Advertisement

Nonsurgical Treatments for Erectile Dysfunction: Oral, Topical, Intracavernous, and Vacuum Devices

  • Alvaro Morales
  • Jeremy P. W. Heaton

Abstract

The availability of vasoactive drugs for intracavernosal injection has been one of the most significant milestones in the treatment of male erectile dysfunction. It has allowed meticulous investigation of the physiologic process of penile erection and opened up viable therapeutic alternatives for the patient with mild to moderate alterations at the level of the corpora. Equally important, the advent of injectable vasoactive drugs has permitted large strides in our understanding of the physiologic mechanisms of erection. The elucidation of many of those mechanisms at the cellular level has permitted the development of therapeutic strategies based on sound pharmacologic principles. We are getting closer to the availability of effective, noninvasive medications. This accomplishment is not the result of fortuitous progress: it is the culmination of dedicated and applied research to an area that for decades has remained in the background of medical interest.

Keywords

Erectile Dysfunction Erectile Function Penile Erection Penile Prosthesis Testosterone Enanthate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Heaton J: Penile erections: what, where, when and how? In Pharmacotherapy of Erectile Dysfunction. Seminar 9771. American Urological Association; 1997.Google Scholar
  2. 2.
    Heaton JPW, Adams MA, Morales A: A therapeutic taxonomy of treatments for erectile dysfunction: an evolutionary imperative. Int J Impotence Res 1997, 9:117–121.CrossRefGoogle Scholar
  3. 3.
    Heaton JWP, Morales A, Adams M, et al.: Resolution of erectile failure after oral treatment with apomorphine. Urology 1995, 45:200–203.PubMedCrossRefGoogle Scholar
  4. 4.
    Linet OI, Ogrinc FG: Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. N Engl J Med 1996, 334:873–877.PubMedCrossRefGoogle Scholar
  5. 5.
    Padma-Nathan H, Auerbach S, Barada J, et al.: Treatment of men with erectile dysfunction with transurethral alprostadil. N Engl J Med 1997, 336:1–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Kurt U, Ozkarde SH, Altug U, et al.: The efficacy of antiserotoninergic agents in the treatment of erectile dysfunction. J Urol 1994, 152:407–409.PubMedGoogle Scholar
  7. 7.
    Montague DK, Barada JH, Belker AM, et al.: Clinical guidelines panel on erectile dysfunction: summary report on the treatment of organic erectile dysfunction. J Urol 1996, 157:2006–211.Google Scholar
  8. 8.
    Bresolle F, Costa P, Rouzier-Panis R, et al.: Pharmacokinetics of moxisylyte in healthy volunteers after intracavernous injection of increasing doses. Eur J Clin Pharmacol, 1996, 49:411–415.CrossRefGoogle Scholar
  9. 9.
    Segraves RT, Bari M, Segraves K, et al.: Effect of apomorphine on penile tumescence in men with psychogenic impotence. J Urol 1991, 145:1174–1175.PubMedGoogle Scholar
  10. 10.
    Manning M, Junemann KP: Pharmacotherapy of Erectile Dysfunction. In Male Infertility and Sexual Dysfunction. Edited by Hellstrom WJG. New York: Springer-Verlag; 1997:440–451.CrossRefGoogle Scholar
  11. 11.
    McMahon CG: A pilot study of the role of intracavernous injection of vasoactive intestinal peptide and phentolamine mesylate in the treatment of erectile dysfunction. Int J Impotence Res 1996, 8:233–236.Google Scholar
  12. 12.
    Porst H: Vasoactive substances in erectile dysfunction: a survey of 10 years global experience. In Penile Disorders. Edited by Porst H. Berlin: Springer-Verlag; 1977:175–196.Google Scholar
  13. 13.
    Ismail M, Abbot L, Hirsh IH: Experience with intracavernous PGE1 in the treatment of erectile dysfunction: dose considerations and efficacy. Int J Impotence Res 1997, 9:39–42.CrossRefGoogle Scholar
  14. 14.
    Morales A, Condra MS, Owen JE, et al.: Oral and transcutaneous pharmacological agents in the treatment of impotence. Urol Clin North Am 1988, 15:87–93.PubMedGoogle Scholar
  15. 15.
    Giuliano FA, Rampin O, Benoit G: Neural control of penile erection. Urol Clin North Am 1995, 22:747–766.PubMedGoogle Scholar
  16. 16.
    Vermuleen A: Androgens in the aging male. J Clin Endocrinol Metab 1991, 73:221–224.CrossRefGoogle Scholar
  17. 17.
    Clark JG: Suppression of copulatory behavior in male rats following central administration of clonidine. Neuropharmacology 1991, 30:373–382.PubMedCrossRefGoogle Scholar
  18. 18.
    Boolell M, Allen MJ, Ballard SA, et al.: Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int J Impotence Res 1996, 8:47–52.Google Scholar
  19. 19.
    Bhsin S: Androgen treatment of hypogonadal men. J Clin Endocrinol Metab 1992, 74:1221–1225.CrossRefGoogle Scholar
  20. 20.
    Bardin CW, Swerdloff RS, Santen RJ: Androgens: risks and benefits. J Clin Endrocrinol Metab 1991, 73:4–10CrossRefGoogle Scholar
  21. 21.
    Morales A, Johnston B, Heaton JWP, et al.: Oral androgens in the treatment of hypogonadal impotent men. J Urol 1994, 152:1115–1118.PubMedGoogle Scholar
  22. 22.
    Morales A, Johnston B, Heaton JPW, et al.: Testosterone supplementation for hypogonadal impotence: assessment of biochemical measures and therapeutic outcomes. J Urol 1997, 157:849–854.PubMedCrossRefGoogle Scholar
  23. 23.
    Morales A, Bain J, Ruijs A, et al.: Clinical practice guidelines for screening and monitoring male patients receiving testosterone supplementation therapy. Int J Impotence Res 1996, 8:95–97.Google Scholar
  24. 24.
    Leonard M, Nickel JC, Morales A: Hyperprolactinemia and impotence: why, when and how to investigate and treat. J Urol 1989, 142:992–994.PubMedGoogle Scholar
  25. 25.
    Guay AT, Varma S, Sabharwal P, et al.: Macroprolactinemia causing delay in the diagnosis of psychological impotence. J Clin Endocrinol Metab 1996, 81:2512–2514.PubMedCrossRefGoogle Scholar
  26. 26.
    Lewis R: Twenty years of vacuum therapy for erectile dysfunction in the United States. In Penile Disorders. Edited by Porst H. Berlin: Springer-Verlag; 1997:162–174.Google Scholar
  27. 27.
    Nadig PW: Vacuum erection devices: a review. World J Urol 1990, 8:114–118.CrossRefGoogle Scholar
  28. 28.
    Burnett AL: Role of nitric oxide in the physiology of erection. Biol Reprod 1995, 52:485–489.PubMedCrossRefGoogle Scholar
  29. 29.
    Burnett AL: Nitric oxide in the penis: physiology and pathology. J Urol 1997, 157:320–324.PubMedCrossRefGoogle Scholar
  30. 30.
    Ignarro LJ, Lippton H, Edwards JC, et al.: Mechanism of vascular smooth muscle relaxation by organic nitrtates, nitrites, nitropresside, and nitric oxide: evidence of the involvement of S-nitrosothiols as active intermediates. J Pharmacol Exp Ther 1981, 218:739–749.PubMedGoogle Scholar
  31. 31.
    Lugnier C, Komas N: Modulation of vascular cyclic nucleotide phosphodiesterases by cyclic CMP: role in vasodilation. Eur Heart J 1993, 14(suppl):141–148.PubMedCrossRefGoogle Scholar
  32. 32.
    Boolell M, Allen MJ, Ballard SA, et al.: Sildenafil: an orally active type 5 cyclic GMP-specific phosphodiesterase inhibitor for the treatment of penile erectile dysfunction. Int J Impot Res 1996, 8:47–52.PubMedGoogle Scholar
  33. 33.
    Giuliano F, Jardin A, Gingell CJ, et al.: Sildenafil, an oral treatment for erectile dysfunction: a 1-year, open-label extension study [abstract]. Br J Urol 1997, 80:93.Google Scholar
  34. 34.
    Buvat J, Gingell CJ, Jardin A, et al.: Sildenafil (Viagra), an oral treatment for erectile dysfunction: a 1-year, open-label extension study, J Urol 1997, 157(suppl):204.CrossRefGoogle Scholar
  35. 35.
    Padma-Nathan H, Sildenafil Study Group: Oral Viagra in the treatment of erectile dysfunction: assessment of erections hard enough for sexual intercourse. J Urol 1998, (suppl): in press.Google Scholar
  36. 36.
    Goldstein I, Lue TF, Padma-Nathan H, et al.: Oral sildenafil in the treatment of erectile dysfunction: Sildenafil Study Group. N Engl J Med 1998: 338:1397–1404.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Alvaro Morales
  • Jeremy P. W. Heaton

There are no affiliations available

Personalised recommendations