Urologic considerations in geriatric erectile failure.

In summary, an understanding of the anatomy and physiology of erection demonstrates how vulnerable this mechanism is to age-associated urologic disease and surgery. Malignant disease or surgical resection of the pelvic organs can disrupt neural pathways, and vascular disease or its reconstruction can disrupt vascular channels. Fortunately, advances in our understanding of the pathophysiology and treatment of erectile failure now permit the clinician and patient to choose from a variety of options. Nerve-sparing techniques can be used in pelvic surgery, and orthoses or self-injection can be used for the patient who prefers a nonsurgical approach. Finally, when nonsurgical options are unsatisfactory, a penile prosthesis can be implanted with success in the vast majority of patients. Through a compassionate and conscientious approach to geriatric erectile failure, the clinician can help patients regain a portion of life that often remains important despite aging and disease.