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PubMed2003

Association of decreased quality of life and erectile dysfunction in hemodialysis patients.

BACKGROUND: Quality of life in hemodialysis patients has been associated with treatment outcomes. We explored the impact of erectile dysfunction on quality of life in a cohort of hemodialysis subjects. METHODS: A random sample of 302 Philadelphia area hemodialysis (HD) subjects was enrolled using a cross-sectional design. Subjects completed a self-administered questionnaire including items on sexual function, past medical history, and quality of life. Linear regression (accounting for sampling design by weighted estimation methods) was used to examine the associations between various measures of quality of life (the dependent variables) and erectile dysfunction (ED) and other variables (the predictor variables). RESULTS: We found the emotional domains of the SF-36, a multi-purpose, short-form health survey with 36 questions, to be more profoundly associated with ED than the physical domains. Using the physical and mental components of the SF-12, a new 12-item short form health survey as predictors of ED, only the mental composite score (MCS) was statistically significant after adjusting for age and diabetes (P = 0.008). Subjects with ED had significantly lower quality of life mean scores. In particular, ED was associated with poorer social interaction (mean score difference, -10.3, adjusted P < 0.001), decreased emotional well-being (-12.9, adjusted P = 0.005), more role limitations due to emotional problems (-22.9, adjusted P = 0.01), and poorer social function (-17.8, P = 0.001). CONCLUSION: Recent advances in therapies for ED warrant that the diagnosis and treatment of erectile dysfunction be included in the global health assessment by the nephrologists and primary care providers of patients with renal insufficiency, as it may improve the quality of life of patients.

Adult↗

PubMed2005

Traditional herbal remedies used in the management of sexual impotence and erectile dysfunction in western Uganda.

BACKGROUND: The utilisation of ethnobotanical indigenous knowledge is vital in male sexual reproductive health care delivery in western Uganda. Reproductive health care is the second most prevalent health care problem in Africa. However, this concept of reproductive health care has been focusing mainly on women disregarding men. Thus, some diseases such as sexual impotence and erectile dysfunction that deserve mention are regarded as petty though important in economic productivity, family stability and sexually transmitted diseases control including HIV/AIDS. OBJECTIVE: This study was carried out mainly to document medicinal plants used in the treatment of sexual impotence and erectile dysfunction disorders in western Uganda. METHODS: The medical ethnobotanical indigenous knowledge were collected by visiting traditional healers and documenting the medicinal plants used and other socio-cultural aspects allied with sexual impotence and erectile dysfunction. The methods used to collect the relevant information regarding the medicinal plants used included informal and formal discussions, field visits and focused semi-structured interviews. RESULTS: Thirty-three medicinal plants used in the management of sexual impotence and erectile dysfunction were documented and Citropsis articulata and Cola acuminata were among the highly utilized medicinal plants. CONCLUSION: From the researchers' point of view, the usage of herbal remedies in managing male sexual disorders is useful because of long cultural history of utilisation and the current renewed interest in natural products to sustain health globally. As a way recognising the values and roles of traditional medical knowledge in health care provision, further research into the efficacy and safety of herbal remedies in male sexual disorders is precious in Uganda and beyond. More so, the establishment of rapport between relevant government department in Ministry of Health, modern health workers through collaborative and networking ventures with traditional healers under close supervision and monitoring of herbal treatments is noble.

Erectile Dysfunction↗

PubMed1994

Topical minoxidil in the treatment of male erectile dysfunction.

Topically applied 2% minoxidil solution has been reported to increase diameter, rigidity and arterial flow to the penis. As a result it has been suggested as a possible treatment for erectile dysfunction. A total of 21 patients received 2% minoxidil for treatment of erectile dysfunction with instructions to apply 1 cc of the solution slowly over the glans penis 20 minutes before intercourse. Average patient age was 52.5 years (range 29 to 65 years). The etiology of the impotence was neurogenic in 8 patients, vascular in 7, psychogenic in 4 and other causes in 2. Two patients also had clinical evidence of venous incompetence and 4 were diabetics. One patient with psychogenic impotence noticed improvement in the duration of erection but no increase in rigidity or size after minoxidil application. One patient with impotence after excision of a Peyronie's plaque reported a rigid erection adequate for intercourse after using minoxidil. This patient subsequently was able to achieve erections without using minoxidil. The remaining 19 patients had no improvement in erectile rigidity, or the ability to obtain or maintain an erection. One patient did notice some mild burning on the glans penis after applying the minoxidil. No other side effects were noted in any patient. These results indicate that 2% topical minoxidil solution is not effective when applied to the penis in the treatment of erectile dysfunction. It is possible that a higher concentration, a different delivery medium or a different chemical composition may yield better results.

Administration, Topical↗

PubMedDate not supplied

[Role of duplex scanning in the diagnosis of erectile dysfunction].

A total of 110 patients aged 34-74 years who complained of erectile dysfunction (ED) were examined. A control group of 9 patients without complaints of ED was formed to determine the normal condition. Baseline ultrasonography was followed by scanning after intracavernous administration of a vasoactive drug to whose use 59 individuals contended to. In the control group, the variation of PSV values was in the range of 23-59 cm/sec. Among the patients with complaints of ED, the baseline study has indicated normal PSV values in both cavernous arteries in 21 cases of the 110 patients; in the other patients, the baseline cavernous arterial blood flow, such as that in the great arteries, was less than 30 cm/sec. Summing up the data of observations of 59 patients undergone erectile stimulation has ascertained that that 20, 34, and 4 patients were diagnosed as having the isolated arterial form of ED, the arteriovenous form, and venous form, respectively; there was no evidence for the form of vascular genesis in 1 patient. Ultrasonography, including color duplex scanning with Doppler energy flow mapping, and B-mode before and after erectile stimulation with intracavernous administration of an E1-prostaglandin drug, makes it possible to assess the contribution of the vascular component to the pathogenesis of erectile dysfunction.

Adult↗

PubMed2004

Efficacy of sildenafil citrate (Viagra) for the treatment of erectile dysfunction in men in remission from depression.

Erectile dysfunction (ED) and depression are highly prevalent and frequently comorbid. Sildenafil effectively treats ED in men with depression and in men taking antidepressants. We evaluated the efficacy of sildenafil in men with depression in remission and ED. Patients with a history of ED when major depressive disorder (MDD) was diagnosed, which persisted after MDD was treated to remission, were randomized to 12 weeks of treatment with sildenafil (50 mg, flexible) or placebo. Efficacy was assessed using intercourse success rates, a global efficacy question (Has treatment improved your erections?), the International Index of Erectile Function (IIEF) and Life Satisfaction Checklist (LSC). By week 12, intercourse success rates were significantly higher among sildenafil- (74%) compared to placebo-treated patients (29%; P=0.0001). About 83% and 34% of sildenafil- and placebo-treated patients, respectively, reported improved erections (odds ratio=9.4, P=0.0001). IIEF scores in the sildenafil group (n=83) were significantly improved compared to those in the placebo group (n=85; P <0.0001). LSC sexual life item improved significantly among sildenafil- versus placebo-treated patients. The most frequently reported adverse events were transient and mild-to-moderate. Sildenafil is an effective and well-tolerated treatment for ED in patients with a history of ED at the time of MDD diagnosis, and which persisted after the MDD was treated to remission.

Adult↗

PubMed2000

Epidemiology of erectile dysfunction: a community-based study in rural New York State.

PURPOSE: Few published population-based studies that deal with the prevalence of erectile dysfunction (ED) involve rural populations. This study determined the prevalence and determinants of ED among a rural population. It also evaluated the relevance of some major predictors of help-seeking decisions. METHODS: A self-administered survey was conducted by mail among 5198 randomly selected men 50-76 years old, living in four rural counties in Central New York State. RESULTS: The response rate was 44.7% and the participation rate among respondents was 71.0%. Mean ages of men reporting and those not reporting ED were 64.5 7.2 and 59.8 7.2 years respectively. The mean duration of self-reported ED was 4.9 4.6 years. The overall prevalence of ED was 46.3% while the minimum prevalence was estimated as 21.3%. Age-specific prevalence was 26.0%, 34.9%, 46.9%, 57.8% and 69.4% among men 50-54, 55-59, 60-64, 65-69, and 70-76 years old respectively. There was a statistically significant relationship between age, socio-economic status, perceived state of health and erectile function status (p < 0.001). However, socio-economic status, marital status, perceived state of health and age were not significant predictors of help-seeking decisions. CONCLUSIONS: The prevalence of ED among men 50-76 years old in rural Central New York State is at least 21.3% and may be as high as 46.3%. Age, perceived state of health and socio-economic status were found to be important determinants of erectile dysfunction among this population. For purposes of comparative analyses, future epidemiological studies should report both the overall and minimum rates among men with clinically relevant erectile dysfunction.

Aged↗

PubMed1999

Evaluation and therapeutic approaches of voiding and erectile dysfunction in neurological Behçet's syndrome.

PURPOSE: Behçet's syndrome is a progressive inflammatory disease which involves multiple systems. It is characterized by 3 main symptoms of iridocyclitis, and oral and genital ulcerations. Nervous system involvement is seen rarely in this clinical entity and is known as neurological Behçet's syndrome. Inflammation usually occurs in the brain stem, cerebellum and medulla spinalis. Voiding and erectile dysfunction can be due to progressive inflammatory reactions in the nervous and vascular systems. We prospectively evaluated the dysfunctional bladder and penis, and therapeutic options were evaluated prospectively. MATERIALS AND METHODS: A total of 24 consecutive patients diagnosed with neurological Behçet's syndrome after neurological evaluation were enrolled in this study. Neurological involvement and localization of the nervous system were proved on evaluation. Voiding and erectile dysfunction was evaluated regardless of the presence of related symptoms, and the results were compared with those of controls. Patients with voiding dysfunction on urodynamic study were treated and reevaluated symptomatically after 3 and urodynamically after 6 months. RESULTS: The rate of erectile dysfunction in neurological Behçet's syndrome was 63%. Mixed type vasculogenic impotence, arterial insufficiency, veno-occlusive dysfunction and neurogenic impotence were identified in 7, 2, 2 and 1 patient, respectively. Detrusor instability was demonstrated in 12 patients with urgency incontinence, including 3 with detrusor-sphincter dyssynergia. Brain stem localization was determined in these patients on neurogenic evaluation. Significant improvement was observed with anticholinergic treatment and clean intermittent catheterization in 3 patients with detrusor-sphincter dyssynergia. Hypersensitive and hypocompliant detrusor was noted in patients with neurological Behçet's syndrome who had normal voiding habits. CONCLUSIONS: Incontinence or irritable bladder symptoms should not be considered innocuous clinical findings in neurological Behçet's syndrome. Lower urinary tract function should be evaluated in all patients with this neurological syndrome. The incidence of erectile dysfunction is approximately 65% and the therapeutic approach should be determined according to lower urinary tract function.

Adult↗

PubMed2005

Elevation of asymmetrical dimethylarginine (ADMA) and coronary artery disease in men with erectile dysfunction.

BACKGROUND: Coronary artery disease (CAD) and erectile dysfunction (ED) of vascular origin are closely related and share common risk factors. The endogenous NO synthase inhibitor asymmetrical dimethylarginine (ADMA) has recently been identified as an independent risk marker for cardiovascular disease and it was the purpose of the present study to investigate the role ADMA in ED with and without underlying CAD. METHODS AND RESULTS: We determined plasma ADMA levels in 132 men with ED. Patients were divided into a group of 56 men with underlying CAD (ED-CAD) and a group of 76 men without clinical evidence for underlying CAD (ED-No-CAD). Diagnosis of ED was based on the International Index of Erectile Function Score (IIEF-5). Plasma ADMA concentrations in the ED-CAD group were elevated as compared to the ED-No-CAD group, median (IQR): 0.76 (0.65-0.91) micromol/l ADMA vs. 0.49 (0.36-0.71) micromol/l, p < 0.001. In a multiple logistic regression analysis adjusting for hypertension, hypercholesterolemia, low HDL cholesterol and diabetes or fasting glucose > or =6.1 mmol/l, ADMA remained a strong and independent predictor for presence of CAD. Odds ratios for second and third tertiles as compared to lowest tertile of plasma ADMA were 3.3 (95%CI, 1.1-10.3; p = 0.041) and 8.7 (95%CI, 2.8-27.2; p < 0.001), respectively. CONCLUSION: As elevation of ADMA has been found to be associated with many risk factors for both CAD and ED, our data provide further strong evidence for the close interrelation of CAD and ED. Determination of ADMA may help to identify underlying cardiovascular disease in men with ED.

Age Distribution↗

PubMed1988

Hypothalamic-hypophyseal-testicular abnormalities and erectile dysfunction.

Forty-five men presenting with erectile dysfunction were evaluated through history and nocturnal penile tumescence, Doppler, and EMG studies. Fifteen were classified as having organic and 30 as having psychogenic impotence. Three men had mild hypergonadotropism with low testosterone levels. One had hyperprolactinemia. No case of hypogonadotropic hypogonadism was detected. Six patients who had psychogenic impotence had low levels of testosterone.

Adolescent↗

PubMed2006

Research instruments for the diagnosis and treatment of patients with erectile dysfunction.

As the incidence and prevalence of erectile dysfunction (ED) increase, healthcare providers will require robust, accurate, and efficient tools for appropriately diagnosing and treating patients with ED. Moreover, clinicians will need effective follow-up tools that assess treatment efficacy and satisfaction, to help patients meet their expectations for successful treatment of ED. We provide a summary of some of the most commonly used instruments for the diagnosis and assessment of ED treatment efficacy that will be referred to in this supplement.

Diagnostic Techniques, Urological↗

PubMed2003

New perspectives in the pharmacotherapy of erectile dysfunction.

Current classification of pharmacological treatments for erectile dysfunction distinguishes between central and peripheral "initiators" and "conditioners" of erection. However, such taxonomy does not take into account the impact on the couple, the ultimate recipient of the treatment. For this reason, we propose here a new, couple-based sexological taxonomy, which divides pharmacotherapies into "harmonious" and "non-harmonious". New treatments and more effective drugs are expected in the near future because of the rapid expansion of research into erection regulation mechanisms and epidemiological studies.

Adrenergic Antagonists↗

PubMed2001

Modern pharmacotherapy for erectile dysfunction: evolving concepts with central and peripheral acting agents.

Pharmacotherapy for men experiencing erectile dysfunction has undergone dramatic advances over the past 5 years with the introduction of an effective oral agent. Sildenafil has increased the pool of couples seeking treatment for this important health issue as well as expanding the numbers of physicians treating it. Research into the growing field of erectile dysfunction is expanding at a rapid pace. Independent investigators worldwide now regularly contribute to our body of scientific knowledge. Novel oral therapies targeted at specific points along the erectile cascade are undergoing pre-clinical and early phase registration trials with the promise of rapid action, extended duration of responsiveness and an improved side effect profile. In this review, we have highlighted recent information on the next generation of phosphodiesterase inhibitors and summarized the evolving research into centrally acting agents, which may lead to effective combination therapy.

Erectile Dysfunction↗

PubMed2000

Current perspectives on intracavernosal pharmacotherapy for erectile dysfunction.

Thirty percent of males afflicted with erectile dysfunction (ED) do not respond to oral drugs, another 15% reveal contraindications to currently available therapy, and a subset of patients actually prefer injection therapy due to its predictable short time-to-onset of erection and reliable rigidity compared to oral drugs. This paper provides both a historical and current perspective on intracavernosal therapy and reviews the popular injectable therapeutic agents that are currently used for the treatment of ED. Emphasis is placed on the efficacy, mechanism of action and side effect profiles of approved and experimental injectable pharmacotherapy for ED. International Journal of Impotence Research (2000) 12, Suppl 4, S91-S100.

Administration, Oral↗

PubMed1988

Erectile dysfunction and premature ejaculation.

In parallel with the increased recognition of organic causes of erectile dysfunction, several new physical methods of treatment have been developed for this problem. These include intracavernosal injections of vasodilators, penile prostheses, vascular surgery, vacuum condoms, and medication. However, psychological treatment approaches are still of considerable importance in the treatment of both erectile dysfunction and premature ejaculation.

Ejaculation↗

PubMed2002

[Erectile dysfunction in primary care as possible marker of health status: associated factors and response to sildenafil].

OBJECTIVES: To find the factors linked to erectile dysfunction, to evaluate this as a possible marker of health status, to analyse the evolution of clinical parameters of associated illnesses and the response to Viagra.Design. Intervention study without a control. SETTING: Alguazas Health Centre (Murcia). PARTICIPANTS: All the patients in the programme (125), with a figure on the sexual health in men index (SHIM) below 21.Interventions. Health education and administration of Viagra. MAIN MEASUREMENTS: Concomitant illnesses, pathologies previously unknown to the patient, changes in erectile function valued on the international index of erectile function (IIEF), and changes in blood pressure, glucaemia and lipids. RESULTS: Factors linked to erectile dysfunction were diabetes (50.4%), hypertension (33.6%), hypercholesterolaemia (22.4%), urological pathology (12.8%) and mental health disorders (33.6%). The hidden pathology detected was 15 cases of hypertension, 3 diabetes, 2 cardiopathies, 20 dyslipaemias, 3 depressions, 13 anxiety and 5 urological problems. The variations in clinical parameters at 3 months were: glucaemia, -38.3 mg (P<.001, Student s t=-5.186); HbA1c, -0.9 (P<.05, Student s t=-2.16); systolic blood pressure, -16 mm Hg (P<.01, Student s t=-3.486) and diastolic pressure -13 mm Hg (P<.001, Student s t=-4.594); and total cholesterol, -14.2% (P<.001, Student s t=7.01). Erectile function improved by 74% with Viagra. CONCLUSIONS: 2 out of every 3 patients with erectile dysfunction presented associated diseases; one in every 3 were ignorant of their health problem. Monitoring of chronic illnesses improved significantly. Finally, 3 in every 4 responded to Viagra.

Adult↗

PubMed2002

Erectile dysfunction. Diagnosis and treatment in older men.

Erectile dysfunction (ED) affects nearly two-thirds of men age 50 and older and is an increasingly common presentation in the primary care setting. A thorough evaluation for ED involves a complete medical history, including a review of medical risk factors such as hypertension, diabetes, cardiovascular disease, renal failure, and medications, as well as lifestyle risk factors such as obesity and tobacco, alcohol, and illicit drug use; a detailed sexual history, including assessment of duration of ED, loss of libido, and overall sexual satisfaction; a physical examination; a psychosocial assessment--with particular attention to depressive symptoms; and appropriate laboratory tests. Treatments include medical management of multi-drug regimens, oral therapy, intracavernosal injection, testosterone replacement therapy, vacuum erection devices, and penile prostheses.

Aged↗

PubMed2005

A multidisciplinary approach to assess erectile dysfunction in high-risk cardiovascular patients.

Erectile dysfunction (ED) is increasingly considered as one manifestation of systemic vascular disease. Accordingly, ED and coronary artery disease share mutual risk factors and frequently coexist. Sexual health is an important aspect of our patients' lives, and ED is a common concern of the cardiovascular patient. Despite this, sexual function is under-addressed in the cardiac patient. Even when this topic is broached by the primary care physician or urologist, ED frequently remains untreated due to safety concerns involving cardiac disease and other comorbidities. This article describes our experience with this unique patient population, as well as our approach to building a multidisciplinary clinic designed to specifically address the important issue of ED in the cardiac patient.

Administration, Oral↗

PubMed2004

Current role of penile implants for erectile dysfunction.

PURPOSE OF REVIEW: The purpose of this review is to appraise new developments and publications in the field of penile prosthetic surgery. Urologists dealing with erectile dysfunction need to recognize the value of penile prosthetic surgery as a very efficacious treatment for this common condition. This type of surgery is needed in a considerable proportion of patients with erectile dysfunction so this review is timely and relevant. RECENT FINDINGS: The main themes in the literature covered include risk factors for infection of penile prostheses, its prevention with the use of hydrophilic and antibiotic-coated prostheses, particularly in re-operations, and its management with the new rescue procedures. Surgical tips for prosthetic surgery are also reviewed as well as clinical outcomes and factors influencing them. SUMMARY: Of all the invasive treatments currently available, placement of a penile prosthesis is one of the most successful, giving high levels of satisfaction. With the aid of new technical advances, the risk of infection--the most feared complication--can be minimized so prosthetic surgery may play a major role in the treatment of erectile dysfunction.

Erectile Dysfunction↗