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PubMed2005

Lower urinary tract symptoms in patients with erectile dysfunction: is there a vascular association?

OBJECTIVE: To assess if there is an underlying vascular association between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED). MATERIALS AND METHODS: A total of 374 male patients with ED were enrolled in this study. Patients were interviewed for ED using the International Index of Erectile Function. Assessments for penile vasculature using color Doppler ultrasonography and rigidometer were performed. All patients were also screened for LUTS using the International Prostate Symptoms Score. All patients underwent routine laboratory investigation, plus total testosterone and prolactin assessment. RESULTS: Mean age+/-SD was 54.4+/-8.9 years with an age range of 28-84 years. Eighty-five percent of the patients had organic causes of ED. Of the patients, 80.7% had different degrees of LUTS. There was a significant association between presence of LUTS and: arteriogenic and neurogenic causes of ED, poor response to intracorporeal injection, poor rigidity in the rigidometer, and low peak systolic velocity of the cavernosal arteries (p < 0.05 for each). No significant association was found between presence of LUTS and increasing values of end diastolic velocity or decreasing values of resistive index of the cavernosal arteries (p > 0.05 for each). There was a significant association between the higher degrees of LUTS and the decreasing values of peak systolic velocity (p < 0.05). CONCLUSIONS: This study demonstrated that reduced peak systolic velocity of the cavernous artery does associate with LUTS in patients with erectile dysfunction. Further studies are warranted to address the underlying vascular mechanisms of ED in patients with LUTS.

Adult↗

PubMed2003

[Hemodynamometry of erectile dysfunction].

OBJECTIVE: To study the clinical causes of the erectile dysfunction (ED). METHODS: One hundred and thirty cases of ED were examined by hemonamometry and cavernosography with vasodilating agent. The data about penile brachial index, intracavernous pressure, maintenance flow rate, and pressure loss change were obtained and the status of the penile veins was detected. RESULTS: Among 130 patients with ED, 39 had venous leakage including penile arterial insufficiency simultaneous venous leakage in 15 patients. Various leakage sites were observed by using cavernosography. Twenty-eight patients showed deep dorsal veins only and the remaining crural veins. CONCLUSION: Hemodynamometry is effective to diagnose the cause of ED.

Adult↗

PubMed1997

[Pharmacological therapy in erectile dysfunction--current standards and new viewpoint].

Intracavernous pharmacotherapy of erectile dysfunction has been established for over 10 years, with prostaglandin E1 (PGE1) being the standard substance with the lowest rate of side effects. Recent investigations deal with the identification of intracellular mechanisms of smooth muscle relaxation in cavernous tissue as the most important aspect of penile erection. Nitric oxide and specific phosphodiesterase-isoenzymes seem to play a central role. This resulted in clinical studies with the intracavernous injected nitric oxide-donor linsidomine (SIN 1) and the orally given phosphodiesterase-inhibitor sildenafil. Furthermore new ways of pharmaco-application are tested, e.g. transdermal treatment with nitroglycerin, minoxidil or papaverine, as well as intraurethral injection of prostaglandin E1.

Alprostadil↗

PubMed1998

Current treatment and future perspectives for erectile dysfunction.

During the last fifteen years the field of erectile dysfunction has grown tremendously, offering several treatment options to impotent patients, such as intracavernosal pharmacotherapy, vacuum therapy, penile vascular surgery and penile prosthetic surgery. Several multicenter clinical trials have been undertaken and numerous studies have been published, showing that the 'gold standard' treatment does not exist. As new oral, intraurethral and intracavernosal medications are added to the armamentarium of physicians and even more will be available for physicians and patients in the near future, the question becomes apparent: which treatment and when? The present paper critically reviews the existing information on currently available treatment options, and discusses future perspectives based on data from ongoing clinical trials. Considerations for the development of a new management strategy are also discussed.

Administration, Topical↗

PubMed2002

Health care clinicians in sexual health medicine: focus on erectile dysfunction.

A consensus guidelines model was developed for managing erectile dysfunction (ED) by urology nurses and other health care clinicians. The model emphasizes identification of ED in all males older than 40, education and counseling as keys to intervention, and inclusion of partners whenever possible. These guidelines are intended to provide a comprehensive care model for ED patients and their partners, which would be optimally cost effective and clinically relevant. If successful, this new model will allow quality sexual health care to be provided to increasing numbers of patients and their partners.

Counseling↗

PubMed2000

Diagnostic evaluation of erectile dysfunction in the era of oral therapy.

Therapy for erectile dysfunction (ED) may be specific to the cause of ED or it may be nonspecific. There are only three causes of ED which have specific therapy: psychogenic, endocrine and certain types of reversible vasculogenic ED. In the era of oral therapy for ED, treatment is not cause-specific in the great majority of patients. For this great majority, only the basic evaluation of ED is needed. Only when there is a strong suspicion that the cause of a patient's ED is endocrine, psychogenic or reversible vascular disease are additional diagnostic tests indicated. In these three categories of patients, specific treatment of the cause of ED can produce a permanent and dramatic improvement in sexual function and satisfaction. International Journal of Impotence Research (2000) 12, Suppl 4, S12-S14.

Administration, Oral↗

PubMed2003

[Conservative treatment of erectile dysfunction].

The development of diagnostical and therapeutical methods of erectile dysfunction opened new possibilities for patients. In our time, andrologists are capable of treating most patients. The ones who cannot be helped are unable to lead sexual life due to physical reasons. The application of hormone examinations, color Doppler and Rigiscan exams help at establishing diagnoses. In the therapy, modern peroral pharmacotherapy is dominant, mainly phosphodiesterase inhibitors and central peroral pharmacon are applied. The means of getting the vasoactive drugs into the body have been extended (subcutan, transdermal, and drugs absorbable through mucosa). Psychotherapy is indispensable at some patients. The surgical solution (mainly prosthesis implantation) can be regarded critically, yet their presence among therapies is necessary. According to authors' opinion, the qualitative development of vasoactive drugs (efficacy extension and side-effect reduction) that can be simply and conveniently applied in the future.

Administration, Oral↗

PubMed2004

Erectile dysfunction: an underdiagnosed condition associated with multiple risk factors.

Erectile dysfunction (ED) is a common condition with a significant effect on the quality of life. The prevalence of ED rises with increasing age and other conditions (hypertension, diabetes, ischaemic heart disease, hypercholesterolaemia and depression). The MALES study is one of the largest epidemiological surveys to investigate the prevalence of ED. This study included 27839 patients spanning eight countries. In addition to the MALES study, we review the emerging link between lower urinary tract symptoms (LUTS), benign prostatic hypertrophy (BPH) and ED, including the effect of BPH treatment on sexual function. Preliminary data from the MALES II study shows a significant cascade effect in the treatment seeking behaviour and treatment adherence of patients taking sildenafil for ED. We explore the possible reasons behind the discontinuation of oral phosphodiesterase inhibitors prescribed for the long-term treatment of ED.

Clinical Trials as Topic↗

PubMed2002

[Conclusions from the Viagra case? Definition of disease in social legislation as exemplified by erectile dysfunction].

The article describes the controversy about the question whether statutory social health insurances are obliged to reimburse the costs for the treatment of erectile dysfunction. Next to the question whether the 'Bundesausschuss der Arzte und Krankenkassen' was entitled to decide it was highly controversial whether erectile dysfunction is a disease according to the laws of social insurance. This enforces more general considerations regarding the possibility to define disease and the relevancy of a concept of disease for the justification and limitation of socially financed services in medicine.

Erectile Dysfunction↗

PubMed2003

Epidemiology of erectile dysfunction.

This review of the current epidemiological literature on erectile dysfunction (ED) suggests that approximately 5-20% of men have moderate-to-severe ED. Different definitions of ED, age distributions and concomitant medical conditions, as well as methodological differences, may explain much of the variance in reported prevalence rates. Various chronic disorders are associated with elevated rates of ED including depression, diabetes, and cardiovascular and neurological diseases. Such disorders are more common in the elderly, which may partially explain the elevated prevalence of ED in men over 60 y of age. Currently, up to 70% of men with ED are not treated. However, so many men experience considerable distress from their condition, that the increasing awareness of ED as well as the availability of noninvasive treatments may result in a greater proportion of patients seeking treatment, and eventually regaining satisfaction with their sex life.

Adolescent↗

PubMed1998

[Value of the vacuum test in the clinic of erectile dysfunction].

Among the few therapeutic alternatives currently available in erectile dysfunction (ED), vacuum is a procedure from which a considerable number of patients may benefit. To know the response and usage availability in each patient, the routine performance of the vacuum test is proposed in order to compare it with other therapeutic methodologies. This study was conducted in 272 patients with ED of various etiologies, with favourable results in 93.3%. 94% presented no complications, which were otherwise minimal (pain, haematoma) in the rest, 94% were in favour to using vacuum as therapy. This study demonstrates that vacuum is an effective methodology free from complications which allows application in most ED patients, its inclusion as a routine study of signs and symptoms of ED appearing to be very useful. This approach makes patient's knowledge of the system easier also facilitating the choice of the most appropriate therapeutic alternative.

Adolescent↗

PubMed2003

[Drug therapy of erectile dysfunction--the current status].

In the medicinal therapy of erectile dysfunction (ED), both oral as well as local application are possible. The introduction of the PDE-5 inhibitor Sildenafil, as the first highly potent oral therapy for ED, caused dramatic changes in the diagnostic and therapeutic strategies in this area. The later PDE-5 inhibitors Tadalafil and Vardenafil show, as far as it is currently possible to judge, a similar profile to Sildenafil. The only previously available oral therapeutic, Yohimbin, plays an insignificant role, and the initial hopes for Apomorphin as an ED therapeutic have settled to a realistic level. Local application therapies have also become less important, with the intra-urethral application of PGE(1) being reduced to a few clinical indicated situations. The intra-cavernosal pharmacotherapy with PGE(1) is considered the gold standard when oral therapies do not work or can not be used.

Administration, Oral↗

PubMed1989

Quantitative and qualitative analysis of dynamic cavernosographies in erectile dysfunction due to venous leakage.

Of 521 patients with erectile dysfunction in whom a multidisciplinary approach was used, 145 (27.8%) showed venous leakage as (concomitant) etiology of the impotence in dynamic cavernosography. The rate of the maintenance flow corresponded well with the response to a standardized intracavernosal injection of vasoactive drugs (p less than 0.05) in patients with venous leakage. The maintenance flow increased with the age in secondary impotent men. It was not statistically different in patients with or without concomitant arterial insufficiency (p = 0.19). Fifty-one of 145 patients (32.2%) presented a pathologic cavernosal drainage via a single venous system; 94/145 (64.8%) showed a combined venous leakage. The type of leakage corresponded neither to the maintenance flow nor to the response to intracavernosal injections. Our findings show that standardized intracavernosal testing and Doppler have a high predictive value for the status of the venous occlusive system. Exact evaluation of the type of leakage can be made by bidimensional cavernosography only.

Adult↗

PubMed2001

Aging and erectile dysfunction: the role of aging and concomitant chronic illness.

Erectile dysfunction (ED) can have a strong negative effect on the well-being and quality of life of the sufferer. Many factors may contribute to the development of this disorder; age in particular and also concomitant chronic illnesses including neurological, hormonal, arterial and cavernosal factors. An understanding of the prevalence and characteristics of risk factors for ED is required, in order to establish effective therapeutic strategies. However, the prevalence of ED depends on the definitions used and the use of an internationally established scale for the assessment of male sexual function is necessary to facilitate the comparison of data between different countries. Further epidemiologic research and analysis of individual risk factors is required. Such studies will clarify the interactive effects of organic factors and their probable etiology with the general physical, sociocultural and psychologic status of patients. These efforts will make it possible to design more effective future strategies for the treatment and prevention of ED.

Aged↗

PubMed2004

Characteristics of erectile dysfunction in Saudi patients.

We investigated the characteristics of erectile dysfunction (ED) in ambulatory Saudi patients. A total of 680 male patients were assessed for ED using IIEF. Patients were also interviewed for sociodemographic data, medical history and risk factors for ED. Assessment for penile vasculature using color Doppler ultrasonography and rigidometer was performed. In all, 21.4% of the patients with severe ED were <50 y and 78.6% of them were > or =50 y (P<0.001). Of the patients, 20% had psychogenic, while 80% had organic causes of ED. Of the patients, 10% had mild, 39.3% had moderate and 50.7% had severe ED. There was a significant association between increasing severity of ED and the presence of diabetes, hypertension, dyslipidemia, smoking, increased BMI, increased values of EDV, decreased values of PSV, RI and rigidometer (P<0.001 for each). Moderate to severe ED is common among Saudi patients. This study provides a quantitative estimate of the characteristics of ED in ambulatory Saudi patients.

Adult↗

PubMed2000

The worldwide prevalence and epidemiology of erectile dysfunction.

This paper: (i) describes the worldwide prevalence of erectile dysfunction (ED); (ii) presents age-specific incidence rates for ED in the US; (iii) summarizes some key epidemiologic correlates of ED in the general population; and (iv) considers the possibility that ED may be a biobehavioral marker (sentinel event) of subsequent cardiovascular disease in men. Clinical, anthropometric, life style and hormonal data are presented from the milestone Massachusetts Male Aging Study (MMAS), a large (over 1000) prospective cohort of randomly sampled community-dwelling, normally aging men. Newly updated population prevalence and (more importantly) age-specific incidence rates are reported. We also estimate the likely magnitude of ED that will accompany the worldwide globalization of aging. Key correlates (predictors) of incident ED, especially vasculogenic influences, are identified and discussed. In conclusion, ED is a common biobehavioral phenomenon and there are strong physiological and epidemiological reasons for considering it a major marker (or predictor) of subsequent cardiovascular disease in men. International Journal of Impotence Research (2000) 12, Suppl 4, S6-S11.

Age Distribution↗

PubMed2003

Quality of Sexual Life Questionnaire (QVS): a reliable, sensitive and reproducible instrument to assess quality of life in subjects with erectile dysfunction.

A French quality of life questionnaire specific to erectile dysfunction (ED), 'QVS' for 'Questionnaire de Vie Sexuelle', has been developed. This paper describes its validation: item reduction and reliability (internal consistency and reproducibility), construct validity and criterion validity (clinical, discriminant and concurrent). The initial 40-item questionnaire was administered once to 316 ED and 117 control subjects, and twice (D0 and D7) to 104 ED and 29 control subjects. Item reduction gave a 27-item questionnaire with three scales (Sexual Life, Skills and Psychosocial Well-being) and four scores (one score for each scale and a Global Index). Psychometric analyses demonstrated the reliability and the validity of the QVS. The questionnaire was able to discriminate patients according to the presence or severity of ED. The Skills scale was the least sensitive. Analysis of responsiveness to change over time still needs to be addressed to consider the questionnaire as a fully validated instrument.

Adult↗

PubMed2000

Relation between psychosocial risk factors and incident erectile dysfunction: prospective results from the Massachusetts Male Aging Study.

Erectile dysfunction (ED) is recognized as a major public health problem. ED may be due to a wide range of factors, but recent work has focused on the medical and physical etiology of ED. The importance of psychosocial risk factors should not be dismissed, however, and several cross-sectional studies have reported associations between ED and depression, anger, and dominance. Whether these factors are prospectively associated with the risk of ED has yet to be established. Longitudinal data obtained from 776 respondents in the Massachusetts Male Aging Study (1987-1997) were used to examine whether the presence of depressive symptoms, the way in which anger was expressed, or the trait of dominance independently contributed to the risk of ED 8.8 years later. The results suggest that new cases of ED are much more likely to occur among men who exhibit a submissive personality. The implications of these findings are discussed.

Adult↗