Guideline of guidelines: a scoping review on comparison of major clinical guidelines for erectile dysfunction

Background: There are numerous published societal guidelines for the management of men with erectile dysfunction (ED), often with specific nuances and some variations in diagnostic and treatment strategies based on relevant locoregional factors such as sociocultural barriers and differences in emphasis between urological organisations versus sexual medicine societies. This “guideline of guidelines” narrative format will enable clinicians to identify best clinical practices, standardize the delivery of healthcare and address any inconsistencies so that future research can be undertaken to improve ED care pathways.

Methods: The review was conducted as a scoping review with a structured comparison of international clinical practice guidelines for the assessment and management of ED. Guidelines were identified through searches of official websites of major urological organisations and sexual medicine societies and published literature, with further review of references within each guideline. A total of eleven national and international ED guidelines were selected for inclusion in this study.

Results: Although first-line pharmacotherapy is well established, recommendations for patient assessment, investigation and further treatment differ across various guidelines. There was a wide consensus in the evaluation of men with ED, especially concerning cardiovascular risk assessment. Divergence was noted in testosterone screening thresholds, adoption of a stepwise management approach and sequencing of intracavernosal injection and vacuum erection device therapy in the treatment algorithm. While there is substantial agreement among the guidelines in assessment and core management principles, meaningful variation exists in testosterone testing thresholds, endocrine evaluation and therapeutic sequencing.

Conclusions: Clinicians need to be mindful of existing discrepancies (and similarities) among these major ED guidelines and to adapt specific nuances and tailor critical aspects of these guidelines based on locoregional factors and personalize the care in the ED model specifically to the individual patient.