Yao WJ. et al., 2025: Advances in erectile dysfunction treatment research: a narrative review.
Wen-Jie Yao 1, Jian-Tong Dong 1, Tian-Pei Jiang 1, Jin-Na Nie 1
1College of Basic Medical Sciences, Changchun University of Chinese Medicine, Changchun, China.
Abstract
Background and objective: Erectile dysfunction (ED) is one of the common diseases in middle-aged and older men, and its etiology mainly includes vascular diseases, neurological diseases, metabolic disorders, and psychological factors. This review takes the physiological mechanisms of penile erection as a starting point and provides an in-depth look at the major current treatments, which include phosphodiesterase type 5 (PDE5) inhibitors, gene therapy techniques, low-intensity extracorporeal shock wave therapy (Li-ESWT), low-intensity pulsed ultrasound therapy (LIPUS), and psychological treatments. The review further provides a critical analysis and summary of the advantages and limitations associated with each treatment approach. Finally, the article discusses the future directions of ED treatment, emphasizing the importance of integrating personalized and precision medicine principles into treatment planning to identify the most appropriate therapeutic strategy for each patient.
Methods: We conducted literature searches on academic platforms such as PubMed, Google Scholar, and Web of Science using the terms "erectile dysfunction", "stem cells", "low-intensity extracorporeal shock wave", "low-intensity pulsed ultrasound", "PDE5 inhibitors", "gene therapy", "penile prosthesis implantation", and "psychosexual therapy" collecting literature published from January 1990 to October 2024.
Key content and findings: The incidence of ED is showing a trend of becoming more widespread and affecting younger people. We have identified the main risk factors that cause ED, which include psychological disorders, hypertension, cardiovascular diseases (CVDs), and unhealthy lifestyles. On this basis, this study comprehensively reviews the latest research progress of traditional treatment methods and emerging treatment approaches, and analyzes their respective advantages and limitations.
Conclusions: As ED treatment technologies continue to advance, the erectile function of numerous patients has seen significant improvement. Looking at the future development trend, combined treatment is expected to become the mainstream strategy for treating ED, and the treatment methods for this condition will gradually move towards personalization and precision.
Transl Androl Urol. 2025 Jul 30;14(7):2106-2117. doi: 10.21037/tau-2025-193. Epub 2025 Jul 24. PMID: 40800084; PMCID: PMC12336725
Comments 1
Background and Objective
Erectile dysfunction (ED) is prevalent among middle-aged and older men, attributed to various factors including vascular and neurological diseases, metabolic disorders, and psychological issues. This review explores the physiological mechanisms of penile erection and examines current treatments, including phosphodiesterase type 5 (PDE5) inhibitors, gene therapy, low-intensity extracorporeal shock wave therapy (Li-ESWT), low-intensity pulsed ultrasound therapy (LIPUS), and psychological therapies. It critically evaluates the advantages and limitations of each treatment and discusses future directions for ED treatment, emphasizing personalized and precision medicine.
Methods
The review is based on literature from academic databases, focusing on studies published between January 1990 and October 2024, covering various treatment modalities for ED.
Key Findings
The incidence of ED is increasing, notably among younger individuals. Key risk factors include psychological disorders, hypertension, cardiovascular diseases, and unhealthy lifestyles.
Current Treatment Approaches
Traditional treatments and emerging approaches for ED are reviewed, highlighting their respective benefits and drawbacks.
1. Li-ESWT: This therapy, established in 2010, may improve erectile function by stimulating the release of vascular growth-related factors. The European Society of Urology endorses it as a first-line treatment.
2. LIPUS: Emerging as a promising therapy, LIPUS has shown potential in repairing nerve injuries associated with ED and may enhance erectile function by promoting blood vessel regeneration. Its application is still being standardized, and combined therapies are recommended.
3. Stem Cell Therapy: Stem cell treatments, especially using adipose-derived stem cells (ADSCs), demonstrate potential for nerve regeneration and improvement of ED. However, these therapies are primarily at the experimental stage.
4. Gene therapy: Gene therapy for ED often involves the delivery of genes that encode for proteins essential for penile erection, such as vascular endothelial growth factor (VEGF) or endothelial nitric oxide synthase (eNOS). These proteins play crucial roles in promoting blood flow to the penis and facilitating the physiological processes necessary for an erection. By introducing genes that promote angiogenesis (the formation of new blood vessels) and neurogenesis (the growth of new neurons), gene therapy can potentially improve erectile function in patients with vascular or nerve-related causes of ED
Conclusions
ED treatment is evolving with advancements in medical technology. While PDE5 inhibitors remain the standard treatment, options like penile prosthesis (IPP) and vacuum erection devices (VED) are viable for certain patients. Emerging therapies such as Li-ESWT, LIPUS, stem cell therapy, and gene therapy show promise but require further research before widespread clinical application. Future treatment strategies are likely to focus on personalized and precise medical approaches tailored to individual patient needs.
Jens Rassweiler