title: Treatments for erectile dysfunction in spinal cord patients: alternatives to phosphodiesterase type 5 inhibitors? A review study.
abstract: METHODS
  Review study.
  
  
  OBJECTIVE
  Alternative treatments to oral phosphodiesterase type 5 inhibitors (PDE5Is) in individuals with spinal cord lesions (SCLs) and erectile dysfunction (ED).
  
  
  METHODS
  Italy.
  
  
  METHODS
  Research clinical trials (1999-2014).
  
  
  RESULTS
  Twelve studies were selected. One article documented that 76% of subjects reached satisfactory sexual intercourse (SI) using intracavernosal injection of vasoactive medications (papaverine and prostaglandin E1). One study regarding perineal training showed a significant increase (P<0.05) in penile tumescence in 10 individuals with preserved sacral segment. Two studies reported contrasting results on erectile function (EF) using various dosages of oral fampridine (25-40 mg). Furthermore, 95.1% of patients on fampridine 25 mg experienced drawbacks. Disappointing findings were found with intraurethral alprostadil (125-1000 μg) and sublingual apomorphine 3 mg. Two studies concerning penile prosthesis reported valid SI more than 75% of the time with a mean follow-up of 11 years, although around 15% of individuals showed side effects. As for surgical treatments, 88% of males submitted to Brindley sacral anterior root stimulator after sacral dorsal rhizotomy achieved valid erection up to 8 years following the procedure. Three studies documented the impact of definitive sacral neuromodulation implant (Medtronic, Minneapolis, MN, USA) also on EF. After surgery, 20-37.5% of patients with ED recovered normal EF.
  
  
  CONCLUSIONS
  Data are scant on the efficacy of ED treatments for SCL subjects who did not respond to PDE5Is. Further research should investigate the effects of any SCL treatments even when they are not strictly used for neurogenic sexual dysfunction.
authors.affiliation: Neuro-Urology Department, Careggi University Hospital, Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Lombardi
authors.affiliation: Neuro-Urology Department, Careggi University Hospital, Florence, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Musco
authors.affiliation: Department of Urology, Antwerp University Hospital and University of Antwerp, Faculty of Medicine, Antwerp, Belgium.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wyndaele
authors.affiliation: Neuro-Urology Department, Careggi University Hospital, Florence, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Del Popolo
mesh_terms: D015761:4-Aminopyridine / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D004305:Dose-Response Relationship, Drug; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008137:Longitudinal Studies; D016239:MEDLINE / Q000706:statistics & numerical data; D008297:Male; D058986:Phosphodiesterase 5 Inhibitors / Q000627:therapeutic use*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000188:drug therapy / Q000601:surgery
chemical_list: D058986:Phosphodiesterase 5 Inhibitors; D015761:4-Aminopyridine