<![CDATA[Phosphodiesterase type 5 inhibitors (PDE5Is) are widely prescribed for erectile dysfunction; however, growing evidence indicates that their pharmacological effects extend beyond urological indications and involve multiple organ systems. This narrative review aims to synthesize and critically evaluate current evidence on the systemic effects of PDE5 inhibitors across cardiovascular, renal, neurological, and urological domains, as well as emerging therapeutic indications. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science for studies published up to May 2024, including preclinical studies, clinical trials, observational studies, systematic reviews, and meta-analyses. The reviewed evidence demonstrates that PDE5 inhibitors are associated with reduced cardiovascular morbidity and mortality, improvements in cardiac and pulmonary hemodynamics, preservation of renal function in diabetic populations, potential neuroprotective effects against cognitive decline and ischemic stroke, and symptomatic improvement in benign prostatic hyperplasia and lower urinary tract symptoms. Additional benefits have been reported in conditions characterized by vascular dysfunction, such as angina pectoris and Raynaud’s phenomenon. Overall, PDE5 inhibitors represent a pharmacologically versatile drug class with clinically relevant systemic effects beyond erectile dysfunction, supporting their potential role as adjunctive therapies in broader disease management, although further well-designed randomized controlled trials are needed to inform clinical guidelines.]]>
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