Erectile dysfunction (ED) affects approximately 40 to 50 million American men each year. The introduction of phosphodiesterase inhibitors, such as sildenafil, has revolutionized the care of these patients, but surgery still has a clear role when these inhibitors and other approaches fail or are contraindicated.
The surgical management of erectile dysfunction, including implantation of penile prostheses and penile vascular (arterial and venous) reconstruction are reviewed here. The correction of curvature abnormalities (ie, Peyronie's disease) and other aspects of erectile dysfunction are discussed elsewhere.
Surgical management of erectile dysfunction should be reserved for men who cannot use, or who have not responded to, first and second-line therapies. (See "Treatment of male sexual dysfunction", section on 'General principles'.)
Patients with curvature abnormalities (ie, Peyronie's disease) with ED or significant risk factors for future ED, are candidates for the placement of a penile prosthesis at the time of their reconstructive surgery.