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This narrative review synthesizes literature from 2000–2025 on vascular aging and erectile dysfunction, examining mechanisms such as reduced nitric oxide bioavailability from oxidative stress and inflammation, impaired cavernosal smooth muscle composition, and increased arterial stiffness compounded by metabolic disorders. Chronic inflammation, oxidative stress, hormonal imbalance, and metabolic disruption are highlighted as accelerators of disease progression, positioning ED as an early indicator of systemic vascular pathology.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/vascular-aging-driven-erectile-dysfunction-pathophysiological-mechanisms-and-emerging-therapies-a-narrative-review/456707/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/vascular-aging-driven-erectile-dysfunction-pathophysiological-mechanisms-and-emerging-therapies-a-narrative-review/456707.png","ImageObject",300,407,{"name":92,"@type":93},"Himbo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",17,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What pathophysiological mechanisms drive age-related erectile dysfunction in this review?","Question",{"text":113,"@type":114},"The review emphasizes reduced nitric oxide bioavailability due to endothelial oxidative stress and inflammation, loss/diminished cavernosal smooth muscle content impairing veno-occlusion, and increased arterial stiffness influenced by metabolic disorders.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How does the review describe the role of vascular aging in systemic health?",{"text":118,"@type":114},"It frames age-related erectile dysfunction as a manifestation of systemic vascular pathology, serving as an early warning signal for overall vascular health.",{"name":120,"@type":111,"acceptedAnswer":121},"What treatment approaches are discussed, and what limitations are noted?",{"text":122,"@type":114},"Current strategies mainly include phosphodiesterase-5 inhibitors and testosterone for symptom relief, but both have serious limitations; emerging interventions are experimental and rely largely on preclinical evidence.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},456707,1790962327,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},687197100911,"https://ap-avatar.wpscdn.com/avatar/a000239b6f1da00475?x-image-process=image/resize,m_fixed,w_180,h_180&k=1785132997149421697","Vascular aging-driven erectile dysfunction: pathophysiological mechanisms and emerging therapies—a narrative review  \nKe Zhong1\\#, Huifang Hu1\\#, Liang Xiao2\\#, Gang Fan1,2, Liyuan Zhang1  \n1Department of Urology, Affiliated Nanshan Hospital of Shenzhen University, Shenzhen, China; 2Medical Research Center, Affiliated Nanshan Hospital of Shenzhen University, Shenzhen, China  \nContributions: (I) Conception and design: K Zhong, H Hu; (II) Administrative support: L Zhang; (III) Provision of study materials or patients: K Zhong, H Hu; (IV) Collection and assembly of data: L Xiao, K Zhong, H Hu; (V) Data analysis and interpretation: G Fan, L Xiao; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.  \n\\#These authors contributed equally to this work.  \nCorrespondence to: Liyuan Zhang, MD. Department of Urology, Affiliated Nanshan Hospital of Shenzhen University, No. 89, Taoyuan Road, Nanshan  \nDistrict, Shenzhen City, Guangdong Province, China, Shenzhen 518000, China. Email: [liyuan.zhang@uszh.org.cn](liyuan.zhang@uszh.org.cn).  \nBackground and Objective: Age-related erectile dysfunction (ED) is a significant health concern linked to vascular aging, characterized by endothelial dysfunction and vascular smooth muscle alterations. This study aimed to explores the pathophysiological mechanisms of age-related ED in elderly men, providing new  \ndirections for diagnosis and the development of novel targeted therapies.  \nMethods: This review focused on literature from 2000 to 2025 concerning vascular aging and ED. We searched PubMed, Web of Science, and Embase using keywords like “erectile dysfunction”,“aging”,“vascular endothelium”, and “vascular smooth muscle”. The selection process prioritized high-quality clinical and innovative preclinical studies in humans or animal models that explored pathophysiology or novel treatments.  \nExclusion criteria included duplicates, non-peer-reviewed articles, and off-topic studies.  \nKey Content and Findings: Key contributors to age-related ED include reduced nitric oxide (NO) bioavailability due to endothelial oxidative stress and inflammation, diminished cavernosal smooth muscle content leading to impaired veno-occlusion, and increased arterial stiffness compounded by metabolic disorders. Chronic inflammation, oxidative stress, hormonal imbalances (particularly testosterone deficiency), and metabolic disruption accelerate these vascular aging processes, making ED an early indicator of systemic vascular pathology. Current treatment strategies mainly include phosphodiesterase-5 inhibitors (PDE5i) and testosterone, both of which are suitable for immediate symptom relief in most ED, although there are serious limitations. Emerging interventions are currently experimental and their evidence is mainly derived from preclinical studies. These include interventions to preserve endothelial NO synthase (eNOS) function, stemcell regenerative therapies targeting tissue repair, nanotechnology to enhance the efficiency of drug delivery,  \nand modulation of mitochondrial integrity and inflammation  \nConclusions: Age-related ED is a manifestation of systemic vascular pathology. A deeper understanding of its mechanisms underscores its role as an “early warning signal” for overall vascular health. While current treatments like PDE5i and testosterone offer symptomatic relief, they have limitations. Promising future directions lie in novel targeted therapies, such as enhancing eNOS function, stem-cell therapy, and  \nnanotechnology, which are currently in the experimental stage and require further clinical validation.  \nKeywords: Erectile dysfunction (ED); aging; vascular endothelialum; vascular smooth muscle  \nSubmitted Aug 14, 2025. Accepted for publication Nov 07, 2025. Published online Dec 26, 2025.  \ndoi: 10.21037/tau-2025-581  \nView this article at: [https://dx.doi.org/10.21037/tau-2025-581](https://dx.doi.org/10.21037/tau-2025-581)  \n© AME Publishing Company. Transl Androl Urol 2","cbCaiu42Qixv8T8l","https://ap.wps.com/l/cbCaiu42Qixv8T8l","pdf",579963,15,"English","# Background and objective\n## Methods\n## Key content and findings\n## Conclusions\n## Keywords","[{\"question\":\"What pathophysiological mechanisms drive age-related erectile dysfunction in this review?\",\"answer\":\"The review emphasizes reduced nitric oxide bioavailability due to endothelial oxidative stress and inflammation, loss/diminished cavernosal smooth muscle content impairing veno-occlusion, and increased arterial stiffness influenced by metabolic disorders.\"},{\"question\":\"How does the review describe the role of vascular aging in systemic health?\",\"answer\":\"It frames age-related erectile dysfunction as a manifestation of systemic vascular pathology, serving as an early warning signal for overall vascular health.\"},{\"question\":\"What treatment approaches are discussed, and what limitations are noted?\",\"answer\":\"Current strategies mainly include phosphodiesterase-5 inhibitors and testosterone for symptom relief, but both have serious limitations; emerging interventions are experimental and rely largely on preclinical evidence.\"}]","Vascular aging-driven erectile dysfunction - pathophysiological mechanisms and emerging therapies - a narrative review | PDF",1790746763,38]