Performance and safety of treatment options for erectile dysfunction in patients with spinal cord injury: a review of the literature.

For a large proportion of patients with spinal cord injury (SCI), sexuality and reproduction are important issues. However, sparse data exist regarding available treatment options for this patient population. We sought to review performance and safety rates of all currently available treatment options for erectile dysfunction (ED) in SCI men.

A systematic literature review without time restrictions was performed using PubMed/EMBASE database for English-, Italian-, German-, and Spanish-language articles. Articles' selection was performed according to the PRISMA guidelines. Relevant papers on ED in SCI patients were included in the final analyses.

Overall, 47 studies were eligible for inclusion in this review. Of these, most evidence dealt with phosphodiesterase 5-inhibitors (PDE5-Is) and intracavernous drug injection (ICI). Both treatment options are associated with high levels of performance and with patients/partners' satisfaction; side effects are acceptable. Overall, penile prostheses and vacuum erection devices are in general less approved by SCI patients and are correlated with increased rates of complications in comparison with PDE5-Is and ICI. Sacral neuromodulation, transcutaneous electrical nerve stimulation, and intraurethral suppositories have been poorly studied, but preliminary studies did not show convincing results.

The best treatment options for ED in SCI patients emerged to be PDE5-Is and ICI. The choice of ED treatment should be based on several aspects, including residual erectile function, SCI location and patients' comorbidities. Future studies assessing the applicability of less well studied treatments, as well as evaluating innovative options, are needed in this specific population.

Andrology. 2020 Aug 02 [Epub ahead of print]

Luca Afferi, Jürgen Pannek, Arthur Louis Burnett, Cedric Razaname, Stamatina Tzanoulinou, Wojciech Bobela, Rodrigo Araujo Fraga da Silva, Mikael Sturny, Nikos Stergiopulos, Julian Cornelius, Marco Moschini, Christophe Iselin, Andrea Salonia, Agostino Mattei, Livio Mordasini

Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland., Neuro-Urology, Schweizer Paraplegiker Zentrum, Nottwil, Switzerland., Department of Urology, John Hopkins Hospital, Brady Urological Institute, Baltimore, Maryland, United States., Medidee Services SA, Chemin de Rovéréaz 5, 1012, Lausanne, Switzerland., Comphya SA, EPFL Innovation Park, 1015, Lausanne, Switzerland., Division of Urology, Department of Surgery, Geneva University Hospital, Switzerland., Division of Experimental Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.

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