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PubMedDate not supplied

Relapse prevention strategies and techniques with erectile dysfunction.

The crucial issues in relapse prevention are building erectile comfort and confidence and maintaining positive, realistic expectations. The basis of relapse prevention is comprehensive, high-quality sex therapy. Erectile dysfunction is best conceptualized as a couple issue with the focus on establishing a broad-based, flexible couple style that integrates intimacy, pleasuring and eroticism. Specific strategies are proposed for men who use Viagra.

Adult↗

PubMedDate not supplied

Efficacy of PDE-5-inhibitors for erectile dysfunction. A comparative meta-analysis of fixed-dose regimen randomized controlled trials administering the International Index of Erectile Function in broad-spectrum populations.

This meta-analytic study aims to estimate the likely improvements of erectile dysfunction (ED) measured by the International Index of Erectile Function (IIEF) at the highest fixed dosages of the three available PDE-5-inhibitors: sildenafil, tadalafil, and vardenafil. MEDLINE and the Cochrane Library were searched electronically for efficacy trials of PDE-5-inhibitors for treating ED. In addition drug manufacturers were contacted to provide unpublished or unrecorded congress proceedings. Randomized, double-blind, placebo-controlled, parallel-group, maximum fixed-dose, broad-spectrum efficacy trials using IIEF were included in the analysis. Data were independently extracted by two reviewers. The results were pooled using weighted mean differences. A formal indirect comparison (including Bonferroni-correction) was conducted to estimate the differences between agents. A total of 14 trials were included in the meta-analysis (three with 100 mg sildenafil, eight with 20-25 mg tadalafil, and three with 20 mg vardenafil). All trials were of good methodological quality. Overall heterogeneity was moderate: I(2)=33.2%, chi(2)=19.47, P=0.11. The funnel plot suggested moderate likelihood of publication bias. Pooled results of IIEF-improvement were for sildenafil 9.65 (95% CI: 8.50, 10.79) points, tadalafil 8.52 (7.61, 9.42) points, and vardenafil 7.50 (6.50, 8.50) points, respectively. Sildenafil proved to be significantly more effective than vardenafil (d=2.15, P=0.006), other pairwise comparisons showed no difference in efficacy. All PDE-5-inhibitors are highly effective in the treatment of ED. At maximum dosage they improve erectile function 7-10 points on the IIEF compared to placebo-treatment. There is evidence that sildenafil might be more efficacious than vardenafil, although this is to be interpreted with caution. To prove higher efficacy truly independent comparative trials are needed.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed1999

Changing practice patterns in erectile dysfunction: a diagnostic algorithm for the new millennium.

In the era when there was only one cause-specific treatment for erectile dysfunction (vasoactive penile injection), most patients could be safely directed to therapy following a good sexual history, assessment of medical risks, and physical examination. Without diagnostic testing, efficacy and satisfaction was a matter of chance. The next millennium will see the development of multiple oral agents for the management of male sexual dysfunction. These agents with their differing mechanisms of pharmacological action (central initiators, central conditioners, and peripheral modulators) present for the first time the possibility of cause-specific therapy. Currently with only 1 pill available, clinicians are compelled to categorize patients as having oral-agent-responsive or oral-agent-resistant erectile dysfunction (ED). For the time being, we may categorize patients as: Viagra (Pfizer Pharmaceuticals, New York, NY) successes or Viagra failures. But when faced with a laundry list of options for ED, the role of erectile function testing will assume a two-fold importance: (1) establishing an etiology specific diagnosis and (2) formulating a treatment plan with a reasonable likelihood of success. Patients failing first-line therapy by primary caregivers will seek the expertise of specialists; they will want to know not only what is wrong with them but also why a specific agent has failed to reverse their ED. We must be prepared to meet these demands; our diagnostic algorithms must incorporate these new pharmacological agents. Our prescribing patterns, to be successful, must have some objective basis. ED testing will need to produce vascular profiles to predict which drug or combination of drugs (oral, cutaneous, urethral, intracavenosal) will effectively restore erection. Conversely, to spare patients the frustration and the potential side effects of empiric trials, ED testing will need to determine whether patients would be better served by a mechanical solution, a vacuum erection device or penile prosthesis.

Algorithms↗

PubMed1994

Erectile dysfunction in multiple sclerosis. Associated neurological and neurophysiological deficits, and treatment of the condition.

Forty-eight men with multiple sclerosis and erectile dysfunction were evaluated. Emphasis was placed on the neurological features and the relationship between impotence and the bladder dysfunction in multiple sclerosis. Erectile failure was invariably associated with pyramidal signs in the lower limbs and with urinary symptoms. All of the men with impotence and marked pyramidal dysfunction in their legs were found by cystometric studies to have bladder hyperreflexia. The severity of the urinary symptoms was related to the degree of pyramidal impairment in the lower limbs. The posterior tibial and the pudendal cortical evoked potentials were abnormal in most of the men with multiple sclerosis and erectile failure. However, recording the pudendal cortical responses in patients with multiple sclerosis and impotence provided no more information than the tibial cortical evoked potentials. The neurological examination findings together with the results of the neurophysiological and cystometric tests suggest that erectile dysfunction in multiple sclerosis is due to spinal lesions situated proximal to the sacral cord. The feasability of papaverine intracorporeal injection therapy for men with multiple sclerosis and impotence was assessed. Papaverine intracorporeal injections produced satisfactory erections in the majority of the impotent men. Erectile failure in patients with multiple sclerosis was successfully managed for up to 2 years, by intracorporeal self-injection therapy.

Adult↗

PubMed1997

Quality of life effects of alprostadil therapy for erectile dysfunction.

PURPOSE: We evaluated the quality of life effects of self-administered intracavernosal injection of alprostadil sterile powder for erectile dysfunction when used by patients for up to 18 months. MATERIALS AND METHODS: Clinical and self-reported measurements were used to assess physiological and psychological status at baseline, and at 3, 6, 12 and 18 months for 579 patients who entered the self-injection phase of an open label, flexible dose clinical trial. Quality of life was measured using the Center for Marital and Sexual Health Sexual Functioning Questionnaire, which focuses on the psychosocial and physical dimensions of erectile dysfunction; the Brief Symptom Inventory, which measures mental health, and the Duke Health Profile, which measures general quality of life. The primary evaluations were quality of life changes from baseline to post-initiation periods and reasons for treatment discontinuation. RESULTS: The Center for Marital and Sexual Health Sexual Functioning Questionnaire displayed improvements at all post-initiation periods in 10 questions (p < 0.001, Student's paired t-tests) grouped into scales representing frequency of sexual activity, erection, orgasm and satisfaction domains. On the Brief Symptom Inventory interpersonal sensitivity, anxiety and depression as well as global scores improved (p < 0.001). Overall mental health as measured by the Duke Health Profile also improved (p < 0.01) between baseline and 6 months. The reasons most frequently cited for treatment discontinuation were nonfirm erections and injection site pain. CONCLUSIONS: Clinical improvements in erectile function due to alprostadil therapy were associated with improvements in sexual activity, sexual satisfaction and overall mental health.

Adult↗

PubMed1991

[Erectile dysfunction. Current diagnosis and therapy].

Today the cause of erectile dysfunction can be evaluated by multidisciplinary diagnostics. Currently, medical treatment, external devices, operative procedures and self-injection of vasoactive drugs are used for therapy. We can therefore offer effective therapeutic options with a low risk, providing an acceptable solution for the patients.

Adult↗

PubMedDate not supplied

Erectile dysfunction in kidney transplanted patients: efficacy of sildenafil.

BACKGROUND: Erectile dysfunction (ED) is the inability to achieve and/or maintain an erection for satisfactory sexual performance. The effects of kidney transplantation on pre-existing ED are poorly understood, as well as the onset of new ED cases after kidney transplantation. This study aimed to evaluate the effects of kidney transplantation on pre-existing ED, to assess the onset of new ED cases after renal transplantation and to assess both the efficacy and safety of sildenafil. METHODS: Erectile function was assessed using the self-administered International Index of Erectile Function (IIEF) to kidney transplanted patients. A 50 mg dose of sildenafil was prescribed. Sildenafil efficacy was assessed by re-administering the questionnaire after 4 weeks of therapy. Blood chemistry and serum cyclosporine concentration were evaluated at the beginning of the study and, in patients treated with sildenafil, after 4 weeks of treatment. RESULTS: One hundred and thirteen patients (87.5%) completed the questionnaire. Fifty-three patients (47%) did not complain of ED, the remaining 60 patients (53%) reported ED. ED was already present during dialysis in 40 patients; it appeared ex novo in 20 patients after transplantation. Pre-existing ED disappeared in 8 patients (20%), ameliorated in 13 patients (32.5%), worsened in 2 patients (5%), and remained unchanged in 17 patients (42.5%) after transplantation. The IIEF score significantly improved in sildenafil-treated patients (n=20); there were no observed changes in blood chemistry, blood pressure (BP), renal function and cyclosporine concentration. The side-effects were minimal. CONCLUSIONS: ED was still present in a large cohort of kidney transplanted men. Renal transplantation cures few ED cases. ED can appear ex novo after transplantation. Sildenafil is an effective ED treatment in kidney transplanted men.

Adult↗

PubMed2006

Erectile dysfunction in hypercholesterolemic atherosclerotic apolipoprotein E knockout mice.

INTRODUCTION: Erectile dysfunction (ED) and cardiovascular diseases share the same risk factors. Although the use of hypercholesterolemic rabbit models has proven to be useful to illustrate the link between ED and hypercholesterolemia, the cost of daily maintenance of the animals and necessity for important amounts of drug have limited their use. AIM: We aimed to develop a new model of atherosclerosis-associated ED in a well-known experimental model of atherosclerosis, the apolipoprotein E knockout (ApoE KO) mouse. METHODS: Erectile function was evaluated by recording frequency-dependent increases in intracavernous pressure following electrical stimulation of the cavernous nerve in 26-, 32-, and 38-week-old ApoE KO mice fed a Western-type diet and age-matched C57BL6/J anesthetized mice. Atherosclerotic lesions were evaluated by planimetry in oil red O-stained aortas. RESULTS: We found that in contrast to C57BL6/J mice, ApoE mice displayed atherosclerotic lesions covering 22% of the aortic luminal surface at 26 weeks of age and increasing to 27% and 35% at 32 weeks and 38 weeks of age, respectively. The amplitude of erectile responses to electrical stimulation of the cavernous nerve was markedly impaired in 26-week-old ApoE KO mice as compared with age-matched C57BL6/J mice. Impairment in erectile function persisted in ApoE KO mice 32 and 38 weeks of age. CONCLUSIONS: The ApoE KO mouse, a well-characterized model to study disorders associated with hypercholesterolemia and atherosclerosis in cardiovascular research, could therefore be suitable for investigation of disease-modifying effects of new therapeutic strategies aiming to target both atherosclerosis and ED.

Animals↗

PubMed1991

[Erectile dysfunction: principles of radiologic clarification and therapy].

Diagnosis of erectile dysfunction is performed by means of Doppler sonography, cavernosography and cavernosometry, as well as by angiographic methods. Interventional radiological treatment methods are, arterially, vasodilatation or vasorecanalisation, and, as far as the venous approach is concerned, percutaneous venous occlusion. The article reviews the diagnostic and therapeutic radiological methods.

Catheterization↗

PubMed2006

Efficacy and safety of on-demand tadalafil for the treatment of erectile dysfunction in South-East Asian men.

AIM: Tadalafil is an inhibitor of phosphodiesterase type 5 used for the treatment of erectile dysfunction (ED). The efficacy and safety of tadalafil have been evaluated extensively in Western populations. Our aim was to assess the efficacy and safety of on-demand tadalafil for the treatment of ED in South-East Asian men. METHODS: This was a randomized, double-blind, placebo-controlled study of men with mild to severe ED of various etiologies randomized to receive placebo (n = 122), tadalafil 10 mg (n = 120), or tadalafil 20 mg (n = 125), taken as needed (maximum once daily) for 12 weeks. Efficacy assessments included the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary, and a Global Assessment Question (GAQ). RESULTS: Men from China, Singapore, and the Philippines participated in this trial (n = 367). Compared with placebo, tadalafil significantly improved erectile dysfunction on all efficacy outcomes (P < 0.001). Patients receiving tadalafil 10 mg and 20 mg experienced a significant mean improvement of 8.1 and 8.7, respectively, in the IIEF Erectile Function (IIEF-EF) domain score from baseline (vs placebo 2.4, P < 0.001). In patients receiving tadalafil 10 mg and 20 mg, the mean per-patient success rate for intercourse attempts (SEP3) was 62% and 70%, respectively, compared with 32% for the placebo group (P < 0.001). Of patients who received tadalafil 10 mg and 20 mg, 81% and 86% reported improved erections at endpoint (GAQ) compared with 44% in the placebo group (P < 0.001). The most common adverse events reported by patients were headache, back pain, dyspepsia, and dizziness. CONCLUSIONS: Tadalafil was an effective and well-tolerated treatment for South-East Asian men with ED.

Adult↗

PubMed2003

[Diagnosis of erectile dysfunction--what is still needed today?].

Diagnostic procedures for erectile dysfunction (ED) are still mandatory because ED can be the presenting symptom for a variety of diseases such as diabetes mellitus, coronary artery disease, atherosclerosis, hypertension and hyperlipidemia. Invasive testing for ED has decreased due to the high responder rate for oral PDE-5 inhibitors.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2002

The role of the partner in erectile dysfunction and its treatment.

Advances in pharmacological, mechanical, and surgical treatment for erectile dysfunction (ED) now allow erectile function to be re-established in most men who experience this problem. However, re-establishing erectile function and re-establishing a satisfying sexual interaction with a partner are totally different objectives, and when the latter is not met, the man may re-present with treatment failure or withdraw from treatment altogether. All nontalking therapies focus on the penis as the dysfunctional element, and all too often clinicians fail to appreciate that ED can result from problems in the patient's partner and/or difficulties in their relationship. This article examines the role of the partner in the etiology, assessment, and treatment of ED.

Erectile Dysfunction↗

PubMed2004

Impact of various questionnaires on the prevalence of erectile dysfunction. The ENIGMA-study.

The prevalence estimates of erectile dysfunction (ED) vary considerably across studies. These differences may be attributed to used definitions of ED. Quantitative data on the effect of different definitions of ED on the prevalence are lacking, because precise information on the used definition and questionnaire is often absent. Aim of this study was to quantify the effect of using different questionnaires for ED on the prevalence estimates. In all, 5721 mail surveys on sexual problems and ED were sent to all men (aged >18 y) in 12 general practices in the middle of the Netherlands of which 2117 were completed. The questionnaire contained Enigma (WHO), International Index of Erectile Function (IIEF), Cologne Erectile Inventory (KEED) and one question (Boxmeer, Krimpen). The prevalence of ED based on the various questionnaires and the effect of these questionnaires on risk factor relationships was compared. IIEF gave the highest age specific and overall ED prevalence, KEED the lowest. The difference in prevalence was 16.8%. The agreement (kappa coefficient) between the various ED definitions varied from 0.52 (IIEF & KEED) to 0.95 (Enigma & Boxmeer). The number of risk factor relations were similar for the Dutch studies, reduced for the IIEF and KEED. This study provides evidence that differences in questionnaires to assess ED have a considerable effect on the (age specific) prevalence estimates and little on the risk factor relations. The number of questions of the survey appears not to be responsible for differences in the prevalence of ED and risk factor relations, however they affect the response rate. Uniform use is strongly recommended, since a 'golden standard' for ED assessment (by questionnaire) is lacking. A short questionnaire with one or two questions is recommended for example the one from the Boxmeer-study. These data may be used to adjust (age-specific) prevalence rates comparing ED prevalence in the open population across studies.

Adolescent↗

PubMed2001

Systemic and cavernous plasma levels of endothelin (1-21) during different penile conditions in healthy males and patients with erectile dysfunction.

The role of the sympathetic adrenergic nerves in mediating the constant tone of penile flaccidity and returning the erect penis to its flaccid state is fairly well established. However, it is not yet known whether additional nonadrenergic transmitters are involved in this process. The peptide endothelin-1 (ET-1) may be one of the factors contributing to such a control. Moreover, it has been speculated by various authors that ET-1 might be involved in the pathophysiology of erectile dysfunction. The present study was undertaken to determine whether or not there is a difference in the courses of ET-1/-2 plasma levels registered in systemic and cavernous blood cavities taken from healthy males and patients with ED during different penile conditions (flaccidity, tumescence/rigidity, detumescence). Thirty-two healthy adult males and 25 patients were exposed to visual and tactile erotic stimuli in order to elicit penile tumescence and, in the group of healthy volunteers, rigidity. Whole blood was aspirated from the corpus cavernosum and the cubital vein, and ET-1/-2 was determined in plasma aliquots by means of an enzyme-linked immunoassay (ELISA). Mean systemic and cavernous plasma level of ET-1/-2 in blood samples obtained from the volunteers was 0.2-0.7 fmol/ml. In the healthy males, no changes in ET-1/-2 levels were observed in the systemic and cavernous blood during penile tumescence, rigidity and detumescence. In the group of patients, mean plasma ET-1/-2 levels in the phase of penile flaccidity and detumescence were found to be higher in the systemic circulation than in the cavernous blood (flaccidity: 0.52+/-0.38 fmol/ml vs. 0.48+/-0.46 fmol/ml, respectively; detumescence: 0.53+/-0.33 fmol/ml vs. 0.27+/-0.11 fmol/ml, respectively). No differences in the plasma courses of ET-1/-2 were found between patients with an organogenic and psychogenic etiology of ED. In the phase of detumescence, the mean ET-1/-2 level was lower in the cavernous blood cavities taken from the patients than in the samples obtained from the healthy males. Our study revealed a difference in the profiles of ET-1/-2 registered in the cavernous blood of healthy subjects and patients with erectile dysfunction. Nevertheless, since this difference seems to be of no physiological significance, our data counteract the hypothesis of an ultimate importance of ET-1 in the control of penile flaccidity and detumescence and do not support speculations regarding an involvement of ET-1 in the pathophysiology of erectile dysfunction.

Adult↗

PubMed2005

Interrelation of erectile dysfunction and lower urinary tract symptoms.

The association between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) has garnered attention as investigators have hypothesized a common pathophysiology to explain the assertion that they are causally linked. This relationship between LUTS and ED has received increased attention because both diseases are highly prevalent, frequently co-associate in the same aging male group, and significantly influence the overall quality of life. A causal association between LUTS and ED cannot be established on the basis of the ever-increasing number of epidemiological studies. Attempting to explain a causal relationship between ED and LUTS requires the use of Hill's criterion, which is used by many epidemiologists to separate causal from non-causal explanations. A review of the epidemiological evidence reveals a strong degree of association, internal consistency and dose response effects between ED and LUTS. The temporal relationships between the two remain unknown because of the strong cross-sectional flavor of the epidemiological studies. The issue of an "alternate explanation" to describe the LUTS-ED association appears to be accounted for in that several large studies have provided convincing multiple regression analyses in which the ED-LUTS relationship remains significant. Biologic plausibility is an important issue if the link between ED and LUTS is to have credence. There are four leading theories of how these diseases interrelate. These explanations have a variable amount of supporting data. These include: 1) autonomic hyperactivity effects on LUTS, prostate growth and ED; 2) nitric oxide synthase/nitric oxide levels decreased or altered in the prostate and penile smooth muscle; 3) prostate and penile ischemia; and 4) increased Rho-kinase activation/ endothelin activity. LUTS and sexual dysfunction are highly prevalent in aging men. Both conditions are also significant contributors to overall quality of life. New data has emerged to indicate potential links in epidemiological, physiologic, pathophysiologic and treatment aspects of these two diseases. Using Hill's causality method to separate causal from non-causal explanations linking ED with LUTS, it appears that most epidemiological components are fulfilled.

Adrenergic alpha-Antagonists↗

PubMed2003

Antidepressant-related erectile dysfunction: management via avoidance, switching antidepressants, antidotes, and adaptation.

The ideal antidepressant would control depression with no adverse effect on sexual function. Erectile dysfunction and other sexual dysfunction associated with antidepressant medication treatment are problems with many antidepressants and can lead to patient dissatisfaction and decreased compliance with treatment. A computerized MEDLINE search (English language, 1966-2003) was performed using the terms antidepressive agents, erectile dysfunction, and sexual dysfunction. Emphasis was placed on studies with specific sexual function measurements taken before and after treatment and placebo control. Mixed mediator, nonserotonergic antidepressants that block postsynaptic serotonin type 2 receptors (nefazodone, mirtazapine) or that primarily increase dopamine or norepinephrine levels (bupropion) were thought to be good choices for avoiding antidepressant-associated sexual dysfunction or for switching patients in whom antidepressant-associated sexual dysfunction emerged. Comparisons with serotonin reuptake inhibitors (SRIs) have revealed less desire and orgasm dysfunction with nonserotonergic bupropion, less orgasm dysfunction with nefazodone, and superior overall satisfaction with sexual functioning with bupropion or nefazodone. However, most of these studies have design flaws that make evidence-based claims of efficacy difficult to substantiate. Agents proposed for antidote use in antidepressant-associated sexual dysfunction have either not been studied in men or not proved efficacious in randomized placebo-controlled trials. Switching to and augmentation with bupropion or nefazodone have also not clearly shown efficacy in controlled trials and require care and monitoring to avoid SRI discontinuation symptoms and loss of antidepressant efficacy. Few proposed treatment options, apart from avoidance, have proved effective for antidepressant-associated sexual dysfunction, which can have negative consequences on depression management.

Antidepressive Agents↗

PubMed2005

Vascular damage as a risk factor for benign prostatic hyperplasia and erectile dysfunction.

OBJECTIVE: To assess benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), both considered to be associated with urogenital ageing, in ageing men in a cross-sectional population study, comparing them with healthy controls by using symptom scores and contrast-enhanced colour Doppler ultrasonography (CDUS). PATIENTS, SUBJECTS AND METHODS: Transrectal CDUS and quantitative measurement of colour pixel intensity (CPI) are excellent minimally invasive techniques for assessing normal and pathological blood flow. CDUS was performed using the microbubble-based ultrasound enhancer for evaluating prostate, bladder neck and corpus cavernosum vascularity in young healthy men, men with BPH, and men with severe vascular damage (diabetes mellitus type 2). Resistive index measurements and computer-assisted quantification of CPI were used to objectively evaluate perfusion. The International Prostate Symptom Score (IPSS) and the International Index of Erectile Function (IIEF) were applied to quantify the symptoms. RESULTS: In patients with BPH, perfusion of the transition zone (TZ) of the prostate was significantly lower and the resistive index of the TZ significantly higher (both P < 0.001) than in healthy controls. The perfusion patterns of men with BPH and those who also had severe vascular damage (diabetes mellitus type 2) showed that vascularity in the latter group was lower in the prostatic TZ and the corpora cavernosa. In patients with BPH the IPSS, quality-of-life and IIEF scores were significantly worse than in the control group. Men with concomitant atherosclerosis had even worse symptom scores. CONCLUSION: These results strongly support the hypothesis that age-related impairment of blood supply to the lower urinary tract is important in the development of BPH and ED. Vascular damage may cause chronic ischaemia and thus be a contributing factor in the pathogenesis of BPH and ED.

Adult↗

PubMed1999

Variable response to intracavernous prostaglandin E1 testing for erectile dysfunction.

OBJECTIVES: Anxiety and apprehension may negatively influence the erectile response to the first intracavernous injection with vasoactive agents. This may result in too many false-positive diagnoses of vascular insufficiency if the first injection ever made in a patient is used for color Doppler duplex sonography (CDS) evaluation. METHODS: One hundred sixty-eight consecutive patients (aged 18 to 75 years) with erectile dysfunction underwent a standardized evaluation, including the intracavernous injection test (ICIT) stimulated with 10 microg prostaglandin E1. Responses were recorded on a four-point scale: no response = 0, tumescence = 1, rigidity sufficient for intercourse = 2, full erection = 3. ICIT was repeated after 10 days and combined with CDS. The clinically assessed response to ICIT was correlated with end-diastolic flow velocity. RESULTS: Of 168 patients, 114 (68%) responded equally to the first and second ICIT, but 45 (27%) had an improved response, from tumescence to full erection in the second test (P <0.0001); in 9 (5%), the response deteriorated. The overall mean response was 1.6 (95% confidence interval 1.5 to 1.7) and 1.9 (95% confidence interval 1.7 to 2.0) (P <0.0001) for the first and second test, respectively. Of 168 patients, 89 (53%) responded with erections sufficient for intercourse when tested the first time and 104 (62%) did so after the second injection. CONCLUSIONS: Erectile response to diagnostic intracavernous injection of prostaglandin E1 significantly improved in the second compared with the first test. Therefore, cautious interpretation of CDS is advised when patients are injected for the first time because too many false-positive tests may result.

Adolescent↗