Porst H
Hamburg.
Urologe A. 2003 Oct;42(10):1330-6. doi: 10.1007/s00120-003-0418-0.
Erectile dysfunction (ED) management in the following 3-5 years will be dominated by substances targeting the L-arginine-NO-guanylate cyclase-cGMP-PDE-5 pathway, resulting in an intracellular elevation of the cGMP concentrations. Promising alternatives to the PDE-5 inhibitors, such as guanylate cyclase activators and Rho-kinase inhibitors, may also effectively compliment a PDE-5 inhibitor. Intranasal application of the melanocortin agonist PT 141 (Melanotan II) seems to be promising. As scheduled sexual activities are not preferred by the majority of couples, the future of ED-therapy will focus on drugs with a 1-2 day long efficacy window, or a daily bedtime application of low dosage agents which result in nocturnal reoxygenation of the cavernous bodies and in turn in functional improvement. Elevation of the cGMP levels and improvement of endothelial function as a result of this approach also promises benefits in cardiovascular diseases and in LUTS.
在未来3至5年，勃起功能障碍（ED）的治疗将主要依赖于作用于L-精氨酸-一氧化氮-鸟苷酸环化酶-cGMP-磷酸二酯酶5（PDE-5）途径的药物，从而使细胞内cGMP浓度升高。PDE-5抑制剂的一些有前景的替代药物，如鸟苷酸环化酶激活剂和Rho激酶抑制剂，也可能有效地补充PDE-5抑制剂的作用。鼻内应用黑素皮质素激动剂PT 141（美拉诺坦II）似乎很有前景。由于大多数夫妻并不偏好按计划进行的性活动，ED治疗的未来将侧重于疗效持续1至2天的药物，或每日睡前应用低剂量药物，从而使海绵体夜间再氧合，进而改善功能。通过这种方法提高cGMP水平和改善内皮功能，也有望对心血管疾病和下尿路症状带来益处。
