Unveiling Treatment Adherence Gaps in Psychogenic Versus Organic Erectile Dysfunction

INTRODUCTION: Erectile dysfunction (ED) cases can be classified as "primary organic" (PO-ED) or "primary psychogenic" (PP-ED) according to the most likely etiology. This study aimed to assess adherence to phosphodiesterase type 5 inhibitor (PDE5i) therapy in men with PP-ED and PO-ED. MATERIALS AND METHODS: We conducted a retrospective analysis of 1252 men presenting with ED as their primary complaint and prescribed a PDE5i. According to the European Association of Urology Guidelines, patients were operationally categorized into two groups based on the presence (≥1) or absence (0) of recognized ED risk factors, in line with EAU guideline definitions (hereafter referred to as PO-ED and PP-ED for descriptive purposes). Comorbidities were assessed using the Charlson comorbidity index (CCI). All patients completed the International Index of Erectile Function (IIEF) at baseline and at treatment discontinuation or switch. Adherence was evaluated over 16 years using Kaplan-Meier survival analysis and Cox regression models. RESULTS: Of the 1252 patients, 211 (17%) had PP-ED and 1041 (83%) had PO-ED. PP-ED patients were younger (p < 0.001) with lower CCI (p < 0.001), healthier lifestyle habits (less smoking, alcohol use, and lower BMI; p < 0.01), and a more favorable biochemical profile (higher testosterone, lower HbA1c and triglycerides, higher HDL; all p < 0.01). Baseline IIEF domain scores were similar except for IIEF-OF, which was higher in PP-ED (p = 0.007). Overall, 614 (49%) patients discontinued treatment: 95 (45%) with PP-ED and 519 (49.8%) with PO-ED. At discontinuation/switch, IIEF scores were comparable except for IIEF-OF, which remained higher in PP-ED (p = 0.033). Adherence was significantly poorer in PO-ED (p < 0.001). Cox regression showed that PO-ED (HR 2.60, 95% CI 1.36-4.98) and sedentary lifestyle (HR 1.51, 95% CI 1.07-2.13) were independent predictors of discontinuation. CONCLUSIONS: In this real-life retrospective study, adherence was lower in patients with an organic risk factor burden compared with those without identifiable risk factors.