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Bonarska M, Adasik D, Szymczyk S, Łocik G, Bumbul-Mazurek E, Marianowski P, Ludwin A. A Narrative Review of Independent Treatment Methods for ED: Assessment of the Effectiveness of Diet, Supplements, Pharmacotherapy, and Physiotherapy. J Clin Med 2025; 14:2386. [PMID: 40217836 PMCID: PMC11989648 DOI: 10.3390/jcm14072386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2025] [Revised: 03/21/2025] [Accepted: 03/21/2025] [Indexed: 04/14/2025] Open
Abstract
The prevalence of erectile dysfunction (ED) among the male population worldwide has significant ramifications for their quality of life and psychological well-being. This narrative review explores both conventional treatments, such as pharmacotherapy and surgery, and emerging approaches, including regenerative therapies, dietary interventions, physiotherapy, and vacuum erection devices (VEDs). Unlike prior reviews, this study emphasises unconventional therapies and their role in comprehensive ED management. A systematic literature review was conducted using PubMed, Embase, and Medline, including studies published up to 2024. Keywords such as "ED", "pharmacotherapy", "shock wave therapy", "regenerative medicine", and "dietary interventions" were used to identify relevant studies. Eligible studies examined treatment efficacy, mechanisms, and patient outcomes. Phosphodiesterase type 5 (PDE5i) inhibitors remain the primary treatment, demonstrating effectiveness across diverse populations. Regenerative therapies, including stem cells and platelet-rich plasma (PRP), show promise, but require further validation. Surgical interventions, particularly penile prostheses, provide high patient and partner satisfaction. Non-invasive methods, including physiotherapy and dietary changes like adoption of the Mediterranean diet, improve vascular health and erectile function. The efficacy of VEDs as standalone or adjunct treatments has been demonstrated, enhancing outcomes in prosthetic surgery. A multimodal, personalised approach is essential for optimising ED treatment. Despite promising advancements, gaps remain in terms of long-term data, standardised protocols, and partner-centred outcomes. Future research should focus on large-scale, multi-centre trials and synergistic treatment approaches to improve therapeutic outcomes and patient satisfaction.
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Affiliation(s)
- Marta Bonarska
- 1st Department of Obstretrics and Gynaecology, University Centre for Women and Newborn Health, pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland; (M.B.); (D.A.); (G.Ł.); (E.B.-M.); (P.M.); (A.L.)
- Faculty of Medicine, Medical University of Warsaw, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Damian Adasik
- 1st Department of Obstretrics and Gynaecology, University Centre for Women and Newborn Health, pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland; (M.B.); (D.A.); (G.Ł.); (E.B.-M.); (P.M.); (A.L.)
- Faculty of Medicine, Medical University of Warsaw, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Simone Szymczyk
- 1st Department of Obstretrics and Gynaecology, University Centre for Women and Newborn Health, pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland; (M.B.); (D.A.); (G.Ł.); (E.B.-M.); (P.M.); (A.L.)
- Faculty of Medicine, Medical University of Warsaw, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Gabriela Łocik
- 1st Department of Obstretrics and Gynaecology, University Centre for Women and Newborn Health, pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland; (M.B.); (D.A.); (G.Ł.); (E.B.-M.); (P.M.); (A.L.)
- Faculty of Medicine, Medical University of Warsaw, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Elżbieta Bumbul-Mazurek
- 1st Department of Obstretrics and Gynaecology, University Centre for Women and Newborn Health, pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland; (M.B.); (D.A.); (G.Ł.); (E.B.-M.); (P.M.); (A.L.)
- Faculty of Medicine, Medical University of Warsaw, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Piotr Marianowski
- 1st Department of Obstretrics and Gynaecology, University Centre for Women and Newborn Health, pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland; (M.B.); (D.A.); (G.Ł.); (E.B.-M.); (P.M.); (A.L.)
- Faculty of Medicine, Medical University of Warsaw, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Artur Ludwin
- 1st Department of Obstretrics and Gynaecology, University Centre for Women and Newborn Health, pl. Starynkiewicza 1/3, 02-015 Warsaw, Poland; (M.B.); (D.A.); (G.Ł.); (E.B.-M.); (P.M.); (A.L.)
- Faculty of Medicine, Medical University of Warsaw, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
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Mao J, Zhang JN, Zhang QB, Zhu DT, Li XM, Xiao H, Kan XL, Zhang R, Zhou Y. Extracorporeal Shock Wave and Melatonin Alleviate Joint Capsule Fibrosis after Knee Trauma in Rats by Regulating Autophagy. Curr Mol Med 2025; 25:222-236. [PMID: 39279114 DOI: 10.2174/0115665240339436240909100847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Revised: 08/13/2024] [Accepted: 08/26/2024] [Indexed: 09/18/2024]
Abstract
BACKGROUND Joint contracture is a common clinical problem affecting joint function. Capsule fibrosis plays a pivotal role in the progression of joint contracture. Previous studies have reported that autophagy plays a regulatory role in visceral fibrosis. OBJECTIVE This study aimed to investigate whether extracorporeal shock wave therapy (ESWT) and melatonin alleviate joint capsule fibrosis in rats with extended knee joint contracture by regulating autophagy. METHODS A rat traumatic knee joint extension contracture model was made. Then, the rats were treated with ESWT, melatonin, ESWT + melatonin, or ESWT + melatonin + mTOR agonist for 4 weeks. The range of motion (ROM) of the knee joints was measured. Joint capsules were collected and observed for pathological changes by H&E and Masson staining. LC3B protein expression was evaluated by immunofluorescence staining. TGF-β1, MMP-1, Col-Ⅰ, Col-Ⅲ, LC3, ATG7, Beclin1, p-AMPK, p-mTOR and p-ULK1 protein expressions were measured by Western blot assay. RESULTS The intervention groups had significantly improved ROM of knee joint (P < 0.05), significantly improved pathological changes on HE and Masson staining, significantly decreased protein expressions of TGF-β1, MMP-1, Col-Ⅰ, Col-Ⅲ and pmTOR (P < 0.05), and significantly increased protein expressions of LC3B, LC3II/LC3I ratio, ATG7, Beclin1, p-AMPK, and p-ULK1 (P < 0.05). Among these groups, the effects demonstrated by the ESWT + melatonin group were the best. With the mTOR agonist supplement, the therapeutic effects of extracorporeal shock waves and melatonin were significantly reduced. CONCLUSION ESWT plus melatonin alleviated knee joint capsule fibrosis in rats by regulating autophagy.
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Affiliation(s)
- Jing Mao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jin-Niu Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Quan-Bing Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - De-Ting Zhu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xue-Ming Li
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Han Xiao
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiu-Li Kan
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Run Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yun Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Wang Z, Wang Z, Wu F. Application of extracorporeal shockwave to regulate subchondral bone homeostasis through tumor necrosis factor-α/hypoxia-inducible factor-1α/vascular endothelial growth factor signaling pathway in treatment of talus bone marrow edema. Medicine (Baltimore) 2024; 103:e40228. [PMID: 39533623 PMCID: PMC11557035 DOI: 10.1097/md.0000000000040228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 10/04/2024] [Indexed: 11/16/2024] Open
Abstract
To investigate the effect of extracorporeal shock wave on the treatment of talus bone marrow edema by regulating subchondral bone homeostasis through tumor necrosis factor-α (TNF-α)/hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF) signaling pathway. A total of 81 patients with talus bone marrow edema admitted to our hospital from May 2019 to May 2021 were studied and divided into control group (n = 40) and extracorporeal shock group (n = 41) according to random number table method. The control group was given conventional treatment, and the extracorporeal shock group was combined with extracorporeal shock wave therapy on the basis of the control group. The expression of TNF-α, HIF-1α, and VEGF in the 2 groups were compared, pain degree, and the area of talus bone marrow edema was evaluated by magnetic resonance imaging. The visual analogue scale scores of 1 month, 2 months and 5 months after treatment were decreased in both groups, and the extracorporeal shock group was lower than the control group (P < .05). After 5 months of treatment, the expressions of TNF-α and HIF-1α were decreased in both groups, and the extracorporeal shock group was lower than the control group, VEGF was increased, and the extracorporeal shock group was higher than the control group (P < .05), and the western blot expression levels of TNF-α, HIF-1α and VEGF in the extracorporeal shock group were higher than the control group (P < .05). The dorsiflexion motion and plantar flexion motion of both groups were increased, and the extracorporeal shock group was higher than the control group (P < .05). Extracorporeal shock wave therapy can regulate subchondral bone homeostasis through TNF-α/HIF-1α/VEGF signaling pathway to treat talus bone marrow edema, reduce the pain degree of talus bone marrow edema, and improve ankle joint function.
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Affiliation(s)
- Zifan Wang
- Department of Orthopedics, School of Medicine, Putuo People’s Hospital, Tongji University, Shanghai, China
| | - Zhizhou Wang
- Department of Orthopedics, School of Medicine, Putuo People’s Hospital, Tongji University, Shanghai, China
| | - Fei Wu
- Department of Orthopedics, School of Medicine, Putuo People’s Hospital, Tongji University, Shanghai, China
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Gao QQ, Wang J, Li DS, Dai YT, Li ZR, Zhao XZ. Efficacy and safety of low-intensity pulsed ultrasound (LIPUS) combined with tadalafil in the treatment of severe erectile dysfunction: a retrospective cohort study. Transl Androl Urol 2024; 13:2045-2054. [PMID: 39434752 PMCID: PMC11491205 DOI: 10.21037/tau-24-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 08/19/2024] [Indexed: 10/23/2024] Open
Abstract
Background Low-intensity pulsed ultrasound (LIPUS) is an effective and safe treatment for mild to moderate erectile dysfunction (ED). This study aimed to investigate the efficacy and safety of combining LIPUS with tadalafil in treating severe ED. Methods The data from 27 patients treated with LIPUS alone (group A) and 21 patients treated with a combination of LIPUS and daily 10 mg tadalafil (group B) were retrospectively analyzed. The LIPUS regimen consisted of twice-weekly treatments for 4 consecutive weeks. The treatment was considered effective if the change in International Index of Erectile Function-Erectile Function Domain (IIEF-EF) score after treatment was greater than or equal to the minimal clinically important difference (MCID) (the MCID for severe ED is 7 points). The effectiveness, IIEF-EF score, erectile hardness score (EHS), peak systolic velocity (PSV), end diastolic velocity (EDV), and adverse events were evaluated before treatment, 4 weeks after treatment, and 12 weeks after treatment. Results Compared to pre-treatment, both groups showed significant improvement in IIEF-EF score and EHS at 4 and 12 weeks after treatment (P<0.001), with no statistically significant difference between the two time points (P>0.05). The effective rate did not significantly differ between group A (9/27, 33.3%) and group B (10/21, 47.62%) at 4 weeks or between group A (9/27, 33.3%) and group B (12/21, 57.14%) at 12 weeks after treatment (P=0.32, P=0.10). However, in patients without comorbidities, the effective rate of group B (12/18, 66.67%) was higher than that of group A (9/25, 36.00%) at 12 weeks after treatment (P=0.047). After LIPUS treatment, the PSV level significantly increased and the EDV level significantly decreased compared with before treatment (P<0.05). No adverse events were reported. Conclusions The study suggests that LIPUS has a therapeutic effect on severe ED patients, especially those without comorbidities. It may have a synergistic or overlapping effect with phosphodiesterase type 5 inhibitors (PDE5Is) on severe ED patients without comorbidities.
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Affiliation(s)
- Qing-Qiang Gao
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Jing Wang
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Da-Sheng Li
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yu-Tian Dai
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhi-Ran Li
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiao-Zhi Zhao
- Department of Andrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
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Narasimman M, Sandler M, Bernstein A, Loloi J, Saltzman RG, Bernie H, Ramasamy R. A primer on the restorative therapies for erectile dysfunction: a narrative review. Sex Med Rev 2024; 12:505-512. [PMID: 38494449 DOI: 10.1093/sxmrev/qeae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Erectile dysfunction (ED) is a common condition that affects millions worldwide. Patients and urologists alike are seeking alternative therapies that can provide long-lasting results in the treatment of ED. This review provides a comprehensive overview of restorative treatments available for ED, such as platelet-rich plasma, stem cell therapy, and shockwave therapy. OBJECTIVE The aim of this narrative review is to provide a primer for urologists and general practitioners on the basics of implementing ED restorative therapies in their practice. METHODS The PubMed, MEDLINE, and Google Scholar databases were searched for articles in the English language through August 31, 2023, that included key terms such as "erectile dysfunction," "restorative therapy," "shockwave therapy," "platelet-rich plasma," "stem cell therapy," and "stromal vascular fraction." Reference lists of selected studies were manually reviewed to find articles not identified by the initial database search. RESULTS Shockwave therapy has demonstrated effectiveness in treating ED, with devices like the Medispec ED1000 and Storz Duolith showing statistically significant improvements in patient scores for International Index of Erectile Function (IIEF)-Erectile Function scores in clinical trials. In reported studies of platelet-rich plasma injections, a substantial percentage of patients reached a minimal clinically important difference in the IIEF-Erectile Function scale after treatment. Studies of ED treatment with stem cell therapy, while limited and with small sample sizes, have demonstrated encouraging improvements in patient scores for the abridged 5-item version of the IIEF after treatment. CONCLUSION Shockwave, platelet-rich plasma, and stem cell therapies are important, novel, noninvasive restorative treatments for ED that can provide relief for patients wishing to avoid a more invasive approach. While these therapies have shown promising results in clinical trials, more research is required to establish them as standardized and efficacious options in the management of ED.
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Affiliation(s)
- Manish Narasimman
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Max Sandler
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Ari Bernstein
- Department of Urology, New York University Langone Health, New York, NY10016, United States
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
| | - Russell G Saltzman
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
| | - Helen Bernie
- Department of Urology, Indiana University, Indianapolis, IN 46202, United States
| | - Ranjith Ramasamy
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL 33136, United States
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Chung DY, Ryu JK, Yin GN. Regenerative therapies as a potential treatment of erectile dysfunction. Investig Clin Urol 2023; 64:312-324. [PMID: 37417556 DOI: 10.4111/icu.20230104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 05/04/2023] [Accepted: 05/22/2023] [Indexed: 07/08/2023] Open
Abstract
Erectile dysfunction (ED) is the most common sexual dysfunction disease in adult males. ED can be caused by many factors, such as vascular disease, neuropathy, metabolic disturbances, psychosocial causes, and side effects of medications. Although current oral phosphodiesterase type 5 inhibitors can achieve a certain effect, they cause temporary dilatation of blood vessels with no curative treatment effects. Emerging targeted technologies, such as stem cell therapy, protein therapy, and low-intensity extracorporeal shock wave therapy (Li-ESWT), are being used to achieve more natural and long-lasting effects in treating ED. However, the development and application of these therapeutic methods are still in their infancy, and their pharmacological pathways and specific mechanisms have not been fully discovered. This article reviews the preclinical basic research progress of stem cells, proteins, and Li-ESWT therapy, as well as the current status of clinical application of Li-ESWT therapy.
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Affiliation(s)
- Doo Yong Chung
- National Research Center for Sexual Medicine and Department of Urology, Inha University College of Medicine, Incheon, Korea
| | - Ji-Kan Ryu
- National Research Center for Sexual Medicine and Department of Urology, Inha University College of Medicine, Incheon, Korea
- Program in Biomedical Science & Engineering, Inha University, Incheon, Korea
| | - Guo Nan Yin
- National Research Center for Sexual Medicine and Department of Urology, Inha University College of Medicine, Incheon, Korea.
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