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Phosphodiesterase type 5 (PDE5) inhibitors for the treatment of erectile dysfunction

Importance to the field: Since sildenafil was introduced 10 years ago, highly selective phosphodiesterase type 5 inhibitors (PDE5i) have changed the medical management of erectile dysfunction (ED). A significant body of research has been devoted to the use of this class of medication for the treatment of ED and has advanced our understanding of erectile physiology. Recently, investigators have noted the potential benefits of this class of medication in the treatment of various urologic and non-urologic conditions, and novel agents in this class are in late-stage trials. Areas covered in this review: Clinical and basic science articles published between 1990 and 2009 were selected from multiple sources, including PubMed, Lexis-Nexis, EBSCO, and manufacturer websites. Our search focused on clinical outcomes of PDE5i for the treatment of ED and other medical conditions and basic science publications examining pharmacologic effects. What the reader will gain: This review provides a thorough description of the currently available PDE5i and the major clinical trials published for the use of PDE5i for the treatment of ED, as well as notable animal and basic science studies. In addition, we review upcoming drugs in this class, emerging indications and goals for future research. Take-home message: PDE5i will remain the mainstay initial medical treatment for ED and will play a larger role in the treatment of other medical conditions. Novel formulations in this class will allow patients to select agents that best suit their needs.