Neurogenic erectile dysfunction: State of the art!

Erection is a neurovascular event characterised by the tumescence of the cavernous bodies that relies upon integration of neural and humoral mechanisms and requires the participation ofautonomic and somatic nerves and the integration of numerous spinal and supraspinal sites.Erectile dysfunction (ED) is a highly prevalent problem increasing with age, as well as being a major sexual concern for men. Neurogenic ED can be broadly defined as an inability to sustain or maintain a penile erection owing to a neurologic impairment, either centrally or peripherally or both. Neurological disorders may cause an interruption of the long spinal tracts between cortex and sacral cord or the pelvic autonomic nerves interfering with genital engorgement, erection, ejaculation, and climax.They can also challenge the physical ability to embrace, stimulate, engage in intercourse, and maintain urinary and bowel continence during sexual activity. Such factors may lead to a primary or secondary neurogenic ED.Patients with neurological disorders, especially if male and young, might consider their sexual dysfunction as the most devastating aspect. Significant advances in the pharmacological treatment of ED have occurred in recent years, most notably after the introduction of Sildenafil, the first oral selective phosphodiesterase type 5 inhibitor.Nevertheless, many other oral, local and surgical treatments are available and their efficacy and safety depend on the specific cases.This chapter is aimed at evaluating the current advances in neurogenic ED management taking into account its complex pathophysiology and targets for treatment.