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Cavernous smooth muscles: innovative potential therapies are promising for an unrevealed clinical diagnosis

  • Ahmed Mohamed HassaninEmail author
  • Ahmed Zain Abdel-Hamid
Urology - Review
  • 73 Downloads

Abstract

While erectile dysfunction (ED) is highly prevalent worldwide, unrevealed cavernous smooth muscles (CSM) defects can confound the diagnosis of vascular ED and lead to failure of treatments. Currently, the first-line oral treatment for ED is phosphodiesterase type 5 inhibitors (PDE5Is). Patients with diabetes mellitus (DM), those who have undergone a radical prostatectomy (RP), and the elderly population are difficult to treat by the PDE5Is; unrevealed CSM defects can result in corporo veno-occlusive dysfunction (CVOD); and penile veno-ligation surgeries are currently abandoned due to high failure rates. It has been found that gene and stem cell therapies, among others, reduce cavernous tissue apoptosis and fibrosis and can specifically target CSM defects such as the nitric oxide (NO)-mediated signaling pathway, Rho–ROCK system, and transformation growth factor (TGF)-β1/angiotensin II (Ang II) pathway, in several laboratory animals. Current data clarify the need of diagnostic techniques that can provide an initial assessment of CSM. This assessment should be essential before giving a diagnosis of vascular ED and before applying several tests searching for a specific CSM defect to guide the specific therapy. Moreover, while patients with corporal fibrosis would fail the current medical therapies, these patients can benefit from the stem cell-based therapies that induce the internal mechanisms of tissue repair. However, penile elastography can determine the stiffness of tissues and corpus cavernosum electromyography (CC-EMG) can assess the integrated activity of CSM bulk, further refinements are required for these techniques before being considered in the evaluation of patients with ED. In conclusion, on the basis of the current scientific research, it may be possible to formulate new therapies and achieve the appropriate selection of patients who can benefit from these therapies.

Keywords

Cavernous smooth muscle CC-EMG Corpus cavernosum electromyography Color duplex Doppler ultrasonography Gene therapy Penile elastography Stem cell therapy Veno-occlusive dysfunction 

Abbreviations

Ang II

Angiotensin II

CC-EMG

Corpus cavernosum electromyography

CDDU

Color Duplex Doppler Ultrasonography

cGMP

Cyclic guanosine monophosphate

CN

Cavernous nerve

CSM

Cavernous smooth muscles

CVOD

Corporo veno-occlusive dysfunction

dHACM

Dehydrated human amnion/chorion membrane

DM

Diabetes mellitus

ED

Erectile dysfunction

eNOS

Endothelial nitric oxide synthase

GRK2

G-protein-coupled receptor kinase 2

GTP

Guanosine triphosphate

hMaxi-K

Human smooth muscle Maxi-K channel

ICI

Intracorporal injection

iNOS

Inducible nitric oxide synthase

LncRNAs

Long non-coding RNAs

MSCs

Mesenchymal stem cells

nNOS

Neuronal nitric oxide synthase

NO

Nitric oxide

NOS

Nitric oxide synthase

PDE5Is

Phosphodiesterase type 5 inhibitors

piNOS

Plasmid expressing iNOS

PK

Protein kinase

ROCK

Rho-associated protein kinase

RP

Radical prostatectomy

shRNA

Short hairpin RNA

TGF

Transformation growth factor

Notes

Acknowledgements

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to declare.

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Andrology and Sexology, Faculty of MedicineCairo UniversityCairoEgypt
  2. 2.Faculty of MedicineCairo UniversityCairoEgypt

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