Use of surgical therapy for erectile dysfunction remains low, study shows

A recent study found that surgical therapy was only used in 1.1% of patients with erectile dysfunction (ED) across community-based urology practices in the US.¹

Overall, 1.1% of patients underwent a surgical procedure for ED during the study period.

The findings were presented by Juan J. Andino, MD, during a poster session at the American Urological Association (AUA) 2025 Annual Meeting in Las Vegas, Nevada.

“ED affects millions of men in the United States, and with an aging population, the incidence and severity of ED is expected to rise. However, rates of surgical treatment of ED have historically been low despite guideline-recommendations,” the authors wrote.

For the analysis, the investigators obtained data from the AUA Quality (AQUA) Registry, which provides de-identified data from 353 community-based urology practices across the US. The type of surgery was identified using CPT codes.

In total, 1,125,395 patients with ED met the inclusion criteria for the study and were included for analysis. Patients were excluded from the study if they had less than a year of enrollment before or after ED diagnosis.

Among all patients included for analysis, 1.1% (n = 12,364) underwent a surgical procedure for ED during the study period (2014 to 2023). There was a total of 14,406 surgeries performed, which included 10,880 virgin inflatable prosthesis placements and 481 virgin malleable prosthesis placements.

The median age of patients who underwent surgery was 65 years (IQR, 58 to 70). Overall, 60% of surgical patients were White, 19% were Black, 9% were Hispanic, and 0.6% were Asian.

Patients who underwent surgical therapy had higher rates of diabetes (23%; P < .05), Peyronie disease (15%; P < .05), prior radical prostatectomy (13%; P < .05), and prior radical cystectomy (0.4%; P < .05) compared with patients in the overall cohort.

The median time to proceeding with penile implant placement was 274 days (IQR, 78 to 802) across the entire cohort.

Hispanic men tended to proceed to surgical therapy more quickly than non-Hispanic men, with a median time to penile implant placement of 173 days (P < .001). Conversely, Black men faced a longer time to penile implant placement, with a median time to surgical therapy of 400 days compared with 278 days among White patients (P < .001).

Data from a regression analysis showed that Black (OR, 1.9) and Hispanic (OR, 1.8) patients were more likely to pursue surgical therapy compared with White patients (P < .001).

Based on these findings, the authors concluded, “Our analysis shows that across community-practices in the US, the use of surgical therapy for ED remains low at 1%. Furthermore, there are differences in likelihood of and time to proceeding with surgical therapy and these vary by race and ethnicity despite controlling for age, co-morbid conditions, and insurance. [These] findings underscore the need for targeted patient education on ED management and early education about the option for surgical therapy when appropriate.”

REFERENCE

1. Andino JJ, Borrell J, Galen E, et al. Trends in surgical management of erectile dysfunction: Data from the AUA Quality (AQUA) Registry. J Urol. 2025;213(5S):e973. doi:10.1097/01.JU.0001110060.12139.1b.23