TREATMENT OF ERECTILE DYSFUNCTION: THE PAST, PRESENT AND FUTURE

Various surgical techniques, penile implants, vacuum pump, intracavernous injections, There have been many more or less invasive attempts before achieving modern and effective oral treatment of erectile dysfunction. It is true that waiting for patients allowed all daring.

Ancestors of hormone replacement therapy and pioneers in the treatment of erectile dysfunction, surgeons Voronoff and Lespinasse attempted, in 1925 and then in 1928, to use monkey testis transplants in humans. As you might expect, this “heroic” approach was soon to be abandoned. It was nevertheless to mark the beginning of the history of erectile dysfunction treatment. At present Kamagra Oral Jelly  plays a major role in erectile dysfunction treatment.

 

 THE SURGICAL AND INSTRUMENTAL APPROACH

  1. COMPRESSION OF THE DORSAL VEIN OF THE VERGE

In fact, the first attempts at the surgical treatment of impotence date back to 1936, when Lowsley and Bray proposed, for severe cases, an intervention comprising a plicature of the bulbo-cavernous and ischio-cavernous muscles and a plication of the suspensory ligament. : the principle consists in obtaining a compression of the dorsal vein of the penis.

 

  1. PENILE IMPLANTS

It was in 1948 that the first penile implant appeared (the autograft of costal cartilage used by Bergman) in relation to which the appearance of inflatable prostheses in 1973 (Scott) constitutes a

 

  1. REVASCULARIZATION SURGERY

Appears immediately after revascularization surgery, intended to restore the patient to near-normal sexual function without the use of prosthesis. The first results in this area were published by Michal’s team, who proposed a femoroperoneal bypass in 1974 then an epigastric cavernous anastomosis in 1977, and by that of Virag, who performed for the first time an arterialization of the dorsal vein of the rod in 1982.

 

  1. THE “VACUUM”

Among the instrumental techniques, let us also mention the publication by Nadig in 1985, of the first article describing a modern device based on a principle known since the 18th century: the use of vacuum for the treatment of erectile dysfunction

 

 THE PHARMACOLOGICAL APPROACH

  1. INTRACAVERNOUS INJECTIONS

After revascularization surgery, the first attempts at pharmacological treatment of erectile dysfunction appear by intracavernous injection. The first active substances used are papaverine (Virag, 1982) then phenoxybenzamine (Brindley, 1983). The α-blocker moxisylyte was the first substance to receive Marketing Authorization for this indication in 1993 and alprostadil, a prostaglandin used for the first time in humans by Ishii in 1986, received its Marketing Authorization in 1994. Intraurethral alprostadil , intended to make this treatment a little less invasive, has been authorized since 2001; unfortunately, its effectiveness does not seem optimal.

 

  1. TOPICAL TREATMENTS

Topical treatments are being evaluated: these are prostaglandin E1 gels to be applied locally on the glans or on the penis (Alprox-TD, Topiglan. These products in development are not yet commercialized 

 

  1. PHOSPHODIESTERASE INHIBITORS

In 1998, the Nobel Prize for Medicine rewarded the Americans Robert F. Furchgott (University of New York), Ferid Murad (School of Medicine of Houston), and Louis J. Ignarro (University of Los Angeles) for having established that the oxide of nitrogen (NO) played a major role in cardiovascular physiology. However, erection is a vascular phenomenon, which will allow Tom LUE to produce his famous aphorism: no NO = no sex (no NO, no sex).

 

This discovery opens the way to a real revolution in the pharmacological treatment of erectile dysfunction: that of oral treatment, marked by the resounding marketing of sildenafil (Viagra). From March 1998 to July 2002, more than 600,000 practitioners dispensed more than 100 million Viagra  prescriptions to more than 20 million patients worldwide.

 

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Sildenafil and the newer phosphodiesterase inhibitors (vardenafil and tadalafil) share a common mechanism of action (Figure 4). The release of NO due to cavernous nerve stimulation (sexual stimulation) activates guanylate cyclase in the smooth muscle cell, which causes GMP to transform into cyclic GMP (cGMP). Inhibition of cellular phosphodiesterase (PDE5) orients cGMP towards the pathway of a cGMP-specific protein kinase, resulting in the outflow of cellular calcium and the opening of potassium channels. The result is a relaxation of the cavernous muscle allowing a durable and good quality erection.

CONCLUSION

A lot of ground has therefore been traveled since the days when everything could be tried to obtain the slightest improvement and thus alleviate the despair of patients suffering from erectile dysfunction. The increasingly effective and non-invasive treatments now pursue the same goal: to obtain a satisfactory erection allowing a normal sex life for the satisfaction of the couple.

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