Babak Karimian - Department of Urology, Alborz University of Medical Sciences, Alborz, Iran
Sayed Mohammed Jawad Alwedaie - Royal College of Surgeons in Ireland Medical University of Bahrain, Manama, Bahrain

Nowadays, the treatment strategy for erectile dysfunction (ED) is the same for all patients, ignoring the underlying etiology that can lead to Phosphodiesterase type ۵ (PDE۵-I) failure in a large (and increasing) subpopulation of ED patients suffering from diabetes mellitus, post-radical prostatectomy (RP) ED, hypogonadism, and Peyronie’s disease. The uni-behavior among all of these novel drugs, except for PDE۵-Is, is the ability to produce an erection without any demand for endogenous Nitric oxide (NO). It can be a promising forthcoming alternative for patients who are unwilling to current medical therapy. Melanocortin receptors (MCR) agonists and dopaminergic agonists have both shown promise in some early clinical trials. Bremelanotide-like agents potentially hold the most promise as centrally acting agents for the treatment of ED. Other peripherally acting agents, including the soluble guanylate cyclase (sGC), rho-kinase inhibitors, and Maxi-K channel activators, have all proved some clinical fruitfulness. Up to now, these novel agents have not yet reached the market. Nevertheless, it is likely that in years to come, patients will be selectively treated with these novel agents as a monotherapy or in combination with others acting synergistically.

Bremelanotide-like agents, sGC activators, Rho-kinase inhibitors, Maxi-K channel activators