Alternatives for non-PDE5-I responders in erectile dysfunction patients.

The management of a patient presenting with erectile dysfunction encompasses the classical complete history, physical examination, blood work-up, and radiographic or sonographic studies. Often the history directs the treatment toward counseling and psychosexual therapy with use of PDE5 inhibitors as the first-line approach. When the latter fails, other oral erectogenic drugs, vasoactive injectables, creams, or hormone treatment is given based on the work-up. In certain cases of vasculogenic etiology, ligation of venous leakers or revascularization of the penis may be appropriate. The port of last call is the penile prosthetic implant. The implant, however, is an all or none option, requiring surgical destruction of the corporal tissue before implantation, and once inserted, it the implant must function forever. Explantation because of infection or for other reasons renders the patient impotent unless another implant is inserted. The Brindley penile drug delivery implant provides a solution that, when no longer needed, can be removed and returns the penis to its preimplant status. If a vasoactive drug like prostaglandin works, the candidate is deemed suitable. The device uses sodium nitroprusside. Through minimal access (day) surgery, the magnitude of which is only a stage slightly higher than integumentary surgery and done within 20-30 minutes, this is an advance that is presented herewith with a full account of the components, preoperative preparation, drug filling and refilling, and a step by step account of the surgery.