Summary of A Review of Current and Emerging Therapeutic Options for Erectile Dysfunction
New Findings on Current and Emerging Therapeutic Options for Erectile Dysfunction
There are many treatments available for Erectile dysfunction (ED) that can improve a man’s sexual function and satisfaction. These treatments can be classified into two categories: standard treatments and novel treatments. Standard treatments include lifestyle changes, oral medications, vacuum-assisted erectile devices, intraurethral suppositories, intracavernosal injections, and surgically implanted prosthetic devices. Novel treatments include shock-wave therapy, gene and cellular-based therapies, external prosthetic devices, injection of stem cells or platelet-rich plasma, microvascular stent, and penile transplant.
Lifestyle changes are the first-line treatment for ED, as they can improve the overall health and vascular function of the patient. Lifestyle changes include quitting smoking, reducing alcohol intake, losing weight, exercising regularly, managing stress, and treating any underlying medical conditions.
Oral medications are the most commonly used treatment for ED, as they are effective, safe, and convenient. Oral medications belong to a class of drugs called phosphodiesterase type 5 inhibitors (PDE5Is), which work by enhancing the effects of nitric oxide, a chemical that relaxes the smooth muscles of the penis and increases blood flow to the erectile tissue. There are four PDE5Is available in the market: sildenafil1, vardenafil2, tadalafil3, and avanafil4. They differ in their onset, duration, side effects, and interactions with other drugs. PDE5Is are usually taken on demand before sexual activity, but tadalafil can also be taken daily for continuous efficacy.
Vacuum-assisted erectile devices are mechanical devices that create a negative pressure around the penis and draw blood into the erectile tissue. The erection is then maintained by placing a constriction ring at the base of the penis. Vacuum-assisted erectile devices are effective, safe, and inexpensive. However, they may also cause some discomfort, bruising, numbness, or loss of spontaneity.
Intraurethral suppositories are small pellets that contain alprostadil, a synthetic form of prostaglandin E1, which is a vasodilator that widens the blood vessels of the penis and increases blood flow to the erectile tissue. The pellet is inserted into the urethra using an applicator before sexual activity. Intraurethral suppositories are easy to use and have few systemic side effects. However, they may also cause some local irritation, pain, or bleeding in the urethra or penis.
Intracavernosal injections are injections that deliver alprostadil or a combination of alprostadil with papaverine or phentolamine directly into the erectile tissue of the penis using a fine needle before sexual activity. Intracavernosal injections are very effective and have a fast onset of action. However, they may also cause some pain, bruising, infection, or priapism (a prolonged and painful erection) in the penis.
Surgically implanted prosthetic devices are devices that consist of inflatable or malleable rods that are inserted into the corpora cavernosa of the penis through an incision in the scrotum or abdomen. The inflatable device can be activated by a pump in the scrotum to produce an erection and deactivated by a release valve to return to a flaccid state. The malleable device can be manually bent into an erect or flaccid position as desired. Surgically implanted prosthetic devices are very effective and reliable and have high patient and partner satisfaction rates. However, they may also cause some complications such as infection, erosion, or malfunction of the device.
In addition to these standard treatments for ED, there are also some novel therapies that are currently being developed and may offer new options for patients who do not respond to or tolerate the existing treatments. Some of these novel therapies include:
- Shock-wave therapy: This is a non-invasive treatment that uses low-intensity sound waves to stimulate the growth of new blood vessels and improve the blood flow to the penis. Shock-wave therapy is painless and has no side effects. However, its long-term efficacy and safety are still under investigation.
- Gene and cellular-based therapies: These are biological treatments that use the patient’s own cells or genes to regenerate the erectile tissue and restore its function. Gene therapy involves the delivery of genes that encode for proteins that are essential for erection, such as nitric oxide synthase or vascular endothelial growth factor. Cellular therapy involves the injection of stem cells or progenitor cells that can differentiate into various types of cells, such as endothelial cells or smooth muscle cells, that are essential for erection. Gene and cellular-based therapies are minimally invasive and have no risk of rejection or allergic reaction. However, their efficacy and safety are still unclear and need more clinical trials.
- External prosthetic devices: These are devices that are worn externally on the penis and provide mechanical support or stimulation to produce an erection. Some examples are the belt penile prosthesis, which is a belt with a rigid rod that can be positioned behind the penis, and the external penile prosthesis, which is a silicone sleeve that can be inflated with air or water. External prosthetic devices are easy to use and have no risk of infection or erosion. However, they may also cause some discomfort, embarrassment, or loss of sensation.
- Injection of stem cells or platelet-rich plasma: These are biological treatments that use the patient’s own cells or blood components to regenerate the erectile tissue and restore its function. Stem cells are undifferentiated cells that can differentiate into various types of cells, such as endothelial cells or smooth muscle cells, that are essential for erection. Platelet-rich plasma is a concentrated solution of platelets, which are blood cells that contain growth factors and cytokines that can promote healing and tissue regeneration. Injection of stem cells or platelet-rich plasma is minimally invasive and has no risk of rejection or allergic reaction. However, its efficacy and safety are still unclear and need more clinical trials.
Conclusion
ED is a prevalent and bothersome condition that can affect a man’s quality of life and relationship. There are many treatments available for ED that can improve a man’s sexual function and satisfaction. These treatments can be standard or novel, depending on the severity, cause, and preference of the patient and his partner. The current article seeks to highlight the advances in management and may eventually alter the treatment paradigm to allow more-inclusive care pathways.