Treatment of erectile dysfunction in the older diabetic patient

Abstract

A degree of erectile dysfunction affects more than 30% of men over the age of 50 years and is thought to be approximately three times more prevalent in diabetic compared with nondiabetic individuals. The etiology and pathophysiology of erectile dysfunction in this subpopulation is multifactorial and a good understanding of the contributing issues is required in order to provide holistic and effective management to the patients. Phosphodiesterase 5 inhibitors are currently the first-line treatment modality, but these are ineffective in approximately a third of patients and more so in diabetics. Other treatments available include androgen replacement, vacuum-erection devices, intracavernosal injections of drugs such as vasoactive intestinal peptide, phentolamine and prostaglandin E1 (also available as intraurethral and topical preparations), as well as surgical prostheses. Future therapeutic options that are promising include drugs that combine nitric oxide donation and phosphodiesterase 5 inhibitory activity, RhoA kinase antagonists and gene therapy.