Neurogenic Erectile Dysfunction. Where Do We Stand?

Medicines, 2021 · DOI: https://doi.org/10.3390/medicines8010003 · Published: January 7, 2021

Simple Explanation

Erectile Dysfunction (ED) is the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance, causing tremendous effects on both patients and their partners. Neurogenic ED consists of a large cohort of ED, accounting for about 10% to 19% of all cases. Its diversity does not allow an in-depth clarification of all the underlying mechanisms nor a “one size fits all” therapeutical approach. This review focuses on neurogenic causes of ED, trying to elucidate the mechanisms that lie beneath it and how we manage these patients.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
PDE5Is are highly recommended as first-line treatment in patients with neurogenic ED. In patients with SCI, tadalafil, sildenafil and vardenafil have improved both ED and retrograde ejaculation, along with overall satisfaction as shown from the improvement in IIEF-15 score.
2
Intra-cavernous injections (ICIs) are effective in 88% of patients with SCI, with an overall complication rate of 13.3%, with the combination of papaverine with phentolamine being responsible for the higher complication rate of 30%.
3
Surgical implantation of a penile prosthesis (PPI) is the last and definitive option in terms of treating ED and it should be considered when all other means of treatment have either failed or are unacceptable to the patient.

Research Summary

Neurogenic ED is characterized by a tremendous diversity since it has many etiological factors. This diversity makes it impossible to fully understand the underlying mechanisms of its pathophysiology, let alone to design a “one ﬁts all” method of treatment. Several studies are needed, not only to elucidate the reason why ED is established in several neurological conditions, but also to identify the pathways that are involved in different conditions, how they intersect and, finally, how we can provide a “tailor-made” therapeutic approach to every one of our patients, trying to meet their needs successfully.

Practical Implications

PDE5Is as First-Line Treatment

PDE5Is are recommended as initial therapy for neurogenic ED, with specific drugs like tadalafil, sildenafil, and vardenafil showing benefits for SCI patients.

ICIs as Effective Second-Line Therapy

Intra-cavernous injections should be considered when PDE5Is fail, demonstrating effectiveness in SCI patients, although with associated complication risks.

Penile Prosthesis as Last Resort

Penile prosthesis implantation is a definitive option when other treatments fail, but higher complication rates in neurogenic patients necessitate careful patient selection and counseling.

Study Limitations

1
Small number of participants in studies evaluating PDE5Is
2
Lack of head-to-head comparisons and double-blind randomized trials for PDE5Is
3
Limited high-quality data on ICIs and penile prosthesis implantation in neurogenic ED

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