Erectile physiological and pathophysiological pathways involved in erectile dysfunction

Karl Erik Andersson, Ajay Nehra, Tom Lue, Arthur Burnett, Irwin Goldstein, Alvaro Morales

Research output: Contribution to journalArticle

Abstract

Purpose: The importance of signaling pathways in penile smooth muscles involved in normal erection and erectile dysfunction (ED) is discussed based on a review of the literature. Materials and Methods: Erection is basically a spinal reflex that can be initiated by recruitment of penile afferents but also by visual, olfactory and imaginary stimuli. The generated nervous signals will influence the balance between the contractant and relaxant factors, which control the degree of contraction of penile smooth muscles and, thus, determine the functional state of the penis. The different steps involved in neurotransmission, impulse propagation and intracellular transduction of neural signals may be changed in different types of erectile dysfunction. Results: Recent findings have suggested an important role for RhoA/Rho kinase in the regulation of cavernosal smooth muscle tone and that changes in this pathway may contribute to ED in various patient subgroups, eg diabetes and vascular disease. Neurogenic nitric oxide is still considered the most important factor for immediate relaxation of penile vessels and corpus cavernosum. However, endothelially generated nitric oxide seems essential for maintaining erection. Endothelial dysfunction can contribute to ED in several patient subgroups. In addition, in conditions associated with reduced function of nerves and endothelium, such as aging, hypertension, smoking, hypercholesterolemia and diabetes, circulatory and structural changes in the penile tissues can result in arterial insufficiency and defect muscle relaxation. Conclusions: Different types of ED often have overlapping pathophysiologies but may also have common pathways contributing to ED. Such pathways may be potential treatment targets.

Original languageEnglish (US)
JournalJournal of Urology
Volume170
Issue number2 II
StatePublished - Aug 1 2003
Externally publishedYes

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Erectile Dysfunction
Smooth Muscle
Nitric Oxide
rho-Associated Kinases
Muscle Relaxation
Penis
Hypercholesterolemia
Vascular Diseases
Synaptic Transmission
Endothelium
Reflex
Signal Transduction
Smoking
Hypertension

Keywords

  • Impotence
  • Penile erection
  • Physiology

ASJC Scopus subject areas

  • Urology

Cite this

Andersson, K. E., Nehra, A., Lue, T., Burnett, A., Goldstein, I., & Morales, A. (2003). Erectile physiological and pathophysiological pathways involved in erectile dysfunction. Journal of Urology, 170(2 II).

Erectile physiological and pathophysiological pathways involved in erectile dysfunction. / Andersson, Karl Erik; Nehra, Ajay; Lue, Tom; Burnett, Arthur; Goldstein, Irwin; Morales, Alvaro.

In: Journal of Urology, Vol. 170, No. 2 II, 01.08.2003.

Research output: Contribution to journalArticle

Andersson, KE, Nehra, A, Lue, T, Burnett, A, Goldstein, I & Morales, A 2003, 'Erectile physiological and pathophysiological pathways involved in erectile dysfunction', Journal of Urology, vol. 170, no. 2 II.
Andersson KE, Nehra A, Lue T, Burnett A, Goldstein I, Morales A. Erectile physiological and pathophysiological pathways involved in erectile dysfunction. Journal of Urology. 2003 Aug 1;170(2 II).
Andersson, Karl Erik ; Nehra, Ajay ; Lue, Tom ; Burnett, Arthur ; Goldstein, Irwin ; Morales, Alvaro. / Erectile physiological and pathophysiological pathways involved in erectile dysfunction. In: Journal of Urology. 2003 ; Vol. 170, No. 2 II.
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