A Single-Arm, Dose Escalation of an Intraurethral Alprostadil Paste for Erectile Dysfunction

Inclusion Criteria: * Have had a confirmed clinical diagnosis of ED for more than three months based upon IIEF * Have failed PDE5 inhibitor therapy (inability to achieve an erection with adequate rigidity to allow penetrative sex) * Ability to take oral medication (sildenafil) and be willing to adhere to the study intervention regimen * Engaged in heterosexual relationship with partner for a minimum of 6 months Exclusion Criteria: * History of unstable medical or psychiatric condition that, in the opinion of the principal investigator, could impact the patient's ability to complete the study investigations or protocol. * Spinal cord injury, or penile anatomical abnormalities * Cardiovascular conditions that prevent sexual activity (NYHA Class II or higher, any angina, or uncontrolled CHF or severe coronary artery disease) * History of myocardial infarction, stroke, or life-threatening arrhythmia within 6 months prior to enrollment into the study * Use of anti-androgens, or oral or injectable androgens * Documented hypotension or known orthostatic hypotension * Use of oral, topical or sublingual nitrates within 3 months prior to enrollment into the study * Hepatic (Child-Pugh Class C) or renal failure (eGFR \< 30) * Inadequate response to intracavernosal injection therapy previously * Peyronie's disease or Meatal stenosis