Diagnostic and therapeutic workup of erectile dysfunction: results from a delphi consensus of andrology experts

Introduction: Erectile dysfunction is a highly prevalent condition. Existing guidelines provide recommendations for diagnosis and treatment, but they are often disregarded in clinical practice in favor of a "patient-tailored" approach.Objectives: We planned a Delphi consensus method to bridge the gap between evidence-based medicine and the real-life approach in daily practice.Materials and Methods: The Advisory Board prepared 15 statements on debated topics in andrology, each including 4-6 items designed as a 5-point Liken scale. After a validation phase, the questionnaire was sent by e-mail to a panel of experts for a first round of voting; members of the panel were later invited to a second round of voting, preceded by discussion of the "hot topics" identified in the first round.Results: The first round of the Delphi consensus involved 101 experts; 71 (70%) also took part in the second round of voting. The Advisory Board deemed 22 items to be worthy of debate, and these underwent the second round of voting. "Real-life" results from the survey proved quite different from evidence-based recommendations.Conclusion: Although guidelines suggest the best approach for a "standard" patient, real-life settings require flexibility. Diagnostic and therapeutic approaches should be tailored to the patients' needs. Phosphodiesterase type 5 inhibitors are recognized as the first-line therapy in both settings, including the newly introduced sildenafil orodispersible film. Indications from the panel might help close the gap between recommendations from guidelines and real-life practice in relation to the diagnosis and treatment of erectile dysfunction. Copyright (C) 2019, The Authors. Published by Elsevier Inc. on behalf of the International Society for Sexual Medicine.