Editorial [Hot topic: Phosphodiesterase-5 Inhibitors and their Use in the Treatment of Urological Conditions (Executive Editor: Perimenis Petros)]

The introduction of orally administered phosphodiesterase-5 inhibitors into clinical practice 10 years ago has been a revolution in the field of urology. The availability of a convenient to use, safe -despite initial concerns- and effective treatment for erectile dysfunction of varying severity and etiology, has radically changed the way that physicians, but most importantly patients, approach this condition. Most of the expectations raised have been fulfilled, and more than 10 years of experience and research with sildenafil, vardenafil and tadalafil has increased our understating of erectile dysfunction pathophysiology, its psychosocial correlates and factors associated with treatment success or failure. Despite this, efforts to satisfy unmet needs are ongoing: new PDE-5 inhibitors are being developed and novel formulations of existing ones, like once-a-day tadalafil, have already enter the pharmaceutical market. Now that treatment options are more than ever before patient preference and adherence issues have become important and the focus of significant amount of research. PDE-5 inhibitors have been successfully used not only for correcting erectile dysfunction but also to preserve erectile function in men treated with radical prostatectomy for prostate cancer. In this setting PDE-5 inhibitors have been shown to be a useful adjunct to improved surgical nerve-sparing techniques. Research is ongoing, aiming to establish the optimal treatment regimen for penile rehabilitation. Evidence is accumulating suggesting that PDE-5 inhibitors may be used in the future by urologists not only for ED treatment but management of BPH- related lower urinary tract symptoms, premature ejaculation, priapism and male infertility. PDE-5 inhibitors are mainly used in urology but the approval of sildenafil for the treatment of pulmonary hypertension a few years ago renewed interest in cardiovascular applications, the field where this drug class was originally studied. The role of PDE-5 inhibitors in the management of heart failure, hypertension, and ischemic heart disease is being actively investigated with promising results.