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Surgical therapy for the treatment of erectile dysfunction

Nature Clinical Practice Urology volume 5, pages 174–175 (2008)Cite this article

Erectile dysfunction (ED) is a major epidemiological problem that affects many patients' quality of life. Scientific advancements during the last 20 years have brought about a revolution in the understanding of the physiology of erection, which has changed the way ED is understood and treated. More recently, ED has gained much notoriety for its role in other systemic disease processes, especially its association with cardiovascular disease. Consequently, a paradigm shift in the treatment of ED has occurred, with an emphasis on addressing the underlying systemic vascular or metabolic etiology, along with providing symptomatic relief. Therapy in the form of orally administered phosphodiesterase type 5 (PDE5) inhibitors is considered to be the first-line treatment for ED, followed by intraurethral suppositories and intracavernosal injections of alprostadil, phentolamine mesilate and papaverine. Vacuum erection devices are another reasonable primary treatment option. In patients who do not respond to these treatments, surgical placement of a penile prosthesis represents a final therapeutic alternative for patients with organic ED. In highly select patients with arteriogenic impotence, penile revascularization surgery might also be indicated to restore normal erectile function.

Although ED is quite common, only a minority of men with this problem seek medical attention; patients cite embarrassment and cost as a hindrance to obtaining medical consultation.1 In addition, a downside to some pharmacologic therapies is the necessity of on-demand use, which decreases the spontaneity of the sexual act. Furthermore, oral PDE5 inhibitors are effective in only 60–80% of men, and are contraindicated in patients receiving certain medications or who have specific concomitant medical illnesses.2 Given the limitations of this treatment modality, gene therapy has emerged as a possible new frontier in ED management. ED is ideally suited for gene therapy because the penis is an external organ with an easily controllable venous return, and has gap junctions between smooth-muscle cells that allow the transfection of naked DNA.3 An advantage of gene therapy is the potential to direct treatment to the individual genetic malfunction that results in ED. Many different gene therapy products for the treatment of ED are currently being studied in animal models, and many different molecular targets have been manipulated to restore erectile function.4

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Authors and Affiliations

  1. K Siddiqi is a Post-Graduate Year 4 Resident and RW Lewis is a Professor and Chief of Urology at the Department of Urology, Medical College of Georgia, Augusta, GA, USA.,

    Kashif Siddiqi & Ronald W Lewis

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  1. Kashif Siddiqi
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  2. Ronald W Lewis
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Correspondence to Kashif Siddiqi.

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The authors declare no competing financial interests.

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Siddiqi, K., Lewis, R. Surgical therapy for the treatment of erectile dysfunction. Nat Rev Urol 5, 174–175 (2008). https://doi.org/10.1038/ncpuro1050

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