It is widely accepted that disorders of the male (uro)genital tract, such as erectile dysfunction (ED) and benign diseases of the prostate (lower urinary tract symptomatology or benign prostatic hyperplasia), can be approached therapeutically by influencing the function of both the vascular and non-vascular smooth muscle of the penile erectile tissue or the transition zone/periurethral region of the prostate, respectively. As a result of the discovery of nitric oxide (NO) and cyclic guanosine monophosphate (GMP) as central mediators of penile smooth muscle relaxation, the use of drugs known to increase the local production of NO and/or elevate the intracellular level of the second messenger cyclic GMP have attracted broad attention in the treatment of ED of various etiologies. Specifically, the introduction of vasoactive drugs, including orally active inhibitors of the cyclic GMP-specific phosphodiesterase (PDE) 5, has offered great advantage in the pharmacotherapy of ED and other diseases of the genitourinary tract. These drugs have been proven efficacious with a fast on-set of action and an improved profile of side-effects. This review summarizes current strategies for the treatment of ED utilizing the application of vasoactive drugs via the oral, transurethral, topical, or self-injection route.
Journal of clinical medicine. 2020 Sep 16*** epublish ***
George T Kedia, Stefan Ückert, Dimitrios Tsikas, Armin J Becker, Markus A Kuczyk, Andreas Bannowsky
Department of Urology & Urological Oncology, Division of Surgery, Hannover Medical School, 30625 Hannover, Germany., Center of Pharmacology & Toxicology, Core Unit Proteomics, Hannover Medical School, 30625 Hannover, Germany., Faculty of Medicine, Academic Hospital Grosshadern, Department of Urology, Ludwig Maximilians University, 81377 Munich, Germany., Imland Hospital, Department of Urology, 24768 Rendsburg, Germany.