Hakky Tariq Said, Jain Lakshay
Turk J Urol. 2015 Jun;41(2):88-92. doi: 10.5152/tud.2015.46354.
The causes of male erectile dysfunction (ED) are quite variable and are now commonly divided into etiologies such as ischemia, smooth muscle damage, or altered blood flow. Although varying rates of ED have been reported in literature, the number of men with ED is projected to increase worldwide by 2025 to approximately 322 million. Since the introduction of phosphodiesterase 5 (PDE5) inhibitors, there has been a paradigm shift in the treatment of ED because PDE5 inhibitors address a broad spectrum of etiologies for ED. Today, the American Urological Association recommends the use of three PDE5 inhibitors (sildenafil, tadalafil, and vardenafil) as a first-line therapy for the treatment of ED. This review evaluates the pharmacological mechanism of PDE5 inhibitors along with the impact and use of sildenafil, vardenafil, tadalafil, and avanafil. By increasing intracellular cGMP levels, PDE5 inhibitors have been shown to be effective in the treatment of ED. Through their effects on other cellular signaling pathways, PDE5 inhibitors have the potential for treating other urologic conditions as well. The use of PDE5 inhibitors can also be combined to produce a synergistic effect in conditions such as male hypogonadism and benign prostatic hyperplasia in addition to ED.
男性勃起功能障碍（ED）的病因颇为多样，目前通常分为缺血、平滑肌损伤或血流改变等病因。尽管文献报道的ED发病率各不相同，但预计到2025年，全球ED患者数量将增至约3.22亿。自磷酸二酯酶5（PDE5）抑制剂问世以来，ED的治疗发生了范式转变，因为PDE5抑制剂可针对多种ED病因。如今，美国泌尿外科学会推荐使用三种PDE5抑制剂（西地那非、他达拉非和伐地那非）作为ED治疗的一线疗法。本综述评估了PDE5抑制剂的药理机制以及西地那非、伐地那非、他达拉非和阿伐那非的作用及应用。通过提高细胞内cGMP水平，PDE5抑制剂已被证明对ED治疗有效。通过对其他细胞信号通路的作用，PDE5抑制剂也有治疗其他泌尿系统疾病的潜力。除ED外，PDE5抑制剂的使用还可联合应用于男性性腺功能减退和良性前列腺增生等疾病，以产生协同效应。
