Book Review

Impotence: Diagnosis and Management of Male Erectile Dysfunction

N Engl J Med 1993; 329:439August 5, 1993

Article

Impotence: Diagnosis and Management of Male Erectile Dysfunction
Edited by Roger S. Kirby, Culley Carson, and George D. Webster. 262 pp., illustrated. Boston, Butterworth-Heinemann, 1992. $115. ISBN: 0-7506-1362-9

Discoveries in the fields of endocrinology, vascular physiology, neurology, and pharmacology during the past decade have been responsible for the evolution of the subspecialty of male erectile dysfunction. These scientific findings have demonstrated that in the majority of patients, erectile dysfunction has physiologic (vascular, hormonal, neurologic, or a combination of these) rather than psychological causes. This new knowledge led to the development of invasive and noninvasive tests to help determine the cause or causes of the dysfunction. Simultaneously, it was found that some drugs can act locally within the penis to induce an erection when injected into the corpora cavernosa. These drugs cause relaxation of both corporal and penile vascular smooth muscle, the primary event needed for an erection to occur.

Impotence attempts to synthesize this knowledge and present it in an understandable and rational way. Experts in the field from both sides of the Atlantic introduce basic mechanisms of the erectile phenomenon, explain how the patient should be evaluated, and discuss the therapeutic options. They conclude by focusing on special problems, such as priapism and Peyronie's disease. The chapters are generally easy to read, informative, and comprehensive, although they show a decided tilt toward the European approach to the field. The book highlights all the important invasive and noninvasive tests currently used in the work-up of impotent patients and discusses in detail the surgical and nonsurgical options. The chapter on cavernosal pharmacotherapy is especially well written and provides the practicing physician with a step-by-step protocol for treating impotent men with parenteral injections.

There is one drawback to this book, which is related to the fact that it has multiple authors. Many of the chapters are interrelated, and certain topics are discussed in detail in more than one chapter. Nevertheless, the book should be a useful source for the physician who is interested in male erectile dysfunction.

Jacob Rajfer, M.D.
UCLA School of Medicine, Los Angeles, CA 90024