• Author
    Ahmed Elauri
  • Discovery PI

    Dr. Sriram Eleswarapu

  • Project Co-Author

    Ha-Jung Kim, Drew Peterson, Jim Yee, Jesse N. Mills, Sriram V. Eleswarapu

  • Abstract Title

    Erectile Dysfunction Evaluation Remains AUA Guidelines-Discordant Across Clinical Settings

  • Discovery AOC Petal or Dual Degree Program

    Basic, Clinical, & Translational Research

  • Abstract

    Introduction 

    Patients with erectile dysfunction (ED) seek treatment from primary care physicians (PCPs), urologists, and increasingly online direct-to-consumer (DTC) pharmacies. Our group previously showed that DTC platforms overlook crucial pathology and do not follow the 2018 AUA Guidelines on Erectile Dysfunction. We sought to evaluate whether PCPs and urologists manage ED in a guidelines-concordant fashion.

    Methods

    In this IRB-approved, retrospective analysis, we identified males ≥18 years with ICD-10 diagnoses of ED who were prescribed a phosphodiesterase-5 inhibitor (PDE-5i) during 1/01/2019-10/01/2025. Men with prior history of bilateral orchiectomy, benign prostatic hyperplasia, pulmonary hypertension, and Raynaud’s phenomenon were excluded. Medical records were queried to identify prescribing practitioner (PCP vs. urologist) and compliance with 11 AUA guideline-based metrics: “clinical principles” (CP) include blood pressure, heart rate, BMI, BUN/Cr, lipid panel, fasting glucose, HgbA1c; moderate recommendations include serum testosterone, mental health referral; and “may be appropriate” include thyroid panel and PSA.

    Results 

    We identified 22,528 men with ED on oral PDE-5i during the query period. 28% of patients had values for 7/7 guideline-directed CP within 12 months. Men prescribed PDE-5i by PCPs had a median of 6/7 CP evaluated within 12 months prior to prescription, and 5/7 within 3 months prior. Men prescribed PDE5i by urologists had a median of 3/7 CP evaluated within 12 months of prescription, and 3/7 within 3 months prior. Among guideline-directed moderate recommendations, urologists were more likely to evaluate testosterone (13.7% vs. 5.4%). PCPs referred for mental health evaluation more often (17.3% vs.11.9%). Availability of lipid panel was the largest discrepancy (PCPs 64.0% vs. urologists 27.7%). For situational guideline recommendations, PCPs were more likely to have thyroid panel and PSA than urologists. 

    Conclusion

    Despite the existence of comprehensive AUA guidelines on the evaluation and management of ED, there remain significant gaps in guideline-directed workup, with differences in approach between urologists and PCPs. These represent opportunities for education and practice improvement among all physicians.

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