Phosphodiesterase-5 inhibitors (PDE5-Is) transformed erectile dysfunction (ED) management as first-line therapy; nonetheless, many patients require second- and third-line options due to inadequate response, side effects, or contraindications. This article evaluates temporal trends in intracavernosal injection (ICI) therapy and penile prosthesis implantation (PPI) in Australia since PDE5-Is introduction.