Neurogenic Sexual Dysfunction Treatment: A Systematic Review

Context: The genesis of neurogenic sexual dysfunction (NSD) can be central, peripheral, or both. The correct stratification of the level of sexual dysfunction allows the clinician to choose the best type of treatment, in order to reduce sexual complaints. Objective: The aim of our review is to focus on the management of NSD due to central nervous system disorders and peripheral neuropathy. Evidence acquisition: A systematic review of the English-language literature was completed until July 2019 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The following terms were included: [(neurogenic sexual dysfunction) OR neurogenic erectile dysfunction)] AND (treatment OR management). An Excel file was created respecting the following criteria: participants, interventions, comparators, outcomes, and study design (PICOS). Evidence synthesis: Overall, from 505 identified records, 52 full-text articles were assessed for eligibility. Finally, 46 original researches were included in quantitative analysis. Conclusions: The phosphodiesterase type 5 inhibitors sildenafil, tadalafil, and vardenafil were proved to be effective and safe in first-line therapy of erectile dysfunction caused by neurogenic disorders. In addition, intracavernous injections of prostaglandin El, papaverine, or phentolamine and vacuum systems have been a mainstay of second-line treatment for NSD, extremely successful in the spinal cord injury population. Surgical therapy via penile prosthesis implantation remains a viable alternative as a third-line approach and may also be utilised to assist men with bladder management, despite higher complication rates of infections. Despite poor evidence, a better understanding of female sexual dysfunction due to neurological complaints is needed, in order to find more efficacious therapies for intercourse and orgasmic phase. Further prospective studies are required to better clarify the more successful treatment in improving sexual function and quality of life of these patients. Patient summary: Management of neurogenic sexual dysfunction includes phosphodiesterase type 5 inhibitors, intracavernous injections/vacuum devices, and penile prosthesis implantation. Female sexual dysfunction due to neurological disease needs to be better investigated. (C) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.