Vasoactive pharmacotherapy to cure erectile dysfunction: Fact or fiction?

Abstract

The modern-day management of erectile dysfunction reflects a host of advances that have occurred in the field of sexual medicine, particularly in the past several years. In the pharmacotherapeutic arena, many forms of treatment are now widely used, including oral, intracavernous, and intraurethral options. 1 Rowland D.L. Burnett A.L. Pharmacotherapy in the treatment of male sexual dysfunction. J Sex Res. 2000; 37: 226-243 Crossref Scopus (20) Google Scholar Prominent among these are orally administered phosphodiesterase-5 (PDE-5) inhibitors, which have proven effective and safe for the treatment of erectile dysfunction and, as a class, represent first-line therapy for a variety of clinical presentations. 2 Rosen R.C. Kostis J.B. Overview of phosphodiesterase 5 inhibition in erectile dysfunction. Am J Cardiol. 2003; 92: 9M-18M Abstract Full Text Full Text PDF PubMed Scopus (178) Google Scholar , 3 Jardin A. Wagner G. Khoury S. et al. Recommendations of the 1st International Consultation on Erectile Dysfunction. in: Jardin A. Wagner G. Khoury S. Erectile Dysfunction. Health Publication, United Kingdom2000: 711-726 Google Scholar However, a common feature of all forms of vasoactive pharmacotherapy, including oral drugs, is their traditional use as “on-demand,” acute therapy. Recent interest has surged to extend the role of vasoactive pharmacotherapies to meet a “curative intent” in the management of erectile dysfunction. Treatment that yields a sustained improvement in natural erectile function is highly sought after in the field at this time. The case for this management objective is demonstrated by the widespread interest in men using PDE-5 inhibitor therapy regularly after radical prostatectomy with the belief that such treatment taken in a quasi-curative manner will increase the opportunity for recovery of erectile function.