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Volume 13, Issue 3 (May 2011) 13, 382–390; 10.1038/aja.2011.2

Combination therapy for erectile dysfunction: an update review

Rohit R Dhir1, Hao-Cheng Lin1,2, Steven E Canfield1,3 and Run Wang1,3

1 Division of Urology, University of Texas Medical School at Houston, Houston, TX 77030, USA
2 Department of Urology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, Nanjing 210008, China
3 Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA

Correspondence: Professor R Wang, (Run.Wang@uth.tmc.edu)

Received 8 January 2011; Revised 2 February 2011; Accepted 18 January 2011; Published online 21 March 2011


The introduction of oral phosphodiesterase-5 inhibitors (PDE5Is) in the late 1990s and early 2000s revolutionized the field of sexual medicine and PDE5Is are currently first-line monotherapy for erectile dysfunction (ED). However, a significant proportion of patients with complex ED will be therapeutic non-responders to PDE5I monotherapy. Combination therapy has recently been adopted for more refractory cases of ED, but a critical evaluation of current combination therapies is lacking. A thorough PubMed and Cochrane Library search was conducted focusing on the effectiveness of combination therapies for ED in therapeutic non-responders to PDE5I therapy. Journal articles spanning the time period between January 1990 and December 2010 were reviewed. Criteria included all pertinent review articles, randomized controlled trials, cohort studies and retrospective analyses. References from retrieved articles were also manually scanned for additional relevant publications. Published combination therapies include PDE5I plus vacuum erectile device (VED), intraurethral medication, intracavernosal injection (ICI), androgen supplement, α-blocker or miscellaneous combinations. Based on this review, some of these combination treatments appeared to be quite effective in preliminary testing. Caution must be advised, however, as the majority of combination therapy articles in the last decade have numerous limitations including study biases and small subject size. Regardless of limitations, present combination therapy research provides a solid foundation for future studies in complex ED management.

Keywords: combination therapy; intracavernosal injection; erectile dysfunction; phosphodiesterase-5 inhibitors; vacuum erectile device

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