Erectile Dysfunction Therapy: Recent Advances and Approaches

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Urology & Nephrology".

Deadline for manuscript submissions: 15 December 2026 | Viewed by 436

Editors


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Guest Editor
Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
Interests: urology; urological surgery; andrology; laparoscopic surgery; robotic surgery

E-Mail Website
Guest Editor
Third Department of Urology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece
Interests: prostate cancer; prostate biopsies; bladder cancer; urogenital cancer
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Special Issue Information

Dear Colleagues,

Erectile dysfunction (ED) affects millions worldwide and substantially reduces quality of life, intimate relationships, and psychological well‑being. Once attributed mainly to aging or psychogenic causes, ED is now understood as a multifactorial disorder with vascular, neurogenic, endocrine, iatrogenic and lifestyle-related contributors, requiring integrated diagnostic and therapeutic approaches. Advances across basic science, pharmacology, device engineering, and behavioral medicine have expanded therapeutic options, improved outcomes, and offered more personalized care pathways.

During the last decades, several advancements have been made in the therapeutic armamentarium of erectile dysfunction. Research into metabolic, hormonal, endothelial, and genetic biomarkers aims to stratify patients, predict treatment response, and tailor therapy regimens. Although phosphodiesterase type 5 inhibitors (PDE5is) comprise the initial option in these patients, novel drugs target alternate pathways or seek synergistic combinations to help PDE5i nonresponders. Regenerative medicine, including platelet‑rich plasma (PRP) injections and stem cell therapies, aims to restore vascular and neuronal function. Penile implants remain a durable solution for refractory ED, with improvements in mechanical reliability and cosmetic outcomes. Concerning less invasive neuromodulatory approaches, percutaneous nerve stimulation and wearable electrical stimulators are under investigation for neurogenic ED.

Therapies for erectile dysfunction are rapidly evolving. A combination of pharmacologic innovation, regenerative approaches, device refinement, psychosocial support, and digital health integration promises more effective, durable, and patient-centered treatment options.

We invite original research and comprehensive reviews that push the frontiers of erectile dysfunction research—especially work that integrates molecular and clinical biomarkers, novel pharmacologic targets and combination therapies, regenerative medicine, neuromodulation and device innovation, health-behavior interventions, and digital/precision-health approaches that improve access and outcomes. Submissions that elucidate mechanisms, validate predictive tools, report rigorously designed clinical trials, or present scalable implementation strategies are particularly welcome.

We encourage interdisciplinary contributions bridging urology, endocrinology, vascular biology, neuroscience, and behavioral medicine; our editorial process will prioritize methodological rigor, clinical relevance, and clear pathways to clinical impact to help your work reach clinicians, scientists, and policymakers shaping future standards of care.

Dr. Zisis Kratiras
Dr. Ilias Giannakodimos
Guest Editors

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Keywords

  • erectile dysfunction
  • PDE5 inhibitors
  • regenerative treatment
  • neuromodulation
  • penile implant
  • pharmacology

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Published Papers (1 paper)

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Review

35 pages, 1588 KB  
Review
Apparent Non-Response to Phosphodiesterase Type 5 Inhibitors in Erectile Dysfunction: A Narrative Review of Structured Reassessment and Management
by Aris Kaltsas
Medicina 2026, 62(8), 1582; https://doi.org/10.3390/medicina62081582 - 18 Aug 2026
Viewed by 245
Abstract
Background and Objectives: Apparent non-response to phosphodiesterase type 5 (PDE5) inhibitors is common, but the label conflates inadequate instruction or drug exposure, partial or absent response, treatment discontinuation, and coexisting clinical contributors. This narrative review presents an author-proposed structured reassessment framework, not [...] Read more.
Background and Objectives: Apparent non-response to phosphodiesterase type 5 (PDE5) inhibitors is common, but the label conflates inadequate instruction or drug exposure, partial or absent response, treatment discontinuation, and coexisting clinical contributors. This narrative review presents an author-proposed structured reassessment framework, not a new or validated diagnostic classification. Materials and Methods: PubMed/MEDLINE was searched from database inception to 7 August 2026 using a documented, reproducible search strategy, with targeted checks of guideline, regulatory, clinical, observational, and mechanistic sources; selection was purposive, without a registered protocol, quantitative synthesis, or certainty-of-evidence grading. Results: PDE5 inhibitors preserve nitric oxide-cyclic guanosine monophosphate signaling but require sexual stimulation, adequate exposure, and sufficient erectile physiology. In one specialist-referral cohort, 88 of 250 men (35.2%) responded after structured re-education, being 88 of the 115 (76.5%) who accepted it, which should not be generalized. The framework separates trial and exposure adequacy, observed response documented with validated measures where feasible, targeted evaluation of contributing domains, and shared selection of oral optimization or an established non-oral option. Persistent clinically meaningful oral-PDE5-inhibitor non-response is defined by principle rather than by a fixed number of attempts, agents, or mandatory daily tadalafil. Conclusions: Structured reassessment may clarify why an observed response is inadequate and may support preference-sensitive management; whether it does so better than existing guidance has not been tested. Switching agents or daily tadalafil is not a prerequisite and should not delay vacuum therapy, intracavernosal injection, or penile-prosthesis discussion. Full article
(This article belongs to the Special Issue Erectile Dysfunction Therapy: Recent Advances and Approaches)
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