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PubMed1998

[Erectile dysfunction secondary to hyperprolactinemia. Apropos of 13 cases].

Hyperprolactinemia is the cause of erectile dysfunction in less than 1% of cases. From 1989 to 1996, 13 patients consulted for erectile disorders associated with hyperprolactinemia. The mean age was 47.5 years. 10 patients complained of decreased libido. 3 patients had gynecomastia. Plasma prolactin levels ranged from 31.3 ng/ml to 1,300 ng/ml. 7 patients had a plasma testosterone less than 4 ml/ng. 7 patients had a micro- or macroadenoma of the sella turcica visualized by MRI. After drug treatment, plasma prolactin levels returned to normal in all patients in whom assays were performed. 6 patients considered that their erectile function was restored. 5 of the 6 patients with no improvement of their sexual function had a concomitant disease able to explain the impotence. Hyperprolactinemia is a rare cause of erectile dysfunction, but it must be considered in any patient presenting with idiopathic erectile dysfunction associated with decreased libido, gynecomastia, and decreased plasma testosterone. Drug treatment is effective and MRI of the sella turcica should be performed looking for a pituitary adenoma.

Adult↗

PubMed2001

Patient and partner satisfaction with Viagra (sildenafil citrate) treatment as determined by the Erectile Dysfunction Inventory of Treatment Satisfaction Questionnaire.

OBJECTIVES: To assess the efficacy and safety of Viagra (sildenafil citrate) in male outpatients with erectile dysfunction and patient and partner satisfaction with treatment using the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). METHODS: A total of 247 patients with erectile dysfunction of broad-spectrum etiology were treated in a randomized, double-blind, parallel-group, multicenter study conducted at outpatient clinics. Patients receiving oral sildenafil (25, 50, and 100 mg) were compared with patients receiving placebo during a 12-week period. The principal efficacy measures were responses to question 3 (ability to achieve an erection) and question 4 (ability to maintain an erection) on the International Index of Erectile Function and three global efficacy questions. Patient and partner satisfaction with treatment were assessed, for the first time, using the EDITS questionnaire. RESULTS: Efficacy scores for the International Index of Erectile Function questions and the global efficacy questions were significantly higher for patients receiving sildenafil than for those receiving placebo (P <0.001). Both patients and partners receiving sildenafil also had significantly higher EDITS scores than those receiving placebo (P <0.001). Adverse events were chiefly mild or moderate. Two patients receiving sildenafil and none receiving placebo discontinued treatment because of adverse events. CONCLUSIONS: Sildenafil was an effective, well-tolerated treatment for erectile dysfunction in an outpatient setting. Partner evaluations corroborated patient assessments. The results from the EDITS questionnaire indicated that after 12 weeks of receiving sildenafil both patients and partners reported higher levels of treatment satisfaction relative to placebo.

Adult↗

PubMed1997

Cavernous oxygen tension in the patients with erectile dysfunction.

We designed a study consisting of 27 consecutive patients with erectile dysfunction in order to evaluate the role of cavernous oxygen tension. Patients were completely evaluated by history, physical examination, multiple blood analyses, serum testosterone level measurements, papaverine test, color duplex sonography and dynamic infusion cavernosometry-cavernosography. Blood gas samples were obtained from femoral artery and corpus cavernosum before drug injection and also from corpus cavernosum at 5, 10, 20, 30, 40 min following drug injection. Aetiologic classification of erectile dysfunction in our patients was as follows: psychogenic in 8, cavernosal failure in 14 and arterial disease in 5 cases. At flaccidity, no significant differences were found in the mean pO2, sO2, pCO2 and pH values of patient groups. After injection of intracavernous papaverine, results of the cavernous pO2 (P < 0.05), sO2 (P < 0.05) levels were found to be statistically significantly different between patients with vascular and psychogenic erectile dysfunction. Analysis of maximal cavernosal oxygen tension and PSV revealed statistically significant correlation (r = 0.66, P < 0.001). The results of this study suggest that changes in arterial and cavernosal pO2 and sO2 values may be contributing factors or co-factors in erectile failure.

Adult↗

PubMed2005

Erectile dysfunction in spinal cord injury: a cost-utility analysis.

BACKGROUND: There is a high incidence of erectile dysfunction after spinal cord injury. This can have a profound effect on quality of life. Treatment options for erectile dysfunction include sildenafil, intracavernous injections of papaverine/alprostadil (Caverject), alprostadil/papaverine/phentolamine ("Triple Mix"), transurethral suppository (MUSE), surgically implanted prosthetic device and vacuum erection devices. However, physical impairments and accessibility may preclude patient self-utilization of non-oral treatments. METHODS: The costs and utilities of oral and non-oral erectile dysfunction treatments in a spinal cord injury population were examined in a cost-utility analysis conducted from a government payer perspective. Subjects with spinal cord injury (n=59) reported health preferences using the standard gamble technique. RESULTS: There was a higher health preference for oral therapy. The cost-effectiveness results indicated that sildenafil was the dominant economic strategy when compared with surgically implanted prosthetic devices, MUSE(R) and Caverject. The incremental cost-utility ratios comparing sildenafil with triple mix and vacuum erection devices favoured sildenafil, with ratios less than CAN$20,000 per quality adjusted life year gained. CONCLUSION: Based on this study, we conclude that sildenafil is a cost-effective treatment for erectile dysfunction in the spinal cord injury population.

Adrenergic alpha-Antagonists↗

PubMed1998

Clinical safety of oral sildenafil citrate (VIAGRA) in the treatment of erectile dysfunction.

Sildenafil citrate has been shown to be effective in a wide range of patients with erectile dysfunction and has been approved in the United States for this indication. The overall clinical safety of oral sildenafil, a potent inhibitor of phosphodiesterase type 5, in the treatment of erectile dysfunction was evaluated in more than 3700 patients (with a total of 1631 years of exposure worldwide). Safety and tolerability data were analysed from a series of double-blind, placebo-controlled studies and from 10 open-label extension studies of sildenafil in the treatment of erectile dysfunction. A total of 4274 patients (2722 sildenafil, 1552 placebo; age range 19-87 y) received double-blind treatment over a period of up to six months' duration, and 2199 received long-term, open-label sildenafil for up to 1 y. The most commonly reported adverse events (all causes) were headache (16% sildenafil, 4% placebo), flushing (10% sildenafil, 1% placebo), and dyspepsia (7% sildenafil, 2% placebo) and they were predominantly transient and mild or moderate in nature. These adverse events reflect the pharmacology of sildenafil as a phosphodiesterase type 5 inhibitor. No cases of priapism were reported. The rate of discontinuation due to adverse events (all causes) was comparable for patients treated with sildenafil (2.5%) and placebo (2.3%). In open-label extension studies, 90% of patients completed long-term sildenafil treatment, with only 2% withdrawing due to adverse events. Sildenafil is a well-tolerated oral treatment for erectile dysfunction.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed1993

[Erectile dysfunctions in patients treated with hemodialysis and kidney transplantation].

The incidence of erectile dysfunction in patients suffering from severe renal diseases in the stage of renal insufficiency is significantly higher in comparison with healthy men of the same age. In the etiopathogenesis of erectile disorders, both organic and psychogenic factors participate in combination. By means of a questionnaire, the authors have collected information from 53 men treated by hemodialysis and kidney transplantation because of renal failure. Erectile disorders occurred in 41.5 per cent of men with chronic renal insufficiency. On one side hemodialysis improved the erectile dysfunction in two patients, in total, however, the incidence of impotence increased to 64.2 per cent. Erectile dysfunction was reported by 71.7 per cent of patients after kidney transplantation. The authors describe two cases of iatrogenic arterial insufficiency of the penis as the cause of impotence after secondary renal transplantation. In uremic patients as possible therapeutic methods, intracavernous application of vasoactive drugs or penile prostheses implantation should be considered. (Fig. 2, Ref. 20).

Adult↗

PubMed2003

Assessment of andropause awareness and erectile dysfunction among married men in Ile-Ife, Nigeria.

Andropause (also known as androgen decline in aging males) has implications for the reproductive health and quality of life of older males. Very few studies have, however, been reported among the Nigerian population on andropause-related issues. This study assesses the perspective and level of awareness of married men in Ile-Ife, South-west Nigeria, of andropause. We also assessed their experience of erectile dysfunction, using a questionnaire based on the review of the International Index of Erectile Dysfunction. The study involved 355 married men, aged between 30 and 70 years. Our result shows a high level of misconception about andropause among our respondents, with 38.9% indicating that it is a myth, and another 23.6% attributing it to various causes other than being a natural aging process. We recorded a prevalence of erectile dysfunction of 43.8% (8.0% severe dysfunction and 35.8% moderate dysfunction). The prevalence of erectile dysfunction increased significantly with age, varying from 38.5% for age 31-40 years to 63.9% for the older age group of 61-70 years. The trend in prevalence of erectile dysfunction with age was significant (p < 0.05). An odds ratio of 2.82 (95% confidence interval 1.19-6.76) was recorded for the prevalence of erectile dysfunction at age 61-70 years compared with age 31-40 years. Our findings indicate a need for health education about andropause in Nigeria, and increased attention to the reproductive health concerns of males, and the older population.

Adult↗

PubMed2006

Prediction of coronary heart disease by erectile dysfunction in men referred for nuclear stress testing.

BACKGROUND: Recent evidence suggests a strong link between erectile dysfunction (ED) and atherosclerotic vascular disease. Stress myocardial perfusion single-photon emission computed tomography (MPS) is a widely used noninvasive imaging modality that allows diagnosis of coronary heart disease and stratification of cardiovascular risk. We sought to determine the relationship between ED and coronary heart disease in men referred for MPS. METHODS: A total of 221 men referred for MPS were prospectively screened for ED with a validated questionnaire. Patient characteristics, MPS findings, and exercise results were correlated with ED. RESULTS: Erectile dysfunction was present in 54.8% of the patients. Patients with ED exhibited more severe coronary heart disease (MPS summed stress score >8) (43.0% vs 17.0%; P<.001) and left ventricular dysfunction (left ventricular ejection fraction <50%) (24.0% vs 11.0%; P=.01) than those without ED. Erectile dysfunction was associated with a shorter exercise time (8.0 vs 10.1 minutes; P<.001) and lower Duke treadmill score (4.4 vs 8.4; P<.001). Multivariate analysis showed ED to be an independent predictor of severe coronary heart disease (odds ratio, 2.50; 95% confidence interval, 1.24-5.04; P = .01) and high-risk MPS findings (summed stress score >8, transient ischemic dilation, or left ventricular ejection fraction <35%) (odds ratio, 2.86; 95% confidence interval, 1.43-5.74; P = .003). CONCLUSIONS: Erectile dysfunction is common in men referred for MPS, is associated with markers of adverse cardiovascular prognosis, and is an independent predictor of severe coronary heart disease and high-risk MPS findings. These results suggest that questioning about sexual function may be a useful tool for stratifying risk in individuals with suspected coronary heart disease.

Adult↗

PubMed2005

Erectile dysfunction and andropause symptoms in infertile men.

PURPOSE: We evaluated the prevalence of andropause symptoms and erectile dysfunction in our infertile population. MATERIALS AND METHODS: A total of 302 consecutive men presenting for infertility evaluation and 60 consecutive men with proven fertility seeking vasectomy (controls) were administered the Androgen Deficiency in the Aging Male and Sexual Health Inventory for Men (SHIM) questionnaires. Information regarding other clinical parameters, including seminal parameters, was collected by review of patient charts. RESULTS: Of the 302 infertile men screened, 38% reported significant andropause symptoms and 28% had abnormal SHIM scores. Of the subgroup of infertile men with nonobstructive azoospermia, 25% reported andropause symptoms and 27% had an abnormal SHIM score. In the fertile group 21% reported andropause symptoms and only 11% had an abnormal SHIM score. The prevalence of erectile dysfunction in infertile men was significantly higher than in the fertile controls (p = 0.007). CONCLUSIONS: Andropause symptoms and erectile dysfunction are common among infertile men, affecting approximately 38% of this population. This finding suggests that the population of infertile men should be carefully screened to identify and treat those with erectile dysfunction.

Adult↗

PubMed1994

[Erectile dysfunction and hypogonadism. Is routine endocrine screening necessary?].

Erectile dysfunction is rarely caused by hypogonadism. We distinguish between primary and secondary hypogonadism. Among 70 consecutive men treated for impotence within 1 year in the authors' clinic, the rate of endocrinopathy was 4.3%. The exact role of testosterone in male sexual function is unclear. Testosterone replacement may be helpful only in patients with low serum testosterone and decreased libido. Endocrine screening is necessary in impotent patients with clinical signs of hypogonadism. Patients with decreased libido and no signs of hypogonadism should also be undergo endocrine evaluation. Routine endocrine testing for all patients with erectile dysfunction is expensive and not productive.

Adult↗

PubMed2001

Potential predictors of asymptomatic ischemic heart disease in patients with vasculogenic erectile dysfunction.

OBJECTIVES: To prospectively define the potential predictors of asymptomatic ischemic heart disease in patients with vasculogenic erectile dysfunction using a simple and practical method. Most patients with vasculogenic erectile dysfunction are known to have at least one significant cardiovascular risk factor. METHODS: After baseline evaluations, patients with erectile dysfunction of presumed vascular origin, who were older than 45 years and with no history of ischemic heart disease, were enrolled in the study. According to the results of repeated pharmacologic erection tests, we divided patients into responders and nonresponders. The cardiologic evaluations consisted of a comprehensive history taking, the assessment of cardiovascular risk factors, a physical examination, and an exercise treadmill test. RESULTS: A total of 97 patients completed the study. Fifteen (32.6%) of 46 responders and 25 (49.0%) of 51 nonresponders, respectively, had two or more cardiovascular risk factors (P = 0.101). Ischemic ST-segment changes on the exercise treadmill test were only observed in 8 nonresponders (15.7%) (P = 0.006). All these patients were older than 55 years, and seven had two or more cardiovascular risk factors, including hypertension. CONCLUSIONS: On the basis of these preliminary data, we suggest that cardiovascular evaluations may prove beneficial before prescribing sildenafil to patients with vasculogenic erectile dysfunction who are nonresponders to the pharmacologic erection test, are older than 55 years, and have two or more risk factors, including hypertension.

Age Factors↗

PubMed2001

Hormonal erectile dysfunction. Evaluation and management.

The clinical diagnosis of hypogonadism in the adult is difficult to establish on the basis of a history and physical examination and universally requires biochemical investigations. A serum testosterone determination is justified in men complaining of erectile dysfunction with or without alterations in sexual desire. Among the causes of erectile dysfunction, hypotestosteronemia rates are low. The prevalence of erectile dysfunction particularly is common at a period in life when alterations occur in male hormonal environment. The treatment of hypogonadal erectile dysfunction, regardless of age, is readily available, safe, and effective. The positive impact of treatment on the overall quality of life can be significant. The presence of erectile dysfunction in an aging man (> 55 years) does not imply the presence of hypogonadism, and, even if the two conditions are present, the indications for treatment require good clinical judgment. Persistent low testosterone levels may have significant detrimental effects in other organ systems; therefore, a timely diagnosis of androgen deficiency and appropriate treatment may have significant effects outside the narrow field of sexual performance.

Administration, Cutaneous↗

PubMedDate not supplied

[New contributions of the usefulness of electromyography of cavernous bodies in the diagnosis of erectile dysfunction].

OBJECTIVES: To test the concordance between clinical and neurophysiologic data of the various types of erectile dysfunction, and to describe a diagnostic algorithm based on corpus cavernosum electromyography (cc-EMG). METHODS: 32 patients with a mean age of 50.6 years (typical deviation 13.2 years) referred with the diagnosis of erectile dysfunction underwent medical history, neuroandrologic physical exam, neurophysiologic studies (bulbocavernous muscle electromyography, S2-S4 latency period, threshold and latency of pudendal nerve somatosensory potentials, as well as genital sympathetic evoked potentials-SSR-), and corpus cavernosum electromyography(cc-EMG) both in basal conditions and after administration of 20 micrograms of E-1 prostaglandin (PGE-1). RESULTS: 1--A significative relationship was shown between clinical data of arterial or corpus cavernosum intrinsic origin erectile dysfunction and patients with vascular or structural lesion on cc-EMG data. 2--A significative relationship was shown between patients without previous pathologic history and patients with normal or anxiety cc-EMG. 3--No significative relationship was shown between patients with neurologic lesion and patients with autonomic lesion on cc-EMG. 4--No significative relationship was found between patients with peripheric neurologic lesion and patients with inferior autonomic lesion on cc-EMG. 5--A significative relationship was shown between patients with suprasacral neurologic lesion and patients with superior autonomical lesion on cc-EMG. CONCLUSIONS: Isolated application of pudendal nerve neurophysiologic techniques for the diagnosis of erectile dysfunction is not enough. Autonomic innervation studies should be included, with a cc-EMG dichotomic qualitative interpretation.

Algorithms↗

PubMed2001

Erectile dysfunction occurs following substantia nigra lesions in the rat.

Erectile function was assessed 6 weeks following uni- and bilateral injections of 6-hydroxydopamine in the substantia nigra nucleus of the brain. Behavioral apomorphine-induced penile erections were reduced (5/8) and increased (3/8) in uni- and bilateral lesioned animals. Intracavernous pressures, following electrical stimulation of the cavernous nerve, decreased in lesioned animals. Lesions of the substantia nigra were confirmed by histology. Concentration of dopamine and its metabolites were decreased in the striatum of substantia nigra lesioned rats. Lesions of the substantia nigra are therefore associated with erectile dysfunction in rats and may serve as a model to study erectile dysfunction in Parkinson's disease.

Animals↗

PubMed1999

Male infertility and erectile dysfunction in spinal cord injury: a review.

OBJECTIVE: To review the pathophysiology, evaluation, and management of erectile dysfunction and infertility in spinal cord injury (SCI). STUDY SELECTIONS: Studies that covered various treatment options and their contraindications, complications, or side effects, including sildenafil (Viagra), intracavernosal injection therapy, topical medications and a urethral delivery system, a vacuum erection device, and penile prostheses. Other studies covered the effects of SCI on reproduction: spermatogenesis and testicular function, and seminal constituents. In addition, assisted reproductive techniques were compared: external vibratory stimulation, electroejaculation, testicular sperm aspiration, and intracytoplasmic sperm injection. CONCLUSION: Goal-directed therapy is the mainstay of treatment of erectile dysfunction in men with or without SCI. The choice of therapy is often defined more by the needs of the patient's sexual relationship than by his erectile dysfunction. The majority of men with SCI are infertile because of a combination of ejaculatory dysfunction, impaired spermatogenesis, and poor semen quality. Although many technological advances have evolved to overcome ejaculatory dysfunction, the sperm density, motility, and function remain poor. Until these parameters are improved, men with SCI will have to pursue more financially and emotionally taxing procedures. Further studies to elucidate the cellular and molecular mechanisms of diminished sperm quality are needed. Addressing the issues of erectile dysfunction and male infertility may help to preserve the relationship between the patient and his partner.

Erectile Dysfunction↗

PubMed1999

[The impact of creating andrology units on the treatment of erectile dysfunction with intracavernosal injections].

OBJECTIVE: The impact of the creation of the andrology unit on intracavernous injection therapy for erectile dysfunction is analyzed in the present study. METHODS: The records of patients treated by intracavernosal injection of vasoactive drugs for erectile dysfunction from 1990 to 1997 were reviewed. RESULTS/CONCLUSIONS: Demands for solutions to the problem of erectile dysfunction have significantly increased over the last decades. The efficacy of intracavernosal injection of vasoactive drugs in the treatment of erectile dysfunction has been demonstrated. After the creation of the andrology unit within the urology services, patient acceptance of treatment and compliance increased, and complications have diminished.

Erectile Dysfunction↗

PubMed2001

Gene therapy: future therapy for erectile dysfunction.

Advances in molecular biological techniques, completion of the Human Genome Project, and the ensuing age of molecular medicine, in conjuction with the sum of a decades-long accumulation of knowledge of the physiology of erection and the pathophysiology of erectile dysfunction have converged to make gene therapy for erectile dysfunction a distinct possibility. In short, both the intrinsic complexities of mechanisms responsible for ensuring normal erection and the multifactorial nature of erectile dysfunction ensure that there is a relatively vast number of physiologically relevant molecular targets for gene therapy. As such, perhaps it is not surprising that virtually every preclinical gene therapy strategy/target examined thus far has been largely successful in ameliorating conditions associated with compromised erectile function in vivo and/or in vitro. This report highlights the goals and strategies of gene therapy for erectile dysfunction and reviews the strategies that initially have been employed. In short, the preclinical data, while still quite preliminary in many regards, are nonetheless quite impressive and encouraging. If similar success is obtained in clinical trials, gene therapy for erectile dysfunction may provide the first concrete "proof of concept" for using gene therapy in the treatment of human smooth muscle disorders.

Erectile Dysfunction↗

PubMed2003

Lower extremity above-knee prosthesis-associated erectile dysfunction.

Blunt pelvic and perineal trauma has been previously reported to result in site-specific veno-occlusive dysfunction and/or site-specific cavernosal artery insufficiency. We herein describe a case of erectile dysfunction in a young previously potent amputee. We postulate that the erectile dysfunction is associated with a newly described form of blunt trauma, that is, site-specific compression from a perineal weight-bearing lower extremity above-knee prosthetic device. It is hypothesized that when the force exerted by the above-knee prosthesis is directed medially towards the ischiopubic ramus, the penile crura and common penile arterial blood supply become susceptible to crush-like injury, since they are in fixed anatomic locations in the perineum sandwiched between the compressive force and the bone. Clinical evaluation of the erectile dysfunction in this patient revealed site-specific corporal veno-occlusive dysfunction and site-specific common penile arterial occlusive pathology in the precise region of the contact of the above-knee prosthesis with the perineum. Further research is needed in above-knee prosthesis design to prevent erectile dysfunction.

Adult↗