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PubMed1998

[Rational diagnosis of erectile dysfunction].

In diagnostics of erectile dysfunction there are different simple or large-scale procedures available. Referring to a three-step-scheme that makes difference in the diagnostics in I. non-invasive, II. semi-invasive and III. invasive procedures the current diagnostic measures will be explained. To the non-invasive measures do account the extensive patients history taking including the sexual history and the psychological diagnostics, the physical examination and laboratory screenings. The semi-invasive procedures include the intracavernous injection test with vasoactice substances, the doppler sonography and duplex or color duplex sonography, the corpus-cavernosum-electromyogram (CC-EMG) and other neurophysiological examinations. The third invasive step contains the dynamic infusion pharmacological cavernosography and cavernosometry (DICC) and the selective pharmacological phallo-arteriography. The procedures of this step are essentially limited to patients with erectile dysfunction who are planned for surgical interventions.

Diagnosis, Differential↗

PubMed2003

Erectile dysfunction after surgical treatment.

Erectile dysfunction is a recognized complication of prostate and bladder radical surgery, although there is significant variation in the reported risk, much of this variability is related to the retrospective nature of most previous studies. Undoubtedly, the quality of life of bladder and prostate cancer patients would be much improved if both normal micturition and potency are preserved, which is the subject of this article. Quality of life studies can delineate sexual function after radical prostatectomy, including the use of sexual aids. Penile erection is a neurovascular event modulated by neurotransmitters and hormonal status. The penis is innervated by autonomic and somatic nerves. Both surgery and radiation therapy appear to affect such a mechanism. Radiation is thought to produce Erectile Dysfunction (ED) by accelerating microvascular angiopathy causing cavernosal fibrosis or stenosis of the pelvic arteries and by accelerating existing arteriosclerosis, leading to vascular impotence. Years may elapse before clinically significant ED occurs. Criteria that influence recovery of erections after surgery include younger patient age, stronger erections before operation, preservation of the neurovascular bundles, and attention to fine details in the surgical technique. Recovery of erections occurs in 68% of preoperatively potent men treated with bilateral nerve-sparing surgery and in 47% of those treated with unilateral nerve-sparing surgery.

Erectile Dysfunction↗

PubMed2001

Socioeconomic considerations in erectile dysfunction treatment.

The socioeconomics of erectile dysfunction have been changed greatly by the introduction of the successful oral therapy, sildenafil. The population of patients presenting for treatment of erectile dysfunction has expanded significantly and rapidly. This article addresses the descriptive and analytic economic implications of erectile dysfunction treatment.

Cost of Illness↗

PubMed1999

Erectile dysfunction in patients with diabetes.

Erectile dysfunction, which is common among men with diabetes, leads to significant reduction in quality of life, and as with other complications of diabetes deserves to be treated on the NHS. This article explores the problem of erectile dysfunction and diabetes and the role of sildenafil, which is likely to be the first choice treatment of patients presenting with erectile dysfunction.

Diabetes Complications↗

PubMed1999

Differential gene expression of growth factors in young and old rat penile tissues is associated with erectile dysfunction.

The molecular mechanisms of erectile dysfunction with aging are unclear. Recent studies have suggested that growth factors may play a role in the etiology of erectile dysfunction. This present study was designed to test the hypothesis that gene expression of various growth factors such as TGF alpha, TGF beta 1, TGF beta 2, TGF beta 3, IGF and NGF modulate with aging in rat penile tissues. For this purpose, total RNA was extracted from young and old rat penile tissues and the gene expression for these growth factors was determined by differential reverse-transcriptase-polymerase chain reaction (RT-PCR) using specific oligonucleotide primers. mRNA levels of growth factors were quantified by using beta-actin as an internal standard. The results of these experiments suggest that: (1) young and old rat penile tissues expressed mRNA transcripts for TGF alpha, TGF beta 1, TGF beta 2, TGF beta 3, IGF and NGF; (2) TGF beta 1 gene expression was significantly increased in old rat penile tissues as compared to young; (3) mRNA transcripts for NGF and TGF beta 3 were significantly lower in old rat penile tissues as compared to young; and (4) TGF alpha, TGF beta 2 and IGF mRNA expression did not change in young and old rat penile tissues. These results suggest that the differential gene expression for various growth factors in young and old rat penile tissues may be important in understanding the pathophysiology of erectile dysfunction associated with aging.

Aging↗

PubMed2001

[Erectile dysfunction].

Diagnostics and therapy of erectile dysfunction are currently one of the main issues dealt with by urologists. The Androcheck--the recommended annual medical checkup for men above 50 years of age--has taken this fact into account. Nearly 10% of all men suffer from persistent erectile malfunction. In addition to age, typical risk factors are diabetes, hypertonia, chronic nicotine abuse, other chronic illnesses as well as operations in the pelvis. Modern diagnostics work in three steps and take into consideration from the beginning the therapeutical requests by both the patient and his partner. The more invasive the therapy, the more extensive as well as comprehensive the preliminary diagnostics must be. After the obligatory basic examination, a Sildenafiltest may already present a satisfactory solution for therapy. With the introduction of this first potent oral drug for the therapy of erectile dysfunction, the status of all other therapy options has changed as a consequence. The indication for semi-invasive therapies such as intraurethral applications of prostaglandin E 1 or invasive methods such as the auto-injection therapy have become far more rare. On the other hand, patients who have been dissatisfied with these methods or other oral drugs may sometimes be successfully treated with Sildenafil. The diversity of therapeutical options should, however, be used for combining methods in order to successfully treat all patients suffering from erectile dysfunction. It goes without saying that primary or concomitant psychotherapy or couple therapy should not be left out.

Aged↗

PubMed1997

[Bromocriptine monotherapy of a prolactinoma causing erectile dysfunction].

OBJECTIVE: A case of erectile dysfunction in a patient with prolactinoma is described herein. METHODS/RESULTS: The literature on the incidence, diagnosis and therapeutic management of this condition is reviewed. Impotence may arise from several causes. It is widely accepted that 30-50% have an organic etiology, with vascular involvement being more prevalent than other causes (neurological, endocrinological, urological, iatrogenic, pharmacological, systemic diseases). Hyperprolactinemia, arising from a prolactinoma, is one of the endocrinological conditions causing impotence. In men, this endocrinological disorder is rarely accompanied by other clinical anomalies, such as gynecomastia, galactorrhea or signs of a pituitary tumor. The patient described herein presented with erectile dysfunction. During evaluation, he was found to be hyperprolactinemic. Subsequent assessment disclosed a pituitary adenoma. The patient was successfully treated with bromocriptine. CONCLUSION: Erectile dysfunction arising from hyperprolactinemia is uncommon. Serum prolactin levels, a lateral skull x-ray and CT/MRI are essential in the diagnosis and treatment of this condition. Treatment must be directed at the underlying cause. Bromocriptine has proved to be effective and carries a low risk of undesired effects.

Adult↗

PubMed2002

Diagnostic steps in the evaluation of patients with erectile dysfunction.

PURPOSE: The necessity for a thorough diagnostic evaluation for erectile dysfunction has been questioned after the availability of effective oral therapies. We determined the impact of the different diagnostic steps on the management strategy for erectile dysfunction. MATERIALS AND METHODS: The study included all patients who presented at an andrology outpatient clinic during a 4-year period. Baseline evaluation included medical and sexual history, blood tests, physical examination and intracavernous injection test. Patients with normal initial screening were evaluated with specific diagnostic procedures. The results were analyzed to identify the diagnostic potential of each screening step separately. RESULTS: Overall 1,644 patients presented at the clinic during the study period, of whom 368 (22.4%) were excluded from study due to severe psychiatric (5.2%) or cardiovascular (2.7%) disease, or to a history of erectile dysfunction less than 3 months in duration (14.5%). In the remaining 1,276 patients with a mean age plus or minus standard deviation of 56 +/- 14 years, and a mean duration of erectile dysfunction of 4.9 +/- 3.4 years medical history revealed erectile dysfunction associated medical conditions in 57%, blood tests identified previously undiagnosed medical conditions in 6.2%, and physical examination and the intracavernous injection test were diagnostic in 13.9% and 2.6%, respectively. Initial screening was negative in 259 cases (20.3%), in which specific diagnostic procedures identified an underlying vascular pathology in 165 (12.9%) and unfavorable penile geometry in 16 (1.3%). The remaining 78 men (6.1%) had no evidence of organic disease. CONCLUSIONS: Baseline diagnostic evaluation for erectile dysfunction can identify the underlying pathological condition or erectile dysfunction associated risk factors in 80% of patients. Such screening may diagnose reversible causes of erectile dysfunction and also unmask medical conditions that manifest with erectile dysfunction as the first symptom. Specific diagnostic procedures may be limited in patients with primary erectile dysfunction or those without risk factors. Such clinical data support previously published guidelines for erectile dysfunction management.

Adult↗

PubMedDate not supplied

[Erectile dysfunction. Its diagnosis and treatment].

Erectile dysfunction is a health problem affecting more than 50% of men between 40 and 70 years old. Although several therapeutic options have become available in the last 20 years, only a small percentage of the patients, perhaps no more than 10%, seek treatment. The recent introduction of oral and intra-urethral medication has been highly publicised, therefore more patients will be involved in this new wave of enthusiasm for non-invasive options. We are challenged to develop new options as to how to present these treatments to our patients. Traditionally the diagnosis of erectile dysfunction is based on a comprehensive evaluation regarding aetiology, including family and sexual history, physical examination, blood tests, pharmacological testing with vasoactive drugs and Doppler study of the penile arteries. Other studies, such as Rigiscan, corpus cavernosum electromyography, cavernosometry, cavernosography and penile angiography should be performed when indicated. With regard to treatment, penile intracavernosal injection remains the best nonsurgical treatment. Application of a vacuum device and penile prosthesis implantation are also reliable therapeutic options. Only a limited number of patients are suitable for arterial revascularization or penile venous surgery. However, in the near future, we will have to face the requests of our patients for an oral or topical prescription without concern for the cause of erectile dysfunction. The results of these new therapies on organic impotence are not as exciting, but warrant further studies.

Adult↗

PubMedDate not supplied

[Dose correcting factors in the treatment of erectile dysfunction with viagra].

28 patients with erectile dysfunction of different origin received viagra (25, 50 or 100 mg depending on the effect and tolerance). The examination on the treatment week 4, 8 and 12 stated a 85% response. It was found that patients with body mass more than 90 kg benefited most in the dose 100 mg. Maximal single dose 100 mg is recommended for patients over 65 years of age. A 100% response was observed in patients with psychogenic and arteriogenic erectile dysfunction. Low effectiveness of viagra in patients with neurogenic erectile dysfunction can be explained by damaged parasympathetic nerve fibers. Thus, in the decision on viagra dose it is advisable to consider the patient's body mass, age and etiology of erectile dysfunction.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMed1999

Efficacy and safety of sildenafil citrate in the treatment of erectile dysfunction in patients with ischemic heart disease.

Erectile dysfunction is a common condition in men with cardiovascular disease, probably as a result of shared factors that impair hemodynamic mechanisms in the penile and ischemic vasculature. Sildenafil citrate, an orally active, selective inhibitor of phosphodiesterase type 5 (PDE5), has demonstrated excellent efficacy and safety profiles in men with erectile dysfunction of various etiologies. Sildenafil administration is contraindicated in patients who are taking nitrates or nitric oxide donors. This retrospective subanalysis of data from double-blind, placebo-controlled studies assessed the efficacy (9 studies) and safety (11 studies) of sildenafil in patients with erectile dysfunction and ischemic heart disease who were not taking nitrates. Of 3,672 patients randomized to receive sildenafil (5-200 mg) or placebo for 4-24 weeks in 11 double-blind, placebo-controlled studies, 357 (10%) reported a history (past or present) of ischemic heart disease and were not taking nitrates. Efficacy was assessed using end-of-treatment responses to Question 3 (ability to achieve an erection) and Question 4 (ability to maintain an erection) of the International Index of Erectile Function (IIEF), scores for the 5 domains of male sexual function assessed by the IIEF (erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), and responses to a global efficacy question ("Did the treatment improve your erections?"). The responses to the 2 IIEF questions were graded on a scale of 1 (almost never or never) to 5 (almost always or always), with a score of 0 indicating no attempt at sexual intercourse. At the end of treatment, the mean scores for Question 3 and Question 4 of the IIEF for patients with erectile dysfunction and ischemic heart disease were significantly higher for the sildenafil group than for the placebo group (p <0.0001). Mean end-of-treatment scores for the IIEF domains also demonstrated significant increases for sildenafil-treated patients compared with those receiving placebo (p <0.05). At the end of treatment, improved erections were reported by 70% of patients who received sildenafil and by 20% of those in the placebo group p <0.0001). For the sildenafil group, the incidences of the most common adverse events (headache 25%, flushing 14%, and dyspepsia 12%) for patients with ischemic heart disease were similar to those in patients without this concomitant illness (21%, 15%, and 10%, respectively). Moreover, the overall incidence of cardiovascular adverse events other than flushing was comparable in patients with and without ischemic heart disease for both treatment groups. Since there is a degree of cardiac risk associated with sexual activity, clinicians should consider the patient's cardiovascular status before initiating any treatment for erectile dysfunction. Physicians should be aware that patients with underlying cardiovascular disease could be adversely affected by the vasodilator effects of sildenafil, especially in combination with sexual activity. The results of the present subanalysis indicate that oral sildenafil significantly improves erectile function and is well tolerated in patients with erectile dysfunction and ischemic heart disease who are not taking nitrate therapy.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMedDate not supplied

Assessment and management of erectile dysfunction in men with diabetes.

PURPOSE: Erectile dysfunction occurs earlier in men with diabetes than in the general population, affecting over 50% of male patients by age 60. This article summarizes the etiologies and presents methods of patient assessment and treatment options for erectile dysfunction. METHODS: Assessments of neurologic and vascular complications related to diabetes should be included in a sexual function history. The assessment must be holistic and focus on organic as well as psychogenic causes. Diabetes educators must be prepared to discuss the various pharmacologic treatment options. RESULTS: Sildenafil currently is the only oral medication available for erectile dysfunction. Injectable treatments have proven successful but with limited long-term use and poor patient acceptance. Implantable devices carry surgical risk and increased rates of infection. CONCLUSIONS: All men with diabetes should be screened for erectile dysfunction. The availability of a new oral medication provides a patient-acceptable treatment option.

Adult↗

PubMed1996

Efficacy and safety of intracavernosal alprostadil in men with erectile dysfunction. The Alprostadil Study Group.

BACKGROUND: Erectile dysfunction is a common medical problem affecting many men. Although several intracavernosal therapies are available, their efficacy and safety have not been studied systematically. METHODS: We investigated the efficacy and safety of alprostadil formulated for intracavernosal treatment in three separate multi-institutional, prospective studies in men with erectile dysfunction of vasculogenic, neurogenic, psychogenic, and mixed causes. Clinical and laboratory evaluations of erection and the feasibility of satisfactoriness of sexual activity as assessed both by the men and by their partners were the primary measures of efficacy. RESULTS: In a dose-response study of 296 men, all doses of alprostadil were superior to placebo and there was a significant dose-response relation (P < / = 0.001), resulting in higher response rates with increasing doses of alprostadil (from 2.5 to 20 microg). In a dose-finding study of 201 men, the minimal effective dose was < / = 2 microg in 23, 20, 38 and 23 percent of men with erectile dysfunction of neurogenic, vasculogenic, psychogenic, or mixed causes, respectively. In a six-month self-injection study in 683 men, the participants reported being able to have sexual activity after 94 percent of the injections. The men and their partners rated the sexual activity as satisfactory after 87 and 86 percent of the injections, respectively. Penile pain, usually mild, occurred in 50 percent of the men at some time but after only 11 percent of the injections. Prolonged erections occurred in 5 percent of the men, priapism in 1 percent, penile fibrotic complications in 2 percent, and hematoma or ecchymosis in 8 percent. CONCLUSIONS: In men with erectile dysfunction, intracavernosal injection of alprostadil is an effective therapy with tolerable side effects.

Adult↗

PubMed2002

Prevalence and determinants of erectile dysfunction in Santos, southeastern Brazil.

CONTEXT: Recent population-based surveys suggest that the prevalence of erectile dysfunction is between 30% and 56% among men over the age of 40. Most of these studies, however, are from the United States or Europe. We need estimates of erectile dysfunction from samples of Brazilian populations, as societies that differ ethnically, culturally, and economically may also differ with respect to potential risk factors for erectile dysfunction. OBJECTIVE: To determine the prevalence of erectile dysfunction and its potential correlates. SETTING: Santos, State of São Paulo. DESIGN: Cross-sectional study. PARTICIPANTS: A population-based sample of men aged 40-70 years. Out of 718 men invited, 342 (47.6%) returned a completed questionnaire. MAIN MEASUREMENTS: Data on demographic variables, medical history, lifestyle habits and degree of erectile dysfunction. RESULTS: The prevalence of any degree of erectile dysfunction was 45.9% (minimal, 33.9%; moderate, 8.5%; complete, 3.5%) and increased with age. In bivariate age-adjusted analyses comparing men with no erectile dysfunction or minimal erectile dysfunction with those with moderate or complete erectile dysfunction, histories of diabetes or hypertension, depressive symptoms, heavy smoking and obesity were significantly associated with increased prevalence of erectile dysfunction, whereas moderate alcohol consumption was inversely associated with erectile dysfunction. In the multivariate model, age was a strong predictor of erectile dysfunction, while history of diabetes or hypertension and heavy smoking remained significantly associated with increased prevalence of erectile dysfunction. CONCLUSION: We found higher prevalence of erectile dysfunction (45.9%) among men older than 40 years old in Brazil. The variables associated with erectile dysfunction may alert physicians to patients who are at risk of erectile dysfunction as well as offer clues to the etiology of erectile dysfunction. Physicians should routinely ask their patients about sexual health and erectile dysfunction.

Adult↗

PubMed1995

Clinical efficacy of Korean red ginseng for erectile dysfunction.

To investigate the efficacy in treating erectile dysfunction and to develop a natural drug without complications, the results of ginseng treatments are compared to placebo and other drug. A total of 90 patients with 30 patients in each group were closely followed. Changes in symptoms such as frequency of intercourse, premature ejaculation, and morning erections after treatment were not changed in all three groups (p > 0.05). However in the group receiving ginseng, changes in early detumescence and erectile parameters such as penile rigidity and girth, libido and patient satisfactions were significantly higher than that of other groups (p < 0.05). The overall therapeutic efficacies on erectile dysfunction were 60% for ginseng group and 30% for placebo and trazodone treated groups, statistically confirming the effect of ginseng (p < 0.05). No complete remission of erectile dysfunction was noted, but partial responses were reported. No cases of aggravation of symptoms were reported. AVS-penogram, which is a recording of penile hemodynamic changes during the natural erection after audiovisual erotic stimulation, is not changed after administration of ginseng. However if administered for a prolonged period of time, the cummulative effect on vascular flow might be seen. The administration of Korean red ginseng has shown to have superior effects compared to the placebo or trazodone. Definitely more researches are required to elucidate the mechanism of ginseng. The effects of saponin, extracted from ginseng, on smooth muscle of erectile tissues, can be evaluated using organ chamber or nitric oxide titration, thereby pinpointing the exact action mechanism of saponin. As more informations are available, possible breakthrough in treatment of erectile dysfunction could be arisen from active saponin extracted from red ginseng, bringing hopes to many sufferers of erectile dysfunction.

Adult↗

PubMed1999

Physician attitudes and behaviour regarding erectile dysfunction in at-risk patients from a rural community.

Erectile dysfunction affects many men in the United States. A 34% prevalence is estimated among male family practice patients. It is associated with a loss of self-image, self-confidence, and even chronic anger. Several risk factors increases the risk of erectile dysfunction. Prevalence is increased by 20-40% in patients with diabetes, hypertension, and those over 65 years old. While erectile dysfunction is generally acknowledged as an important health problem, misconceptions remain as to the need for clinician-initiated discussion regarding the issue. A retrospective chart review of patients at three health clinics in a predominately rural area was conducted. Subjects (n = 102) were those at risk of erectile dysfunction who had undergone a complete physical exam between October 1995 and December 1996. All physician encounters were examined for documentation of physician inquiry about erectile dysfunction. A survey of physician perceptions on initiating discussions of erectile dysfunction was also conducted. Physician-initiated discussion of erectile dysfunction was documented in 17% of patients with hypertension, 18% with diabetes mellitus, and 30% of patients > 65 years. The physician survey (11 respondents) showed 27% reported asking all male patients about erectile dysfunction at routine physical, while 45% reported asking 80% of their male patients. A 'lack of time' or belief that the 'patient will initiate discussions' was cited by several practitioners as reasons why inquiries were not initiated. All physicians in the study agreed that sexual function is an integral part of overall health. They either overestimated the percentage of patients asked about erectile dysfunction or they had not documented results consistently.

Aged↗

PubMed2003

Coronary artery flow reserve in diabetics with erectile dysfunction using sildenafil.

BACKGROUND: Diabetics with erectile dysfunction have a high prevalence of microvascular disturbance of the coronary circuit as measured by coronary flow reserve (CFR). PURPOSE: We aimed to evaluate the effects of the phosphodiesterase 5 inhibitor sildenafil on CFR in diabetics with erectile dysfunction. METHODS: Diabetics seeking diabetes refinement therapy were screened for vascular or neurogenic erectile dysfunction which was confirmed in 43 patients. No ischemic ECG changes were found in any of the ECG stress tests at the 100 W level. Cardiologic examinations raised suspicion of coronary artery disease in 16 patients; coronary angiography confirmed severe coronary artery lesions in 12, who were excluded from further analysis. CFR measurements were not possible in 10 participants. The 21 diabetics eligible for CFR measurements aged 60 years (50-69) had known diabetes for 11 years (3-30) and a BMI of 27 kg/m2 (24-36). CFR of the left anterior descending artery was assessed at baseline and 1 hour after 50 mg sildenafil, using transthoracic Doppler echocardiography. RESULTS: Baseline CFR was at the lower level of the normal range (median 245%, range 210-490%). After sildenafil administration, CFR decreased insignificantly (DeltaCFR -10%, p = 0.3). Patients with a BMI > 25 kg/m2 and left ventricular hypertrophy exhibited the highest reduction of CFR after sildenafil. No decrease of CFR below 200 % was observed. Systemic blood pressure dropped from 130/80 mmHg to 120/72 mmHg (p < 0.002). CONCLUSIONS: Diabetics with erectile dysfunction exhibit a CFR in the lower normal range indicating severe microvascular disturbance. Sildenafil did not alter CFR in those patients. A high prevalence of severe coronary macroangiopathy was identified in asymptomatic diabetic patients screened for contraindications for sildenafil.

Journal Article↗

PubMed2003

A historical review of erectile dysfunction.

Over the last three decades, there has been a significant increase in our understanding of the physiologic mechanisms responsible for erectile dysfunction. Erectile dysfunction has become a topic of considerable media and societal interest and acceptance. Paralleling the increase in knowledge has been an explosion in therapeutic options. This article will evaluate the therapeutic options, from a historical perspective of what has been available, and outline the progress that has been made.

Administration, Oral↗