An overview of the history, current strategies, and potential future treatment approaches in erectile dysfunction: a comprehensive review

Abstract

Introduction Erectile dysfunction (ED) is one of the most common urologic problems in men worldwide, with an approximately high incidence rate, significantly affecting patients’ quality of life and their sexual partners. Objectives Due to the association of this disorder with essential diseases such as cardiovascular disease and diabetes, its prevention and treatment are vital for overall human physiologic and psychological health. Along with reviewing the history of treatment and current methods, we seek new approaches to curb this issue in the future. Methods In this review, investigations were based on the focus of each section’s content or conducted on an ad hoc basis. Searches were performed in Scopus and PubMed. Results In recent years, many treatments for ED have been reported besides oral administration of phosphodiesterase 5 inhibitors such as sildenafil and tadalafil (approved by the Food and Drug Administration). Common oral medications, intracavernous injections, herbal therapies (eg, herbal phosphodiesterase 5 inhibitors), and topical/transdermal medications are routine ED treatment approaches. Moreover, some novel medications are innovative candidates for completing ED’s treatment protocols: stem cell injection, low-intensity extracorporeal shock wave therapy, platelet-rich plasma injection, gene therapy, amniotic fluid matrices, rho-kinase inhibitors, melanocortin receptor antagonists, maxi-K channel activators (ie, large-conductance calcium-activated potassium channels), guanylate cyclase activators, and nitric oxide donors. Conclusion Due to the importance of this complicated problem in men’s society, a faster course of treatment trends toward new methods is needed to increase efficiency. Combining the mentioned treatments and attentively examining their efficacy through programmed clinical trials can be a big step toward solving this global problem.

Nitro-oleic acid (NO2-OA) ameliorates erectile dysfunction in a rat model of diabetes mellitus via modulation of fibrosis, inflammation and autophagy

“…Although oral PDE5 inhibitors can provide an effective and safe treatment of ED in non-diabetics, DMED patients often respond poorly to these drugs, mainly due to the chronic inflammation induced by long-term hyperglycemic stimulation, which then induces penile fibrosis and reduces penile diastolic function ( 32 , 33 ). Although in its initial stages fibrosis represents an adaptive response to unfavorable conditions such as tissue damage, its long-term consequences are irreversible and often more harmful than beneficial.…”

Recent Advances in Nanotechnology-Based Drug Delivery Systems for the Diagnosis and Treatment of Reproductive Disorders

“…The discontinuation of these treatments may be ascribed to their high cost, along with the accompanying discomfort, reduced naturalness, extended erections, and priapism . An exemplary instance was the application of MRI in the monitoring and treatment of erectile dysfunction by the incorporation of superparamagnetic iron oxide nanoparticles (SPION) and mesenchymal stem cells (MSCs) (SPION-MSCs) that were tagged with human mesenchymal stem cells . SPION-MSC was administered into the cavernosal area of rats.…”

“…226 An exemplary instance was the application of MRI in the monitoring and treatment of erectile dysfunction by the incorporation of superparamagnetic iron oxide nanoparticles (SPION) and mesenchymal stem cells (MSCs) (SPION-MSCs) that were tagged with human mesenchymal stem cells. 227 SPION-MSC was administered into the cavernosal area of rats. The animals were then monitored for about 4 weeks after the induction of cavernous nerve damage.…”

Sildenafil Citrate Induces Prostatic Hyperplasia in BPH Model Rats and Aged Rats

“…Meanwhile, cGMP undergoes hydrolysis by phosphodiesterase 15 . Therefore, the inhibition of PDE serves to increase the level of cGMP, effectively realizing the therapeutic purpose of treating ED.…”