compared with T0 (p<.001). Subjective patient satisfaction regarding their sexual lives was associated with higher IIEF-5 scores at both time points (p=.006 and p=.03, respectively). At T12, subjective sexual contentment showed a nonsignificant trend towards decline (p=.074). Patients who opted for medical treatment of ED showed significantly better IIEF-5 scores at both time points compared with the rest of the cohort (p<.001 and p=.005, respectively). In summary, AAT seems to have a negative effect on erectile function in RCC patients, however, the role of psychosocial issues warrants further elucidation. Affected patients may benefit from a proactive approach promoting medical treatment of erectile dysfunction during AAT.

Low-Intensity Extracorporeal Shockwave Therapy for Erectile Dysfunction

Erectile dysfunction (ED) is a common and disabling impairment in ability to attain and maintain erections for sexual activity. Currently approved medical treatments for ED mitigate the organic elements of the disease on a short-term basis but do not address the underlying physiological issues; ergo, they do not “cure” so much as “manage” ED. Shockwave therapy (SWT) has recently attracted a great deal of interest as a potential means to resolve the physiological circumstances that lead to organic ED. In this review, we investigate the mechanisms by which SWT may help resolve ED and explore the existing evidence on this modality for management of ED. Recent studies have revealed membrane receptors capable of converting mechanical deformation into molecular signaling in cells. Subsequent signal transduction via these pathways may explain the beneficial effects of SWT including (but not limited to) vasodilation, enhanced nitric oxide synthase (NOS) activity, angiogenesis, neuro-regeneration, activation of progenitor cells, tissue remodeling, and anti-inflammatory effects. A limited body of evidence supports a role for SWT in restoration of erectile function in men with ED. These data are hampered by short-term follow-up and ambiguity about optimal administration protocols. Pulse wave and SWT may be conflated by patients and some providers; however, these modalities are not equivalent in terms of energy transfer nor evidence basis for efficacy in ED. Shockwave therapy is an intriguing and counterintuitive approach to the problem of ED. Evidence from other organ systems and a limited body of direct evidence from animal models and human men with ED suggest that this modality may improve erectile function without the need for supplemental or adjuvant treatments. Additional mechanistic data will be informative. Optimal treatment protocols remain unclear. The long-term durability of erection improvement and potential need for repeat treatment with SWT remains unknown.

A Systematic Review of Penile Prosthesis Surgery in Organ Transplant Recipients.

There is an increased prevalence of erectile dysfunction in patients with solid organ transplant (SOT) compared with the general population. Many of these patients may become refractory to medical treatment of erectile dysfunction and penile prosthesis (PP) is often recommended. Concerns regarding the safety of PP in patients with SOT are due to their immunosuppressed state. We aim to review all current literature on the outcomes of patients with SOT who have received PP. A PubMed search was performed to identify articles pertaining to the outcomes of PP in patients with SOT. We identified and included 14 studies that report on outcomes of PP placement in 143 patients with SOT and 191 non-SOT controls from interval period from 1979 to 2019. Studies included retrospective cohort studies, case series, and case reports. Compared with non-SOT controls who had PP, aggregate analysis demonstrated that patients with SOT who had PP did not develop significantly increased overall complications. However, they were significantly more likely to experience future surgical complications. Our aggregate analysis demonstrated that patients with SOT are not at a significantly increased risk of overall complications when receiving a PP. Nevertheless, there is an increased risk of experiencing PP injury during subsequent surgeries, which may be mitigated by the earlier involvement of a urologist. Given the lack of recent data, large studies are prerequisite to further evaluate the safety and overall outcome of PP surgery in patients with SOT. Dick B, Greenberg JW, Polchert M, etal. A Systematic Review of Penile Prosthesis Surgery in Organ Transplant Recipients. Sex Med Rev 2021;9:636-640.

Utilization and prescription patterns of phosphidiesterase-5 inhibitor medications in the United States military health system.

Phosphodiesterase-5 inhibitors (PDE-5Is) are the first-line medical treatments for erectile dysfunction (ED), but are often restricted in public formularies. This study assesses PDE-5I usage among active-duty service members before and after the addition of sildenafil to the formulary of the Military Health System (MHS) in 2012. To assess, a cross-sectional evaluation was conducted, utilizing encounter and pharmaceutical claims data from the Military Health System Data Repository between 2010 and 2014. Separate zero-inflated, negative binomial models were used to assess changes in usage rates by prescription and by number of pills issued, for 37 947 patients. Increased PDE-5I usage was noted with select comorbidities, notably mental health and neurologic conditions. There was significant proportional variation in medication distribution following inclusion of sildenafil within the MHS formulary, with a minimal demographic impact on medication models. The average number of prescriptions decreased, while the quantity of distributed medications increased. A significant portion of PDE-5I recipients were young men, under 25 years old, who received medications on the first visit, which invites speculation about the effectiveness of treatment and appropriateness of use. Future studies aimed at evaluating prevalence in younger population may be of benefit.

Low-intensity extracorporeal shock wave therapy of vasculogenic erectile dysfunction - three-week treatment in a cohort of North Italian patients

Introduction/Objective. Although phosphodiesterase 5 (PDE 5) inhibitors represent the gold standard for medical treatment of erectile dysfunction (ED), they are not curative. Over the recent years, low-intensity extracorporeal shock wave therapy (LI-ESWT) has been proposed as a valid non-invasive therapy approach for ED. The aim of our work is to assess the shortened, three-week low-intensity extracorporeal shock wave therapy of vasculogenic ED. Methods. The study involved 32 patients with an International Index of Erectile Function (IIEF) score between 5 and 20, and whose vasculogenic ED had been proven through Doppler ultrasound. All the patients had a washout period of one month after previous therapy and agreed to discontinue the PDE5-I therapy during the follow-up. The LI-ESWT was applied for three weeks, twice weekly, without repeating. The patients were evaluated at baseline, after one, three, and six months with the IIEF, Doppler ultrasound, and the Beck Depression Inventory. Results. All investigated parameters (International Index of Erectile Function, Beck Depression Inventory and penile Doppler ultrasound parameters) showed statistically significant improvement just one month after the treatment, compared to pre-treatment values, in all investigated domains. The international index of erectile function passed from baseline values of 12.75 ? 4.62 to 14.87 ? 5.04 at one month after treatment (p &lt; 0.01). This trend remained positive in IIEF and all the parameters tested at the three-month and six-month follow-up. Conclusion. The shortened three-week low-intensity shock wave treatment of vasculogenic erectile dysfunction proved to be clinically effective.

Medical treatment of erectile dysfunction: too many medical prescriptions?

Erectile dysfunction (ED) is a worldwide commonly reported condition; epidemiological data showed a prevalence ranging from 2.3 to 53.4% within different population subsets. In this context, the advent of phosphodiesterase type 5 inhibitors (PDE5is) in the second mid of 1990s has deeply changed the treatment scenario of this bothersome condition. Being user-friendly compounds with an excellent overall safety profile, PDE5is emerged as the first-line treatment for ED, thus overcoming topical alprostadil and intracavernous injections (ICIs). However, available data on treatment-utilization patterns and medical prescriptions of PDE5is showed a range of as wide as 22-78% of patients reporting to purchase PDE5is even without a proper medical prescription. Moreover, an increase in the recreational use of PDE5is among young men has been observed in the last decades, with a worrisome diffusion of potential health-risky behaviours associated with this habit. Indeed, treatment of ED should carefully follow internationally based clinical guidelines to avoid inappropriate drug prescriptions, which may eventually expose treated patients to drug-related side effects. Thereof, a careful assessment of the so-called modifiable and reversible ED risk factors along with a patient-tailored screening for potential contraindications to the treatment itself should be performed in every case. Lastly, although conclusive data still lack, the potential association between life-risky PDE5is side effects (i.e. cardiovascular adverse events, melanoma skin cancer and worsening of prostate cancer outcomes) should be carefully taken into account when counselling patients for ED treatment.

A randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer and their female partners.

The diagnosis and treatment of prostate cancer is followed by substantive sexual morbidity. The optimal approach for intervening remains unclear. A three-arm randomised control trial was undertaken with 189 heterosexual couples where the man had been diagnosed with prostate cancer and treated surgically. The efficacy of peer-delivered telephone support versus nurse-delivered telephone counselling versus usual care in improving both men's and women's sexual adjustment was investigated. Assessments were undertaken at baseline (pre-test) with follow-up at 3, 6 and 12 months. At 12 months, men in the peer (p = 0.016) and nurse intervention (p = 0.008) were more likely to use medical treatments for erectile dysfunction (ED) than men in the usual care arm. Men in the nurse intervention more frequently used oral medication for ED than men in usual care (p = 0.002). No significant effects were found for sexual function, sexuality needs, sexual self-confidence, masculine self-esteem, marital satisfaction or intimacy. Although peer and nurse couples-based interventions can increase use of medical treatments for ED, this may not translate into better sexual or relationship outcomes. More research is needed into the optimal timing of interventions to improve sexual outcomes for men with prostate cancer and to identify the subpopulations that will benefit from them.

Tubing erosion of an inflatable penile prosthesis long after implantation.

IntroductionErosion through skin of connecting tubing of an inflatable penile prosthesis (IPP) has not been previously reported.AimThe aim of this study was to present a case of tubing erosion, review the pertinent literature, and discuss the possible causes and management options, including preservation of the device and its components.MethodsA 42-year-old male failing to respond to medical treatment for erectile dysfunction underwent insertion of an AMS 700 IPP in 1986. Six years later, a revision was necessary because of a leak in the right cylinder and 4 years after, the pump was replaced. Fourteen years after the original implant, he presented with a portion of the tube connecting the pump to the right cylinder eroding through the skin. There was no infection. The skin area involved was resected and the original pump and tubing were buried in a new scrotal pocket after thorough irrigation.ResultsThe IPP remained in place, allowing vaginal penetration and without infection for another 11 years. Three years later, it was de-functionalized, converted into a fixed volume device. It eventually was replaced 25 years after originally implanted with a semirigid prosthesis because it did not provide sufficient rigidity and because of concerns about the presence of “screws” detected during pelvic imaging.ConclusionsMechanical failures in the early IPP models, as illustrated in this case, were expected. However, the long survival of the device is remarkable. Erosion of the connecting tubing through the skin is unique and, under exceptional circumstances, may be managed conservatively without replacing components of the IPP. Clinicians unfamiliar with procedures involving inflatable devices need to be aware of “foreign bodies” visible in radiological examinations in men who have had revisions of an IPP. Morales A. Tubing erosion of an inflatable penile prosthesis long after implantation. Sex Med 2014;2:103–106.

Sexual Values as the Key to Maintaining Satisfying Sex After Prostate Cancer Treatment: The Physical Pleasure–Relational Intimacy Model of Sexual Motivation

Sexual dysfunction is the most significant long lasting effect of prostate cancer (PrCa) treatment. Despite the many medical treatments for erectile dysfunction, many couples report that they are dissatisfied with their sexual relationship and eventually cease sexual relations altogether. We sought to understand what distinguishes successful couples from those who are not successful in adjusting to changes in sexual function subsequent to PrCa treatment. Ten couples who maintained satisfying sexual intimacy after PrCa treatment and seven couples that did not were interviewed conjointly and individually. Interviews were transcribed and analyzed using grounded theory methodology. The theory that resulted suggests that individuals are motivated to engage in sex primarily because of physical pleasure and relational intimacy. The couples who valued sex primarily for relational intimacy were more likely to successfully adjust to changes in sexual function than those who primarily valued sex for physical pleasure. The attributes of acceptance, flexibility, and persistence helped sustain couples through the process of adjustment. Based on these findings, a new theory, the Physical Pleasure-Relational Intimacy Model of Sexual Motivation (PRISM) is presented. The results elucidate the main motives for engaging in sexual activity-physical pleasure and/or relational intimacy-as a determining factor in the successful maintenance of satisfying sexual intimacy after PrCa treatment. The PRISM model predicts that couples who place a greater value on sex for relational intimacy will better adjust to the sexual challenges after PrCa treatment than couples who place a lower value on sex for relational intimacy. Implications of the model for counselling are discussed. This model remains to be tested in future research.

Assessing satisfaction in men and their female partners after treatment with phosphodiesterase type 5 inhibitors for erectile dysfunction

The Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) and its partner version questionnaire were used to assess couples' satisfaction with the use of phosphodiesterase type 5 (PDE5) inhibitors to treat erectile dysfunction (ED) over a 3-month period. Of 161 ED patients, who together with their female partners were invited to answer separate questionnaires at home, 111 patients (68.9%; mean age 61.8 (23-87) years) and female partners (mean age 52.8 (22-77) years) returned completed questionnaires. Patients reported a substantially higher treatment satisfaction score and level of satisfaction with ED treatment than their female partners (P<0.001). Patients with milder severity of ED at baseline and better erectile function after treatment were more likely to be satisfied with the outcome of the treatment. Of the different aspects of satisfaction that patients were asked about, they reported the lowest level of satisfaction about their partners' feeling about continued treatment for ED. Our study shows that more patients than their female partners are more satisfied with medical treatment for ED. To maintain long-term therapy for ED, it is important to include female partners in the assessment and management of the therapy.

How to Evaluate the Efficacy of the Phosphodiesterase Type 5 Inhibitors

Several methods have been so far proposed to compare the effectiveness of the three available phosphodiesterase type 5 inhibitors (PDE5Is). Two urologists (E.C. and G.B.B.), together with the Controversy's Editor (E.A.J.), with expertise in the area of medical treatment of erectile dysfunction (ED) present the various perspectives on the evaluation of PDE5Is in ED. The use of the most popular psychometric tool, the International Index of Erectile Function, is presented by an expert psychologist (L.R.D.). Expert opinion supported by the critical review of the currently available literature. Trials have demonstrated that the PDE5Is are excellent drugs with a great specificity of action and an almost perfect tolerance profile. Some instruments for comparison of clinical efficacy have to be considered subjective (psychometry, patient's preference, changes in quality of general, or sexual life). Some others are more objective (hardness, hormonal levels, and local circulation). An evidence-based comparison of the three PDE5Is should in the future be rooted in both subjective and objective methods. This will be of paramount importance in the drug trial design of new, forthcoming PDE5Is. Comparison between PDE5Is using both subjective and objective parameters will permit to individuate, on the basis of the evidence, the subset of couples where one drug, or one dose, or dose regimen, is to be considered of first choice.

Current Status of Phosphodiesterase Type 5 Therapy in the Medical Treatment of Erectile Dysfunction

Current Status of Phosphodiesterase Type 5 Therapy in the Medical Treatment of Erectile Dysfunction

The Role of The Yohimbine, Apomorphine and İntraurethral Treatments in The Medical Treatment of Erectile Dysfunction

The Role of The Yohimbine, Apomorphine and İntraurethral Treatments in The Medical Treatment of Erectile Dysfunction

Recent Developments in the Medical Treatment of Erectile Dysfunction

Recent Developments in the Medical Treatment of Erectile Dysfunction

Intracavernosal Procedures in the Medical Treatment of Erectile Dysfunction

Intracavernosal Procedures in the Medical Treatment of Erectile Dysfunction