Advances in the treatment of erectile dysfunction: what’s new and upcoming?

Abstract

Erectile dysfunction adversely affects up to 20% of all men and is the most commonly treated sexual disorder. The public health implications of this condition are significant and represent a challenge for our healthcare system. The physiological pathways responsible for erections have been extensively studied, and much advancement has been made since the introduction of phosphodiesterase 5 inhibitors. Newer agents, such as dopaminergic and melanocortin receptor agonists, which target central erectogenic pathways, are under investigation. Newer formulations and delivery methods of existing medications such as alprostadil will also be introduced in the near future. Furthermore, low-intensity shockwave lithotripsy and stem cell regenerative techniques are innovative approaches to the treatment of erectile dysfunction.

Retracted

“…Phosphodiesterase type-5 inhibitors (PDE5i), such as sildenafil, vardenafil, tadalafil, and avanafil, are currently the first-line therapy for ED. [ 10 , 11 ] These drugs enhance blood flow to the penis through nitric oxide (NO)/cyclic guanosine monophosphate signaling pathways. However, PDE5i agents are effective in only ∼60% of patients and are associated with adverse effects such as headache, flushing, and dyspepsia.…”

“…Alternative therapies for ED include intracavernous injections (ICI) with vasogenic agents (such as prostaglandin E 1 , phentolamine, vasoactive intestinal polypeptide, papaverine, and atropine), intraurethral pharmacotherapy with prostaglandin E 1 suppositories, vascular surgery, and surgical implantation of a penile prosthesis. [ 10 , 11 ] However, none of these treatment options are first-line therapies because of their invasive nature and other disadvantages. Although gene therapy and stem cell transplantation are currently being investigated as novel potential treatments for ED, they have yet to be successfully developed into therapies for routine use in the clinic.…”

“…Although gene therapy and stem cell transplantation are currently being investigated as novel potential treatments for ED, they have yet to be successfully developed into therapies for routine use in the clinic. [ 10 , 11 ]…”

Nitric Oxide Synthase in Male Urological and Andrologic Functions

“…Penile erection is an integrated process of artery blood supply and cavernous blood storage launched by nerve, and during this process, neurotransmitter plays an important role [4]. NO is a main messenger, which involves in the induction and maintenance of erection through hemangiectasis and corpus cavernosum relaxation [5].…”

Direct comparison of tadalafil with sildenafil for the treatment of erectile dysfunction: a systematic review and meta-analysis

“…PDE5-Is are similar to cyclic guanosine monophosphate (cGMP) in structure; thus, PED5-Is can bind to PDE5 competitively and inhibit cGMP hydrolysis, leading to a penile erection [ 8 ]. Four PDE5-Is (sildenafil, tadalafil, vardenafil and avanafil) are currently approved by the US FDA and have comparable efficacy and side effect profiles [ 9 ]. Sildenafil and tadalafil are the two most common phosphodiesterase inhibitors (PDEIs) around the world.…”