[Ambulatory treatment of erectile dysfunction].

Intracavernous injection of vasodilating agents and vacuum constriction devices are the therapeutic alternatives in outpatients with secondary erectile dysfunction in Europe. The agents commonly used include papaverine, alprostadil and phentolamine, singly or in combination. Quality of erectile response has agent related characteristics and is dose-dependent. Optimal clinical response ranges from full response for adequate sexual performance to a duration exceeding patient's and partner's wishes. Therefore, the adequate response must be titrated for every patient individually. Vacuum erection devices are efficacious and well accepted from patients and their partners if they can accept the artificial aspect of this approach. Vacuum erection devices are not suitable for men in unstable relations. Injection therapy and vacuum device interfere with spontaneity. The medicated urethral system for erection (MUSE) is a new approach to deliver alprostadil to the corpus cavernosum. The application is more user-friendly than with injections but response rates for adequate satisfactory sexual performance are lower than with intracavernous injections. Therefore indications may be limited to specific etiologies such as neurogenic erectile dysfunction. There is currently no efficient pill on the market although a wide range of therapies are used. Approval and introduction of new oral treatments like Sildenafil and others are awaited by patients and physicians. The availability of new and highly efficient treatment options does not simplify evaluation and treatment of patients with ED. In the contrary they request refinements in the diagnostic process for etiologic diagnosis with subsequently least invasive treatment and minimal side effects.