Abstract
Contemporary treatment algorithms for erectile dysfunction (ED) involve the use of medical therapies such as phosphodiesterase type 5 (PDE5) inhibitors and intracavernosal injection therapy of vasoactive agents, as well as vacuum erection devices and penile prosthesis implants in medically refractory cases. However, the current therapeutic options only address the symptoms of ED and not the underlying pathogenesis that results in ED. Newer and novel ED therapies aspire to reverse ED conditions by preventing cavernosal fibrosis, promoting endothelial revascularization and modulating various neuro-hormonal pathways. Regenerative therapeutic strategies such as low-intensity shock wave, gene and cellular-based therapies, and penile transplants are designed to improve penile hemodynamics and revitalize the cavernosal smooth muscle to mitigate and/or reverse underlying ED. This state-of-art article evaluates current and emerging therapeutic options for ED.
Highlights
While the introduction of oral phosphodiesterase type 5 (PDE5) inhibitors revolutionized the management of erectile dysfunction (ED) since 1998, they are not always effective since the development and progression of ED is frequently attributable to both psychogenic factors and physiological alterations in various neural, vascular, hormonal and endothelial functions
It is important to note that Phosphodiesterase Type 5 Inhibitor (PDE5i) only works with sexual stimulation, and despite the initial success in 65–70% of patients, 30–40% do not respond to PDE5i alone, so alternative strategies must be considered to enhance the response rate [11]
Data from key clinical studies of intraurethral alprostadil show that it has a fast onset and a good safety profile, with no risk of penile priapism, fibrosis or other typical systemic effects observed with oral ED drugs [17]
Summary
While the introduction of oral phosphodiesterase type 5 (PDE5) inhibitors revolutionized the management of erectile dysfunction (ED) since 1998, they are not always effective since the development and progression of ED is frequently attributable to both psychogenic factors and physiological alterations in various neural, vascular, hormonal and endothelial functions. There have been significant advances made in the field of sexual medicine in terms of our understanding of the underlying molecular biology and neuro-humoral mechanisms governing male sexual function. In contrast to existing therapeutic approaches, newer and innovative. ED therapies aspire to prevent underlying cavernosal fibrosis, promote endothelial revascularization and modulate the neuro-hormonal pathway with angiogenic and tissue growth factors (see Table 1). Gene and cellular-based therapies are designed to act on the molecular level to improve specific cellular and enzymatic functions to mitigate and/or reverse underlying ED.
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