madman
Super Moderator
Management of male erectile dysfunction: From the past to the future (2023)
Chang-Ming Wang, Bao-Rui Wu, Ping Xiang, Jun Xiao and Xue-Chun Hu
Erectile dysfunction is a common disease of the male reproductive system, which seriously affects the life quality of patients and their partners. At present, erectile dysfunction is considered a social-psychological-physiological disease with complex etiology and various treatment methods. Oral PDE5I is the first-line treatment for erectile dysfunction with the advantages of high safety, good effect, and non-invasiveness. But intracavernosal injection, hormonal replacement therapy, vacuum erection device, and penile prosthesis implantation can also be alternative treatments for patients who have organic erectile dysfunction or tolerance to PDE5I. With the rapid development of technologies, some new methods, such as low-intensity extracorporeal shock waves and stem cell injection therapy can even repair the organic damage of the corpora cavernosa. These are important directions for the treatment of male erectile dysfunction in the future. In this mini-review, we will introduce these therapies in detail.
Introduction
Erectile dysfunction (ED) is defined as the consistent inability to attain and maintain an erection sufficient to perform satisfactory sexual intercourse (1). ED is a common male problem at all ages that has a great impact on the quality of life of sufferers and their partners. More than 150 million men worldwide are reported to have ED to different extents (2). Due to racial and regional differences and different definitions of ED, there is a large gap in the existing epidemiological data on ED. In the United States, the incidence of ED is 25.9 cases per 1000 people, and it increases with age with more than 70% of men over 70 years old affected by ED. It is predicted that by 2025, 322 million men worldwide will have ED (3–5). Studies have shown that the occurrence of ED is associated with many comorbidities and risk factors, such as aging, smoking, obesity, decreased androgen levels, cardiovascular disease, depression, prostate surgery, and penile trauma (6–8).
Normal penile erection is a neurovascular phenomenon controlled by psychological factors and coordinated by the endocrine, vascular, and nervous systems (9). The first step in the management of ED is often making lifestyle changes, such as losing weight, reducing alcohol intake, and avoiding smoking. These psychosocial methods are effective when ED is mainly caused by emotional or psychological factors (10). Current therapies to treat ED mainly include oral phosphodiesterase 5 inhibitor (PDE5I), intracavernosal injection, hormonal replacement therapy, vacuum erection device, penile prosthesis, low-intensity extracorporeal shock wave (LiESW), and stem cell injection therapy (11) (Figure 1). Under different conditions, any option can be the first line of treatment. To date, PDE5I is still the most popular treatment option due to its good efficacy, safety, and non-invasiveness. But, the growing number of patients with no or low response to PDE5I, and the potential for adverse reactions have prompted the development of safer and more effective treatments (12). In this paper, we will introduce various treatment methods for ED in detail based on current research progress.
Drug therapy
*Phosphodiesterase 5 inhibitors
*Intracavernosal injection
*Hormonal replacement therapy
*Vacuum erection device
*Penile prosthesis implantation
*Low-intensity extracorporeal shock wave
*Stem cell injection therapy
Conclusions and outlook
ED is a common disease in men and seriously affects the life quality of patients and their partners. Currently, oral PDE5I is the first-line treatment of ED which has the advantages of high safety and good effect. For patients with a low response to PDE5I, other treatments including intracavernosal injection, hormonal treatment, vacuum erection device, and penile prosthesis implantation can also be alternative methods. In recent years, some new therapies like low-intensity extracorporeal shock wave and stem cell injection therapy proved to have exciting effects and can even reverse the organic damage of the corpora cavernosa. In fact, there are other advanced therapies, such as gene therapy (69), 3D-printed hydrogel scaffolds (70), and gene-edited stem cells (71), they have all been shown to improve erectile function in animal experiments.
Despite these promising therapies being important directions for the treatment of ED in the future, only impressive animal studies prove the benefit. Large-scale, randomized, placebo-controlled studies are desperately needed for these novel therapeutics. In summary, ED is a complex disease associated with multiple risk factors, and effective therapy should be taken according to the etiology and individual conditions. The safety and efficacy of the promising therapies still need to be evaluated through a number of clinical trials with ethical support and fully informed consent.
Chang-Ming Wang, Bao-Rui Wu, Ping Xiang, Jun Xiao and Xue-Chun Hu
Erectile dysfunction is a common disease of the male reproductive system, which seriously affects the life quality of patients and their partners. At present, erectile dysfunction is considered a social-psychological-physiological disease with complex etiology and various treatment methods. Oral PDE5I is the first-line treatment for erectile dysfunction with the advantages of high safety, good effect, and non-invasiveness. But intracavernosal injection, hormonal replacement therapy, vacuum erection device, and penile prosthesis implantation can also be alternative treatments for patients who have organic erectile dysfunction or tolerance to PDE5I. With the rapid development of technologies, some new methods, such as low-intensity extracorporeal shock waves and stem cell injection therapy can even repair the organic damage of the corpora cavernosa. These are important directions for the treatment of male erectile dysfunction in the future. In this mini-review, we will introduce these therapies in detail.
Introduction
Erectile dysfunction (ED) is defined as the consistent inability to attain and maintain an erection sufficient to perform satisfactory sexual intercourse (1). ED is a common male problem at all ages that has a great impact on the quality of life of sufferers and their partners. More than 150 million men worldwide are reported to have ED to different extents (2). Due to racial and regional differences and different definitions of ED, there is a large gap in the existing epidemiological data on ED. In the United States, the incidence of ED is 25.9 cases per 1000 people, and it increases with age with more than 70% of men over 70 years old affected by ED. It is predicted that by 2025, 322 million men worldwide will have ED (3–5). Studies have shown that the occurrence of ED is associated with many comorbidities and risk factors, such as aging, smoking, obesity, decreased androgen levels, cardiovascular disease, depression, prostate surgery, and penile trauma (6–8).
Normal penile erection is a neurovascular phenomenon controlled by psychological factors and coordinated by the endocrine, vascular, and nervous systems (9). The first step in the management of ED is often making lifestyle changes, such as losing weight, reducing alcohol intake, and avoiding smoking. These psychosocial methods are effective when ED is mainly caused by emotional or psychological factors (10). Current therapies to treat ED mainly include oral phosphodiesterase 5 inhibitor (PDE5I), intracavernosal injection, hormonal replacement therapy, vacuum erection device, penile prosthesis, low-intensity extracorporeal shock wave (LiESW), and stem cell injection therapy (11) (Figure 1). Under different conditions, any option can be the first line of treatment. To date, PDE5I is still the most popular treatment option due to its good efficacy, safety, and non-invasiveness. But, the growing number of patients with no or low response to PDE5I, and the potential for adverse reactions have prompted the development of safer and more effective treatments (12). In this paper, we will introduce various treatment methods for ED in detail based on current research progress.
Drug therapy
*Phosphodiesterase 5 inhibitors
*Intracavernosal injection
*Hormonal replacement therapy
*Vacuum erection device
*Penile prosthesis implantation
*Low-intensity extracorporeal shock wave
*Stem cell injection therapy
Conclusions and outlook
ED is a common disease in men and seriously affects the life quality of patients and their partners. Currently, oral PDE5I is the first-line treatment of ED which has the advantages of high safety and good effect. For patients with a low response to PDE5I, other treatments including intracavernosal injection, hormonal treatment, vacuum erection device, and penile prosthesis implantation can also be alternative methods. In recent years, some new therapies like low-intensity extracorporeal shock wave and stem cell injection therapy proved to have exciting effects and can even reverse the organic damage of the corpora cavernosa. In fact, there are other advanced therapies, such as gene therapy (69), 3D-printed hydrogel scaffolds (70), and gene-edited stem cells (71), they have all been shown to improve erectile function in animal experiments.
Despite these promising therapies being important directions for the treatment of ED in the future, only impressive animal studies prove the benefit. Large-scale, randomized, placebo-controlled studies are desperately needed for these novel therapeutics. In summary, ED is a complex disease associated with multiple risk factors, and effective therapy should be taken according to the etiology and individual conditions. The safety and efficacy of the promising therapies still need to be evaluated through a number of clinical trials with ethical support and fully informed consent.
