TY  - EJOU
AU  - Gu, Hang 
AU  - Shi, Yihan 
AU  - Du, Xiancheng 
AU  - Zhang, Bo 
AU  - Liu, Chunhui 
AU  - Chen, Ming 
AU  - Shen, Yuanji 
AU  - Sun, Chao 

TI  - Potential role of mirabegron in the treatment of erectile dysfunction: a narrative review
T2  - Canadian Journal of Urology

PY  - 
VL  - 
IS  - 
SN  - 1488-5581

AB  - Erectile dysfunction (ED) is a multifactorial disorder closely associated with vascular dysfunction, metabolic disease, impaired smooth muscle regulation, and aging-related changes. Although phosphodiesterase type 5 inhibitors (PDE5i) remain the cornerstone of pharmacological treatment, a substantial proportion of patients, particularly those with diabetes, endothelial dysfunction, or complex cardiometabolic comorbidities, show incomplete or inadequate responses. These limitations have encouraged growing interest in alternative pathways that regulate cavernosal smooth muscle tone beyond the classical nitric oxide–cyclic guanosine monophosphate axis. Mirabegron, a selective β<sub>3</sub>-adrenergic receptor agonist widely used for overactive bladder, has recently attracted attention as a potential repurposing candidate in ED. β<sub>3</sub>-adrenergic receptor activation may promote corpus cavernosum relaxation through hydrogen sulfide/cyclic guanosine monophosphate signaling and inhibition of the RhoA/Rho-kinase pathway, thereby providing a mechanistically distinct approach to erectile physiology. This narrative review summarizes the pathophysiological rationale, mechanistic evidence, preclinical findings, and emerging clinical observations regarding the possible role of mirabegron in ED, with particular attention to its relevance in patients with lower urinary tract symptoms, benign prostatic obstruction, overactive bladder, or smooth muscle dysregulation. Current evidence suggests that mirabegron may be more appropriately viewed as a biologically plausible adjunctive or phenotype-oriented therapeutic candidate rather than as a broadly applicable treatment for unselected ED populations. Available clinical data remain limited by small sample sizes, short follow-up durations, heterogeneous patient populations, and incomplete mechanistic validation in humans. Therefore, mirabegron should not currently be considered an established first-line therapy for ED. Further well-designed, adequately powered randomized controlled trials incorporating erectile function endpoints, safety monitoring, patient stratification, and mechanistic biomarkers are needed to clarify its therapeutic value and clinical positioning.
KW  - mirabegron; erectile dysfunction; β<sub>3</sub>-adrenergic receptor; hydrogen sulfide (H<sub>2</sub>S); RhoA/Rho-kinase pathway

DO  - 10.32604/cju.2026.085214