Abstract
Erectile Dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance, causing tremendous effects on both patients and their partners. The pathophysiology of ED remains a labyrinth. The underlying mechanisms of ED may be vasculogenic, neurogenic, anatomical, hormonal, drug-induced and/or psychogenic. Neurogenic ED consists of a large cohort of ED, accounting for about 10% to 19% of all cases. Its diversity does not allow an in-depth clarification of all the underlying mechanisms nor a “one size fits all” therapeutical approach. In this review, we focus on neurogenic causes of ED, trying to elucidate the mechanisms that lie beneath it and how we manage these patients.
Highlights
Erectile dysfunction (ED) is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance [1]
It seems that intraurethral use of alprostadil, in any form, is an alternative treatment for neurogenic patients, less effective though than the traditional intra-cavernous administration, and the most apparent reason of failure in patients with Spinal Cord Injury (SCI) might be the use of intermittent catheterizations, since such a practice alters the epithelium of the urethra to squamous, making the agent less absorbable through it
All the data are experimental in rats and have not yet been verified in human trials, we are far from implementing these methods let alone including the use of Low-Intensity Extra-Corporeal Shock Waves Treatment (LI-ESWT) in treatment of neurogenic ED caused by SCI, Multiple Sclerosis (MS) or Parkinson’s Disease (PD) in our everyday practice
Summary
Erectile dysfunction (ED) is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance [1] Besides the obvious, it has tremendous effects on the patient’s psychosocial health, and it affects their quality of life but the lives of their partners [2]. Several reasons may influence ED in patients suffering from neurological diseases, depending on the genesis, which can be central, peripheral, or both. It appears that many neurogenic conditions have overlapping characteristics, for example, patients with diabetes mellitus (DM) may have a vasculogenic and a neurogenic component, the following Table 1 must be used only for diagnostic classification purposes. Surgery of the urethra (urethral stricture, urethroplasty, etc.) Adapted from European Urology Association (EAU) Guidelines on Sexual and Reproductive Health 2020 [1]
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