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A study investigating the dermatologic use of Melanotan-II (MT-II) was found to generate erections unexpectedly leading to the development of MTII derivatives for ED treatment (120).

MT-II was initially used to induce pigment changes in the skin for artificial tanning but has been suspected to induce melanoma, however (121). Finally, gene therapy and stem cell research has widened the frontier of ED treatment proposed as possibility to even reverse ED. Specifically, gene therapy pertains to repairing the cause of ED by restoring defective gene function and/or altering the expression of the mutant gene (32). Most of the available data on gene therapy are in the animal model.

However, a phase I clinical trial in men with ED undergoing intracavernous injection with a DNA plasmid carrying the alpha-subunit of the corporal smooth muscle Maxi-K channel showed promise in increased erectile function based on IIEF assessment sustained throughout the 3-month study period (122).

Recently, several advances in the uses of stem cells have bet met with great anticipation.

Stem cells have the ability to differentiate into different cell lines based on the cellular signaling they receive.

Bone marrow mononuclear cells in particular have been used for the treatment of ED in animal models. recently delivered bone marrow-mononuclear cells (BM-MNC) into the intracavernous smooth muscle of post radical prostatectomy men (123). The open label, dose escalation phase I/II trial showed improvements in IIEF-15 assessment as well as increased vascularization of the corpora based on penile Doppler arterial velocity measurements.

Although promising, further investigation in humans is required to substantiate BM-MNCs impact on erections, and erectile function recovery going forward.

Clearly, PDE5i have revolutionized the treatment of ED in general and the neurogenic ED population is no exception.

They remain safe and effective in most men with neurogenic ED; however, care must be taken in prescribing PDE5i to men high spinal cord lesions, MSA or possibly PD.

VEDs are minimally-invasive and can be as effective as other modalities at leading to erection.

However, high discontinuation rates are associated with VED use related to pain, difficulty using the device or sildenafil teva 25 cold penis. Intracavernosal therapy has been a mainstay of treatment for neurogenic ED and remains extremely successful in the SCI population. Trial of intracavernosal therapy for other causes of neurogenic ED can be considered second-line therapy, but there is a relative paucity of data for clinical outcomes related to its use outside of SCI men.

Surgical therapy via penile implantation remains another second line approach and may also be utilized to assist men with bladder management. Higher complication rates of infections, and perforation have been reported compared to neurologically intact men.

Many other compounds are currently being evaluated for the treatment of neurogenic ED as well as gene and stem cell therapy, but still should be considered investigational until substantiated by randomized controlled trials. Neurogenic ED remains difficult to diagnose and treat effectively.

It is important to realize that many men with neurologic disorders may have ED related to disease related factors separate from the insult to the neuro-erectile

pathway

These disease related factors must be addressed prior or simultaneously with pharmacologic and/or surgical therapy to effectively treat their SD.

As awareness of sildenafil teva 25 the complexities of normal sexual function increase so will the recognition of SD in this population.

This movement will lead to improved quality of life in men with neurologic disorders, as proven by the strong link between sexual function and quality of life. Conflicts of Interest: The authors have no conflicts of interest to declare. AXOL THERAPY FOR ERECTILE DYSFUNCTION, ENHANCED SEXUAL PERFORMANCE NOW AVAILABLE AT COLORADO UROLOGY.

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This safe and non-invasive treatment option is helping many men with ED achieve spontaneous and natural erections without the help of medications. The therapy can also be used to enhance a man’s sexual performance.

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This non-invasive procedure uses gentle full-spectrum, low-intensity sound waves that stimulate revascularization, a process in which new blood vessels form. Axol Therapy promotes improved blood flow to the penis, reduces inflammation, and stimulates the migration of the body’s stem cells for long-term healing.

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Axol Therapy is a modern approach to healing the body by using four types of energy: Heat, Electrohydraulic, Acoustic, and Light (HEAL). Unfocused acoustic waves are delivered to the shaft of the penis using a treatment wand that features a patented unfocused electrohydraulic acoustic wave. The pulsed acoustic waves are delivered through the skin into the tissue to open and repair aging blood vessels, stimulate new blood vessel growth, restore blood flow, and improve erectile quality.