News in erectile dysfunction

News in erectile dysfunction. Erectile dysfunction (ED) is the most commonly treated sexual disorder affecting up to 20% of all men. As ED adversely affects the lives of millions of men, the public health implications of this condition are significant and represent a challenge for our healthcare system. Several options are available for treating ED : oral pharmacotherapy with phosphodiesterase 5 (PDE5) inhibitors represent so far the first-line option for many patients with ED. They are effective in three quarters of patients, with a similar response rate with the 4 available molecules (sildenafil, vardenafil, tadalafil and avanafil). Recently, an alprostadil cream (Vitaros) combining the active molecule with a skin enhancer has been allowed for usage in France. Low systemic adverse effects (3%), together with a high efficacy (up to 83%) make it a possible first-line therapeutic option for patients with ED who are reluctant to take systemic treatments. The intra-cavernous injections of alprostadil, the vacuum, and ultimately the penile implant (reserved for ED refractory to other treatments) remain effective therapeutic options that must be discussed with the patient. Other therapeutic options are currently under investigation, such as low-intensity shockwave lithotripsy, dopaminergic and melanocortin receptor agonists, which target central erectogenic pathways, soluble guanylate cyclases, rho-kinase inhibitors, and maxi-k channel activators that act peripherally. Newer formulations of existing medications, such as alprostadil and PDE5 inhibitors are also developed. Finally, stem cell regenerative techniques and gene therapy are promising new approaches to the treatment of erectile dysfunction. Most of these novel drugs have yet to reach Phase III studies. However, it is likely that in years to come, patients will be selectively treated with these novel agents as a monotherapy or in combination with others acting in a synergistic manner.