Current role of local treatments for erectile dysfunction in the real-life setting.

PURPOSE OF REVIEW: Local treatments for erectile dysfunction include intraurethral alprostadil as well as topical alprostadil cream. They are alternative treatment options to oral or intracavernosal treatments that could overcome unmet needs in patient treatment.

RECENT FINDINGS: Intraurethral and topical alprostadil are two local methods of delivering an erectogenic drug to the patient. They have an established efficacy and a safety profile without important systemic adverse events. Efficacy data show that they result in significantly improved erections sufficient for sexual intercourse compared with placebo. Comparative efficacy data to other treatments are very limited. There are no specific contraindications to other drugs. They can be offered to patients who do not tolerate or do not respond to oral treatment. They can be also combined to oral treatment as a salvage therapy before proceeding to intracavernosal injections. The major advantages of them are the patient-friendly modality of delivering and the presence of minor local adverse events that are self-limited and mild in nature. Priapism or prolonged erections are very rare with local treatments.

SUMMARY: Local treatments can have an important role as a first-line treatment for erectile dysfunction or in drug combinations mainly because of their excellent safety profile.