Oral Pharmacotherapy to Manage Erectile Dysfunction in Spinal Cord-Injured Men

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Background:Until recently, approved available treatments for neurogenic sexual disorders related to spinal cord injury (SCI) included intracavernosal injection or intraurethral delivery of vasoactive agents such as PGE1, alprostadil, vacuum constriction devices, and surgical implantation of penile prosthetic devices. Improved understanding of penile physiology led to the development of sildenafil as the first oral pharmacotherapeutic agent available to successfully treat erectile dysfunction (ED) in men with SCI.Materials and Method:We reviewed the current English literature related to oral pharmacotherapy to treat ED in men with SCI including emerging oral agents that have yet to be tested in the SCI population.Results:Sildenafil is the most extensively studied oral agent to treat ED in spinal cord-injured patients. The results are invariably favorable, and the drug is safe in men with SCI T5 and above. Emerging agents, including sublingual apomorphine and vardenafil, have yet to be adequately studied in the SCI population.Conclusion:Clinicians caring for spinal cord-injured patients should remain informed of the current developments in oral pharmacotherapy of ED in men with SCI. Prospective, randomized trials involving a large number of participants with SCI should be encouraged to objectively measure the merit and safety of these emerging oral erectogenic agents in this patient population.

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