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PubMed2000

[Diagnosis of erectile dysfunction].

The diagnostic view on the erectile dysfunction has clearly changed in the last years. According to the development of new therapy options a better understanding about the physiology of the erectile dysfunction has arisen. This fact implies on one hand to pursue a subtile diagnostics, on the other hand you have also to concern the patient's imagination about the therapies ordered to him. It's useful to divide the clarification into 3 steps: step 1--the non-invasive diagnostics, step 2--the semi-invasive diagnostics, step 3--the invasive diagnostics. A great number of patients can be cleared up by examinations of step 1. A thorough anamnesis of the whole body and a sexual anamnesis, a physical examination, laboratory exams and a first psychological exploration should be obligatorily carried out. With the following drug tests there are some differential-diagnostic statements possible. Only in special cases more invasive diagnostic methods will be used. In this essay the different diagnostic possibilities are introduced and the corresponding indications are explained.

Alprostadil↗

PubMed2004

[Management of erectile dysfunction in daily practice--PISTES study].

INTRODUCTION: Despite the improved knowledge on erectile dysfunction and its prevalence over recent years, no pharmaco-epidemiology study on the management of erectile dysfunction in daily practice has been performed. This absence of data is all the more regrettable in view of the real revolution in the management of this disorder, leading an increasing number of patients to consult. OBJECTIVES: To determine and analyse the presenting complaints, aetiological diagnoses, and modalities of management of patients with erectile dysfunction. METHOD: PISTES pharmaco-epidemiological, prospective and transverse study of a representative national sample of 411 private or hospital urologists and sexologists between April and June 2002. RESULTS: The majority of patients (56.7%) expressed discomfort talking about this subject. Patients with mixed predominant psychogenic ED and mixed predominant organic ED represented 67.1% of the population, confirming the multifactorial aetiology. The management varies according to the aetiology. Complementary investigations are essentially hormone assays (89.6%), well ahead of provoked erection tests (21.9%). Patients are reviewed within 2 months and 65% resumed a satisfactory sexual activity. The main causes of failure are inefficacy (83.7%) and the high cost of treatment preventing purchase (56%). CONCLUSION: This study shows an effective management of erectile dysfunction, but which is still faced with difficulties of access to care for psychological or economic reasons. These difficulties concern the patient, his partner and the practitioner Although information on erectile dysfunction has been greatly improved, it does not sufficiently encourage effective therapeutic management.

Cross-Sectional Studies↗

PubMedDate not supplied

Two clinical problems in elderly men: osteoporosis and erectile dysfunction.

Seventy-six of 108 random men aged 50 years or over were evaluated for erectile dysfunction with interviews of patients using the International Index of Erectile Function Form and minimal evaluation. Serum hormone concentrations were measured. Bone mineral density was measured using dual energy x-ray absorptiometry. Hormone levels did not show significance in terms of erectile dysfunction or bone mineral density results. Erectile dysfunction was determined in 57 (75%) of 76 patients. Ten (13.2%) patients had osteoporosis and 45 (59.2%) had osteopenia at the bone mineral density measurements. The distribution of bone mineral density groups relating to erectile dysfunction did not show significance. The frequencies of osteoporosis and erectile dysfunction increased with age, but the association of these conditions seems to be independent of each other and hormonal changes appear not to be the major determinants for both conditions in elderly men.

Absorptiometry, Photon↗

PubMedDate not supplied

Treatment of erectile dysfunction.

The evaluation and treatment of Erectile Dysfunction has evolved dramatically over the last 10 years thanks to the improvement of our understanding of the physiology of erection and the development of effective drugs to be taken "on demand" before intercourse. In addition, Erectile Dysfunction is now clearly recognized as a medical disorder. It is beyond the scope of this article to go into details about the physiology and pathophysiology of the sexual cycle and the different diagnostic procedures for evaluating erectile disorders. Rather, we will concentrate on the therapeutic options for managing erectile disorders after a brief review of the most recent concepts of erection physiology and diagnosis.

Disease Management↗

PubMed2001

Erectile dysfunction in uremic dialysis patients: diagnostic evaluation in the sildenafil era.

The two words that mean sexual dysfunction, impotence and erectile dysfunction (ED), express two different concepts. Impotence is a general male sexual dysfunction that includes libidinal, orgasmic, and ejaculatory dysfunction. ED is the inability to achieve or maintain an erection sufficient to allow satisfactory sexual intercourse and is part of the general male sexual dysfunction termed impotence that includes libidinal, orgasmic, and ejaculatory dysfunction. Uremic men of different ages report a variety of sexual problems, including sexual hormonal pattern alterations, reduction in or loss of libido, infertility, and impotence, conditioning their well-being status. In evaluating and treating sexual dysfunction, a nephrologist must consider factors involved in its pathogenesis, such as hypothalamic-pituitary-gonadal axis alterations, psychological problems related to chronic disease, secondary hyperparathyroidism, anemia, autonomic neuropathy, derangements in arterial supply or venous outflow, and the normal structure of cavernous body smooth muscle cells. The introduction of sildenafil to treat impotent patients has completely changed the approach to evaluating these subjects because this drug is considered an effective well-tolerated treatment for men with ED. In the past, we proposed an algorithm that gave the opportunity to explore the previously mentioned factors using such instrumental interventions as the nocturnal penile tumescence test, penile echo color Doppler, nervous conduction velocity, and cavernous body biopsy, addressed to prescribe needed surgical or medical interventions. The complexity of the proposed algorithm requires many diagnostic procedures and much time and economic resources to localize the pathological lesions responsible for ED. Because of the new oral drug sildenafil, we propose a new algorithm to test the possibility of obtaining an erection and classify patients as responders or nonresponders to the sildenafil test.

Bromocriptine↗

PubMed1995

Oral and topical treatment of erectile dysfunction. Present and future.

A great deal of progress has been made in the pharmacological treatment of erectile dysfunction. At present, however, the most effective therapies require intracavernosal injections with a number of associated drawbacks. An increasing number of oral and transdermal agents have been introduced clinically or are at various phases in their development. It is evident that severe end-organ disease probably will not result in successful systemic therapy. Nevertheless, in men with intact or mildly dysfunctional erectile mechanisms, noninvasive treatments can offer some measure of success. Further study of individual and synergistic activity of available compounds is underway.

Administration, Oral↗

PubMed2003

[Erectile dysfunction: knowledge, wishes and attitudes. Results of a French study of 5.099 men aged 17 to 70].

OBJECTIVE: Although erectile dysfunction is today considered as a frequent disease, few patients actually seek for medical advice and take medication. The purpose of the study was therefore to analyse use and behaviour of men with erectile dysfunction. MATERIAL AND METHODS: The study, performed between the 12th April and the 21st May 2002, involved 10,000 men 18 to 70 years old and consisted in self-administered questionnaires including 55 items (5099 questionnaires were eligible for analyse). RESULTS: Despite a high prevalence of erectile dysfunction (25%), increased with age (44% in the men aged 45 and over), the study showed that only 22.2% of men with erectile dysfunction take medical advice with 36.9% of them take medication. Men generally think erectile dysfunction is not very common in comparison to other diseases, and correlate it with stress and tiredness. However, men with erectile dysfunction (particularly those over 45) mention diseases as hypertension, prostatic and cardiovascular diseases. 94% of men would take medical advice if their problems should repeat. However, obstacles to consultation still remain for men presenting with erectile dysfunction and especially the difficulty to talk about sexuality with their physician (for 63% of men). CONCLUSION: This study confirms the high prevalence of erectile dysfunction and that few men concerned actually seek for professional assistance and take medication. Moreover, it demonstrates the major contribution of the physician in opening the dialogue on sexual problems because men are frequently embarassed or afraid to discuss this sensitive topic.

Adolescent↗

PubMed1997

Treatment of erectile dysfunction: can pelvic muscle exercises improve sexual function?

Erectile dysfunction, the inability to achieve or maintain an erection sufficient for satisfactory sexual performance, affects 10 to 20 million American men. The underlying causes of erectile dysfunction are commonly classified as neurogenic, arteriogenic, venogenic, or psychogenic. The perineal muscles, specifically the ischiocavernosus and bulbospongiosus, play a role in human penile erection. This article explores the role of pelvic muscle exercises, designed to strengthen the perineal muscles. In the treatment of erectile dysfunction secondary to venous leakage.

Adult↗

PubMed2000

Current status of standardized questionnaires in the measurement of erectile dysfunction.

The evaluation and management of erectile dysfunction has evolved dramatically over the past decade. Clinicians now benefit from advances in the understanding of the physiologic pathways involved in the function of erections and from the availability of innovative and effective therapies. The clinical history remains the essential starting point in the evaluation of patients with erectile dysfunction. The standardized questionnaire has been used as a valuable complement to the clinical history and in the assessment of treatment efficacy.

Erectile Dysfunction↗

PubMed2002

Prevalence of erectile dysfunction and active depression: an analytic cross-sectional study of general medical patients.

Erectile dysfunction is a common problem, affecting more than half of all men between the ages of 40 and 70 years. The authors' goal was to quantify the prevalence of concomitant erectile dysfunction and active depression among patients seen in a general medical setting between September 1998 and September 1999. Simple random sampling techniques were used to select a subset of 334 patients from 73 general medical practices affiliated with an academic tertiary referral center in Pennsylvania. Of the 334 patients sampled, the authors received responses from 268 subjects (80.2%) and completed questionnaires from 199 subjects (59.6%) with a mean age of 59 years. The survey instrument consisted of three major sections: demographic and health history information, the Center for Epidemiologic Studies Depression (CES-D) Scale, and the five-item version of the International Index of Erectile Function Scale. The prevalence of moderate or complete erectile dysfunction in this sample was 36.4% (95% confidence interval (CI): 29.6, 43.1). The prevalence of current depression by CES-D Scale criteria was 12.1% (95% CI: 7.5, 16.7), and the prevalence of concomitant erectile dysfunction and depression was 5.1% (95% CI: 2.0, 8.1). Using logistic regression, the authors found that current depressive symptoms were not associated with moderate or complete erectile dysfunction (odds ratio = 1.3, 95% CI: 0.5, 3.1; p = 0.565). Concomitant erectile dysfunction and depression represent a significant public health problem.

Adult↗

PubMed1999

The epidemiology, anatomy, physiology, and treatment of erectile dysfunction in chronic renal failure patients.

Erectile dysfunction (ED) is an associated morbidity for men with chronic renal failure. An understanding of the epidemiology, anatomy, physiology, and treatment options for ED can greatly improve the quality of life for men with chronic renal failure. There are psychological and physiological causes for erectile dysfunction. Once the key features leading to the patient's loss of potency have been identified, appropriate treatment plans can be instituted, often with successful outcomes. The purpose of this article is to assist the nephrology interdisciplinary team in the management of ED by reviewing possible causes, available studies, and treatment options for their patients.

Erectile Dysfunction↗

PubMed1997

Comparative results of goal oriented therapy for erectile dysfunction.

PURPOSE: Goal oriented therapy for erectile dysfunction, based on a complete education of the couple, was offered to 460 patients. The short-term and long-term results of the first and second treatments selected were compared. MATERIALS AND METHODS: From September 1991 to March 1995, 460 patients with erectile dysfunction were evaluated and treated prospectively. The success of treatment, selected by the patient or couple, was defined as the ability to achieve and maintain good erections for successful coitus for at least 1 year after the start of therapy. Sexual satisfaction of the couple was required to confirm a successful outcome. RESULTS: The preferred first line of treatment by 322 patients was pharmacotherapy, with intracavernous injections being the second most selected therapy (80% success rate). However, there was a high long-term dropout rate for intracavernous injections. Approximately 70% of the patients were lost to followup or refused further treatment. CONCLUSIONS: Overall, this prospective study showed that goal oriented therapy is initially highly successful. However, the long-term high dropout rate and dissatisfaction of the couple cast doubt about the efficacy of the present treatment options.

Adult↗

PubMed2001

Spontaneous erections in a patient with erectile dysfunction after palliative chemotherapy for non-small cell lung cancer.

Erectile dysfunction is a common problem, especially among older men. It is often caused by psychological problems, and is also the reason for pronounced impairment of psychosocial well-being. Many systemic diseases, genitourinary surgery, drugs, particularly antihypertensive and psychotropic drugs, and also chemotherapeutic agents and dexamethasone are attributed as being causes of erectile dysfunction. In our case, severe erectile dysfunction was present for 8 months before non-small cell lung cancer was diagnosed. Normal sexual function, observed for a short period immediately following chemotherapy, is a highly unusual finding and has not been published before. Chemotherapeutic agents have repeatedly been shown to result in cessation of sexual function including erection. While we cannot offer a definite explanation for our findings, undefined paraneoplastic processes leading to erectile dysfunction amenable to successful cytotoxic intervention could be a possible explanation for our observation.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2003

[Erectile dysfunction and phosphodiesterase type 5 inhibitors].

Erectile dysfunction affects 150 millions of men and its prevalence increases with age. The improvement of life expectancy will increase the worldwide prevalence to 300 million in 2025. Oral treatments are nowadays the first line therapy for the vast majority of people as they have a good reliability and tolerance and restore more spontaneity. The authors relate the widespread interest in phosphodiesterase type 5 inhibitors with the advent of sildenafil for the treatment of erectile dysfunction and present characteristics of 2 new phosphodiesterase type 5 inhibitors in Belgium, tadalafil and vardenafil.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed1995

Erectile dysfunction. Are you prepared to discuss it?

Erectile dysfunction is more common than previously thought in men older than 40 years, perhaps because contributing medical risk factors increase with age. The medical history is of prime importance in outlining these factors, the most common of which are diabetes, hypertension, and smoking. Nocturnal penile tumescence and rigidity testing with a portable home monitor may be helpful in determining whether the cause of erectile dysfunction is primarily organic or psychological. Specific therapeutic measures include sex therapy, psychotherapy, treatment for alcohol or tobacco dependency, replacement of offending medications, improved glycemic control, constriction rings, vascular surgery, androgen replacement therapy, bromocriptine mesylate (Parlodel), and thyroid, adrenal, or pituitary replacement therapy. Nonspecific therapies include yohimbine hydrochloride (Yocon), use of vacuum tumescence devices, intracorporeal injections, and penile implants.

Erectile Dysfunction↗

PubMed2004

Impact of erectile dysfunction and its subsequent treatment with sildenafil: qualitative study.

OBJECTIVES: To determine the effects of erectile dysfunction and to explore the impact of treatment with sildenafil (Viagra). DESIGN: An exploratory qualitative study with semistructured interviews. SETTING: Men's health clinic in NHS hospital. PARTICIPANTS: 40 men who had had erectile dysfunction and had attended the clinic during the year before interview. MAIN OUTCOME MEASURES: Impact of erectile dysfunction on men, their expectations of sildenafil, and impact of treatment on men and their relationships. Issues explored with exploratory qualitative approach. RESULTS: Erectile dysfunction caused serious distress to all those men who experienced it, with marked effects on their self esteem and their relationships. Sildenafil, when it worked, caused a great improvement in wellbeing. The expectations raised by media hyperbole with the launch of sildenafil had an adverse effect on the morale of those who found it did not work. When, according to the patient, treatment did not work, the distress was severe and for many confirmed their lack of self worth. CONCLUSIONS: Further study is needed to explore the feelings of men affected by erectile dysfunction and their perception of treatment. Health professionals should be aware of the extreme distress erectile dysfunction can cause.

Adult↗

PubMed2000

The challenges of diagnosing erectile dysfunction in the primary care setting.

Erectile dysfunction is present in approximately half of all men between the ages of 40 and 70. Patients are often reluctant to discuss this problem with their practitioner; therefore, unless the practitioner is able to initiate the discussion, the diagnosis will not be made and successful treatment will not be started. Primary care practitioners have previously received little training in taking the sexual history of their patients. In addition, primary care practitioners are under increasing pressure to see more and more patients in less and less time. Erectile dysfunction is a condition that is relatively easy to diagnose using history, physical examination, and laboratory tests at the disposal of the primary care practitioner. Although referral to an urologist may be necessary, most patients can be successfully treated in the primary care setting.

Erectile Dysfunction↗

PubMed2005

Correlation between ejaculatory and erectile dysfunction.

Summary Premature ejaculation (PE) and erectile dysfunction (ED) are different sexological issues. However, they have many little-known links. PE is the most common male sexual dysfunction, but ED is undoubtedly the most common reason that medical help is sought. As a consequence, PE is largely under-diagnosed and under-treated, while ED has received great scientific and clinical attention in recent years. There are plenty of reasons for this: (i) PE is classically considered as psychogenic in nature; (ii) it is traditionally treated with behavioural psychotherapies; (iii) clear and accepted clinical definition(s) are lacking; (iv) the aetiologies are largely unknown; (v) the pathogenesis is still obscure - there is a lack of awareness and acknowledgement of PE as a symptom of medical disease; (vi) lacking a medical presence in the field and requests for help from patients are low. Finally, erectile dysfunctions (ED) and ejaculatory dysfunctions frequently overlap. The aim of this review article is to propose a new taxonomy of PE, which considers ED as an important factor of PE and vice versa.

Ejaculation↗