A 55-Year-Old-Man Comes to the Office Due to Erectile Dysfunction

A 55-year-old-man comes to the office due to erectile dysfunction.  He has normal libido but has been unable to maintain a satisfactory erection to have intercourse.  The patient often wakes up in the morning with an erection.  He has no history of testicular injury or peripheral vision loss.  Medical history includes end-stage renal disease resulting from idiopathic focal segmental glomerulosclerosis.  Peritoneal dialysis was started 6 months ago due to intractable fluid retention despite high-dose diuretic therapy, and he is being evaluated for possible renal transplant.  The patient does not use tobacco, alcohol, or illicit drugs.
Temperature is 37.1 C (98.7 F) , blood pressure is 138/82 mm Hg, pulse is 76/min, and respirations are 12/min.  BMI is 25 kg/m².  Visual fields are normal on confrontation.  Testes are normal in size and consistency, and cremasteric reflex is present.  There is trace edema at the ankles and feet.
Laboratory results are as follows:
Which of the following is the most appropriate next step in management of this patient's erectile dysfunction?

A) Initiate testosterone supplementation
B) Order pituitary MRI
C) Prescribe intraurethral alprostadil
D) Prescribe oral sildenafil
E) Switch to hemodialysis

Correct Answer:

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