What is your preferred second-line treatment for erectile dysfunction refractory to PDE5 inhibitors after radiation therapy for prostate cancer?

When PDE5i's fail after XRT for prostate cancer, my usual progression is to offer a duplex ultrasound to evaluate penile vascular integrity and to see if the response to Trimix is adequate and one that would be acceptable to the patient. If not, the other options would include VED and IPP.

Once PDE5 inhibitors are no longer effective, I counsel patients about all of their alternative options, including the advantages/disadvantages of each. I discuss vacuum erection devices, intracavernosal injections, intraurethral vasodilator gel, or penile implants. It is guidelines supported to dis...