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PubMed2002

A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report.

PURPOSE: We investigated the efficacy of Korean red ginseng for erectile dysfunction using the International Index of Erectile Function, RigiScan (UroHealth Systems, Laguna Niguel, California), hormonal levels and penile duplex ultrasonography with audiovisual sexual stimulation. MATERIALS AND METHODS: A total of 45 patients with clinically diagnosed erectile dysfunction were enrolled in a double-blind, placebo controlled, crossover study (8 weeks on treatment, 2 weeks of washout and 8 weeks on treatment) in which the effects of Korean red ginseng and a vehicle placebo were compared using multiple variables. The ginseng dose was 900 mg. 3 times daily. RESULTS: Mean International Index of Erectile Function scores were significantly higher in patients treated with Korean red ginseng than in those who received placebo (baseline 28.0 +/- 16.7 and 38.1 +/- 16.6 versus 30.9 +/- 15.7, p <0.01). Scores on questions 3 (penetration) and 4 (maintenance) were significantly higher in the ginseng than in the placebo group (p <0.01). In response to the global efficacy question 60% of the patients answered that Korean red ginseng improved erection (p <0.01). Among other variables penile tip rigidity on RigiScan showed significant improvement for ginseng versus placebo. CONCLUSIONS: Our data show that Korean red ginseng can be as effective alternative for treating male erectile dysfunction.

Blood Flow Velocity↗

PubMed2004

Morphologic findings and blood flow parameters of penile vasculature in patients with erectile dysfunction.

The objective was to study the risk factors in patients with erectile dysfunction in correlation with ultrasound findings of penile vasculature. Patients with erectile dysfunction were classified in four groups according to their risk factors. Group A (37 pts) who were heavy smokers, group B (40 pts) who suffered from diabetes mellitus, group C (30 pts) who suffered from hyperlipidemia and group D (40 pts) with no risk factors. The peak systolic velocity (PSV) was measured after the intracavernous injection of 10 mg alprostadile. Normal values were PSV>35 cm/s and endiastolic venous velocity<4 cm/s. It was found that the mean PSV in group A was 22.2+/-2.25 cm/s without venous leakage, in group B the mean PSV was 24.6+/-1.29 cm/s but there was a significant venous leakage (mean end-diastolic velocity 6.2+/-1.37 cm/s). Patients with hyperlipidemia (group C) had a mean PSV of 26.2+/-1.74 cm/s and insignificant venous leakage and patients in group D had a normal vascular profile. Patients with erectile dysfunction who are heavy smokers are predisposed to have penile arterial insufficiency, while diabetics have both arterial insufficiency and venous leakage.

Adult↗

PubMed2003

Novel treatment options for overlapping yet distinct erectile dysfunction and andropause syndromes.

The Food & Drug Administration has recently approved, or is in the process of approving newer drugs such as the phosphodiesterase inhibitors and apomorphine to treat men's health issues including erectile dysfunction. Increasing age results in a gradual hypogonadal state in men, for which different novel delivery systems of androgens are currently offered for the symptomatic patient. As such, many men are presenting to healthcare practitioners for the first time. The age of presentation for erectile dysfunction and andropause often overlaps, typically in the fifties and beyond, therefore, it makes sense to screen for erectile dysfunction in andropause patients and vice versa. Erectile dysfunction is usually a harbinger for other illnesses, such as coronary heart disease and depression. The hypogonadal state, likewise, could be a harbinger for other ill health states in men, including obesity, depression, osteoporosis and possibly memory loss. While the newer treatments for erectile dysfunction and andropause are distinctly different and targeted at symptom relief, the presentation of the patient with erectile dysfunction or andropause offers an excellent opportunity for screening for other health states and health education strategies.

Androgens↗

PubMed2002

Therapeutic strategies for managing erectile dysfunction: a step-care approach.

During the past two decades, advances in the understanding of erectile dysfunction have provided primary care physicians, urologists, and other healthcare providers with additional treatment options. The introduction of sildenafil citrate, the first oral phosphodiesterase type 5 (PDE5) isoenzyme inhibitor, has helped to restore erectile function and improve overall health and quality of life. The step-care approach to the treatment of erectile dysfunction can be divided into first-, second-, and third-line modes of therapy. Most patients with erectile dysfunction will choose oral agents because of their simplicity and ease of administration. This article reviews all treatment strategies for erectile dysfunction, with a focus on PDE5 inhibitors, including novel agents that may optimize patient outcomes.

Counseling↗

PubMed2001

Vacuum constriction and external erection devices in erectile dysfunction.

The development of external erection devices has evolved as the social stigma surrounding the treatment of erectile dysfunction has gradually disappeared during the late twentieth century. Although the success of surgical and medical therapy for erectile dysfunction has been documented, especially since the introduction of sildenafil citrate, patient demand for an effective, noninvasive, drug-free management of erectile dysfunction has remained. As the population continues to age, acquiring the comorbidities commonly associated with erectile dysfunction, such as hypertension, diabetes mellitus, and atherosclerotic vascular disease, the demand for such treatment should persist. This article examines the development, mechanism of action, efficacy, and patient satisfaction with regard to vacuum constriction and external erection devices.

Constriction↗

PubMed2002

Gene therapy for erectile dysfunction: where is it going?

PURPOSE OF REVIEW: This review will summarize the most recent preclinical data from the leading US laboratories regarding the application of gene therapy to the treatment of erectile dysfunction. The implications of these findings in the field of gene therapy in general, and more specifically to the treatment of non-life threatening disorders such as erectile dysfunction, will be outlined. RECENT FINDINGS: The preclinical work of several laboratories has clearly documented 'proof-of-concept' for the utility of gene therapy for the treatment of erectile dysfunction. A variety of vectors and several distinct molecular targets have been successfully leveraged. Such observations suggest that numerous potential strategies may exist for gene-based treatments of erectile dysfunction. SUMMARY: The apparent preclinical success of most, if not all, gene-based strategies for the treatment of erectile dysfunction is consistent with the multifactorial regulatory mechanisms governing the erectile process. The bottleneck in the gene therapy clinical development process therefore apparently will not lie in the ability to identify relevant molecular targets that are amenable to gene therapy for erectile dysfunction, but rather in the safety, specificity and longevity of those targets. That is, the next technical hurdle is to find the strategy(ies) that has the best safety profile, the greatest specificity for altering (increasing) intracavernous pressure 'on demand' and, furthermore, the most appropriate (longest?) half-life. While these criteria may correspond to intuition, finding molecular targets that clear these clinical hurdles may place restrictions on the molecular choices for gene transfer.

Erectile Dysfunction↗

PubMed2001

Is there a role of radial rigidity in the evaluation of erectile dysfunction?

RigiScan has been the most widely utilized device for measuring erectile rigidity. However, the use of the RigiScan in the evaluation of erectile dysfunction has questionable because the RigiScan device does not directly determine axial rigidity. The aim of this study is to clarify that radial rigidity measured by RigiScan reflects the intracorporeal pressure and erectile capability efficiently. From January 1998 to May 1999, a total of 23 patients with erectile dysfunction were involved in the study. They were evaluated by RigiScan and duplex ultrasonography after intracorporeal injection of prostaglandin E1. We investigated the relationship between radial rigidity and the resistance index. The results of radial rigidity were also compared with that of the degree of erection. For the entire group, significant correlations were found between radial rigidity and the resistance index (r=0.680, P<0.001 for tip rigidity; r=0.703, P<0.001 for base rigidity). In addition, for 12 patients whose tip rigidity exceeded 60% and for 10 whose base rigidity exceeded 60%, the correlations between radial rigidity and the resistance index remained (r=0.659, P=0.020 for tip rigidity; r=0.759, P=0.011 for base rigidity). Based on the response determined by patients, radial rigidity represented the degree of erection efficiently. Our findings suggest that RigiScan is a useful diagnostic tool. Radial rigidity represents the intracorporeal pressure efficiently and has an acceptable role in the evaluation of erectile dysfunction.

Adult↗

PubMed2004

Facing erectile dysfunction due to prostate cancer treatment: perspectives of men and their partners.

A well-known side effect of prostate cancer treatment is erectile dysfunction. However, little is known about how men and their sexual partners think about the threat of erectile dysfunction prior to prostate cancer treatment. Twenty-one patients who had been diagnosed with early prostate cancer, but not yet treated, and 13 female partners of these men were recruited from two urologists' offices. In separate, semistructured individual interviews with men and their partners, thoughts about the threat of erectile dysfunction were solicited. Men's reactions to the possibility of losing their sexual capacity due to prostate cancer-related treatment were linked to their current level of sexual function. Women reacted to erectile dysfunction by stressing the existence of other relationship dimensions, whereas they were aware about the gravity of their male partners' feelings about potency. Finally, both men and women alike had concerns about the implications of erectile dysfunction on their relationship. Physicians advising men about treatment options should consider exploring men's current sexual function, thoughts about identity, and especially men's relationship situation. Physicians addressing these issues with men and their partners should provide resources for counseling.

Adult↗

PubMed1989

Standardized evaluation of erectile dysfunction in 95 consecutive patients.

We investigated 95 patients referred for erectile dysfunction by penile blood pressure measurement, the intracavernous papaverine test and Doppler investigation of the penile arteries. Furthermore, penile cutaneous perception threshold, bulbocavernosus reflex latency and somatosensory cortical evoked potentials of the pudendal nerve were measured. In selected cases cavernosometry, cavernosography and corpus cavernosum electromyography were performed. Doppler investigation of the cavernous arteries after papaverine injection was more reliable than penile blood pressure measurement in the diagnosis of arteriogenic erectile dysfunction. Decreased sensibility of the penis may be the sole factor responsible for inability to sustain an erection. Erectile dysfunction may be provoked by impaired function of the pudendal nerve. Penile cutaneous perception threshold measurement and corpus cavernosum electromyography are mandatory in the evaluation of neurogenic etiology. Cavernosometry and cavernosography are reliable methods in the determination of abnormal drainage from the corpus cavernosum.

Adult↗

PubMed2001

Systematic review of randomised controlled trials of sildenafil (Viagra) in the treatment of male erectile dysfunction.

BACKGROUND: Sildenafil (Viagra), a new oral drug for the treatment of erectile dysfunction, was licensed for use across Europe in 1998. AIM: To examine the effectiveness and safety of sildenafil as an oral treatment for erectile dysfunction. DESIGN OF STUDY: Systematic review and meta-analysis. SETTING: All published or unpublished randomised controlled trials comparing sildenafil with a placebo or alternative therapies. METHOD: Published studies were sought by computerised searches of electronic databases using the keywords 'sildenafil' and 'Viagra'. A hand search was also done of the British Medical Journal, Lancet, Journal of the American Medical Association, New England Journal of Medicine, British journal of General Practice, Drug, Inpharma and Scrip. An assessment of quality of all identified studies and data extraction was undertaken independently by two researchers. Results were combined in a meta-analysis where appropriate, using RevMan version 3. RESULTS: Twenty-one trials were identified. All trials showed a statistically significant improvement in erectile or sexual function in patients using sildenafil compared with a placebo. A meta-analysis of 16 trials reporting a global efficacy response showed that men were 3.57 (95% CI = 2.93-4.43) times as likely to have improved erections on sildenafil compared with those on a placebo. The number needed to treat to have one man with improved erections was two. The drug has a relatively safe side-effect profile. CONCLUSIONS: Available research shows that sildenafil is an effective treatment for male erectile dysfunction. Many trial participants had some baseline erectile function and it is probable that in clinical practice, where the erectile function tends to be more impaired, the number needed to treat may be higher.

Adult↗

PubMedDate not supplied

Intracavernosal injection therapy and other treatment options for erectile dysfunction.

In the United States, almost 30 million men have complete or partial erectile dysfunction. This disorder occurs in approximately 52% of men between 40 and 70 years of age; 70% of affected men younger than 35 years of age have psychogenic causes, and 85% of men older than 50 years of age have organic impotence. Furthermore, erectile dysfunction is exacerbated by the presence of such conditions as heart disease, diabetes, and hyperlipidemia and the medications used to manage them. Thus, a widespread segment of the population is in need of a safe and effective treatment strategy for restoration of normal sexual function. The technique of intracavernosal injection therapy was initially described in the early 1980s. During the subsequent decade, the effectiveness of various drug combinations and the associated side effects were demonstrated. In 1995, prostaglandin E(1) was approved for intra-cavernosal pharmacotherapy. It has proved highly effective for neurogenic, vasculogenic, and psychogenic erectile dysfunction, with reported response rates of 75 to 92%. The major side effect (albeit uncommon) is corporal fibrosis. Other options for treatment of erectile dysfunction are vacuum-erection devices and penile prostheses.

Journal Article↗

PubMedDate not supplied

Pilot study of the endothelin-A receptor selective antagonist BMS-193884 for the treatment of erectile dysfunction.

Endothelins have been postulated to be important regulators of penile erectile function. The endothelin-A receptor antagonist BMS-193884 was evaluated as a treatment for mild-to-moderate erectile dysfunction in an animal model and in human volunteer subjects. In laboratory studies, organ bath preparations of rabbit and human penile cavernosal tissue strips were incubated with BMS-193884 and exposed to increasing concentrations of endothelins. In rabbit tissue, 1 microM BMS-193884 significantly inhibited contraction to ET-1, ET-2, and ET-3 by 34.5%, 42.9%, and 100%, respectively. In human tissue, 1 microM BMS-193884 inhibited contraction to ET-2 by 44.4%. In rabbit tissue strips contracted with 20 nM of ET-1 or ET-2, BMS-1 93884 caused dose-dependent relaxation with EC50 values of 107.2 +/- 32.3 nM and 1.7 +/- 0.5 nM, respectively. In anesthetized male rabbits, intravenous administration of BMS-193884 (systemic plasma concentration approximately 50 and 100 nM) increased the duration of pelvic nerve-stimulated penile erection. To further assess the safety and efficacy of BMS-193884, 53 men diagnosed with mild-to-moderate erectile dysfunction were administered oral placebo or 100 mg BMS-193884 in a double-blind fashion. Evaluations were based on 1) erectile function testing during 2 in-office visits and 2) diary and questionnaire data of 4 intercourse attempts over 2-4 weeks of home use. Although the drug was well tolerated, BMS-193884 did not significantly improve erectile function during office visits or home use when compared to placebo. Thus, BMS-193884 facilitated cavernosal smooth muscle relaxation ex vivo and prolonged penile tumescence in vivo. In contrast, a pilot clinical study failed to show enhancement of erectile response in men with mild-to-moderate erectile dysfunction. The disparity between the laboratory and clinical studies suggests that there may be differences between species with regard to the role of endothelin in erectile function.

Administration, Oral↗

PubMed1998

Opportunities for the treatment of erectile dysfunction by modulation of the NO axis--alternatives to sildenafil citrate.

Erectile function in man depends upon a complex interaction of psychogenic, neurologic, hormonal and vascular factors, and therefore the management of erectile dysfunction (ED) reflects this complexity of control. Therapeutic options include psychological and non-pharmacological approaches as well as drug treatments. The effectiveness of the type-5 cGMP phosphodiesterase inhibitor sildenafil citrate (Viagra) confirms the pivotal role of the NO-cGMP axis in promoting and maintaining erection. Although widely acclaimed, sildenafil leaves many questions unanswered, especially regarding its susceptibility to pharmacokinetic drug interactions, and its safety in patients with ischaemic heart disease and those taking nitrates. In view of the epidemiological link between erectile dysfunction and cardiovascular disease in the elderly, this limitation might have much broader implications. The presently available scientific documentation, although less extensive, indicates that NO donors, such as topically applied nitroglycerin (GTN; for example, 1-2 puffs of an ordinary GTN spray applied to the shaft of the penis), might be a reasonable alternative. Further larger-scale research on the efficacy and tolerability of topical GTN is needed to establish its full therapeutic potential in the treatment of erectile dysfunction.

Cyclic GMP↗

PubMedDate not supplied

Association between lower urinary tract symptoms and erectile dysfunction.

Our aim was to assess the association between lower urinary tract symptoms (LUTS) and erectile dysfunction by means of International Prostate Symptom Score (IPSS) and Sexual Health Inventory for Men (SHIM) questionnaire. A total of 69 eligible patients who were admitted to our outpatient clinic with lower urinary tract symptoms were included in the study. A self administered questionnaire of IPSS and SHIM were given to patients. Demographics and medical history data were recorded. Any risk factor that may be associated with erectile dysfunction, including coronary artery disease, diabetes, hypertension, and smoking status, was determined in each patient. Correlation tests were used to examine the relationship between lower urinary tract symptoms and erectile dysfunction by controlling the effects of age and comorbidities. Mean age was 58.6 +/- 13.1 31-86 years. Mean SHIM and IPSS total score was 14.3 +/- 7.5 and 11.5 +/- 8.1, respectively. Spearman correlation coefficient between IPSS and SHIM scores was found to be -0.41. There was a significant negative correlation with IPSS total scores of moderate degree when both age and presence of risk factor was controlled (r = -0.31; p = 0.009). Storage symptom scores showed significant correlation with SHIM scores (r = -0.33; p = 0.000). The association between SHIM score and each item of IPSS showed significant correlation for urgency, straining and nocturia when age controlled. The degree of bother by LUTS as determined by the IPSS quality of life question was also correlated with SHIM scores; however, this correlation was not significant when age or risk factor for ED was controlled. The presence of LUTS especially storage symptoms is strongly associated with erectile dysfunction independent of age and comorbidities.

Adult↗

PubMed1996

[Neurologic diagnosis of erectile dysfunction].

OBJECTIVES: To describe a clinical method for the evaluation of neurological disorders in erectile dysfunction. METHODS: A new method for neurological evaluation in erectile dysfunction is presented. CONCLUSIONS: Although the study is complex, the method of evaluation described herein is considered to be indicated basically in erectile dysfunction highly suspected as having an underlying neurogenic cause.

Erectile Dysfunction↗

PubMed2005

Endothelial nitric oxide synthase gene therapy for erectile dysfunction.

Basic science research on erectile physiology has been devoted to investigating the pathogenesis of erectile dysfunction (ED) and has led to the conclusion that ED is predominately a disease of vascular origin. It is well recognized that the incidence of ED dramatically increases in men who suffer from diabetes mellitus, hypercholesterolemia, and cardiovascular disease. Endothelial nitric oxide synthase (eNOS) is an important factor in cardiovascular homeostasis, angiogenesis, and erectile function. Given the impact of endothelial-derived nitric oxide (NO) in vascular biology, a great deal of research over the past decade has focused on the role of NO synthesis from the endothelium in normal erectile physiology as well as in disease states. Loss of the functional integrity of the endothelium and subsequent endothelial dysfunction plays an integral role in the occurrence of ED. Therefore, a likely target of gene therapy for the treatment of ED is eNOS. This communication reviews the role of eNOS in erectile physiology and discusses the alterations in eNOS expression in various vascular diseases of the penis. Putative gene therapy interventions to restore eNOS expression and subsequent endothelial function may represent an exciting new therapeutic strategy for the future treatment of ED.

Erectile Dysfunction↗

PubMed2003

Long-term effect of sildenafil citrate on erectile dysfunction after radical prostatectomy: 3-year follow-up.

OBJECTIVES: To evaluate the long-term effect and safety of sildenafil citrate for the treatment of erectile dysfunction after radical prostatectomy (RP). METHODS: The study consisted of 91 patients with erectile dysfunction from our institution who received oral sildenafil citrate after RP. We surveyed these patients using a self-administered questionnaire during the first year of sildenafil citrate use to determine treatment satisfaction, patient compliance, and safety. Those who had responded positively to the drug were surveyed again 3 years later (n = 48). Sildenafil citrate was prescribed at a dose of 50 mg and increased to 100 mg if needed. Data were collected from a self-administered questionnaire using the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory of Men, and the Erectile Dysfunction Inventory of Treatment Satisfaction. The patients were stratified according to the type of nerve-sparing (NS) RP procedure they underwent: bilateral NS, unilateral NS, and non-NS. RESULTS: At 3 years, 31 (71%) of the 43 patients who had returned the second surveys were still responding to sildenafil. Of these 31 respondents, 10 (31%) had augmented their dose from 50 to 100 mg. The dropout rate was 27%; 6 of 12 had discontinued because of the return of natural erections, 5 because of a loss of efficacy, and 1 because his spouse had died. No differences were found in the 1-year and 3-year five-item International Index of Erectile Function (Sexual Health Inventory of Men) and Erectile Dysfunction Inventory of Treatment Satisfaction scores between the NS groups. The most common side effects at 3 years were headache (12%), flushing (10%), and blue or blurred vision (2%). No patient discontinued the drug at 3 years because of side effects. CONCLUSIONS: The results of this study indicate that the vast majority of patients with erectile dysfunction after RP who initially respond to sildenafil continue to do so at 3 years and are satisfied and compliant with the treatment regimen.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed1988

Differentiating the etiology of male erectile dysfunction using the Millon Behavioral Health Inventory and self-report measures.

This study examines the effectiveness of using the Millon Behavioral Health Inventory in conjunction with self-report measures of erectile dysfunction to classify the etiology of erectile dysfunction in males. Subjects were 70 males with erectile dysfunction. The results indicate that 47% of the subjects with psychogenic etiology, 65% with mixed etiology, and 71% of the subjects with organic etiology were correctly classified. These and previous findings indicate that the MBHI is an effective method of assessing the etiology of erectile dysfunction.

Adult↗