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PubMed2004

Concomitant use of sildenafil and a vacuum entrapment device for the treatment of erectile dysfunction.

PURPOSE: Men not entirely satisfied with erectile function after separate use of sildenafil or a vacuum entrapment device (VED) are usually given more invasive alternatives. This prospective study was designed to evaluate the efficacy of concomitant use of sildenafil and a vacuum entrapment device in men not satisfied with erectile function while using each of these treatment modalities separately. MATERIALS AND METHODS: A total of 161 patients suffering from erectile dysfunction for at least 6 months were evaluated and treated with 100 mg sildenafil and a VED each as monotherapy. The 41 patients not satisfied with erectile function while using either modality alone were treated with concomitant use of sildenafil and a VED. The International Index of Erectile Function and global assessment question about satisfaction from treatment were used to evaluate satisfaction before and after each treatment. RESULTS: All 41 patients stated on the global assessment question that they had a greater level of satisfaction with the results of combined treatment than with each treatment alone (p <0.0001). Older (age greater than 60 years) participants reported better overall satisfaction. There was no correlation between treatment outcome and erectile dysfunction etiology or between satisfaction from treatments and the order in which they were given and the pretreatment scores for the International Index of Erectile Function domains. CONCLUSIONS: Combined use of sildenafil and a VED may be offered to patients not satisfied when either treatment is used alone.

Adult↗

PubMed2004

Gonadal and erectile dysfunction in diabetics.

The high prevalence of erectile dysfunction in patients with diabetes is caused mainly by vascular and neurological conditions;nevertheless, hypogonadism may also contribute to erectile dysfunction and to changes in mood, libido, body composition, and bone density. Age, obesity, and the assay used to measure testosterone will affect the diagnosis of hypogonadism. This article focuses on the interaction of these conditions and attempts to explain possible mechanisms for observations reported in the literature.

Age Distribution↗

PubMed2004

Erectile dysfunction after a long-distance cycling event: associations with bicycle characteristics.

PURPOSE: We conducted a prospective cohort study to examine the relationship between bicycle characteristics and the occurrence of erectile dysfunction. MATERIALS AND METHODS: Subjects consisted of 463 cyclists completing a cycling event of at least 320 km who were free of erectile dysfunction before their event. RESULTS: The cumulative incidence of erectile dysfunction after the ride was 4.2% (95% confidence interval [CI] 2.4%-6.8%) and 1.8% (95% CI 0.7%-3.8%) 1 week and 1 month after the event, respectively. Bicycle characteristics associated with an increased risk of erectile dysfunction included a mountain bicycle compared with a road bicycle (risk ratio [RR] 4.1, 95% CI 1.6-12.5), and the relative height of the handlebars parallel with or higher than the saddle compared with the relative handlebar height lower than the saddle (RR 3.0, 95% CI 1.1-9.3). Perineal numbness during the ride was experienced by 31% of the cyclists and was associated with erectile dysfunction (RR 4.4, 95% CI 1.6-12.7). Saddle cutouts were associated with an increased risk of erectile dysfunction among those who experienced numbness (RR 6.0, 95% CI 1.3-27.1), but the association was reversed among those who did not report numbness (RR 0.3, 95% CI 0.0-2.5). CONCLUSIONS: If the associations described are causal, then cyclists on a long-distance ride may be able to decrease the risk of erectile dysfunction by riding a road bicycle instead of a mountain bicycle, keeping handlebar height lower than saddle height and using a saddle without a cutout if perineal numbness is experienced.

Adult↗

PubMed2002

Yohimbine treatment of organic erectile dysfunction in a dose-escalation trial.

Yohimbine has had questionable effects in men with organic erectile dysfunction. We conducted this study to better define the population of men responsive to yohimbine, because tobacco was thought to affect a regimen of yohimbine more than other risk factors. We measured nocturnal penile tumescence with the RigiScan monitor, hormone profiles, answers to the Florida Sexual Health Questionnaire, and clinical responses at baseline and after two different doses of yohimbine in 18 nonsmoking men with erectile dysfunction. Of the 18 men, nine (50%) were successful in completing intercourse in more than 75% of attempts. The yohimbine responders were men with less severe erectile dysfunction as manifested by improved increased rigidity on RigiScan testing, higher Florida Sexual Health Questionnaire scores, and slightly higher levels of serum testosterone. Yohimbine is an effective therapy to treat organic erectile dysfunction in some men with erectile dysfunction.

Adrenergic alpha-Antagonists↗

PubMedDate not supplied

Erectile dysfunction.

In this era of increased awareness of sexual health, male erectile dysfunction has become a primary care issue. Since erectile dysfunction can be either a physiologic or psychological problem, the general practitioner needs to be prepared for how to approach the evaluation, treatment and overall management for their patients. This manuscript will review the epidemiology, definition, evaluation, and various treatment modalities for erectile dysfunction, including a review of the pharmacologic mechanism of PDE-5 inhibitors such as sildenafil, vardenafil, and tadalafil.

Erectile Dysfunction↗

PubMed2001

Age-related prevalence of erectile dysfunction in Japan: assessment by the International Index of Erectile Function.

BACKGROUND: The effects of age and concomitant chronic illness on male sexual function were investigated to obtain insight into the prevention of erectile dysfunction (ED). METHODS: A questionnaire from the International Index of Erectile Function (IIEF) was given to 2311 non-institutionalized men aged 23-79 years along with a survey of health status. The study sample consisted of 1517 men who provided complete responses to the questionnaire. For statistical analysis, ANOVA was conducted to evaluate the effect of aging on the sexual functions and a logistic regression model was used to identify significant independent risk factors for ED. RESULTS: There was a significant correlation between age and the scores for erectile function, orgasmic function, sexual desire and intercourse satisfaction. The prevalence of moderate and severe cases of ED were 1.8% and 0% for ages 23-29; 2.6% and 0% for ages 30-39; 7.6% and 1.0% for ages 40-49; 14.0% and 6.0% for ages 50-59; 25.9% and 15.9% for ages 60-69; and 27.9% and 36.4% for ages 70-79 years, respectively. Hypertension, diabetes mellitus, heart disease, chronic hepatitis, disc herniation and cerebral infarction under treatment with anticoagulants were significant independent risk factors for ED. CONCLUSIONS: The results obtained indicated a significant association between aging and chronic diseases and erectile function. Further epidemiologic research and analysis of individual risk factors are required to allow more effective future strategies for the treatment and prevention of ED.

Adult↗

PubMed1997

Endothelin-1 in diabetic and nondiabetic men with erectile dysfunction.

PURPOSE: We evaluated plasma concentration of endothelin-1 in diabetic and nondiabetic men complaining of erectile dysfunction, and the variation of endothelin-1 in cavernous body blood during intracavernous injection of prostaglandin E1. MATERIALS AND METHODS: We evaluated plasma concentrations of endothelin-1 in venous blood of 20 men with erectile dysfunction, 10 with and 10 without diabetes. Plasma concentration of endothelin-1 was also evaluated in the cavernous body blood of the 20 men with erectile dysfunction, during erection induced by intracavernous injection of 10 micrograms prostaglandin E1. A severe vasculogenic component of erectile dysfunction was excluded in all patients. RESULTS: Basal plasma concentration of endothelin-1 in the cubital vein was increased in nondiabetic (1.13 +/- 0.4 pg./ml.) and in diabetic (1.80 +/- 0.2 pg./ml.) patients with erectile dysfunction, compared to control men (0.64 +/- 0.1 pg./ml.) (p < 0.0005 and p < 0.0001, respectively), and in diabetic compared with nondiabetic patients (p < 0.002). No difference and close correlation were observed in the concentration of endothelin-1 in the cavernous body blood evaluated 5 minutes and 30 minutes after injection of prostaglandin E1 (r = 0.89, p < 0.0001, y = 0.98 x + -0.066). The concentration of endothelin-1 in the cavernous body blood evaluated 30 minutes after injection of prostaglandin E1 did not show any difference compared to peripheral venous concentration of the peptide in the 2 patient groups. Concentrations of endothelin-1 in the peripheral vein and the cavernous body blood were not different in patients with a full erection compared with incomplete penis erection after injection of prostaglandin E1 in the cavernous body.

Adult↗

PubMed2002

[Current opinion in vasculogenic erectile dysfunction].

Diagnosis of vasculogenic erectile dysfunction (ED), which can not based on single method, is the key for the successive surgical treatment. Revascularization is a safe, effective method to treat arteriogenic ED. The key for successive treatment is to select the most suitable patients and to avoid any risk factors for the surgical candidates, especially for those revascularization as the only therapeutic method. The high failure rate in surgery of ED is due to venous leakage which has led to these techniques being abandoned by almost all urologist. Newly appeared methods with little or no damage are welcome by the patients with vasculogenic ED, and the better results can be achieved by the combination of general treatment.

Humans↗

PubMed2002

Nonpharmacologic treatment of erectile dysfunction.

Nonpharmacologic treatment for erectile dysfunction (ED) includes sex therapy, the use of vacuum erection devices, penile prosthesis implantation, and penile vascular surgery. Sex therapy is indicated for psychogenic ED and is at times a useful adjunct for other treatments in men with mixed psychogenic and organic ED. Vacuum erection devices produce usable erections in over 90% of patients; however, patient and partner acceptability is an issue. Three-piece inflatable penile prostheses create flaccidity and an erection that comes close to that which occurs naturally. Penile vascular surgery has shown greatest efficacy in young men with vasculogenic ED resulting from pelvic or perineal trauma.

Journal Article↗

PubMed2005

Histomorphometry of penile smooth muscle fiber in severe erectile dysfunction.

CONTEXT AND OBJECTIVE: Smooth muscle fiber has fundamental importance in erection. Alterations in its function or quantity may be associated with erectile dysfunction. The study objective was to assess the proportion of penile smooth muscle fiber in patients with severe erectile dysfunction. DESIGN AND SETTING: Clinical study, in the Sexual Dysfunction Group, Universidade Federal de São Paulo (Unifesp), and in the Anatomy Laboratory, Universidade Estadual do Rio de Janeiro (UERJ). METHODS: Twenty patients with severe erectile dysfunction were selected to form two groups of ten patients: one with normal arterial flow (age range: 44 to 78 years) and the other with altered arterial flow (age range: 38 to 67 years). These groups were compared with a group formed by ten cadavers aged 18 to 25 years that were presumed to have been potent. Quantification of the smooth muscle fibers was done by means of an immunohistochemical study. RESULTS: The proportion of smooth muscle fiber found was 41.15% for the control group. The patients with erectile dysfunction and normal arterial flow presented 27.24% and those with altered arterial flow presented 25.74%; 19 patients presented at least one chronic disease or risk factor for erectile dysfunction, with prominence for diabetes mellitus, systemic arterial hypertension and smoking. CONCLUSION: Among patients with severe erectile dysfunction, the arterial flow on its own does not present interference in the proportion of smooth muscle fiber. The diminution of the proportion of smooth muscle fiber may result from chronic diseases and vascular risk factors.

Adolescent↗

PubMed2000

[Penile prosthesis for erectile dysfunction--long-term follow-up].

Our armamentarium for the treatment of erectile dysfunction has recently been expanded by addition of Viagra and the MUSE. However, their long-term results are still unknown. The insertion of a penile prosthesis is invasive, expensive, and irreversible, but under optimal condition provides an acceptable, definitive solution for erectile dysfunction. We evaluated our long-term results with penile prosthesis insertion (PPI). From 1987-1998, 57 patients underwent PPI in our department. Mean age was 55 years and the common causes of erectile dysfunction were atherosclerotic disease (23), radical pelvic surgery (15), and diabetes mellitus (14). Semirigid prostheses were inserted in 12 and inflatable prostheses in 45, including 42 single-component and 3 multi-component prostheses. Recently we interviewed these patients by telephone, using a standard questionnaire. Those not satisfied with the surgical results (83% of the living patients) were examined in our clinic. Mean follow-up was 53 months. In 37 (84%) the prosthesis was mechanically functional (rates after 1, 5 and 10 years were 87.8%, 80%, and 75%, respectively). In only 2 (2.5%) had serious complications led to prosthesis removal. All mechanical failures had occurred in those with inflatable prostheses after a mean of 48.5 months (range 4-113). At the time of the survey 68% were sexually active and 64% were satisfied with the surgical result. We conclude that PPI is safe treatment for erectile dysfunction. Although the rate of mechanically functioning prostheses decreases with time, modern multi-component prostheses may lead to better mechanical results.

Adult↗

PubMed1999

New treatment options for erectile dysfunction.

BACKGROUND: As increasing insight is gained into the aetiology of erectile dysfunction, many men formerly considered as suffering from psychogenic erectile dysfunction are now recognised as suffering from organic disease. As such, these men are currently identified as candidates for aggressive treatment of the organically caused problem. OBJECTIVE: This article discusses current and recently introduced treatments for erectile dysfunction, highlighting the advantages of each treatment and their position in the therapeutic armamentarium of the general practitioner. DISCUSSION: Investigative and treatment modalities have become more varied, such that to treat sexual dysfunction adequately, physicians must constantly keep abreast of new developments.

Alprostadil↗

PubMedDate not supplied

Erectile dysfunction: evaluation and new treatment options.

OBJECTIVE: Erectile dysfunction (ED) is a common condition of aging men. Indeed as many as 50% of men over age 40 will suffer some degree of ED. This erectile dysfunction has substantial impact on interaction with their partners, families, and employment. ED may be a harbinger of more serious vascular events and is commonly associated with depression. METHODS: Evaluation of ED begins with a careful history, asking the patient about his sexual function during clinical visits. Once identified, ED must be carefully considered with full history, careful physical examination, and laboratory studies to include markers of vascular risk factors, diabetes, and hypogonadism. RESULTS: The treatment of ED was revolutionized by the introduction of phosphodiesterase type 5 (PDE5) inhibitors in 1998. Currently, 3 PDE5 inhibitors are available internationally with excellent expected results and somewhat unique profiles. Although these agents are safe in all patients who do not have severe cardiac disease or who are taking nitrate medications, they require some patient instruction and counseling to optimize results. In that small group of patients who do not respond to these oral medications, additional alternatives are available for patients motivated to pursue treatment of their ED. CONCLUSION: Currently available safe and effective alternatives for the treatment of ED can improve the lives of patients and partners and increase their quality of life.

Adult↗

PubMed1996

[Psycho-therapeutic process of erectile dysfunction].

OBJECTIVES: To underscore the importance of psychological evaluation in erectile dysfunction. METHODS: Different methods of psychological evaluation (questionnaires, tests, directive interview, etc.) are utilized in erectile dysfunction. We use a flexible approach since different patients require different treatments. RESULTS: The curative process is directly related with the psychotherapist's interpretation of the information given by the patient and the analysis of the resistance to the resolution of the underlying conflict that may arise. CONCLUSIONS: Erectile dysfunction may be organic or psychogenic. Although it may arise from organic causes, the physical symptoms cannot be separated from the psychological components. The membrane that separates the conscious from the subconscious becomes permeable through psychotherapy. The success of treatment largely depends on the patient's desire to be cured. Correct diagnosis is essential to treatment by behavioural, psychoanalytical or combined and adaptable therapy. The importance of strict observation of the protocol and a multidisciplinary approach, which includes the intervention of a psychotherapist, is emphasized.

Erectile Dysfunction↗

PubMed1995

Oral trazodone as empirical therapy for erectile dysfunction: a retrospective review.

OBJECTIVES: Anecdotal reports of increased libido and sexual function in patients taking trazodone have led to its empirical use in patients with erectile dysfunction. A retrospective review of patient-reported responses to trazodone was performed to outline the efficacy and side-effect profile of this agent. METHODS: Between 1989 and 1994, 182 patients were placed on oral trazodone as empirical therapy for erectile dysfunction. Patients ranged in age from 26 to 85 years, with a mean of 60 years. Patients were evaluated before receiving trazodone with a thorough medical history and physical examination. Known risk factors for erectile dysfunction were assigned based on historical information and the findings of the examination. Patients received trazodone for at least 2 consecutive months, with daily doses starting at 25 mg. RESULTS: One hundred twenty-seven patients were available for follow-up by a standardized questionnaire regarding perceived improvement in erectile function, sexual function, and side effects. In patients less than 60 years of age, with no known risk factors for erectile dysfunction, 21 of 27 (78%) showed significant improvement in erectile ability. Smokers and patients older than 60 years with a history of significant peripheral vascular disease responded poorly to trazodone therapy. The duration of erectile dysfunction was inversely related to a response to trazodone. Of patients with a duration of impotence less than 12 months, 48% reported a positive response. Only 16% of patients with duration of erectile dysfunction greater than 60 months reported improvement in erections and sexual function. Trazodone was well tolerated by this population, with 62% reporting no side effects. CONCLUSIONS: Despite the limitations of a nonrandomized, retrospective study, trazodone appears to benefit younger patients with erectile dysfunction with few known risk factors. A prospective, placebo-controlled trial is needed to confirm the observations of this pilot study.

Administration, Oral↗

PubMedDate not supplied

Ten-year incidence of self-reported erectile dysfunction in people with long-term type 1 diabetes.

OBJECTIVE: The purpose of this report is to examine the overall 10-year incidence of erectile dysfunction and its relationships to other characteristics in men with younger onset diabetes. METHODS: In a population-based cohort study in southern Wisconsin, a 10-year cumulative incidence of reported erectile dysfunction was obtained in men who were 21 years of age or older, were less than 30 years of age at diagnosis of diabetes, had 10 or more years of diabetes, and were taking insulin (n=264). RESULTS: Twenty-five percent developed erectile dysfunction. The incidence of erectile dysfunction increased with age (from 10.2% in those 21-29 years of age to 48.6% in those 40 years of age or older, P<.0001) and with increasing duration of diabetes (from 16.0% in those with 11-14 years of diabetes at baseline to 38.2% in those with 25 or more years of diabetes, P=.01). In multivariate analyses, incidence of erectile dysfunction was associated with age [odds ratio (OR) 1.10, 95% confidence interval (CI), 1.06, 1.14], untreated hypertension (OR 5.01, 95% CI, 2.05, 12.27), and a history of smoking (OR 2.41, 95% CI, 1.09, 5.30) at baseline. CONCLUSIONS: These data suggest that cessation of cigarette smoking and tighter control of blood pressure might prevent or delay the onset of erectile dysfunction in persons with type 1 diabetes.

Adult↗

PubMed2001

Epidemiology of erectile dysfunction.

Epidemiologic studies are descriptive and analytical. The prevalence of erectile dysfunction in various community studies has varied from as low of 7% to as high as 52%. The prevalence of erectile dysfunction increases with age. Incidence data are scarce but a recent study of white males in the United States described an incidence of 26 cases per 1000 man-years. Risk factors for erectile dysfunction include certain medications, such as cardiovascular medications and psychotropic drugs, and chronic diseases, particularly neurologic diseases and diabetes mellitus.

Erectile Dysfunction↗

PubMed1998

Erectile dysfunction: a practical approach for primary care.

Erectile dysfunction has been poorly recognized and managed in the past, due to its taboo aspects and erroneous perceptions of its medical significance. With research, improved understanding has guided a practical approach to its diagnosis and treatment. In most presentations, erectile dysfunction has an organic etiology. Likely causes are often discerned from the clinical history and physical examination. Management may be a simple matter of addressing correctable risk factors, or a direct intervention may need to be pursued. For an individual patient, selection of the "ideal" treatment is based on an understanding of the extent of the problem and consideration of the patient's preferences.

Adrenergic alpha-Agonists↗