Erectile dysfunction (ED) affects 20-30 million American men, most of whom are over 50 years of age. In a UK-based study, 32% of British men had difficulty obtaining an erection, 20% with maintaining an erection. In recent years the physiology and pathophysiology of ED have changed our understanding of what ED is from a purely psychological-based disorder to a multifactorial one, with neurological, endocrinological, psychological factors and the role of the vascular system. Recently identified risk factors include diabetes, cardiovascular disease, spinal cord injury, smoking, depression, atherosclerosis, hypertension, pelvic surgery and trauma, pharmacological medications, arthritis, peripheral vascular disease, substance abuse, endocrine abnormalities and peptic ulcer disease. Many ED patients have a combination of these risk factors, thus exacerbating ED further. The treatment of ED was revolutionized in 1998 with the introduction of sildenafil. Beside these oral treatments, newer injectable agents are being investigated as are topical preparations. However, not all patients are tolerant of oral agents, many patients still require penile reconstruction with penile implants, an option with low complications and morbidity. There are options for all patients and this excellent, updated text, edited by some of the world's leading authorities – Culley Carson, Roger Kirby and Irwin Goldstein – discusses them all.
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