Advances in erectile dysfunction treatment research: a narrative review.

Background and Objective: Erectile dysfunction (ED) is one of the common diseases in middle-aged and older men, and its etiology mainly includes vascular diseases, neurological diseases, metabolic disorders, and psychological factors. This review takes the physiological mechanisms of penile erection as a starting point and provides an in-depth look at the major current treatments, which include phosphodiesterase type 5 (PDE5) inhibitors, gene therapy techniques, low-intensity extracorporeal shock wave therapy (Li-ESWT), low-intensity pulsed ultrasound therapy (LIPUS), and psychological treatments. The review further provides a critical analysis and summary of the advantages and limitations associated with each treatment approach. Finally, the article discusses the future directions of ED treatment, emphasizing the importance of integrating personalized and precision medicine principles into treatment planning to identify the most appropriate therapeutic strategy for each patient. Methods: We conducted literature searches on academic platforms such as PubMed, Google Scholar, and Web of Science using the terms "erectile dysfunction", "stem cells", "low-intensity extracorporeal shock wave", "low-intensity pulsed ultrasound", "PDE5 inhibitors", "gene therapy", "penile prosthesis implantation", and "psychosexual therapy" collecting literature published from January 1990 to October 2024. Key Content and Findings: The incidence of ED is showing a trend of becoming more widespread and affecting younger people. We have identified the main risk factors that cause ED, which include psychological disorders, hypertension, cardiovascular diseases (CVDs), and unhealthy lifestyles. On this basis, this study comprehensively reviews the latest research progress of traditional treatment methods and emerging treatment approaches, and analyzes their respective advantages and limitations. Conclusions: As ED treatment technologies continue to advance, the erectile function of numerous patients has seen significant improvement. Looking at the future development trend, combined treatment is expected to become the mainstream strategy for treating ED, and the treatment methods for this condition will gradually move towards personalization and precision.