How to treat penile erectile dysfunction The National Institutes of Health defines penile erectile dysfunction (ED) as the persistent inability of the penis to achieve and/or maintain an erection sufficient to complete a satisfactory sexual life. Data from the Massachusetts male aging study (MMAS) showed that the prevalence of ED in middle-aged and older men aged 40-70 was 52%, with the prevalence of mild, moderate and severe ED being 17.2%, 25.2% and 9.6%, respectively, and its incidence increasing with age. In addition to psychological factors, more than half of the ED patients are related to organic pathologies such as diabetes, hypertension, hyperlipidemia, atherosclerosis, neuropathy, trauma to the cerebral spinal cord and genital organs. In 1998, oral selective phosphodiesterase type 5 inhibitors (PDE5i) were developed and marketed, revolutionizing ED treatment, and today have become the first-line treatment for ED. Currently, the main such drugs commonly used in China are: Viagra, Cialis, and Elidel. As a one-time erection-inducing drug, PDE5i is about 80% effective in treating ED under adequate sexual stimulation, and about 15% of patients experience one-time side effects such as headache, dizziness and abnormal color vision during the use of the drug. For those patients with diabetes, severe vascular disease and ED after radical prostate cancer treatment, PDE5i is less effective. In recent years, studies have shown that a long course of oral PDE5i (Cialis) may improve the response to treatment in patients with refractory ED, possibly by a mechanism related to improving vascular endothelial function, preventing cavernous fibrosis and reducing the smooth muscle content of the penile corpus cavernosum. Vacuum erectile devices (VEDs) and low-energy external shock waves (LESW) have been included in the new European Society of Urology “Guidelines for Male Sexual Dysfunction” as first-line therapies for ED. return to maintain penile erection. However, this method does not maintain penile erection by physiological means, and approximately 30% of patients experience varying degrees of penile pain, delayed ejaculation, bruising, numbness, and other adverse effects. Short-term clinical satisfaction 27%-94%, satisfaction after two years of use to 50%-64%, most patients have difficulty in long-term adherence . In recent years, LESW has received widespread attention as a new treatment modality for ED. The results of animal studies have shown that LESW can promote the regeneration of penile neuronal nitric oxide synthase (nNOS) nerves, endothelial cells and cavernous smooth muscle , and the mechanism may be related to the regulation of endogenous stem cell recruitment in the penis . The second line of therapy for ED is intracavernosal injection therapy (ICI), such as injections of poppies, phentolamine and prostaglandin E1, which can induce erection usually 5-10 minutes after injection and has a clinical efficiency of about 85%. The side effects such as abnormal erection and cavernous fibrosis of the penis must be individualized under the guidance of a doctor and the dose of the drug. For patients with severe organic ED whose first- and second-line therapies are ineffective or whose other treatments are ineffective, penile prosthesis implantation (PPI) is an option. The artificial penile prosthesis uses modern technology to support the erection of the penis by using silicone rubber cylinders that are histocompatible with the human body and are surgically placed in the penile corpus cavernosum. The implantation of penile prosthesis can be the best semi-permanent treatment method, with a clinical efficiency of about 95%, and does not affect the original penile sensation, urination, ejaculation function and sexual pleasure, and has become the third-line standard treatment for erectile dysfunction. At present, there are several types of penile erectors, which can be broadly divided into semi-rigid flexable prosthesis, mechanically expandable prosthesis and liquid-filled prosthesis, the latter with single-piece, double-piece and three-piece prosthesis. However, due to the high price and the risk of infection, erosion, and device failure, the number of patients opting for surgical treatment is limited.