madman
Super Moderator
Abstract
Purpose of Review To highlight and review encouraging preliminary studies behind several alternative products and interventions for erectile dysfunction (ED).
Recent Findings Alternative treatments for ED are becoming more prevalent with increased consumer interest. “Natural” products are sold online, and numerous clinics offer various off-label and investigational interventions. These alternative treatments have demonstrated varying degrees of efficacy in randomized trials and meta-analyses, but none of these interventions has robust enough evidence to be considered first-line therapy. These treatments may find a role in combination with guideline treatments or may be used in novel penile rehabilitation research protocols.
Summary With growing interest in alternative treatment for men’s health, an awareness of the literature is imperative for patient counsel. Alternative treatments, like L-arginine, have a growing body of evidence for efficacy in combination with PDE5i, and low-intensity shock wave therapy and stem cell therapy continue to demonstrate encouraging outcomes in ED trials.
Introduction
Erectile dysfunction (ED) is one of the most prevalent sexual health conditions, with an estimated 18 million men affected in the USA alone [1]. ED is defined as the “consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual activity” [2]. It has been shown to significantly affect the quality of life of many afflicted men [3]. The current standard treatments, according to 2018 American Urology Association (AUA) guidelines include the following: oral phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VEDs), penile implants, intraurethral (IU) alprostadil suppositories, and intracavernosal injections (ICI) [4]. Oral PDE5i are the most common initial treatment of ED, but medical contraindications and decreased efficacy in advanced erectile dysfunction may prohibit this option [4]. While VEDs, penile implants, IU suppositories, and ICI are all viable therapies for ED, patients may not elect to undergo these treatments due to their varying levels of commitment and invasiveness. In addition, all currently recommended treatments treat the ED without causing a reversal of the pathophysiology. As such, patients may prefer to try “natural solutions” and interventions that are available on the market but not necessarily FDA approved or recommended by the AUA or Sexual Medicine Society (SMS). In this review, we discuss the possible clinical uses, efficacy, and support for alternative therapies with existing and emerging literature in ED treatment
Therapies Using Physical Energy
*Low-Intensity Extracorporeal Shockwave Therapy
*Low-Intensity Pulsed Ultrasound
Intracavernosal Injection Therapies
*Stem Cell Therapy
*Platelet-Rich Plasma
Amino Acids
*L-Arginine
*L-Citrulline
Herbal Supplements
*Ginseng
*Yohimbine
Topical Alprostadil
Hyperbaric Oxygen Therapy
Penile Vibratory Stimulation
Conclusion
Alternative medicine is becoming more popular and accessible, with many patients seeking these treatments for ED. A variety of new and innovative modalities are emerging with promising preliminary results. Providers should have an understanding of the literature behind these investigational therapies in order to set appropriate expectations and give recommendations regarding off-label treatment. The writers of this review hope that readers may utilize the information presented here as a scaffold to initiate a further investigation into the presented modalities, and for quick reference in clinical scenarios.
Purpose of Review To highlight and review encouraging preliminary studies behind several alternative products and interventions for erectile dysfunction (ED).
Recent Findings Alternative treatments for ED are becoming more prevalent with increased consumer interest. “Natural” products are sold online, and numerous clinics offer various off-label and investigational interventions. These alternative treatments have demonstrated varying degrees of efficacy in randomized trials and meta-analyses, but none of these interventions has robust enough evidence to be considered first-line therapy. These treatments may find a role in combination with guideline treatments or may be used in novel penile rehabilitation research protocols.
Summary With growing interest in alternative treatment for men’s health, an awareness of the literature is imperative for patient counsel. Alternative treatments, like L-arginine, have a growing body of evidence for efficacy in combination with PDE5i, and low-intensity shock wave therapy and stem cell therapy continue to demonstrate encouraging outcomes in ED trials.
Introduction
Erectile dysfunction (ED) is one of the most prevalent sexual health conditions, with an estimated 18 million men affected in the USA alone [1]. ED is defined as the “consistent or recurrent inability to attain and/or maintain penile erection sufficient for sexual activity” [2]. It has been shown to significantly affect the quality of life of many afflicted men [3]. The current standard treatments, according to 2018 American Urology Association (AUA) guidelines include the following: oral phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VEDs), penile implants, intraurethral (IU) alprostadil suppositories, and intracavernosal injections (ICI) [4]. Oral PDE5i are the most common initial treatment of ED, but medical contraindications and decreased efficacy in advanced erectile dysfunction may prohibit this option [4]. While VEDs, penile implants, IU suppositories, and ICI are all viable therapies for ED, patients may not elect to undergo these treatments due to their varying levels of commitment and invasiveness. In addition, all currently recommended treatments treat the ED without causing a reversal of the pathophysiology. As such, patients may prefer to try “natural solutions” and interventions that are available on the market but not necessarily FDA approved or recommended by the AUA or Sexual Medicine Society (SMS). In this review, we discuss the possible clinical uses, efficacy, and support for alternative therapies with existing and emerging literature in ED treatment
Therapies Using Physical Energy
*Low-Intensity Extracorporeal Shockwave Therapy
*Low-Intensity Pulsed Ultrasound
Intracavernosal Injection Therapies
*Stem Cell Therapy
*Platelet-Rich Plasma
Amino Acids
*L-Arginine
*L-Citrulline
Herbal Supplements
*Ginseng
*Yohimbine
Topical Alprostadil
Hyperbaric Oxygen Therapy
Penile Vibratory Stimulation
Conclusion
Alternative medicine is becoming more popular and accessible, with many patients seeking these treatments for ED. A variety of new and innovative modalities are emerging with promising preliminary results. Providers should have an understanding of the literature behind these investigational therapies in order to set appropriate expectations and give recommendations regarding off-label treatment. The writers of this review hope that readers may utilize the information presented here as a scaffold to initiate a further investigation into the presented modalities, and for quick reference in clinical scenarios.
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