(243) A HISTORY OF ERECTILE DYSFUNCTION AND ITS TREATMENT
Authors: Dittmer B 
Published: December 2024

Abstract

Introduction
Erectile function and its subsequent dysfunction has always been of great importance to men, due to the societal links between erectile function, virility and masculinity. Treatment of erectile dysfunction has been prevalent throughout history, with significant advancements in recent years. Erectile dysfunction is defined as the persisting inability to achieve a functional/satisfying erection. Erectile dysfunction has been demonstrated to be linked to comorbidities such as; cardiovascular disease, hyperlipidaemia, diabetes, obesity, hypertension, alcohol and tobacco use. Given the ongoing prevalence of these conditions, it is safe to assume that erectile dysfunction will continue to be an issue for future generations of men. Currently there are many options for the treatment of erectile dysfunction; ranging from oral PDE5 inhibitors to inflatable penile prosthesis.

Objective
The objective of this study was to assess the literature regarding historical treatments for erectile dysfunction and the progression to current interventions with the inflatable penile prosthesis; as well as reflect on further developments and considerations in regards to future management of these prosthesis.

Methods
Ancient remedies for erectile dysfunction ranged from wearing animal talismans to consumption of rabbit or wolf genitalia, in hopes that this would act as an aphrodisiac and improve sexual function. Once the link between testosterone and erectile function was identified, this led to the synthesis of testosterone from cholesterol by Adolf Butenandt and Leopold Ruzica in the 1930s. In the late 1990s the first Phosphodiesterase type 5 inhibitor (PDE5i), Sildenafil was released; acting on the Nitric Oxide - cyclic GMP pathway to increase penile blood flow. Intracorporeal injections of Prostaglandin E1 have been shown to stimulate cyclic AMP to promote penile blood flow.

Results
The first penile implant in 1936, by Nicolos Bogoras was developed using rib cartilage and bone. This subsequently was reabsorbed by the body a few years later. In the 1950s acrylic rods were implanted by Dr Goodwin and Dr Scott, however these were associated with infection and erosion of penile soft tissue. These implants were then changed to a silicone material to provide rigidity with lower adverse effects. The three piece inflatable penile prosthesis was developed by Dr F. Brantly Scott in 2009; it consists of a pair of inflatable intracorporeal cylinders connected to a scrotal pump and an intra-abdominal fluid reservoir. Compression of the scrotal pump cycles fluid from the reservoir to and from the inflatable cylinders allowing a functional erection when desired.

Conclusions
There has been a rise in the use of inflatable penile prosthesis since it was pioneered. Within Australia up to 1000 inflatable penile prosthesis have been inserted in recent years. With increasing prevalence, education and training regarding these devices needs to develop to ensure appropriate management of any complications; such as infected prosthesis or inability to deflate the device etc. There is further potential development of these devices. With the progressive digitalization of our age, the possibility of digitally/bluetooth activities pumps are a possibility; however the sequelae of complications need close consideration.

Disclosure
No.