Urologists offer more options for treating erectile dysfunction

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By Will Boggs MD

NEW YORK (Reuters Health) - Urologists and non-urologists differ in their management of men with erectile dysfunction (ED), according to survey data from the U.S.

"While oral medications can be very effective, many men do not respond to these medications, and these men might benefit from another approach, such as injection therapy," said Dr. Joshua A. Halpern of Northwestern University Feinberg School of Medicine, in Chicago.

"The fact that non-urologists almost never ordered these medications, and even urologists rarely did so, may indicate that a substantial proportion of men are being undertreated for erectile dysfunction," he told Reuters Health by email.

In the U.S., ED might be treated by urologists, primary-care physicians, and a variety of other specialists, but the extent to which ED is managed and how it is treated by each provider group is unknown.

Dr. Halpern and colleagues used data from the National Ambulatory Medical Care Survey between 2006 and 2016 to characterize the epidemiology, diagnosis and outpatient treatment of ED.

Among the more than 2,000 patient visits associated with a diagnosis of ED, most were with urologists (58.0%), followed by family practitioners (26.2%) and internists (10.4%).

A diagnosis of ED was associated with 1.1% of internal-medicine outpatient visits, 1.2% of family-practice visits and 8.7% of urology visits.

Men seeing a urologist for ED were more commonly over the age of 65 (47% vs. 23% among those seeing non-urologists) and were more likely to have Medicare (41% vs. 24%) and less likely to be self-pay (2.7% vs. 8.8%) or to use other state-based insurance programs (2.4% vs. 10.7%).

Significantly more men seeing urologists than non-urologists had an active cancer diagnosis (24.2% vs. 2.8%), whereas men seeing non-urologists were more likely to be active smokers and to have depression, obesity, or diabetes, the researchers report in Urology.

About two-thirds of men seen by non-urologists were treated with phosphodiesterase-5 inhibitors, compared to only about half of men seen by urologists. Non-oral therapies (including intracavernosal injections and intra-urethral agents) were almost exclusively ordered by urologists (2.72% of patients versus 0.25% of patients, P<0.05).

"ED is a very common problem for men in the United States, and it generates a high volume of visits to physicians," Dr. Halpern said. "We hope that both primary-care physicians and specialists will continue to be proactive in both asking their male patients about sexual health and function and in helping them to pursue the wide array of treatments that are available to help men achieve a fulfilling sex life."

"There is great opportunity for collaboration between primary-care physicians and specialists when it comes to the treatment of erectile dysfunction," he said. "On a broad scale, increasing the dialogue and partnership between professional societies in creating guidelines and educational materials for both physicians and patients could be quite helpful. Locally, it is important to create and foster close relationships between primary-care physicians, cardiologists and urologists in order to optimize care for men suffering from ED."

Dr. Halpern added, "As urologists, we welcome any opportunity to collaborate with non-urology colleagues to optimize patient care, and we hope that our work promotes future efforts to do so."

SOURCE: https://bit.ly/36vnrer Urology, online September 23, 2020.

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