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PubMed2004

Current concepts in the management of erectile dysfunction in men with prostate cancer.

Development in the management of prostate cancer has placed increased attention on patient quality of life after treatment, particularly sexual function. The incidence of erectile dysfunction (ED) in men following radical prostatectomy has been estimated to range from 16% to 82%. Several factors determine the postoperative incidence of erectile difficulties; these include patient age, degree of cavernosal nerve sparing during surgery, cancer stage, and associated comorbidities. Early initiation of available treatments after radical prostatectomy, such as phosphodiesterase-5 (PDE-5) inhibitors and intracavernosal alprostadil, may improve the speed and degree of recovery of erectile function. Oral PDE-5 inhibitors are recognized as the first line of therapy for men with ED after radical prostatectomy, with reasonable success rates reported for all commercially available PDE-5 inhibitors. In recognition of the neurogenic basis for erectile dysfunction after radical prostatectomy, new strategies have been devised, such as cavernous nerve graft interposition procedures, perioperative neuroprotection measures, and postoperative neurotrophic treatments. Hopefully, these efforts will improve quality of life for patients with prostate cancer. The aim of this article is to review the current modalities of ED management for men with prostate cancer.

Adult↗

PubMed2004

Treatment of erectile dysfunction in patients with cardiovascular disease : guide to drug selection.

Erectile dysfunction (ED) is common in cardiac patients and shares the same risk factors--smoking, hypertension, hyperlipidaemia and diabetes mellitus. Sexual activity is not unduly stressful to the heart and, providing patients are properly assessed using established guidelines, sexual intercourse can be enjoyed without increased risk. The treatment of ED in patients with cardiovascular disease has been transformed by the introduction of the oral phosphodiesterase type 5 inhibitors, the first of which was sildenafil. Success in restoring erectile function is possible in up to 80% of patients (depending on the aetiology) with minimal adverse effects. A synergistic hypotensive effect with nitrates, and almost certainly nicorandil, is the only major contraindication. ED in asymptomatic patients may be a marker of silent vascular disease or increased vascular risk factors and should alert the physician to the need for cardiac risk screening. ED is common in patients with cardiovascular disease and should be routinely enquired about. ED is a distressing condition for the man and his partner, and severely impairs quality of life. Patients with cardiovascular disease and patients with diabetes represent the largest group of patients with ED, the majority of whom benefit from the drug therapies currently available. Addressing ED in patients with cardiovascular disease can lead to a substantial improvement in quality of life and success is not difficult to achieve.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2006

Erectile dysfunction in heart failure patients.

Chronic heart failure (HF) and erectile dysfunction (ED) are 2 highly prevalent disorders that frequently occur concomitantly. Coronary artery disease, HF, and ED share several common risk factors, including diabetes mellitus, hypertension, smoking, and dyslipidemia. Additionally, the distinct physiologic sequelae of HF create unique organic and psychologic factors contributing to ED in this patient population. Standard HF therapy with beta-receptor blockers, digoxin and thiazide diuretics may worsen sexual dysfunction owing to medication side effects. This may, in turn, lead to noncompliance in misguided efforts to retain satisfactory sexual activity, with secondary worsening of cardiac capacity. This review describes the unique aspects of ED in the HF population.

Cardiac Output, Low↗

PubMed2003

Cavernosal tissue nitrite, nitrate, malondialdehyde and glutathione levels in diabetic and non-diabetic erectile dysfunction.

The aim of this study is to investigate the role of nitric oxide (NO) stabile end products, membrane lipid peroxidation and antioxidant defensive mechanism in diabetic erectile dysfunction (ED) and compare these parameters with non-diabetic ED groups. We examined the penile cavernosal tissues, obtained from 22 patients who had undergone surgery of penile prostheses implantation, for the nitrite, nitrate, malondialdehyde (MDA) and glutathione (GSH) levels. Eight patients were suffering from diabetic erectile dysfunction (ED) and 14 patients had non-diabetic ED. Nitrite and nitrate levels were lower; MDA and GSH levels were higher in the diabetic group. There were statistically significant differences between diabetic and non-diabetic groups amongst the nitrite (p<0.001), nitrate (p<0.01), MDA (p<0.001) and GSH (p<0.01) levels. Our data provide evidence that NO deficiency, possibly due to the membrane lipid peroxidation and defective antioxidant defensive mechanism, may contribute to the development of diabetic ED and thus is involved in the pathogenesis of ED in diabetic patients.

Adult↗

PubMed2003

Clinical trial of Butea superba, an alternative herbal treatment for erectile dysfunction.

AIM: To study the effect of Butea superba on erectile dysfunction (ED) in Thai males. METHODS: A 3-month randomized double-blind clinical trial was carried out in volunteers with ED, aged 30 years approximately 70 years, to evaluate the therapeutic effect of the crude preparation of Butea superba tubers on ED. RESULTS: There was a significant upgrading in 4 of the 5 descriptive evaluations of the IIEF-5 questionnaire. Estimation of the sexual record indicated that 82.4% of the patients exhibited noticeable improvement. Haematology and blood chemistry analysis revealed no apparent change. CONCLUSION: The plant preparation appears to improve the erectile function in ED patients without apparent toxicity.

Adult↗

PubMed2006

Current use of penile implants in erectile dysfunction.

Penile implants became popular with the introduction of effective models more than 30 years ago. Today they play a secondary but definitive role in the treatment of erectile dysfunction at times when more conservative therapies have failed. Improvements in reducing the incidence of infection, treating infection with antiseptic washes, enhancing device longevity, and instituting new techniques to manage complicated implantation procedures have made them more acceptable to patients. Although penile implants are the least often chosen and most invasive treatment for erectile dysfunction, they have the highest satisfaction rate--in the range of 80% to 90%--among both patients and partners.

Erectile Dysfunction↗

PubMed1998

Efficacy and safety of oral sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury.

OBJECTIVE: To evaluate the efficacy and safety of 50-mg doses of sildenafil during a 28-day period in patients with erectile dysfunction caused by spinal cord injury (cord level range, T6 through L5). BACKGROUND: Sildenafil is an orally active, potent, and selective inhibitor of phosphodiesterase type 5, an important regulator of cyclic guanosine monophosphate in the human corpus cavernosum. METHODS: To be included in this double-blind, placebo-controlled study, all patients had to be able to achieve at least a partial reflexogenic erectile response to penile vibratory stimulation. The study utilized a single triangular sequential trial design. A total of 27 patients were randomized to receive 50 mg of sildenafil or placebo, taken orally as required (not more than once daily) approximately 1 hour before sexual activity. RESULTS: After 28 days of treatment, nine of 12 patients (75%) on sildenafil and one of 14 patients (7%) on placebo reported that treatment had improved their erections (p=0.0043). Furthermore, eight of 12 patients (67%) on sildenafil and two of 13 patients (15%) on placebo indicated that they wished to continue treatment (p=0.018). A significant improvement in satisfaction with their sex life was reported by patients taking sildenafil (p=0.012). No patients discontinued treatment due to adverse events. CONCLUSION: Oral sildenafil, taken as required (not more than once daily), significantly improves the quality of erections and satisfaction with sex life in men with erectile dysfunction caused by a spinal cord injury between T6 and L5.

Administration, Oral↗

PubMedDate not supplied

[An open non-comparative study of impase for treating erectile dysfunction].

Clinical efficacy and safety of the drug impase in erectile dysfunction (ED) were studied in 30 patients with ED of various genesis (mean age 52.09 +/- 4.75 years). IIED questionnairing was employed, combined andrological examination and standard laboratory investigations. Impase was taken 1 tablet a day each other day for 12 weeks irrespective of the intercourse. The number of attempted intercourses was at least 4 times a month. The treatment efficacy was assessed by changes of IIED parameters, subjective and objective effects. ED was psychogenic in 5 (16.7%) patients, organic in 25 (83.3%) patients. Blood hormones were normal for age in all the patients. According to IIED, "erectile function" mean score after 12 week treatment rose from 18.89 +/- 5.25 to 22.50 +/- 4.86. In 11 (36.7%), 4 (13.3%), 5 (16.7%) patients the response was rated as excellent, good and satisfactory, respectively. No response was stated in 10 (33.3%) patients. Side effects were absent. Tolerance and safety were excellent. Thus, efficacy of impase therapy varied from 60 to 66.7% depending on ED etiology and pathogenesis. Cost-efficacy, absence of side effects, possible parallel therapy of concurrent diseases, course administration are advantages of the treatment.

5'-Nucleotidase↗

PubMed2006

Positive effect of counseling and dose adjustment in patients with erectile dysfunction who failed treatment with sildenafil.

OBJECTIVE: Many patients with erectile dysfunction (ED) stop using sildenafil due to subjective failure. This study examined whether counseling and maximal dosing (100 mg) could achieve better treatment compliance and could possibly improve treatment outcome. MATERIAL AND METHODS: Patients were recruited by newspaper advertisements and referred to 5 ED centers throughout the country. Details about their previous experiences with sildenafil were recorded and following an explicit explanation about the nature and action of the drug, were offered to enter the study. Instructions on drug use were provided during each visit in which four 100 mg Sildenafil tablets were provided. Treatment outcomes were assessed by the international index of erectile function (IIEF) questionnaire after taking 4 and 8 tablets. In 2 ED centers a short video with sexual counseling content was added in between visits. RESULTS: The study cohort was comprised of 220 patients aged 27-88 years. The majority reported having received limited or no instructions on drug use when sildenafil was first prescribed. A significant increase in IIEF erectile function domain scores (EFDS) between visits 1, 2 and 3 was observed (10.96+/-0.40, 16.73+/-0.51 and 17.82+/-0.55 mean+/-SE, respectively), with 23.6% of the study patients achieving normal erectile function at the end of the study. The parameters of age and initial severity of ED most influenced treatment success. CONCLUSIONS: Counseling and dose adjustment were directly influential in achieving an excellent response to a second trial of sildenafil in patients with ED who had previously failed treatment with the drug, and obviated their needing to seek more invasive measures.

Adult↗

PubMed2000

Cardiovascular effects of oral pharmacotherapy in erectile dysfunction.

Several drugs have been developed to treat patients with erectile dysfunction (ED). In general, patients prefer orally administered drugs. The use of these drugs (e.g. sildenafil and apomorphine) is reviewed. Because ED is a common problem in men with vascular disease it is important to assess the effect of these drugs on the cardiovascular system. The safe use of these drugs in patients with vascular disease needs to be clearly established in appropriately designed trials.

Arginine↗

PubMed2002

[Prevalence of erectile dysfunction in France: results of an epidemiological survey conducted on a representative sample of 1004 men].

OBJECTIVE: Several studies have recently reported the prevalence rates of erectile dysfunction (ED) that vary according to the country. The authors report the results of a survey conducted in France in 2001. MATERIAL AND METHODS: This study was conducted by telephone conversation with a representative sample of 1,004 men over the age of 40. The prevalence of ED was measured by the patient's self-assessment and by the IIEF-5 index. RESULTS: The results show that about 1 man in 3 (31.6%) suffers from ED in France, which is essentially mild to moderate (according to IIEF-5). The majority of men reporting ED declared to be dissatisfied with their relationship with their partner. Finally, a large proportion of men declared that they would be willing to consult a practitioner. CONCLUSION: This survey confirms the high prevalence of erectile dysfunction in France. It is responsible for a distress that is still difficult to express and assess. This disease needs to be more accurately evaluated by rigorous and standardized methods, especially as simple and effective treatments are now available.

Adult↗

PubMed1998

Treatment of erectile dysfunction by an external ischiocavernous muscle stimulator.

OBJECTIVE: The aim of the present study was to evaluate the therapeutic potency of an electrotherapy of striated ischiocavernous muscles in patients with erectile dysfunction. PATIENTS AND METHODS: Transcutaneous electrostimulation of striated ischiocavernous muscles by self-adhesive penile or perineal skin electrodes was performed in 48 patients with erectile dysfunction. 6/48 patients (R) responded to intracavernous pharmacotherapy while 42/48 (NR) did not show significant penile rigidity even to intracavernous papaverine/phentolamine/PGE1 triple drug medication. RESULTS: Within the observation time of 3 months, 10/48 patients dropped out. 22/38 patients reported a penile rigidity for sufficient sexual intercourse whereby 3/22 NR required additional intracavernous pharmacotherapy. Penile rigidity could be objectivated by triple drug medicaton in 12/14 NR after ischiocavernous muscle stimulation (EIS) therapy. 5/6 R were treated successfully for premature erection loss. During EIS treatment neither discomfort nor complications could be observed. CONCLUSION: Transcutaneous electrostimulation of ischiocavernous muscles is a new, noninvasive therapy for the improvement of penile rigidity. The clinical results underline the importance of the striated ischiocavernous muscles for penile rigidity.

Adult↗

PubMed1998

Erectile dysfunction in aging: upregulation of endothelial nitric oxide synthase.

OBJECTIVES: To evaluate whether alterations in nitric oxide (NO) synthesis or activity contribute to age-related erectile dysfunction and to elucidate the mechanisms causing these alterations using the rabbit as our model of aging. METHODS: We compared the ability of the rabbit cavernosal smooth muscle to relax in the organ bath in response to acetylcholine (Ach, endothelium-dependent vasodilator), sodium nitroprusside (SNP, an NO donor), and A23187 (a calcium ionophore) in young (6 month old) and aged (2.5 to 3.5 year old) rabbits. In addition, the immunohistochemical expression of endothelial nitric oxide synthase (eNOS) in both young and aged rabbit cavernosal tissue was examined. Endothelial integrity was examined immunohistochemically with JC70. RESULTS: Ach-mediated relaxation of penile corporal tissue was significantly attenuated from a maximum of 68.39 +/- 6.27 (0.1 mM Ach, n = 4) in young rabbits to 39.02 +/- 4.88 (0.1 mM Ach, n = 6) in aged rabbits (P < 0.04). No statistically significant difference (P > 0.05) was noted between cavernosal relaxation to sodium nitroprusside between young rabbits (97.8%, 0.1 mM SNP, n = 5) and aged rabbits (76.1%, 0.1 mM SNP, n = 5). This suggested that the defect in the Ach-NO pathway was at the level of NO synthesis, not activity. Immunohistochemical staining for eNOS demonstrated upregulation in both the vascular endothelium and corporal smooth muscle of aged rabbit tissue compared with young rabbit cavernosal tissue (n = 5). Anatomic endothelial integrity was demonstrated in the young and aged rabbits by the presence of JC70. This suggested that the defect in the Ach-NO synthetic pathway was not at the level of eNOS and was not due to anatomic endothelial cell disruption. Finally, Ach-mediated cavernosal smooth muscle relaxation in the young rabbit was not significantly augmented (P > 0.05) in the presence of the calcium ionophore A23187 (10 microM). A23187, however, significantly augmented (P < 0.04) Ach-mediated relaxation in the aged rabbit from a maximum of 33.93 +/- 6.58 to 41.55 +/- 6.58 (10 microM Ach, n = 5). This suggested that a potential defect in the Ach-NO synthetic pathway was at the level of intracellular calcium flux and possibly at the level of the calcium-eNOS interaction. CONCLUSIONS: Endothelium-dependent relaxation is attenuated in the aging rabbit; eNOS is upregulated in the aging rabbit; and no difference is noted in response to direct NO donation between the young and aged rabbit. The endothelium is anatomically intact in both the young and aging rabbit. The calcium ionophore A23187 augmented the attenuated vasorelaxation in the aging rabbit cavernosum (although not to the levels seen in the young rabbit cavernosum) and had no effect on the young rabbit cavernosum. These data suggest that erectile dysfunction in the aging rabbit cavernosum appears to be related to endothelial dysfunction and is characterized by eNOS upregulation and aberrant intracellular calcium fluxes.

Acetylcholine↗

PubMed2003

Tadalafil: a new agent for erectile dysfunction.

Oral phosphodiesterase 5 (PDE5) inhibitors for the treatment of erectile dysfunction are preferred by most men, and are recommended in guidelines as first-line therapy, because of convenience, high efficacy, and low rates of side effects. Tadalafil (Cialis) is a new agent that has been studied in different patient populations. It has a different molecular structure than other PDE5 inhibitors, and a different pharmacologic profile that provides a longer period of effectiveness than other agents. This article will review clinical trials on tadalafil, to provide a comprehensive overview of its efficacy and safety.

Administration, Oral↗

PubMed2006

[Whole rehabilitation: a new goal of erectile dysfunction therapy].

Phosphodiesterase type 5 (PDE5) inhibitors effectively enhance the erectile function of the patients with erectile dysfunction (ED). The use of sildenafil citrate is expanding to a broader extent. Pulmonary artery hypertension has become a new indication of sildenafil. Sildenafil could improve the epithelial function in several vascular conditions in clinical trials. This article reviews the recent advances on basic and clinical studies of ED and sildenafil. On animal models, sildenafil could resume the cavernous epithelial function, up-regulate the protein expression of phosphorylated endothelial NO synthase (eNOS), reverse the decreased intracavernosal pressure (ICP) induced by pudendal artery blood flow restriction or hypoxia. In clinical studies, over 50% of ED patients receiving sildenafil got a fully rigid erection (grade 4 erection). And the same percentage of post-nerve-sparing radical prostatectomy patients receiving sildenafil obtained penile rehabilitation and spontaneously resumed erection sufficient for sexual intercourse. Sildenafil treatment has contributed to the normalization of self-esteem, confidence and sexual harmony in men with ED. All this suggests that a whole rehabilitation from erectile to psychosocial function may become a new goal of ED therapy.

Animals↗

PubMed1986

MMPI evaluation of erectile dysfunction: failure of organic vs. psychogenic decision rules.

This study examined previously published decision rules to ascertain the empirical utility of the MMPI in discriminating between organic and psychogenic erectile dysfunction. Subjects were 41 males who were being evaluated for prosthesis implant surgery. The mean overall 1-2-3 MMPI profile revealed diffuse somatic complaints, depression, and denial. Results indicate that the MMPI failed to discriminate between organic and psychogenic subgroups. Men with psychogenic erectile dysfunction evidenced neither significantly more nor less psychopathology on the MMPI than did those with objective organic findings.

Diagnosis, Differential↗

PubMed2004

Efficacy and safety of sildenafil citrate in men with erectile dysfunction and stable coronary artery disease.

This was a double-blind, placebo-controlled, flexible-dose study of the efficacy and safety of sildenafil in men with erectile dysfunction (ED) and clinically stable coronary artery disease (CAD). Patients were randomized to receive sildenafil or placebo for 12 weeks. Primary outcomes were questions 3 and 4 of the International Index of Erectile Function (IIEF). Secondary outcomes included the other IIEF questions and functional domains, the Life Satisfaction Checklist, the Erectile Dysfunction Inventory of Treatment Satisfaction, 2 global efficacy assessment questions, and intercourse success rate. By week 12, sildenafil-treated patients (n = 70) showed significant improvements on questions 3 and 4 compared with placebo-treated patients (n = 72; p <0.01). Larger percentages of sildenafil-treated patients reported improved erections (64%) and improved intercourse (65%) compared with placebo-treated patients (21% and 19%, respectively). Sildenafil-treated patients were highly satisfied with treatment and their sexual life compared with placebo-treated patients. Forty-seven percent of sildenafil- and 32% of placebo-treated patients experienced adverse events, including transient headache, hypertension, flushing, and dyspepsia. There were no serious drug-related cardiovascular effects. Thus, sildenafil is an effective and well-tolerated treatment for ED in men with CAD. Sildenafil was not associated with additional safety risks in this patient population.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2001

Vasomax for the treatment of male erectile dysfunction.

This paper reviews laboratory and clinical data concerning oral phentolamine mesylate, Vasomax, an alpha-1, alpha-2 adrenergic receptor antagonist developed specifically for treatment of erectile dysfunction. A contemporary view of the neurovascular mechanisms in penile erection includes the effects of both smooth muscle relaxation and contraction. Contraction of the cavernosal arteries and trabecular smooth muscle appears to be predominantly under the control of alpha-adrenergic innervation. Conversely, adrenergic blockade of alpha-1 and alpha-2 receptors has been shown to facilitate penile erection in both animal and human models. The pharmacokinetic profile of Vasomax appears well suited for an oral erectogenic agent. Vasomax is rapidly absorbed and eliminated in normal males. Peak plasma concentrations are achieved in 30-60 min, and the half-life approximates 5-7 h. Food decreases the rate, but not the extent of bioavailability. Vasomax has low protein binding and is excreted primarily via urine and feces. There is a strong dose-response relationship in maximum plasma concentration (Cmax) and area under the curve (AUC), and there are no clear age-related differences in absorption or elimination rates. Efficacy of Vasomax has been systematically evaluated in two (ZON300, ZON301) large-scale, placebo-controlled trials, in addition to two long-term open-label studies. In both studies, Vasomax was associated with significant improvements in the erectile function domain scores of the International Index of Erectile Function (IIEF). Further improvements were noted as the duration of treatment and dose level were increased. The percentage of successful penetration attempts was also significantly improved with Vasomax compared to placebo. For patients who continued in open-label treatment with Vasomax, efficacy was generally well maintained. Vasomax was well tolerated by the majority of patients. The most common side effects observed were nasal congestion (10%), headache (3%), dizziness (3%), tachycardia (3%) and nausea (1%). Side effects were generally dose-related and in the mild-to-moderate range in all three studies. Furthermore, side effects seldom resulted in treatment discontinuation. Very few serious adverse events were observed in these trials. In summary, Vasomax appears to be effective in the treatment of male erectile dysfunction and well-tolerated by the majority of patients. The drug has a satisfactory side effect profile, without significant risk of cardiovascular effects. Results of clinical trials with Vasomax support the concept of adrenergic-blockade as a clinically relevant mechanism in the control of penile erection.

Adrenergic alpha-Antagonists↗