Impotence: evaluation and treatment.

Impotence is a multifaceted problem. Complex neurologic pathways intermingle to control specific vascular changes in a tightly controlled hormonal milieu. Although great progress has been made in understanding the mechanism of erection, further studies are needed. Careful history and physical examination along with appropriate laboratory tests and noninvasive penile vascular studies are important in differentiating organic from psychogenic impotence. Understanding the etiology of impotence permits a more logical and effective treatment plan. The advent of the semirigid and inflatable penile prostheses has provided a simple and effective treatment for patients with organic impotence for whom there were no treatment options available in the past. The continued improvement in the design of the prostheses and the simplicity with which they can be implanted have revolutionized the treatment of impotence. With newer prosthetic devices being developed, the penile prosthesis will continue to improve the quality of life for impotent patients.