The American Urological Association (AUA), the European Urological Association (EAU) and the Chinese Guidelines for the Diagnosis and Treatment of Erectile Dysfunction (Guidelines) all classify the treatment of penile erectile dysfunction (ED) into first-line, second-line and third-line treatments. The Chinese Guidelines point out that while treating ED, risk factors for ED such as smoking, alcohol abuse, obesity, and drug abuse should be removed; primary diseases such as diabetes, hypertension, hyperlipidemia, and endocrine diseases should be actively treated; psychological factors such as anxiety and depression should be lifted; and behavioral treatments such as sexual medicine education and joint participation of couples should be strengthened. The first-line treatment for ED includes oral medication, psycho-behavioral therapy, vacuum negative pressure erection device and narrowing ring, etc. The milestone event for ED medication was the introduction of sildenafil (Viagra), the first highly selective phosphodiesterase type 5 inhibitor developed and marketed by Pfizer in 1998. The current oral medications for ED treatment include sildenafil, vardenafil, tadalafil, apomorphine, yohimbine, testosterone preparations and herbal medicines. 1, Viagra (sildenafil) commonly known as “Viagra”, the introduction of Viagra is epoch-making, it broke the low efficacy of oral drugs. The clinically recommended dose is 50 mg, taken 1 h before sexual activity, and can be increased to 100 mg based on efficacy and safety, and reduced to 25 mg in elderly patients or those with severe renal impairment. 2. Elidel (vardenafil) can be taken orally to achieve a full erection for sexual intercourse within 10 min at the earliest. Vardenafil is available in doses of 5 mg, 10 mg and 20 mg, with the clinically recommended initial dose of 10 mg, which can be adjusted according to efficacy and adverse effects. 3, cialis (tadalafil) cialis has a long half-life (17, 5h), the effect lasts 36h, and its effectiveness is not affected by diet such as alcohol or high fat. The recommended starting dose is 10 mg, and the efficiency of oral administration of 10 mg or 20 mg is 67% and 81%, respectively. 4, apomorphine apomorphine for mild to moderate organic ED and psychological ED patients have certain efficacy, the main adverse effects are nausea, vomiting, dizziness, sweating, drowsiness, yawning, hypotension, etc.. 5, testosterone preparations testosterone preparations are only effective for ED caused by hypogonadism, such as the exclusion of other endocrine hypogonadism, androgen replacement or combined with PDE5i has a certain effect. There are many methods of hormone replacement therapy, such as oral, topical dermal, intramuscular injection and subcutaneous implantation, as appropriate. Oral preparations such as testosterone undecanoate (Antel), commonly used dose 80~160 mg/d, divided into 2~3 times after meals. 6, Chinese medicine preparations Commonly used Chinese medicine formulas such as Liu Wei Di Huang Wan, Right Return Pill, Tonic Zhong Yi Qi Wan, Strong Kidney Tablets, Compound Xuan Ju Capsule, etc. Aphrodisiac herbs such as Epimedium, donkey whip, cuscuta, deer antler, wolfberry, etc. also have some effect in the treatment of ED. Second-line treatment When first-line treatment is ineffective or clearly contraindicated, second-line treatment methods such as intracavernosal drug injection or transurethral drug delivery can also be chosen. 1. Intracavernosal drug injection This method involves the injection of vasoactive drugs into the cavernous body of the penis using a skin test syringe, which usually induces erection in 5 to 10 minutes. The vasoactive drugs injected include poppy bases, phentolamine, prostaglandin E1, etc. 2, intra-urethral administration The preparation for intra-urethral administration is MUSE developed in the United States, the active ingredient of which is Prostil. Befar is a new cream for the treatment of ED by the transurethral route, which uses transdermal technology to enhance the absorption of the drug. The third line of treatment for ED is surgery, which involves penile prosthesis implantation and vascular surgery, the latter including penile artery reconstruction and penile vein ligation. 1. Penile prosthesis implantation Penile prosthesis includes a single set of flexible support and two and three sets of expandable support, which is a semi-permanent treatment method by surgically implanting penile support in the penile corpus cavernosum to assist penile erection to complete sexual intercourse. Since the three-piece expandable support can achieve a function close to normal penile erection, the satisfaction of patients and sexual partners after implantation is as high as 98% and 96%. 2.Penile vascular surgery Including penile artery reconstruction and penile vein ligation. Penile artery reconstruction surgery is only applicable to young patients with congenital or traumatic arterial blood supply deficiency. For young patients with arterial ED caused by trauma, the long-term cure rate of penile revascularization is about 60% to 70%. The common surgical methods of penile artery reconstruction include anastomosis of the inferior abdominal wall artery to the dorsal penile artery, anastomosis of the inferior abdominal wall artery to the cavernous artery and arterialization of the deep dorsal penile vein. Penile vein ligation is only indicated for young patients with incomplete venous occlusion or venous leakage. Surgical procedures for penile venous leakage include: dorsal deep penile vein ligation/excision, dorsal deep penile vein encapsulation, cavernous pedicle vein ligation/folding, dorsal deep penile vein arterialization, spiral vein and guiding vein ligation, urethral cavernous stripping, and sclerosing vein embolization.