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Erectile Dysfunction in the Elderly: Epidemiology, Etiology and Approaches to Treatment

2003; Lippincott Williams & Wilkins; Volume: 169; Issue: 6 Linguagem: Inglês

10.1097/01.ju.0000067820.86347.95

1527-3792

Allen D. Seftel,

Sexuality, Behavior, and Technology

No AccessJournal of UrologyCLINICAL UROLOGY: Review Articles1 Jun 2003Erectile Dysfunction in the Elderly: Epidemiology, Etiology and Approaches to Treatment ALLEN D. SEFTEL ALLEN D. SEFTELALLEN D. SEFTEL View All Author Informationhttps://doi.org/10.1097/01.ju.0000067820.86347.95AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Erectile dysfunction is experienced at least some of the time by most men who have reached 45 years of age, and it is projected to affect 322 million men worldwide by 2025. The prevalence of erectile dysfunction is high in men of all ages and increases greatly in the elderly. Materials and Methods: This paper reviews the epidemiology of erectile dysfunction with an emphasis on the experience of older men, normal age related changes in the structure and function of the penis that may contribute to increased risk with age, how the accumulation of risk factors with age may contribute to the high prevalence of the disease in older men, and established and emerging therapies. The normal aging process and age related risk factor accumulation contribute to the increased prevalence of erectile dysfunction in the elderly. Results: Remarkable progress has been made in the treatment of erectile dysfunction. At present inhibition of phosphodiesterase 5 with oral agents such as sildenafil would appear to be the initial treatment of choice. These drugs have been shown to be safe and effective, and sildenafil has demonstrated efficacy in patients with many of the comorbidities observed in older men with erectile dysfunction. New treatments, in particular transfection with genes for key mediators of erectile function that are known to be down-regulated in elderly men, also hold promise. Conclusions: Further research into the neural, vascular and molecular mechanisms involved in penile erection will lead to the development of even safer, more effective and more convenient therapies for men with erectile dysfunction. References 1 : The worldwide prevalence and epidemiology of erectile dysfunction. Int J Impot Res2000; 12: S6. Google Scholar 2 : Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol1994; 151: 54. Abstract, Google Scholar 3 : Decline of sexual function with age in Japanese men compared with American men—results of two community-based studies. Urology1999; 54: 335. Google Scholar 4 : Age-related prevalence of erectile dysfunction in Japan: assessment by the International Index of Erectile Function. Int J Urol2001; 8: 53. Google Scholar 5 : Erectile and ejaculatory dysfunction in a community-based sample of men 50 to 78 years old: prevalence, concern, and relation to sexual activity. Urology2001; 57: 763. Google Scholar 6 : Epidemiology of erectile dysfunction: results of the 'Cologne Male Survey.'. Int J Impot Res2000; 12: 305. Google Scholar 7 : The role of aging and chronic disease in sexual dysfunction. J Am Geriatr Soc1988; 36: 520. Google Scholar 8 : Erectile dysfunction. N Engl J Med2000; 342: 1802. Google Scholar 9 : Erectile dysfunction: from biochemical pharmacology to advances in medical therapy. Eur J Endocrinol2000; 143: 143. Google Scholar 10 : Phosphodiesterase isoenzymes as pharmacological targets in the treatment of male erectile dysfunction. World J Urol2001; 19: 14. Google Scholar 11 : Expression of three isoforms of cGMP-binding cGMP-specific phosphodiesterase (PDE5) in human penile cavernosum. Biochem Biophys Res Commun2000; 268: 628. Google Scholar 12 : Drugs for the treatment of impotence. Drugs Aging1997; 11: 140. Google Scholar 13 : The male menopause and mood: testosterone decline and depression in the aging male—is there a link?. J Geriatr Psychiatry Neurol2000; 13: 93. Google Scholar 14 : Impotence and aging: clinical and hormonal factors. J Am Geriatr Soc1988; 36: 511. Google Scholar 15 : The relationship between pituitary-gonadal function and sexual behavior in healthy aging men. Psychsom Med1991; 53: 363. Google Scholar 16 : Treatment of endocrinologic male sexual dysfunction. Mayo Clin Proc2000; 75: S40. Google Scholar 17 : Hormonal replacement and sexuality in men. Clin Endocrinol Metab1982; 11: 599. Google Scholar 18 : Structural alterations in the tunica albuginea of the penis: impact of Peyronie's disease, aging and impotence. Br J Urol1997; 79: 47. Google Scholar 19 : Pathophysiology of erectile dysfunction: the contributions of trabecular structure to function and the role of functional antagonism. Int J Impot Res2000; 12: S39. Google Scholar 20 : Intracavernous collagen analysis in impotence. Acta Urol Belg1996; 64: 7. Google Scholar 21 : Novel image analysis of corpus cavernous tissue in impotent men. Urology2000; 55: 252. Google Scholar 22 : Penile and finger sensory thresholds in young, aging, and diabetic males. Arch Sex Behav1989; 18: 1. Google Scholar 23 : Age decreases nitric oxide synthase-containing nerve fibers in the rat penis. J Urol1997; 157: 1088. Link, Google Scholar 24 : Sympathetic and sensory innervation of the urinary tract in young adult and aged rats: a semi-quantitative histochemical and immunohistochemical study. Histochem J1994; 26: 127. Google Scholar 25 : Vasoactive intestinal polypeptide levels and distribution in the penis of old rats. J Neural Transm1987; 70: 137. Google Scholar 26 : Effect of aging on nitric oxide-mediated penile erection in rats. Am J Physiol1995; 268: H467. Google Scholar 27 : Enzymatic function of nitric oxide synthases. Cardiovasc Res1999; 43: 521. Google Scholar 28 : Role of inducible nitric oxide synthase in the regulation of leucocyte recruitment. Clin Sci2001; 100: 1. Google Scholar 29 : Ex vivo expression of nitric oxide synthase isoforms (eNOS/iNOS) and calmodulin in human penile cavernosal cells. J Urol1998; 160: 2210. Link, Google Scholar 30 : Aging-related expression of inducible nitric oxide synthase and markers of tissue damage in the rat penis. Biol Reprod2001; 64: 974. Google Scholar 31 : Erectile dysfunction in aging: upregulation of endothelial nitric oxide synthase. Urology1998; 51: 516. Google Scholar 32 : Integrative erectile biology. The effects of age and disease on gap junctions and ion channels and their potential value to the treatment of erectile dysfunction. Urol Clin North Am2001; 28: 217. Google Scholar 33 : Age-related increase in an advanced glycation end product in penile tissue. World J Urol1995; 13: 369. Google Scholar 34 : cGMP-mediated negative-feedback regulation of endothelial nitric oxide synthase expression by nitric oxide. Hypertension1999; 34: 1237. Google Scholar 35 : Age-related changes in tissue contents of immunoreactive calcitonin gene-related peptide. Aging1992; 4: 211. Google Scholar 36 : The impact of aging on penile hemodynamics in normal responders to pharmacological injection: a Doppler sonographic study. J Urol1997; 157: 2129. Link, Google Scholar 37 : Assessing sexual functioning in patients with chronic disorders by using a generic health-related quality of life questionnaire. Qual Life Res2000; 9: 1081. Google Scholar 38 : Age-associated changes in nitric oxide metabolites nitrite and nitrate. Int J Clin Lab Res2000; 30: 83. Google Scholar 39 : Role of endothelial nitric oxide in shear stress-induced vasodilation of human microvasculature: diminished activity in hypertensive and hypercholesterolemic patients. Circulation2001; 103: 1752. Google Scholar 40 : Hypertension in the aging patient: new imperatives, new options. Am J Geriatr Cardiol2000; 9: 12. Google Scholar 41 : Erectile dysfunction in general medicine practice: prevalence and clinical correlates. Int J Impot Res2000; 12: 41. Google Scholar 42 : Incidence of erectile dysfunction in men 40 to 69 years old: longitudinal results from the Massachusetts Male Aging Study. J Urol2000; 163: 460. Link, Google Scholar 43 : Frequency and determinants of erectile dysfunction in Italy. Eur Urol2000; 37: 43. Google Scholar 44 : Prevalence and independent risk factors for erectile dysfunction in Spain: results of the Epidemiologia de la Disfunction Erectil Masculina Study. J Urol2001; 166: 569. Abstract, Google Scholar 45 : Does severity of ischemic coronary disease correlate with erectile function?. Int J Impot Res1997; 9: 123. Google Scholar 46 : Screening of ischemic heart disease with cavernous artery blood flow in erectile dysfunctional patients. Int J Impot Res2001; 13: 100. Google Scholar 47 : Erectile dysfunction in hypertensive subjects: assessment of potential determinants. Hypertension1996; 28: 859. Google Scholar 48 : The role of nitric oxide in hypertension and renal disease progression. Nephrol Dial Transplant2001; 16: 60. Google Scholar 49 : Current therapeutic options in type 2 diabetes. Eur J Clin Invest1999; 29: 17. Google Scholar 50 : Sexual function in men with diabetes type 2: association with glycemic control. J Urol2000; 163: 788. Link, Google Scholar 51 : Advanced glycation end products in human penis: elevation in diabetic tissue, site of deposition, and possible effect through iNOS or eNOS. Urology1997; 50: 1016. Google Scholar 52 : The role of AGEs is aging: causation or correlation. Exp Gerontol2001; 36: 1527. Google Scholar 53 : Epidemiology of benign prostatic hyperplasia: present knowledge and studies needed. Eur Urol1991; 20: 3. Google Scholar 54 : The evaluation of sexual function in men presenting with symptomatic benign prostatic hyperplasia. Br J Urol1998; 82: 842. Google Scholar 55 : An investigation into the relationship between prostate size, peak urinary flow rate and male erectile dysfunction. Int J Impot Res2001; 13: 322. Google Scholar 56 : The epidemiology of affective disorders in the elderly: a review. Int Clin Psychopharmacol1997; 12: S3. Google Scholar 57 : The relationship between depressive symptoms and male erectile dysfunction: cross-sectional results from the Massachusetts Male Aging Study. Psychosom Med1998; 60: 458. Google Scholar 58 : Male andropause: myth, reality, and treatment. Int J Impot Res2002; 14: S93. Google Scholar 59 : Minimally invasive therapy for erectile dysfunction: intracavernosal, oral, transdermal/transglanular, and intraurethral approaches. In: Topics in Clinical Urology: Diagnosis and Management of Male Sexual Dysfunction. Edited by . Tokyo: Igaku-Shoin1999: 182. Google Scholar 60 : The treatment choice of elderly patients with erectile dysfunction. Geriatr Nephrol Urol1998; 8: 15. Google Scholar 61 : Intracavernous self-injection of prostaglandin E1 in the treatment of erectile dysfunction. Int J Impot Res1999; 11: 21. Google Scholar 62 : Oral drug therapy for erectile dysfunction. Urol Clin North Am2001; 28: 321. Google Scholar 63 : On-demand IC351 (Cialis) enhances erectile function in patients with erectile dysfunction. Int J Impot Res2001; 13: 2. Google Scholar 64 : New therapies and delivery mechanisms for treatment of erectile dysfunction. Int J Impot Res2000; 12: S158. Google Scholar 65 : Sildenafil for treatment of erectile dysfunction in men with diabetes: a randomized controlled trial. Sildenafil Diabetes Study Group. JAMA1999; 281: 421. Google Scholar 66 : Sildenafil citrate (VIAGRA) improves erectile function in elderly patients with erectile dysfunction: a subgroup analysis. J Gerontol A Biol Sci Med Sci2001; 56: M113. Google Scholar 67 : The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology1997; 49: 822. Google Scholar 68 : Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group. Am J Hypertens2001; 14: 70. Google Scholar 69 : Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease. Am J Cardiol1999; 83: 29C. Google Scholar 70 : Sildenafil citrate (Viagra) efficacy in the treatment of erectile dysfunction in patients with common concomitant conditions. Sildenafil Study Group. Int J Clin Pract1999; 102: 21. Google Scholar 71 : Prognostic factors for response to sildenafil in patients with erectile dysfunction. Eur Urol2001; 40: 641. Google Scholar 72 : Efficacy and safety of tadalafil for the treatment of erectile dysfunction: results of integrated analyses. J Urol2002; 168: 1332. Link, Google Scholar 73 : The efficacy and tolerability of vardenafil, a new, oral, selective phosphodiesterase type 5 inhibitor, in patients with erectile dysfunction: the first at-home clinical trial. Int J Impot Res2001; 13: 192. Google Scholar 74 : Improved arterial compliance by a novel advanced glycation end-product crosslink breaker. Circulation2001; 104: 1464. Google Scholar 75 : Gene transfer of endothelial nitric oxide synthase to the penis augments erectile responses in the aged rat. Proc Natl Acad Sci USA1999; 96: 11648. Google Scholar 76 : Gene transfer or prepro-calcitonin gene-related peptide restores erectile function in the aged rat. Biol Reprod2001; 65: 1371. Google Scholar From Case Western Reserve University, Department of Urology, University Hospital of Cleveland, Cleveland VA Medical Center, Cleveland, Ohio© 2003 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byGriebling T (2020) Re: Profile of Sexuality and Symptoms of Lower Urinary Tract in Non-Institutionalized ElderlyJournal of Urology, VOL. 204, NO. 6, (1358-1358), Online publication date: 1-Dec-2020.Griebling T (2019) Re: Urologic Symptoms and Burden of Frailty and Geriatric Conditions in Older Men: The Aging Study of PyeongChang Rural AreaJournal of Urology, VOL. 202, NO. 2, (189-189), Online publication date: 1-Aug-2019.Griebling T (2013) Re: Gender Differences in Factors Influencing Sexual Satisfaction in Korean Older AdultsJournal of Urology, VOL. 190, NO. 6, (2207-2209), Online publication date: 1-Dec-2013.WALD M, SEFTEL A, ROSS L, MOHAMED M and NIEDERBERGER C (2018) COMPUTATIONAL MODELS FOR DETECTION OF ERECTILE DYSFUNCTIONJournal of Urology, VOL. 173, NO. 1, (167-170), Online publication date: 1-Jan-2005.DAYAN L, GREUNWALD I, VARDI Y and JACOB G (2018) A NEW CLINICAL METHOD FOR THE ASSESSMENT OF PENILE ENDOTHELIAL FUNCTION USING THE FLOW MEDIATED DILATION WITH PLETHYSMOGRAPHY TECHNIQUEJournal of Urology, VOL. 173, NO. 4, (1268-1272), Online publication date: 1-Apr-2005. Volume 169Issue 6June 2003Page: 1999-2007 Advertisement Copyright & Permissions© 2003 by American Urological Association, Inc.Keywordsagingimpotencedrug therapyagedMetricsAuthor Information ALLEN D. SEFTEL Financial interest and/or other relationship with Pfizer, Bayer and Lilly-ICOS. More articles by this author Expand All Advertisement PDF downloadLoading ...