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PubMed2004

Sildenafil citrate for erectile dysfunction in men receiving multiple antihypertensive agents: a randomized controlled trial.

BACKGROUND: Erectile dysfunction (ED) is common among men taking antihypertensive drugs to control blood pressure. We evaluated the safety and efficacy of sildenafil citrate for treating ED in men taking multiple antihypertensive medications in a randomized, double-blind, placebo-controlled trial. METHODS: A total of 568 men (> or =18 years) with ED and hypertension who were taking two or more antihypertensives were randomized to sildenafil (n = 281) or matching placebo (n = 287) for a 6-week double-blind trial followed by a 6-week open-label phase during which all patients received sildenafil. Primary efficacy variables were questions (Q) 3 and 4 (frequency of erections and penetration) of the International Index of Erectile Function (IIEF), and secondary efficacy variables were two global efficacy assessment (GEA) questions regarding improvement in erections and intercourse. RESULTS: A total of 562 men (mean age, 59 years) took > or =1 dose of study drug. At week 6, mean scores on both Q3 and Q4 improved significantly among sildenafil-treated compared with placebo-treated patients. In regard to Q3 and Q4 there were no differences between patients taking two and those taking three or more antihypertensive agents. In all, 71% and 69% of sildenafil-treated patients reported improved erections (GEA1) and intercourse (GEA2) compared with 18% and 20% of placebo-treated patients, respectively. By week 12, >80% of all patients (regardless of initial treatment group) had improved erections and intercourse. During double-blind treatment, 40% of sildenafil-treated and 25% of placebo-treated patients experienced adverse events; fewer than 2% in each group discontinued because of adverse events. CONCLUSIONS: Sildenafil was an effective and well tolerated treatment for ED in men receiving multiple antihypertensives. The results suggest that there were no additional safety risks associated with the use of sildenafil in these patients.

Adolescent↗

PubMed2006

Erectile dysfunction in an urban HIV-positive population.

The International Index of Erectile Function (five-item version) was used to assess the prevalence and risk factors of erectile dysfunction (ED) in an HIV-positive urban population of men. The prevalence of ED was found to be 74%. Age, CD4 count, history of opportunistic infections, highly active antiretroviral therapy (HAART) use, and serum testosterone level were not significantly associated with ED in this study. These results emphasize the high prevalence of ED in HIV-positive men.

Adult↗

PubMed2004

3-Thio-quinolinone maxi-K openers for the treatment of erectile dysfunction.

A series of Maxi-K openers for the treatment of erectile dysfunction based on the 3-thio-quinolinone core is described. Significant levels of channel opening (up to 550% of control) are seen in transfected oocytes. Functional activity in rabbit corpus cavernosum tissue strips confirms the potential to effect therapy for ED, the effect being maximal for the 3-amino-2-hydroxy thiol side chain.

Animals↗

PubMed2005

Relation of endothelial cell function to erectile dysfunction: implications for treatment.

The prevalence of both cardiovascular disease (CVD) and erectile dysfunction (ED) increases with advancing age. These conditions share the common risk factors of diabetes mellitus, hypertension, hyperlipidemia, smoking, and obesity. They also share a pathophysiologic mechanism of decreased vascular blood flow via endothelial dysfunction. There are several lines of evidence that endothelial dysfunction in men with ED can be detected well before overt manifestations of vascular damage, including atherosclerotic effects. Some evidence shows that ED can be improved not only with phosphodiesterase 5 inhibitors but also by treating the risk factors directly. This includes cessation of smoking, correction of hyperlipidemia, and amelioration of obesity through weight loss. Conversely, ED may be prevented through maintenance of lean body mass, consistency of physical activity, and smoking abstinence, similar to other risk factors for CVD.

Endothelial Cells↗

PubMed1998

[Use of prostaglandin E1 for treatment of erectile dysfunction].

Recently there has been observed a significant increase in frequency of erectile dysfunction in Poland. Contemporary methods of the therapy of this disturbance are based not only on psychotherapy, oral drugs and other non invasive methodes, but on intracavernous injection of vasodilatory agents as well. The objective of the study was to evaluate the efficiency of intracavernous quick self-injection of prostaglandin E1 implementing automatic "SELFINJECT" device. Authors achieved 93% of positive results. That method seems to be safe and well tolerated.

Adult↗

PubMed2005

Prevalence and risk factors for erectile dysfunction in 2869 men using a validated questionnaire.

PURPOSE: To assess prevalence and risk factors for erectile dysfunction (ED) by using the International Index of Erectile Function- 5 (IIEF-5) in men undergoing a health investigation. METHODS: Men aged 20-80 years participating in a health-screening project in the area of Vienna completed the IIEF-5 for evaluation of ED. In parallel, all men underwent a detailed health examination including physical assessment, evaluation of various life-style factors, medical history and a blood analysis. RESULTS: A total of 2869 men were analysed. According to the IIEF-5 score, 32.2% reported on any degree of ED (IIEF-5 score <22), 23.7% had mild ED (IIEF-5 score 17-21), 5.0% mild to moderate ED (IIEF-5 score 12-16), 2.2% moderate ED (IIEF-5 score 8-11) and 1.3% severe ED (IIEF-5 score 5-7). The proportion of men with ED remained stable from 20 to 50 years (26-29%) and increased thereafter to 37.5% (51-60 years) and to 71.2% in those 71-80 years of age. Severe ED (IIEF-5 score 5-7) increased from 0.4% (20-30 years) to 0.5% (41-50 years), 1.3% (51-60 years) and to 9.6% in those aged 71-80 years. Risk factors for ED were age, diabetes (OR: 3.0; 95%CI: 1.53-5.87), hyperlipidemia (OR: 2.29; 95%CI: 1.42-3.7), lower urinary tract symptoms (OR: 2.2; 95%CI: 1.76-2.76), hypertension (OR: 2.05; 95%CI: 1.61-2.6), psychological stress (OR: 1.68; 95%CI: 1.43-1.98) and low physical activity (OR: 1.35; 95%CI: 1.15-1.6) (all, p < 0.05). CONCLUSION: Overall, 32.2% of men in our study had ED according to the IIEF-5. Apart from age, most important risk factors for ED were diabetes, hyperlipidemia, lower urinary tract symptoms, hypertension and psychological stress.

Adult↗

PubMed2000

Erectile dysfunction, sildenafil and cardiovascular risk.

Cardiovascular risk factors are commonly associated with erectile dysfunction and should be identified and treated. Patients with cardiovascular diseases should be assessed and counselled regarding their fitness for sexual activity. The danger of concurrent use of sildenafil and nitrates under any circumstances, regardless of age and sex, must be highlighted at all levels of the community. Sildenafil is absolutely contraindicated in patients receiving treatment with long-acting nitrates for ischaemic heart disease. Patients who need sublingual short-acting nitrates infrequently should not be precluded from taking sildenafil, provided they are aware that sildenafil is not to be taken within 24 h of taking the nitrate.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2001

Is erectile dysfunction a marker for cardiovascular disease?

There is now significant evidence that erectile dysfunction (ED) can be a symptom of cardiovascular disease, and can act as a marker for disease progression. National Health Service (NHS) prescribing restrictions on treatments for ED have recently been reviewed by the Department of Health, and current arrangements will not change. Unrestricted availability of licensed treatments for ED on the NHS, irrespective of the cause of the ED, may encourage men to present for investigation, enabling early detection of cardiovascular disease. Sildenafil citrate (Viagra), an effective treatment for ED, can also have a direct beneficial effect on cardiovascular disease. Unrestricted NHS availability of ED treatments such as sildenafil could facilitate greater achievement of National Service Framework targets for coronary heart disease.

Adult↗

PubMedDate not supplied

Erectile dysfunction and depression: category or dimension?

Depression, as a risk factor for erectile dysfunction (ED), has received minimal systematic attention. One-hundred twenty men with ED evaluated in a sexual behaviors clinic were studied. The categorical Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994) diagnosis of a depressive disorder was found in only 14 subjects (14.7%). Dimensional quantification of depression was measured with the Brief Symptom Inventory (BSI). The BSI data revealed clinically significant elevations of depression and other dysphoric affects. The presence of a comorbid medical diagnosis did not affect the rates of categorical diagnosis of depression or the dimensional levels. The five factors of personality in the NEO-PI were within normal range. The data demonstrates that men with ED are affectively distressed but infrequently meet criteria for categorical DSM-IV depression.

Major Depressive Disorder↗

PubMed2003

Under-reporting of erectile dysfunction among men with unrelated urologic conditions.

To evaluate the incidence of erectile dysfunction (ED) in men with unrelated urologic conditions paying special attention to the reasons for patient under-reporting. We asked 500 consecutive men over age 50 visiting their urologist's office for problems unrelated to ED, whether or not they had any difficulty with their potency. Those who gave a positive response were then asked to complete a questionnaire to assess their reasons for under-reporting and whether they had had any previous discussions with their primary-care physicians regarding their sexual function. Out of 500 men, 218 (44%) reported experiencing some degree of ED. Reasons for failure to discuss ED with their urologist included: 161 out of 218 (74%) were embarrassed; 27 out of 218 (12%) felt that ED was a natural part of aging; 20 out of 218 (9%) were unaware that urologists dealt with the problem of ED; and 10 out of 218 (5%) did not consider the problem worthy of attention. Only 48 of the 218 men with ED reported having previous discussions about their problem with their primary-care physicians. Of the 170 patients who did not report having such discussions, 140 (82%) reported that they would have liked their primary-care physician to have initiated a discussion of ED during their routine visits. In conclusion. a significant percentage of older men with some unrelated urologic complaint also suffer from some degree of ED and remain undiagnosed unless specifically questioned about this problem. By far, the most common reason for under-reporting of ED was patient embarrassment. While urologists are able to elicit information regarding erectile function on specific questioning, patients appear comfortable and willing to discuss their potency with primary-care physicians.

Aged↗

PubMed1998

Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group.

BACKGROUND: Sildenafil is a potent inhibitor of cyclic guanosine monophosphate hydrolysis [corrected] in the corpus cavernosum and therefore increases the penile response to sexual stimulation. We evaluated the efficacy and safety of sildenafil, administered as needed in two sequential double-blind studies of men with erectile dysfunction of organic, psychogenic, and mixed causes. METHODS: In a 24-week dose-response study, 532 men were treated with oral sildenafil (25, 50, or 100 mg) or placebo. In a 12-week, flexible dose-escalation study, 329 different men were treated with sildenafil or placebo, with dose escalation to 100 mg based on efficacy and tolerance. After this dose-escalation study, 225 of the 329 men entered a 32-week, open-label extension study. We assessed efficacy according to the International Index of Erectile Function, a patient log, and a global-efficacy question. RESULTS: In the dose-response study, increasing doses of sildenafil were associated with improved erectile function (P values for increases in scores for questions about achieving and maintaining erections were <0.001). For the men receiving 100 mg of sildenafil, the mean score for the question about achieving erections was 100 percent higher after treatment than at base line (4.0 vs. 2.0 of a possible score of 5). In the last four weeks of treatment in the dose-escalation study, 69 percent of all attempts at sexual intercourse were successful for the men receiving sildenafil, as compared with 22 percent for those receiving placebo (P<0.001). The mean numbers of successful attempts per month were 5.9 for the men receiving sildenafil and 1.5 for those receiving placebo (P<0.001). Headache, flushing, and dyspepsia were the most common adverse effects in the dose-escalation study, occurring in 6 percent to 18 percent of the men. Ninety-two percent of the men completed the 32-week extension study. CONCLUSIONS: Oral sildenafil is an effective, well-tolerated treatment for men with erectile dysfunction.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2005

Predictors for erectile dysfunction among diabetics.

This study aims to examine the predictors related to erectile dysfunction (ED) among Chinese diabetics. From 1995 to 1999, 327 men with diabetes mellitus (DM) were enrolled into this study. They completed face to face interview, professional psychogenic assessment, measurements of penile hemodynamic parameters and measurements of hormone levels. Complications of diabetes were obtained from hospital medical records. One hundred and twenty nine diabetics were diagnosed as ED. The associations between individual predictor and ED were accessed using both univariate and multivariate logistic regression models. We found that the risk of ED was significantly associated with age (adjusted odd ratios (OR) = 1.16, 95% confident intervals (CI): 1.10-1.38), duration of DM (adjusted OR = 1.30, 95% CI: 1.28-1.87), lower physical activity (adjusted OR = 1.67, 95% CI: 1.15-3.03), retinopathy (adjusted OR = 1.15, 95% CI: 1.01-1.89), neuropathy (adjusted OR = 2.07, 95% CI: 1.54-3.06) and depression (adjusted OR = 1.46, 95% CI 1.32-2.56). The study shows that diabetics with ED suffer more serious complications than those patients with non-ED. ED may act as a sentinel event for underlying complications among male diabetics.

Adult↗

PubMedDate not supplied

Drug combinations in the therapy of low response to phosphodiesterase 5 inhibitors in patients with erectile dysfunction.

Combinatorial drugs utilising a clinically-proven single agent approach in erectile dysfunction (ED) have led to the search for additional compounds to improve therapy and the safety profile. Selective inhibitors of Phosphodiesterase type 5, such as Sildenafil, demonstrate a defined failure rate in ED. The therapeutic concept to increase blood influx and or to decrease blood efflux in patients with ED under therapy encountered severe drawbacks. It appeared impossible to decrease the NO-content in the corpora cavernosa and associated organs followed by synchronized increase of NO by a second drug. One has to metabolically activate cAMP by the first acting compound followed by cGMP stimulation. The pharmacology of the counteractive drugs was investigated clinically and a combination of 50 mg sildenafil with 5 mg dihydro-ergotamine (DHE) was identified as of practical use in patients with low response to Sildenafil. The safety profile appeared to be improved by this combination therapy. The present study is a clinical follow-up of patients treated with different therapeutical regimens to document the effectiveness of Sildenafil in combination with DHE.

Adult↗

PubMed1999

Sildenafil: a new oral therapy for erectile dysfunction.

Sildenafil citrate (Viagra) is a relatively selective 5-phosphodiesterase (PDE) inhibitor. It is the first oral medication approved for the treatment of erectile dysfunction (ED). The neuronal release of NO which binds to the heme-containing region of guanylate cyclase increases levels of cGMP. This leads to a cascade of reaction which results in corporal smooth muscle relaxation and penile erection. Sildenafil causes an erection by inhibiting PDE5, which in turn causes an increase in the intracellular levels of cGMP. Sildenafil is well absorbed after a single oral administration with a t(1/2) of approximately 4 h. The mode of onset varies from 0.5-4 h. The drug has been used in millions of men since first approved by the U.S. FDA 1 year ago and has revolutionized the approach to, and therapy of, erectile dysfunction.

Journal Article↗

PubMed2001

Emergency sperm extraction for transient erectile dysfunction prior to assisted conception.

PURPOSE: During assisted conception treatment the male partner is under stress and consequently can fail to produce semen sample prior to egg collection. Failure to produce spermatozoa at a given time could lead to cancellation of the procedure. METHODS: We report the use of emergency percutaneous epididymal sperm aspiration (PESA) for temporary erectile dysfunction in a couple undergoing in vitro fertilization treatment. In the last 2 years, we saw three men who failed to produce a semen sample on the day of their partners' egg collection procedure. RESULTS: In the first case the male partner failed to produce semen after egg collection and the cycle was canceled. This clinical scenario was likely to recur and one of the options was to consider PESA. In the second case the male partner was counseled about the availability of PESA but he managed to produce spermatozoa at home. The third patient was unable to produce a semen sample despite being provided audiovisual support and being allowed to go home. Five hours after the egg collection, emergency PESA was performed after appropriate counseling. The procedure yielded motile spermatozoa which were used for intracytoplasmic sperm injection which resulted in successful fertilization, embryo transfer, and pregnancy. CONCLUSIONS: This case emphasizes that surgical procedures, such as PESA,TESA, and TESE, are useful alternatives but should be the last option to obtain sperm for ART. Other nonsurgical procedures, such as audiovisual aids, producing sperm at home, and the use of sildenafil citrate (Viagra) must be offered first to men with temporary erectile dysfunction during ART treatment.

Epididymis↗

PubMed1990

[Analyses of factors contributing to the erectile dysfunction with aging by nocturnal penile tumescence, penile blood pressure index and papaverine test].

To evaluate the factors contributing to the decline in erectile function with age, we performed measurement of nocturnal penile tumescence (NPT) and penile vascular examinations in 407 men. The following results were obtained. 1) The penile circumferential increment during NPT measured by an erectometer was gradually decreased with age, especially markedly after 60 years of age. The percentage of subjects in whom the NPT was less than 10 mm increased with age: 2.7% in the 5th decade, 7.1% in the 6th decade, 16.7% in the 7th decade and 29.1% in the 8th decade. These findings indicate that the incidence of organic erectile dysfunction increased with age. 2) To evaluate the penile vascular status, measurement of penile blood pressure index (PBPI) and papaverine test were performed. The mean PBPI values were significantly decreased in the subjects over 70 years of age. The percentage of subjects having good response to papaverine injection obviously decreased with age: 66.7% between 50 to 59 years, 48.6% between 60 to 69 years, and 15.8% of over 70 years. All subjects in whom the NPT was less than 10 mm showed either a low PBPI level of less than 0.6 or an incomplete response to papaverine injection. These results suggest that penile vascular impairment plays a major role in the age-associated decline in erectile function. 3) We investigated the relationship between cigarette smoking and penile vascular impairment. Smokers showed not only lower PBPI values but higher incidence of the incomplete response to papaverine injection than nonsmokers. Therefore, it is considered that cigarette smoking is a significant risk factor in the erectile dysfunction that occurred in the aged.

Adult↗

PubMed2001

Prognostic factors for response to sildenafil in patients with erectile dysfunction.

OBJECTIVE: To assess the clinical efficacy of sildenafil as treatment for erectile dysfunction (ED) the factors associated with treatment failure were investigated. METHODS: Open, prospective study including 244 patients suffering from ED who were evaluated by anamnesis, physical exploration, blood test, dynamic penile color duplex ultrasonography and Sexual Health Inventory for Male (SHIM). The efficacy of sildenafil was assessed by repeating the SHIM 2 months after therapy, independent of the final dose used. Side effects were also recorded. Factors influencing treatment outcome were evaluated by univariate and multivariate statistical analysis. RESULTS: Overall, sildenafil was effective in 56.8% of 213 eligible patients. When the etiologic diagnosis was not included in the multivariate analysis, antecedents of diabetes mellitus, non-nerve-sparing radical prostatectomy and SHIM basal score were selected as predictors of a poor response. In a second analysis including etiologic diagnosis, only SHIM basal score and etiological diagnosis proved to be of prognostic value. Side effects were noticed by 24.4% of patients, none of them being severe. CONCLUSIONS: Sildenafil is a rather effective and well-tolerated treatment for ED. The basal severity of ED and etiological diagnosis are the prognostic factors most significantly associated with treatment outcome.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed2006

How do men perceive erectile dysfunction and its treatment? A qualitative study on opinions of men.

INTRODUCTION: Erectile dysfunction (ED) is a common medical disorder affecting the aging male. A man's perception of a disease affects his health seeking behaviour. This study aimed to explore perceptions of ED among men with ED and how these perceptions came about. METHODS: This qualitative study utilized in-depth interviews involving 17 urban men aged between 40 and 75 years old. RESULTS: Misconceptions existed regarding the definitions of ED. Most men perceived impotence to be more serious than ED. Although most were aware of the medical causes of ED, 'overuse of penis' and black magic were mentioned as culturally-related causes. ED was perceived as a serious problem associated with loss of manhood and it had a significant impact on relationships with their partners. However, some adopted an 'accepting' view and attributed it to aging and fate. Most men were only familiar with PDE-5 inhibitors and traditional therapies. PDE-5 inhibitors were perceived to be effective but they were concerned about side effects and costs. CONCLUSIONS: Identifying men's perceptions of ED and its treatment would help doctors in their consultation, and inform health policy makers in planning appropriate public education and services.

3',5'-Cyclic-GMP Phosphodiesterases↗