Advertisement
No AccessJournal of UrologyCLINICAL UROLOGY: Review Articles1 Jun 2003

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

    View All Author Information

    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. LinkGoogle 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. LinkGoogle 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. LinkGoogle 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. LinkGoogle 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. LinkGoogle 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. AbstractGoogle 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. LinkGoogle 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. LinkGoogle 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

    Advertisement