madman
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Conservative Non‑surgical Options for Erectile Dysfunction (2022)
Manuel Alonso‑Isa · Borja García‑Gómez · Ignacio González‑Ginel · Clara García‑Rayo‑Encina · María del Prado Caro‑González · José Medina‑Polo · Esther García‑Rojo · Javier Romero‑Otero
Abstract
Purpose of Review This study aimed to review recent evidence on conservative non-surgical options for erectile dysfunction (ED) in men. A narrative review of the literature was performed. A comprehensive search in the MEDLINE, Embase and Cochrane databases was done. Papers in the English language, published from May 2017 until May 2022, were included. Papers reporting basic research or animal research were excluded, as long as reviews or meta-analyses. Congress reports clinical cases or clinical trial protocols with no results were also excluded.
Recent Findings We found a multitude of different treatment modalities for ED. We must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of the treatments show good results with a good level of evidence (new IPDE5 formulations, intracavernous injections, shock wave therapy, hormonal therapy, and psycho-sexual therapy). However, others (some new molecules, stem cell therapy, platelet-rich plasma injections, oxygenation-based therapy, nutraceuticals), although some of them present promising results, require randomized studies with a larger number of patients and a longer follow-up time to be able to establish firm recommendations.
Summary Regarding the conservative treatment of erectile dysfunction, in recent years, some therapies have been consolidated as efective and safe for certain types of patients. On the other hand, other treatment modalities, although promising, still lack the evidence and the necessary follow-up to be recommended in daily practice.
Introduction
Erectile dysfunction (ED) is defined as the persistent inability to achieve and maintain an erection hard enough to permit satisfactory sexual intercourse [1]. According to the five-item International Index of Erectile Function questionnaire (IIEF-5) score, ED severity is classified as severe (score 1–7), moderate (8–11), mild-moderate (12–16), mild (17–21), and no ED (22–25) [2].
ED has become a major health concern even in younger men, causing a significant impact on men’s quality of life [3]. Its prevalence varies in the different series published, but it is constantly high. In the Boston area, 52% of men between 40 and 70 years old were shown to suffer some grade of ED, according to the Massachusetts Male Aging Study (MMAS) [4]. Generally, ED can be considered a natural part of aging, and its prevalence increases with age, ranging from 12% in those men<59 years, 22% in men 60–69 years, and 30% in men>69 years old, as per a population-based study of US health professionals [5]. In a cross-sectional real-life study performed among men asking for their first medical help for new-onset ED, 25% of patients were younger than 40 years old, with almost 50% of the younger men complaining of severe ED [6]. It is expected that by the end of 2025, the number of ED cases can rise to as high as 322 million across the world [7]
Treatment of ED has evolved over the years, with the introduction of sildenafil, the first 5-phosphodiesterase inhibitor (5-PDEi), as a major milestone in the late 1990s [8]. Since then, clinical practice guidelines have established different algorithms and recommendations, usually proposing therapeutic lines depending on the invasiveness of the treatments [9]. But recently, the European Association of Urology Guidelines on Sexual and Reproductive Health has proposed some changes in this paradigm [10]. Thereby, some treatments are no longer considered second-line options, and they can be offered to patients according to their preferences and their clinical situation, like intracavernous injections (ICI) or topical or intraurethral alprostadil. Also, some treatments previously considered experimental have recently been included in clinical practice guidelines according to their growing scientific evidence, like shockwave therapy. In the present paper, we aimed to comprehensively review the evidence on non-surgical treatments for ED of the last 5 years (2017–2022), focusing on the new developments.
Results
*Psycho‑sexual Therapy
*Hormonal Therapy
*5‑PDE5i
*Topical Drugs
*Shockwave Therapy
*Stem Cells
*Phytotherapy/Nutraceuticals
*Platelet‑Rich Plasma Injections
*Effect of Previously Known Molecules on ED
*ICI of Vaso‑active Agents
*Oxygenation‑Based Therapies
*Other Physical Therapies
Conclusion
Numerous publications related to the conservative treatment of ED have been carried out. The significant rate of discontinuation of available therapies and the paucity of curative options prompted research on possible new treatments. In some cases, we must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of these new treatments show good results with a good level of evidence (new PDE5i formulations, intracavernous injections, Li-ESWT, hormonal therapy). However, others (some new molecules, SCT, PRP, oxygenation-based therapies), although they present promising results, require better quality studies to establish firm recommendations.
Manuel Alonso‑Isa · Borja García‑Gómez · Ignacio González‑Ginel · Clara García‑Rayo‑Encina · María del Prado Caro‑González · José Medina‑Polo · Esther García‑Rojo · Javier Romero‑Otero
Abstract
Purpose of Review This study aimed to review recent evidence on conservative non-surgical options for erectile dysfunction (ED) in men. A narrative review of the literature was performed. A comprehensive search in the MEDLINE, Embase and Cochrane databases was done. Papers in the English language, published from May 2017 until May 2022, were included. Papers reporting basic research or animal research were excluded, as long as reviews or meta-analyses. Congress reports clinical cases or clinical trial protocols with no results were also excluded.
Recent Findings We found a multitude of different treatment modalities for ED. We must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of the treatments show good results with a good level of evidence (new IPDE5 formulations, intracavernous injections, shock wave therapy, hormonal therapy, and psycho-sexual therapy). However, others (some new molecules, stem cell therapy, platelet-rich plasma injections, oxygenation-based therapy, nutraceuticals), although some of them present promising results, require randomized studies with a larger number of patients and a longer follow-up time to be able to establish firm recommendations.
Summary Regarding the conservative treatment of erectile dysfunction, in recent years, some therapies have been consolidated as efective and safe for certain types of patients. On the other hand, other treatment modalities, although promising, still lack the evidence and the necessary follow-up to be recommended in daily practice.
Introduction
Erectile dysfunction (ED) is defined as the persistent inability to achieve and maintain an erection hard enough to permit satisfactory sexual intercourse [1]. According to the five-item International Index of Erectile Function questionnaire (IIEF-5) score, ED severity is classified as severe (score 1–7), moderate (8–11), mild-moderate (12–16), mild (17–21), and no ED (22–25) [2].
ED has become a major health concern even in younger men, causing a significant impact on men’s quality of life [3]. Its prevalence varies in the different series published, but it is constantly high. In the Boston area, 52% of men between 40 and 70 years old were shown to suffer some grade of ED, according to the Massachusetts Male Aging Study (MMAS) [4]. Generally, ED can be considered a natural part of aging, and its prevalence increases with age, ranging from 12% in those men<59 years, 22% in men 60–69 years, and 30% in men>69 years old, as per a population-based study of US health professionals [5]. In a cross-sectional real-life study performed among men asking for their first medical help for new-onset ED, 25% of patients were younger than 40 years old, with almost 50% of the younger men complaining of severe ED [6]. It is expected that by the end of 2025, the number of ED cases can rise to as high as 322 million across the world [7]
Treatment of ED has evolved over the years, with the introduction of sildenafil, the first 5-phosphodiesterase inhibitor (5-PDEi), as a major milestone in the late 1990s [8]. Since then, clinical practice guidelines have established different algorithms and recommendations, usually proposing therapeutic lines depending on the invasiveness of the treatments [9]. But recently, the European Association of Urology Guidelines on Sexual and Reproductive Health has proposed some changes in this paradigm [10]. Thereby, some treatments are no longer considered second-line options, and they can be offered to patients according to their preferences and their clinical situation, like intracavernous injections (ICI) or topical or intraurethral alprostadil. Also, some treatments previously considered experimental have recently been included in clinical practice guidelines according to their growing scientific evidence, like shockwave therapy. In the present paper, we aimed to comprehensively review the evidence on non-surgical treatments for ED of the last 5 years (2017–2022), focusing on the new developments.
Results
*Psycho‑sexual Therapy
*Hormonal Therapy
*5‑PDE5i
*Topical Drugs
*Shockwave Therapy
*Stem Cells
*Phytotherapy/Nutraceuticals
*Platelet‑Rich Plasma Injections
*Effect of Previously Known Molecules on ED
*ICI of Vaso‑active Agents
*Oxygenation‑Based Therapies
*Other Physical Therapies
Conclusion
Numerous publications related to the conservative treatment of ED have been carried out. The significant rate of discontinuation of available therapies and the paucity of curative options prompted research on possible new treatments. In some cases, we must take into account the type of patient, their comorbidities, the origin of their ED, and its severity in order to reproduce effective results using these therapies. Some of these new treatments show good results with a good level of evidence (new PDE5i formulations, intracavernous injections, Li-ESWT, hormonal therapy). However, others (some new molecules, SCT, PRP, oxygenation-based therapies), although they present promising results, require better quality studies to establish firm recommendations.
