AUA 2026: Updates on the Management of Erectile Dysfunction

Obesity, Not PDE5 Inhibition, Drives Uric Acid Levels in Men with Erectile Dysfunction: A Retrospective Study

Authors: Ahmed Al Saeedi, Onder Canguven, Yaser M. Ata, Khalid Al Kubaisi, and Ahmad Al Malki

This retrospective study evaluated the effect of long-term phosphodiesterase type 5 inhibitor (PDE5i) therapy on serum uric acid (UA) levels in 300 men with erectile dysfunction (ED). The mean age of patients was 59.2 ± 9.6 years, and the mean body mass index (BMI) was 29.9 ± 4.9 kg/m². Mean serum UA levels were 359.5 ± 79.7 µmol/L before treatment and 351.2 ± 77.0 µmol/L after treatment. The change in UA levels was not statistically significant (change in UA (ΔUA) = -8.3 µmol/L; p>0.05), suggesting that long-term PDE5i therapy did not significantly affect serum UA levels. UA levels showed a significant positive correlation with BMI (Pearson r=0.288, p=0.026; Spearman ρ=0.332, p=0.009). No significant correlation was observed between UA and high-density lipoprotein (HDL), low-density lipoprotein (LDL), or total testosterone levels. Overall, the study suggests that serum UA levels are more closely associated with obesity and metabolic dysfunction compared to PDE5i therapy in men with ED.

PDE5 Inhibitors and Cardiovascular Outcomes in Men with ED: Propensity-Weighted Hazard Ratios over 12 Months

Authors: Ahmed Al Saeedi, Onder Canguven, Yaser M. Ata, Khalid Al Kubaisi, and Ahmad Al Malki

This study evaluated the association between early phosphodiesterase type 5 inhibitor (PDE5i) use and 1-year major adverse cardiac events (MACE) in men with erectile dysfunction (ED). Data were obtained from the Global Collaborative Network involving 155 healthcare organizations. Men aged 50-70 years diagnosed with ED after January 1, 2015, without recent pulmonary hypertension or coronary artery disease, were included. Patients who started PDE5i therapy within 1 month of ED diagnosis were assigned to Group A, while those who did not receive PDE5i formed Group B. After propensity score matching, 336,795 patients were included in each group with a median follow-up of 1 year. Patients in Group A were slightly older and had higher rates of chronic ischemic heart disease, chronic kidney disease, and chronic obstructive pulmonary disease. They also had lower creatinine, triglyceride, and glycated haemoglobin levels, but higher low-density lipoprotein and high-density lipoprotein cholesterol levels. Both all-cause mortality and (MACE) outcomes favored patients who initiated PDE5i therapy within 1 month of ED diagnosis. Overall, early initiation of PDE5i therapy was associated with lower hazard ratios for 1-year mortality and cardiovascular events.

Real-World Evaluation of Onset of Action and Efficacy of a Novel Sildenafil Oral Suspension in Men with Erectile Dysfunction

Authors: Federica Passarelli, Edoardo Pozzi, Gabriele Birolini, Fausto Negri, Massimiliano Raffo, Alessandro Bertini, Ciro Piccolo, Alessia D'Arma, Michele Rizzo, Carlos Miacola, Giovanni Liguori, Andrea Salonia, and Luca Boeri

This real-world study evaluated the onset of action and effectiveness of a new oral suspension formulation (OSF) of sildenafil in 123 men with erectile dysfunction (ED) treated for 12 weeks. Median patient age was 58 years, and the median baseline International Index of Erectile Function-Erectile Function (IIEF-EF) score was 15. Most patients (64.2%) had not previously used phosphodiesterase type 5 inhibitors (PDE5is). Sildenafil OSF significantly improved IIEF-EF scores from 15 to 22 at follow-up (p<0.001). Clinically meaningful improvement based on minimal clinically important difference (MCID) criteria was achieved in 69.1% of patients, while complete response according to Yang’s criteria was observed in 17.1%. Regarding onset of action, 26.8% of patients reported satisfactory erection suitable for vaginal penetration within 30 minutes after dosing, while 52.8% achieved onset within 45 minutes. Patients with onset of action ≤30 minutes were younger and had lower Charlson Comorbidity Index (CCI) scores compared with those with slower onset. Younger age was independently associated with faster onset of action (odds ratio [OR] 0.9; p<0.01), while higher baseline IIEF-EF scores predicted complete treatment response (OR 1.2; p<0.001). Overall, sildenafil OSF demonstrated effective symptom improvement, with about 70% of patients achieving clinically meaningful benefit.

AUA 2026, May15 – 18, Washington, DC.