RESUMEN
OBJECTIVES: To investigate clinical features of Chinese patients with severe primary erectile dysfunction (S-PED) and to identify the ideal treatment options for this population. METHODS: Patients with PED were screened for enrollment in our study. Sexual history, marital status, and erectile function were evaluated by inquiry including International Index of Erectile Function-5. Individuals with severe PED (defined as refractory to management with phosphodiesterase type 5 inhibitor [PDE5i]) underwent serum hormone analysis, penile color duplex Doppler ultrasound, neuroelectromyogram, and cavernosography as appropriate. Long-term treatment results were determined. RESULTS: Among 220 PED patients, 72 (32.7%) suffered from severe PED (PDE5i nonresponse). Mean age was 31.5 +/- 4.5 years and mean duration of attempts at sexual activity was 2.4 +/- 3.2 years, Sixty-eight men (94.5%) had organic etiologies for erectile dysfunction, including arteriogenic (n = 13), venogenic (n = 35), endocrinologic (n = 6), neurologic (n = 9), and cavernosal fibrosis (n = 5). Sixteen men (22.2%) had been divorced. Mean erectile function and quality-of-life were significantly improved (P <.001) in the 25 men (34.7%) who were treated by penile prosthesis implantation, at a mean follow-up of 5.6 years. Satisfaction with penile prosthesis for patients and partner was 93.4% and 92.3%, respectively. CONCLUSIONS: Severe PED has a major impact on young couple's life quality. Venous leak is the most common cause of severe PED. Penile prosthesis implantation is safe and effective for severe PED.