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PubMedDate not supplied

Long-term results of corpus cavernosum autoinjection therapy for chronic erectile dysfunction.

Between May 1985 and March 1992, 172 patients suffering from chronic erectile dysfunction (21-70 years old) underwent constant corpus cavernosum autoinjection therapy (CAT) with a standardized papaverine phentolamine mixture (16385 injections). Thereafter 41 patients continued CAT with the single agent papaverine (1257 injections). On the basis of both these 17642 protocol auto-injections, and over 6 years of experience with intracavernosal autoinjection therapy we conclude that, especially with the papaverine-phentolamine mixture, CAT constitutes an effective therapy (full rigidity in 95.8%) with tolerable side-effects for chronic erectile dysfunction when preceded by careful patient selection and thorough multi-disciplinary evaluation. This is especially so in the case of arterial and/or neurogenic aetiology of the erectile dysfunction. In addition, the contraindications must be strictly observed, the treatment and technique fully explained, and a regular follow-up instituted. CAT is generally well accepted by the patients and their partners (98.8%/97.6%) and has distinct positive effects on self-esteem (77.8%), performance anxiety (84.4%), and partnership (79.5%). The most serious side-effect was prolonged erection (25 out of 17642 injections). In 6 patients reversible fibrotic changes near the tunica albuginea were observed.

Adult↗

PubMed2005

Physiology of penile erection and pathophysiology of erectile dysfunction.

This article reviews the physiology of penile erection, the components of erectile function, and the pathophysiology of erectile dysfunction. The molecular and clinical under-standing of erectile function continues to gain ground at a particularly fast rate. Advances in gene discovery have aided greatly in working knowledge of smooth muscle relaxation/contraction pathways. The understanding of the nitric oxide pathway has aided not only in the molecular understanding of the tumescence but also greatly in the therapy of erectile dysfunction.

Erectile Dysfunction↗

PubMed2005

[Time effect window of sildenafil for the treatment of erectile dysfunction].

The therapeutic efficacy of sildenafil for the treatment of erectile dysfunction is correlative with the pharmacokinetics of the drug and the time of sexual behavior. More and more researches on the time effect window of sildenafil for the treatment of erectile dysfunction have elucidated the least time to achieve sufficient penile hardness for intercourse and to reach the best erectile state after the drug administration, as well as the therapeutic effect of the long-term treatment with the drug.

Erectile Dysfunction↗

PubMed2005

Visual side effects associated with erectile dysfunction agents.

PURPOSE: To describe the known ocular side effects of agents used to treat erectile dysfunction. DESIGN: Retrospective observational case series and literature review. METHODS: We reviewed 892 case reports from the National Registry of Drug-Induced Ocular Side Effects (Casey Eye Institute, Portland, Oregon), the Food and Drug Administration (FDA), and the World Health Organization (WHO) and conducted a comprehensive review of the literature. RESULTS: Ocular side effects of these drugs appear fully reversible and transitory. CONCLUSIONS: To date, evidence does not exist to discourage use of erectile dysfunction agents attributable to harmful ocular side effects. Ischemic optic neuropathy (ION) is "possible" by WHO classification, however, conclusive evidence linking ION to erectile dysfunction medications is still lacking.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2005

Androgen deficiency in the etiology and treatment of erectile dysfunction.

The evaluation and management of erectile dysfunction (ED) has evolved dramatically following the introduction of oral phosphodiesterase-5 inhibitors. Despite the limited role of directed diagnostic testing in the evaluation of the impotent patient, routine de-termination of a serum testosterone likely is indicated based on evidence that testosterone modulates erectile function, that hypogonadism is prevalent among elderly men and men with ED, and that symptomatology alone rarely detects hypogonadism. Forms of testosterone commonly used include oral, parenteral, transdermal, and implantable preparations, each with significant advantages and disadvantages. The risks and benefits of testosterone supplementation have been characterized incompletely and will require further validation before widespread use of testosterone as hormone replacement therapy in aging men.

Adult↗

PubMedDate not supplied

Physicians' knowledge, attitude and practice towards erectile dysfunction in Saudi Arabia.

We aimed to test the knowledge, attitude and practice (KAP) of physicians towards erectile dysfunction in the Eastern province of Saudi Arabia. At a scientific meeting about erectile dysfunction, 159 physicians from both government and private sectors answered a 34-item questionnaire in private. The mean total KAP score for the group was below the expected standard of 60%. Male physicians scored significantly higher than females. Urologists scored the highest, followed by andrologists. Surprisingly, physicians with higher qualifications scored lower than those with intermediate qualifications and even less than general practitioners. Those who had practised for > or = 10 years scored better than those with < 10 years practice. The role of cardiologists in the diagnosis and management of erectile dysfunction is discussed.

Attitude of Health Personnel↗

PubMed2001

Intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: an observational study.

CONTEXT: Despite the recent improvements in performing radical retropubic prostatectomy that have led to a considerable decrease in the complication rate, erectile dysfunction still represents a major problem. Moreover, less invasive treatment options that are emerging for erectile dysfunction have not shown satisfactory results in managing these patients. OBJECTIVE: To study the efficacy and side effects of self-injection therapy in the treatment of men who had become impotent after undergoing radical prostatectomy due to prostate cancer, over a study period of 96 months. DESIGN: Observational study. SETTING: University Referral Center. PARTICIPANTS: 168 patients with erectile dysfunction, aged 43 to 78 years old, who underwent radical retropubic prostatectomy due to localized prostate cancer. PROCEDURES: The patients were treated with self-injection therapy using papaverine, phentolamine and prostaglandin E1, at home. RESULTS: This study showed an acceptable 94.6% success rate, with no life-threatening complications. In addition to this, our series presented a 13.1% cure rate with this therapy. CONCLUSION: Self-injection therapy with papaverine, phentolamine and prostaglandin E1 is effective and safe in the treatment of erectile dysfunction after radical prostatectomy.

Adult↗

PubMedDate not supplied

Assessment of cardiovascular risk in patients with erectile dysfunction: focus on the diabetic patient.

Erectile dysfunction (ED) is commonly associated with risk factors for cardiovascular disease, including diabetes. The prevalence of ED in diabetic patients is high--about 75% of diabetic men 60 yr of age or older had ED in one study. Endothelial dysfunction, accelerated atherosclerosis, and diabetic neuropathy likely contribute to ED in diabetics. As silent ischemia is common in the diabetic patient, and diabetes is now often thought of as a coronary heart disease risk equivalent, diabetic men seeking therapy for ED may be considered candidates for exercise stress testing. Phosphodiesterase 5 (PDE5) inhibitors improve erectile function in diabetic men with ED; however, efficacy rates may be somewhat lower than in nondiabetic men. Studies to date have suggested that PDE5 inhibitors per se do not cause an increase in myocardial infarction rates in men being treated for ED.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed1998

Sildenafil for erectile dysfunction.

At any one time, around 10% of men are unable to achieve and/or maintain an erection sufficient for satisfactory sexual activity, a condition known as erectile dysfunction. Several mechanical, surgical and medical approaches have been developed for the treatment of this problem but none are ideal. Sildenafil (Viagra-Pfizer), a selective phosphodiesterase inhibitor, is the first licensed oral drug treatment for erectile dysfunction. It was marketed in the UK in October 1998, at which time the Department of Health was advising doctors that they "should not prescribe sildenafil" and that health authorities should not "support the provision of sildenafil at NHS expense to patients requiring treatment for erectile dysfunction, other than in exceptional circumstances". Here we review sildenafil for the management of erectile dysfunction and discuss whether it should be available on the NHS.

Controlled Clinical Trials as Topic↗

PubMed1999

Cardiac autonomic function during sleep in psychogenic and organic erectile dysfunction.

The present study investigated the sympathetic/parasympathetic balance during non-rapid eye movement (NREM) and rapid eye movement (REM) sleep in patients with psychogenic and organic erectile dysfunction. The cardiac autonomic balance was assessed from the power of the low frequency (LF) and high frequency (HF) spectral components of heart-rate variability in 11 patients with psychogenic erectile dysfunction and 11 patients with organic erectile dysfunction as determined by monitoring sleep-related erections. Spectral analysis of heart-rate variability was calculated for at least four successive 4-min epochs of electrocardiogram recordings during NREM sleep and for all available 4-min epochs during REM sleep. Statistical analysis revealed that organic patients had a significantly higher LF/HF ratio (P < 0.01) during both stages of sleep, which resulted from a significantly lower power in the HF component (P < 0.004) and higher power in the LF component (P < 0.01) in these patients, in both REM and NREM sleep stages. These results demonstrate that patients complaining of daytime sexual dysfunction and found by sleep-related erection monitoring to suffer from organic erectile dysfunction, have altered cardiac autonomic balance during both stages of sleep.

Adult↗

PubMed2003

[Erectile dysfunction in kidney transplanted patients].

BACKGROUND: Erectile dysfunction (ED) is the inability to achieve and/or maintain an erection for satisfactory sexual performance or intercourse. ED profoundly affects the quality of life. While the effects of dialysis on ED are documented, the benefits of renal transplantation are unknown. METHODS: This study evaluates the prevalence of ED and the effects of transplantation on ED in kidney transplanted patients. Erectile function was assessed using the self-administered International Index of Erectile Function (IIEF). The domains investigated by IIEF are: (1) erectile function, (2) orgasmic function, (3) sexual desire, (4) intercourse satisfaction, (5) overall satisfaction. At the entry patients underwent clinical examination by urologist and neurologist; blood was collected for biochemical analysis. One-hundred-fifteen (89%) patients filled in the questionnaire. RESULTS: Fifty-two (45%) patients did not complain about ED, which was reported by sixty-three patients (55%). No clinical and/or biochemical difference was found between patients with and without ED. Hypertension was equally present among patients; administration of beta-blockers was significantly more frequent among patients without ED. ED was already present during dialysis in 40 patients. After transplantation ED disappeared in 8 (20%), ameliorated in 13 (32,5%), worsened in 2 (5%), remained unchanged in 17 (42,5%) and appeared "ex novo" in 27 (43%) patients. ED is significantly correlated (p<0.01) to the age of subjects. CONCLUSIONS: The data of the present study indicate that: 1) ED is still present in many transplanted men; 2) renal transplantation cures ED in only few cases; 3) ED may appear "ex novo" after transplantation.

Adult↗

PubMed1999

Gene-polymorphisms of angiotensin converting enzyme and endothelial nitric oxide synthase in patients with erectile dysfunction.

AIMS OF THE STUDY: Regulation of the penile smooth muscle tone and contractility is closely related to the activity of vasoactive substances, angiotensin II or nitric oxide. We investigated the relationship between gene polymorphism in the angiotensin converting enzyme (ACE) or endothelial nitric oxide synthase (ecNOS) and development of erectile dysfunction. METHODS: In 84 subjects with organic erectile dysfunction and 63 control subjects, gene polymorphisms in the ACE and ecNOS were determined by the polymerase chain reaction (PCR). RESULTS: The DD genotype of ACE was significantly (P < 0.01) more frequent in subjects with organic erectile dysfunction (54%) than in control subjects (24%). There was no significant difference in the distribution of the genotypes of ecNOS. CONCLUSION: The deletion polymorphism in the ACE gene, the DD genotype, as a marker of general vascular disease, may be seen more frequently in men with a diagnosis of vasculogenic erectile dysfunction.

Adult↗

PubMedDate not supplied

A comparison of colour duplex ultrasonography after transurethral alprostadil and intracavernous alprostadil in the assessment of erectile dysfunction.

This study aimed to investigate whether transurethral alprostadil could be used for the diagnosis of erectile dysfunction using colour duplex ultrasound. The ultrasonography results were compared after transurethral and intracavernous alprostadil administration in 20 patients with erectile dysfunction. There were no significant differences in the mean peak systolic velocities (PSVs) between the two routes of administration, but the mean end diastolic velocities (EDVs) showed significant differences, with patients treated with transurethral alprostadil having higher EDVs. Linear regression analysis of the PSVs reached following the two routes of administration showed a moderate relationship, but linear regression analysis of the EDVs showed no relationship. We concluded that transurethral alprostadil was an inappropriate vasoactive drug to use with colour duplex ultrasonography for the evaluation of patients with erectile dysfunction because it required a longer scan time and it was less effective and less reliable than intracavernous alprostadil at stimulating complete corporeal smooth muscle relaxation.

Adult↗

PubMed2000

Sildenafil citrate (Viagra) for the treatment of erectile dysfunction in men with Parkinson's disease.

Sildenafil citrate (Viagra) is a phosphodiesterase type V inhibitor used to treat erectile dysfunction. Ten men with idiopathic Parkinson's disease (PD) and erectile dysfunction were prescribed 50-100 mg sildenafil citrate to use in eight sexual encounters over a 2-month period. Patients underwent Unified Parkinson's Disease Rating Scale (UPDRS) evaluations and completed a Beck's Depression Inventory (BDI) and a Sexual Health Inventory-M version (SHI-M) at baseline and after 8 weeks. There was statistically significant improvement in total SHI-M scores (23.8 +/- 2.0 vs 16.6 +/- 2.8; p = 0.01), overall sexual satisfaction (p = 0.03), satisfaction with sexual desire (p = 0.04), ability to achieve erection (p = 0.02), ability to maintain erection (p = 0.03), and ability to reach orgasm (p = 0.04) with use of sildenafil citrate. UPDRS and BDI scores were not significantly changed. Side effects included headache in one patient during three sexual encounters. In this open-label study, sildenafil citrate significantly improved sexual function in men with PD and erectile dysfunction.

Aged↗

PubMed2006

Clinical and psychosocial characteristics of men with erectile dysfunction: baseline data from ExCEED.

INTRODUCTION: Erectile dysfunction (ED) is associated with psychological impairment, and further research is required to understand their relationship. AIM: We present descriptive baseline results from a longitudinal observational study of North American men seeking treatment for ED. METHODS: Patients completed clinical and health-related quality-of-life information at baseline and three follow-up points over 12 months; 162 patients had usable baseline data, including clinical history and current status, sociodemographic information, and standard paper-and-pencil scales of psychosocial characteristics. Scores on the International Index of Erectile Functioning erectile functioning subscale were collapsed into mild (N = 27), moderate (N = 41), or severe (N = 94) categories. Using chi-square, anova, and logistic regression, we identified baseline characteristics associated with ED severity. MAIN OUTCOME MEASURE: The main outcome measure was the degree of psychosocial impairment associated with mild, moderate, and severe ED. RESULTS: Severe ED was significantly associated with not having a regular sex partner; a history of prostate cancer; and worse scores on measures of positive affect, belonging/loneliness, sexual self-efficacy-strength, psychological adjustment, marital happiness, anxiety at last intercourse, and depression. In a multivariate logistic regression model, poorer sexual self-efficacy was most closely associated with severe ED. The model rescaled R(2) was 0.63 (area-under-the-curve, 0.91). CONCLUSIONS: Severe ED is related to impairment across a broad range of psychosocial domains, and clinicians should consider offering patients assistance in dealing with its psychosocial impact.

Adult↗

PubMed1986

Erectile dysfunction in narcoleptic patients.

Many male narcoleptic patients complain of erectile dysfunction related to chemotherapy, and some find it so distressing that they fail to continue treatments. This is a potentially dangerous situation. We studied the erectile capabilities of 28 narcoleptic men who had complaints of erectile dysfunction with our objective sleep laboratory measurement of nocturnal penile tumescence (NPT) for diagnostic workup. We found that while short REM latency, a classic indicator of narcolepsy, was present in all patients, NPT, which is associated with REM sleep, did not coincide with the short REM latencies in about half the patients. This may be partially due to the fact that first-cycle REM is often not accompanied by NPT episodes (even in the control population). We also found that, in a few cases, the patients' subjective beliefs about their erectile capacity tended to underestimate our measurements. The patients receiving drug treatment already had some vasculogenic or neurogenic genital impairment, which probably made them more vulnerable to the effects of the drugs. Patients who had none of these complications showed similar erectile impairment under the influence of medication. Additionally, we found unique manifestations of the disease in three drug-free patients; one had cataplectic attacks upon arousal, and two had unexplained erectile impairment.

Adult↗

PubMed1994

Intracavernous prostaglandin E1 in erectile dysfunction.

Prostaglandin E1 (PGE1) is a naturally occurring substance that is present in a variety of mammalian tissues, including the semen of fertile men. Its use in the diagnosis and treatment of erectile dysfunction has been extensively studied. In doses of 10-20 micrograms, PGE1 produces full erections in 70-80% of patients with erectile dysfunction. In diagnostic use PGE1 is employed as a simple office test and in conjunction with various hemodynamic tests. Self-injection of PGE1, either with the patient or his partner administering the injection, is a minimally invasive and effective treatment for erectile dysfunction in patients with organic or psychogenic erectile dysfunction. Its use is contraindicated in patients with sickle cell anemia, severe coagulopathy, schizophrenia or severe psychiatric disorder, poor manual dexterity, severe venous incompetence, or severe systemic disease. As calculated from data in the published literature, the most frequent side effects are pain at the injection site or during erection (occurring in 16.8% of patients), hematoma/ecchymosis (1.5% of patients), and prolonged erection/priapism (1.3% of patients). The potential for prolonged erection/priapism, the most serious side effect, can be minimized by careful titration of the dose and through patient education. Systemic side effects occur rarely during PGE1 use. During extended use, patients should be monitored for potential long-term side effects, such as fibrosis and angulation.

Alprostadil↗

PubMed2005

Erectile dysfunction: interrelationship with the metabolic syndrome.

Erectile dysfunction (ED) is more commonly seen in men with various components of the metabolic syndrome (a constellation of various cardiovascular and diabetes risk factors). ED can be considered as a risk marker of the metabolic syndrome and its associated conditions. The patient with ED should be thoroughly evaluated for coexisting vascular disease. Any cardiovascular risk factors should be modified or treated (ie, smoking, diabetes, hypertension, and hyperlipidemia). Endothelial dysfunction is a major unifying etiology for many of the aspects of the metabolic syndrome, especially diabetes and cardiovascular disease. It also plays a major role in ED. The multifactorial etiology of ED, especially in patients with the metabolic syndrome, increases the complexity of managing this problem so clinicians need to be aware of the underlying pathophysiology to ensure the best possible outcomes in management.

Biomarkers↗