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Asker H, Yilmaz-Oral D, Oztekin CV, Gur S. An update on the current status and future prospects of erectile dysfunction following radical prostatectomy. Prostate 2022; 82:1135-1161. [PMID: 35579053 DOI: 10.1002/pros.24366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/30/2022] [Accepted: 04/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly utilized in RP, erectile dysfunction (ED) due to neuropraxia remains a frequent complication. Erectile function recovery rates after RP remain unsatisfactory, and many men still suffer despite the availability of various therapies. OBJECTIVE This systematic review aims to summarize the current treatments for post-RP-ED, assess the underlying pathological mechanisms, and emphasize promising therapeutic strategies based on the evidence from basic research. METHOD Evaluation and review of articles on the relevant topic published between 2010 and 2021, which are indexed and listed in the PubMed database. RESULTS Phosphodiesterase type 5 inhibitors, intracavernosal and intraurethral injections, vacuum erection devices, pelvic muscle training, and surgical procedures are utilized for penile rehabilitation. Clinical trials evaluating the efficacy of erectogenic drugs in this setting are conflicting and far from being conclusive. The use of androgen deprivation therapy in certain scenarios after RP further exacerbates the already problematic situation and emphasizes the need for effective treatment strategies. CONCLUSION This article is a detailed overview focusing on the pathophysiology and mechanism of the nerve injury developed during RP and a compilation of various strategies to induce cavernous nerve regeneration to improve erectile function (EF). These strategies include stem cell therapy, gene therapy, growth factors, low-intensity extracorporeal shockwave therapy, immunophilins, and various pharmacological approaches that have induced improvements in EF in experimental models of cavernous nerve injury. Many of the mentioned strategies can improve EF following RP if transformed into clinically applicable safe, and effective techniques with reproducible outcomes.
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Affiliation(s)
- Heba Asker
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
- Department of Medical Pharmacology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
- Graduate School of Health Sciences, Ankara University, Ankara, Turkey
| | - Didem Yilmaz-Oral
- Department of Pharmacology, Faculty of Pharmacy, Cukurova University, Adana, Turkey
| | - Cetin Volkan Oztekin
- Department of Urology, Faculty of Medicine, University of Kyrenia, Girne, Turkey
| | - Serap Gur
- Department of Pharmacology, Faculty of Pharmacy, Ankara University, Ankara, Turkey
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Cho MC, Lee J, Park J, Kim SW. Restoration of Cavernous Veno-Occlusive Function through Chronic Administration of a Jun-Amino Terminal Kinase Inhibitor and a LIM-Kinase 2 Inhibitor by Suppressing Cavernous Apoptosis and Fibrosis in a Rat Model of Cavernous Nerve Injury: A Comparison with a Phosphodiesterase Type 5 Inhibitor. World J Mens Health 2020; 39:541-549. [PMID: 32777863 PMCID: PMC8255392 DOI: 10.5534/wjmh.200085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 11/21/2022] Open
Abstract
Purpose To determine if chronic administration of Jun-amino terminal kinase (JNK)-inhibitors and LIM-kinase 2 (LIMK2)-inhibitors from the immediate post-injury period in a rat model of cavernous-nerve-crush-injury could normalize cavernous-veno-occlusive-function, and to compare it with phosphodiesterase type 5 (PDE5)-inhibitors. Materials and Methods A total of 75 12-week-old male Sprague–Dawley-rats were randomized into five groups: sham-surgery (S), cavernous-nerve-crush-injury (I), cavernous-nerve-crush-injury treated with 10.0 mg/kg LIMK2-inhibitor (L) or 10.0 mg/kg JNK-inhibitor and 10.0 mg/kg LIMK2-inhibitor (J+L) or 20.0 mg/kg udenafil (P) for five-weeks. Five-weeks after surgery, dynamic-infusion-cavernosometry, histological-studies, caspase-3-activity-assay, and Western-blot were investigated. Results Group-I had lower papaverine-response, higher maintenance-rate and higher drop-rate, compared to Group-S. Group-L, Group-J+L and Group-P showed improvement in the three dynamic-infusion-cavernosometry parameters. The papaverine-response and drop-rate in Group-J+L and Group-P recovered to sham-control level, but those in Group-L did not. Regarding apoptosis, Group-I had decreased content of α-smooth-muscle-actin, increased caspase-3 activity and increased cJun-phosphorylation. The cJun-phosphorylation improved only in Group-J+L. The α-smooth-muscle-actin content and caspase-3-activity in Group-J+L and Group-P improved, but those in Group-L were not. Regarding fibrosis, Group-I had decreased smooth muscle (SM)/collagen-ratio, increased protein-expression of fibronectin, and increased Cofilin-phosphorylation. Cofilin-phosphorylation was normalized in Group-L and Group-J+L, but not in Group-P. SM/collagen-ratio and protein-expression of fibronectin in Group-L, Group-J+L and Group-P improved. Conclusions Our data indicate that chronic inhibition of JNK and LIMK2 can restore cavernous-veno-occlusive-function by suppressing cavernous-apoptosis and cavernous-fibrosis, comparable to the results by PDE5-inhibitors. Chronic inhibition of JNK and LIMK2 might be a potential mechanism-specific targeted therapy for cavernous-veno-occlusive-dysfunction induced by cavernous nerve-injury.
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Affiliation(s)
- Min Chul Cho
- Department of Urology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Junghoon Lee
- Department of Urology, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Juhyun Park
- Department of Urology, Asan Medical Center, Seoul, Korea
| | - Soo Woong Kim
- Department of Urology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
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Cho MC, Lee J, Park J, Oh S, Chai JS, Son H, Paick JS, Kim SW. The effects of single versus combined therapy using LIM-kinase 2 inhibitor and type 5 phosphodiesterase inhibitor on erectile function in a rat model of cavernous nerve injury-induced erectile dysfunction. Asian J Androl 2020; 21:493-500. [PMID: 30829289 PMCID: PMC6732899 DOI: 10.4103/aja.aja_114_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We aimed to determine whether combination of LIM-kinase 2 inhibitor (LIMK2i) and phosphodiesterase type-5 inhibitor (PDE5i) could restore erectile function through suppressing cavernous fibrosis and improving cavernous apoptosis in a rat model of cavernous nerve crush injury (CNCI). Seventy 12-week-old Sprague-Dawley rats were equally distributed into five groups as follows: (1) sham surgery (Group S), (2) CNCI (Group I), (3) CNCI treated with daily intraperitoneal administration of 10.0 mg kg-1 LIMK2i (Group I + L), (4) daily oral administration of 20.0 mg kg-1 udenafil, PDE5i (Group I + U), and (5) combined administration of 10.0 mg kg-1 LIMK2i and 20.0 mg kg-1 udenafil (Group I + L + U). Rats in Groups I + L, I + U, and I + L + U were treated with respective regimens for 2 weeks after CNCI. At 2 weeks after surgery, erectile response was assessed using electrostimulation. Penile tissues were processed for histological studies and western blot. Group I showed lower intracavernous pressure (ICP)/mean arterial pressure (MAP), lower area under the curve (AUC)/MAP, decreased immunohistochemical staining for alpha-smooth muscle (SM) actin, higher apoptotic index, lower SM/collagen ratio, increased phospho-LIMK2-positive fibroblasts, decreased protein kinase B/endothelial nitric oxide synthase (Akt/eNOS) phosphorylation, increased LIMK2/cofilin phosphorylation, and increased protein expression of fibronectin, compared to Group S. In all three treatment groups, erectile responses, protein expression of fibronectin, and SM/collagen ratio were improved. Group I + L + U showed greater improvement in erectile response than Group I + L. SM content and apoptotic index in Groups I + U and I + L + U were improved compared to those in Group I. However, Group I + L did not show a significant improvement in SM content or apoptotic index. The number of phospho-LIMK2-positive fibroblasts was normalized in Groups I + L and I + L + U, but not in Group I + U. Akt/eNOS phosphorylation was improved in Groups I + U and I + L + U, but not in Group I + L. LIMK2/cofilin phosphorylation was improved in Groups I + L and I + L + U, but not in Group I + U. Our data indicate that combined treatment of LIMK2i and PDE5i immediate after CN injury could improve erectile function by improving cavernous apoptosis or eNOS phosphorylation and suppressing cavernous fibrosis. Rectification of Akt/eNOS and LIMK2/cofilin pathways appears to be involved in their improvement.
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Affiliation(s)
- Min Chul Cho
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Junghoon Lee
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Juhyun Park
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Ji Sun Chai
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Soo Woong Kim
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 03080, Korea
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Kim SW, Lee J, Park J, Chai JS, Oh S, Paick JS, Cho MC. Combination of LIM-kinase 2 and Jun Amino-terminal Kinase Inhibitors Improves Erectile Function in a Rat Model of Cavernous Nerve Injury. Urology 2019; 131:136-143. [PMID: 31202856 DOI: 10.1016/j.urology.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/24/2019] [Accepted: 06/03/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine if combined administration of LIMK2 and JNK inhibitors in a rat model of erectile dysfunction induced by cavernosal nerve (CN) injury could restore erectile function by suppressing both cavernosal apoptosis and fibrosis via rectification of molecular pathways related to the structural alterations. METHODS Sixty 12-week-old male Sprague-Dawley rats were categorized into 4 groups: (1) Sham-surgery (Sham) group, (2) CN-crush-injury (CNCI), (3) CNCI group (CNCI+L+1.0J) treated with a combination of 10.0 mg/kg LIMK2-inhibitors and low-dose (1.0 mg/kg) JNK-inhibitors, and (4) CNCI group (CNCI+L+10.0J) treated with a combination of 10.0 mg/kg LIMK2-inhibitors and a high dose (10.0 mg/kg) of JNK-inhibitors. Ten days after surgery, erectile response, histological-studies, and Western-blot was investigated. RESULTS The CNCI group showed a reduced maximal ICP/MAP or AUC/MAP, decreased immunohistochemical-staining of α-SMA, decreased SM/collagen ratio, increased phospho-cJun-positive apoptotic cells, increased phospho-LIMK2-positive fibroblasts, increased cJun-phosphorylation, increased LIMK2/Cofilin-phosphorylation, decreased Bcl-2/Bax ratio, and increased protein-expression of fibronectin, compared to the Sham group. Both the CNCI+L+1.0J and CNCI+L+10.0J groups showed improvements in erectile-responses, content of cavernosal α-SMA, number of phospho-cJun-positive apoptotic cells, Bcl-2/Bax ratio and cJun phosphorylation. Their improvements in the CNCI+L+10.0J group showed a tendency to be greater than those in the CNCI+L+1.0J group. Also, in the 2 treatment groups, rectification of SM/collagen ratio, number of phospho-LIMK2-positive fibroblasts, LIMK2/Cofilin-phosphorylation, and protein-expression of fibronectin was observed. CONCLUSION This study suggests that combined inhibition of JNK and LIMK2 may improve erectile function by suppressing cavernosal apoptosis and fibrosis via restoration of cJun/Bcl-2/Bax and LIMK2/Cofilin pathways at 10 days after CN injury.
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Affiliation(s)
- Soo Woong Kim
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Junghoon Lee
- Department of Urology, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Juhyun Park
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Ji Sun Chai
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sohee Oh
- Department of Biostatistics, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jae-Seung Paick
- Department of Urology, Mediplex Sejong Hospital, Incheon, Republic of Korea
| | - Min Chul Cho
- Department of Urology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
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Hamidi N, Altinbas NK, Gokce MI, Suer E, Yagci C, Baltaci S, Turkolmez K. Preliminary results of a new tool to evaluate cavernous body fibrosis following radical prostatectomy: penile elastography. Andrology 2017; 5:999-1006. [DOI: 10.1111/andr.12408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/04/2017] [Accepted: 06/29/2017] [Indexed: 12/24/2022]
Affiliation(s)
- N. Hamidi
- Department of Urology; Atatürk Training and Research Hospital; Ankara Turkey
| | - N. K. Altinbas
- Department of Radiology; Ankara University School of Medicine; Ankara Turkey
| | - M. I. Gokce
- Department of Urology; Ankara University School of Medicine; Ankara Turkey
| | - E. Suer
- Department of Urology; Ankara University School of Medicine; Ankara Turkey
| | - C. Yagci
- Department of Radiology; Ankara University School of Medicine; Ankara Turkey
| | - S. Baltaci
- Department of Urology; Ankara University School of Medicine; Ankara Turkey
| | - K. Turkolmez
- Department of Urology; Ankara University School of Medicine; Ankara Turkey
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The Protective Effect of Salidroside on Hypoxia-Induced Corpus Cavernosum Smooth Muscle Cell Phenotypic Transformation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:3530281. [PMID: 28798798 PMCID: PMC5535750 DOI: 10.1155/2017/3530281] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/25/2017] [Accepted: 06/06/2017] [Indexed: 01/08/2023]
Abstract
Salidroside, a major active ingredient isolated from Rhodiola rosea, has a long application in Chinese medical history. It has widely demonstrated effects on fatigue, psychological stress, and depression and exhibits potential antihypoxia activity. Emerging evidence shows that hypoxia is an important independent risk factor for erectile dysfunction (ED). The aim of this study was to clarify the effect of salidroside on hypoxia-induced phenotypic transformation of corpus cavernosum smooth muscle cells (CCSMCs). Our results showed that salidroside decreased the hypoxia-induced expression of collagen and content of vimentin, a corpus cavernosum smooth muscle synthetic protein, in vitro. Simultaneously, salidroside increased expression of the CCSMC contractile proteins, α-smooth muscle actin (α-SMA) and desmin. In vivo, similarly, the expressions of collagen and hypoxia-inducible factor-1α were increased in bilateral cavernous neurectomy (BCN) rats while they were decreased in the salidroside group. Among the phenotypic proteins, α-SMA and desmin increased and vimentin decreased after treating BCN rats with salidroside compared with the BCN alone group. Overall, our results demonstrate that salidroside has the ability to oppose hypoxia and can inhibit the CCSMC phenotypic transformation induced by hypoxia. Salidroside may provide a new treatment method for ED.
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Campbell J, Alzubaidi R. Understanding the cellular basis and pathophysiology of Peyronie's disease to optimize treatment for erectile dysfunction. Transl Androl Urol 2017; 6:46-59. [PMID: 28217450 PMCID: PMC5313310 DOI: 10.21037/tau.2016.11.01] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Erectile dysfunction (ED) is a common condition that significantly impacts a man’s physical and psychological well-being. ED is often associated with Peyronie’s disease (PD), which is an abnormal curvature of the penis. Delayed treatment of or surgical invention for PD often results in ED and therefore unsatisfied patients. The pathophysiology of PD is incompletely understood, but has been studied extensively and based on our current understanding of PD physiology, many medical treatment options have been proposed. In this paper, we will review what is known about the pathophysiology of PD and the medical treatment options that have been trialed as a result. More investigations in regards to the basic science of PD need to be carried out in order to elucidate the exact mechanisms of the fibrosis, and propose new, more successful treatment options which should be implemented prior to the onset of ED.
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Affiliation(s)
- Jeffrey Campbell
- London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Raidh Alzubaidi
- London Health Sciences Centre and St. Joseph's Health Care, Western University, London, Ontario, Canada
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Salonia A, Castagna G, Capogrosso P, Castiglione F, Briganti A, Montorsi F. Prevention and management of post prostatectomy erectile dysfunction. Transl Androl Urol 2016; 4:421-37. [PMID: 26816841 PMCID: PMC4708594 DOI: 10.3978/j.issn.2223-4683.2013.09.10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Sexual dysfunction is common in patients with prostate cancer (PC) following radical prostatectomy (RP). Review the available literature concerning prevention and management strategies for post-RP erectile function (EF) impairment in terms of preoperative patient characteristics, intra and postoperative factors that may influence EF recovery, and postoperative treatments for erectile dysfunction (ED). A literature search was performed using Google and PubMed database for English-language original and review articles, either published or e-published up to July 2013. The literature still demonstrates a great inconsistency in the definition of what is considered normal EF both before and after RP. Thus, using validated psychometric instruments with recognized cut-offs for normalcy and severity during the pre- and post-operative evaluation should be routinely considered. Therefore, a comprehensive discussion with the patient about the true prevalence of postoperative ED, the concept of spontaneous or pharmacologically-assisted erections, and the difference between “back to baseline” EF and “erections adequate enough to have successful intercourse” clearly emerge as key issues in the eventual understanding of post-RP ED prevention and promotion of satisfactory EF recovery. Patient factors (including age, baseline EF, comorbid conditions status), cancer selection (non- vs. uni- vs. bilateral nerve-sparing), type of surgery (i.e., intra vs. inter vs. extrafascial surgeries), surgical techniques (i.e., open, laparoscopic and robotically-assisted RP), and surgeon factors (i.e., surgical volume and surgical skill) represent the key significant contributors to EF recovery. A number of preclinical and clinical data show that rehabilitation and treatment in due time are undoubtedly better than leaving the erectile tissue to its unassisted postoperative fate. The role of postoperative ED treatment for those patients who received a non-nerve-sparing RP was also extensively discussed. Optimal outcomes are achieved mainly by the careful choice of the correct patient for the correct type of surgery. Despite a plethora of potential rehabilitative approaches, they should be only considered as “strategies”, since incontrovertible evidence of their effectiveness for improving natural EF recovery is limited. Conversely, numerous effective therapeutic options are available for treating post-RP ED.
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Affiliation(s)
- Andrea Salonia
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Giulia Castagna
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Paolo Capogrosso
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Fabio Castiglione
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Alberto Briganti
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
| | - Francesco Montorsi
- 1 Department of Urology, University Vita-Salute San Raffaele, Milan, Italy ; 2 Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy
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Factors predicting outcomes of penile rehabilitation with udenafil 50 mg following radical prostatectomy. Int J Impot Res 2015; 28:25-30. [DOI: 10.1038/ijir.2015.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 08/04/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
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Abstract
Erectile dysfunction (ED) is often perceived by both patients and sexual partners as a serious problem that can jeopardize quality of life, psychosocial or emotional well-being, and the partnership in the long term. Since their introduction, oral phosphodiesterase type 5 inhibitors (PDE5Is) have been found to be highly effective and well tolerated, and are available as the first-line therapy for the treatment of ED. Udenafil is one of the selective PDE5Is made available in recent years for the treatment of ED. Udenafil has clinical properties of both relatively rapid onset and long duration of action due to its pharmacokinetic profile, thereby providing an additional treatment option for ED men to better suit individual needs. There is positive evidence that udenafil is effective and well tolerated in the treatment of ED of a broad spectrum of etiologies or severity. Udenafil is as effective in the treatment of diabetes mellitus-associated ED as other PDE5Is. Due to the clinical property of relatively long duration of action, udenafil may be another option in daily dosing treatment for ED, as suggested by its favorable efficacy and safety profile. Most adverse effects reported from clinical trials are mild or moderate in severity, without any serious adverse event, with headache and flushing being the most common. Also, the concomitant use of anti-hypertensive drugs or alpha-1-blockers does not significantly affect the efficacy and safety profile of udenafil. However, additional studies with larger cohorts including prospective, multicenter, comparative studies with patients of different ethnicities are needed to further validate the favorable findings of udenafil in the treatment of ED.
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Affiliation(s)
- Min Chul Cho
- Department of Urology, Dongguk University College of Medicine, Goyang, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Yiou R, De Laet K, Hisano M, Salomon L, Abbou C, Lefaucheur J. Neurophysiological Testing to Assess Penile Sensory Nerve Damage After Radical Prostatectomy. J Sex Med 2012; 9:2457-66. [DOI: 10.1111/j.1743-6109.2012.02793.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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12
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El-Sakka AI. Alleviation of post-radical prostatectomy cavernosal fibrosis: future directions and potential utility for PDE5 inhibitors. Expert Opin Investig Drugs 2011; 20:1305-9. [PMID: 21846259 DOI: 10.1517/13543784.2011.609315] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Reversion of cavernosal fibrosis remains a controversial issue. The relative smooth muscle cells' loss that happens with cavernosal nerve damage and their impact on deterioration of erectile function were demonstrated in several studies. Furthermore, chronic ischemia that occurs with aging and medical co-morbidities is associated with the reduction of nitric oxide-cyclic guanosine monophosphate and ultimately cavernosal fibrosis. Despite the encouraging recent results of the role of phosphodiesterase type 5 inhibitors in the prevention of post-prostatectomy erectile dysfunction, debate regarding the exact mechanism of PDE5 inhibitors in prevention, amelioration and reversion of penile fibrosis still exists. Recently, several reports suggested that PDE5 inhibitors may improve endothelial function and decrease arterial stiffness, introducing this class of compounds as potential drugs for the treatment of erectile dysfunction-associated penile fibrosis. In this editorial, we intended to address the role of PDE5 inhibitors as a promising treatment to alleviate or reverse ED associated-cavernosal fibrosis.
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Zhao C, Kim SW, Yang DY, Kim JJ, Park NC, Lee SW, Paick JS, Ahn TY, Min KS, Park K, Park JK. Efficacy and Safety of Once-Daily Dosing of Udenafil in the Treatment of Erectile Dysfunction: Results of a Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial. Eur Urol 2011; 60:380-7. [DOI: 10.1016/j.eururo.2011.03.025] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 03/16/2011] [Indexed: 11/25/2022]
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Abstract
Erectile dysfunction is a common problem after radical prostatectomy, with almost all men experiencing this complication for at least a short period after such surgery. There is evidence that early use of phosphodiesterase type 5 inhibitors, intracavernous vasoactive drugs, intraurethral alprostadil or vacuum devices can improve the recovery of postoperative erectile function. The same therapeutic modalities can be used to treat erectile dysfunction after radical prostatectomy. Physicians must be active and counsel patients and partners to improve adherence to penile rehabilitation or erectile dysfunction treatment.
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Affiliation(s)
- Sidney Glina
- Instituto H. Ellis, Rua Cincinato Braga, São Paulo, Brazil.
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Reversion of penile fibrosis: Current information and a new horizon. Arab J Urol 2011; 9:49-55. [PMID: 26579268 PMCID: PMC4149188 DOI: 10.1016/j.aju.2011.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Accepted: 02/14/2011] [Indexed: 11/22/2022] Open
Abstract
Ageing has a detrimental effect on cavernous tissue and the tunica albuginea of the penis. Furthermore, atherosclerosis of the penile vessels that occurs with ageing causes a decrease in penile oxygen tension. A reduction in smooth muscle cells (SMCs) was shown in relation to diminution of oxygen tension. Chronic ischaemia is therefore not only associated with fibrosis but also with nitric oxide-cyclic guanosine monophosphate reduction. The sensitivity of the α-adrenoceptors on the SMCs increases with ageing. The decrease in penile elasticity and compliance are explained by the changes in the ratio of penile collagen that occur with ageing. Contradictory to the view that testosterone is only necessary for sexual desire, numerous recent studies showed that androgen deprivation produces penile tissue atrophy, alterations in dorsal nerve structure, alterations in endothelial morphology, reduction in trabecular SM content, increase in deposition of extracellular matrix and accumulation of fat-containing cells (adipocytes) in the subtunical region of corpus cavernosum. The aim of the current review is to shed some light on the underlying aetiology of corporal fibrosis especially ageing, cavernous nerve damage, androgen deprivation and tunical fibrosis. Ultimately I will address the proposed prevention of erectile dysfunction associated with penile fibrosis.
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Key Words
- (i)(e)NO(S), (inducible) (endothelial) nitric oxide (synthase)
- CVOD, corporal veno-occlusive dysfunction
- Corpora cavernosa
- ECM, extracellular matrix
- ED, erectile dysfunction
- Fibrosis
- HIF-1α, hypoxia-inducible factor-1α
- PD, Peyronie’s disease
- PDE5-I, phosphodiesterase type 5 inhibitor
- PGE, prostaglandin E
- ROS, reactive oxygen species
- SM(C), smooth muscle (cells)
- Tunica albuginea
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