A Retrospective Review of Men Referred to a Dedicated Erectile Dysfunction Clinic in Secondary Care

TL;DR

This study reviews how men with erectile dysfunction were managed in primary and secondary care, finding many could have been treated in primary care.

Contribution

The study provides insights into the effectiveness of primary care management for erectile dysfunction.

Findings

55 out of 148 men could have been treated in primary care, with 76.3% successfully managed using phosphodiesterase inhibitors.

Almost 60% of men treated in secondary care required second-line therapies like vacuum devices or alprostadil.

15% of patients needed surgical implantation of a penile prosthesis.

Abstract

Background and objectives

Erectile dysfunction (ED) is a multifactorial disease associated with many medical co-morbidities and risk factors commonly encountered in primary care. Initial management includes lifestyle changes and the treatment of any identifiable conditions. Guidelines exist recommending the assessment and management of sufferers with clear indications for referral to secondary care. With the outbreak of COVID-19, non-urgent medical services, including ED, were suspended, creating a significant waiting list for these patients. The aim of this study was to review the management of men in both primary and secondary care who had been referred to a dedicated ED service.

Materials and methods

A retrospective review of men referred to secondary care between June 2018 and April 2021 with ED was undertaken, reviewing whether the guidelines published by the National Institute for Health and Care Excellence (NICE) and GP Notebook for the assessment, initial treatment, and referral were followed by the primary care clinician. A secondary aim was to record the outcome of those men after review in a secondary care dedicated ED clinic.

Results

One hundred and forty-eight men were reviewed in the ED clinic, with 55 men (37.2%) requiring an intervention that was appropriate to have been delivered in primary care. The majority of those (76.3%) were successfully managed with a phosphodiesterase inhibitor. Of those treated in secondary care, almost 60% required a second-line therapy, such as a vacuum device or the administration of alprostadil, with 14 men (15%) necessitating the surgical implantation of a penile prosthesis.

Conclusion

With a rise in both the prevalence and incidence of ED, primary care physicians have a pivotal role in the screening and initial assessment of patients with ED, with evidence suggesting that a significant proportion can be successfully managed in this setting.