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[Effects of penile vasoactive mediators on the development of erectile dysfunction].
Penile corpus cavernosum can be seen as a special kind of vascular structure. The cause of erectile dysfunction (ED) is often related to the changes of penile vasoactive mediators which modulate the functional conditions of penile erectile tissues. The penile vasoactive mediators including angiotensin and kinins, prostaglandins, endothelins, endothelium-derived hyperpolarizing factors (EDHF), NOS and NO, RhoA/Rho-kinases, etc., may play an important role in the development of ED. Further researches on these mediators can furnish some theoretical evidence for the clinical treatment of ED.
Experience with intracavernosal tri-mixture for the management of neurogenic erectile dysfunction.
Using papaverine, papaverine/phentolamine, or prostaglandin E1 (PGE1), intracavernosal pharmacotherapy has been successful in treating erectile dysfunction. The limiting factor of using these medicines is intracorporeal fibrosis with the first two and a high cost with PGE1. Our experience with intracavernosal therapy in patients with impotence secondary to neurogenic disease has included 35 men, 30 of whom are spinal cord injured, 3 after radical prostatectomy, 1 with multiple sclerosis, and 1 with lower extremity weakness after surgery. Patients ranged in age from 22 to 59 years, with an average of 36.3 years; mean follow-up was 13.8 months. Intracavernosal therapy has been performed with a tri-mixture of papaverine hydrochloride (smooth muscle relaxant), phentolamine mesylate (alpha-adrenergic blocking agent) and alprostadil (PGE1- a vasodilator and smooth muscle relaxant). Of the patient population, all 35 patients were able to have adequate erections for sexual relations with minimal complications. Acting synergistically, the ingredients promote erectile activity using small doses and without a significant incidence of priapism or fibrosis. Techniques of injection, dosing and followup are discussed.
Management of erectile dysfunction following radical prostatectomy.
Radical prostatectomy is the standard treatment for organ/specimen-confined prostate cancer, yet erectile dysfunction in selected series is still reported as high as 90% after this procedure. Thus, most men need adjuvant treatments to be sexually active following radical prostatectomy. These include vacuum constriction devices, intracorporeal injections of vasoactive drugs, and transurethral dilators, all of which have reported response rates of 50% to 70%. Unfortunately, long-term compliance is suboptimal, with a discontinuation rate of nearly 50% at one year. These non-oral options should be offered on an individual basis to patients who have failed oral therapy since efficacy and compliance vary. Also, these options should be considered in the early postoperative period to enhance sexual activity and penile oxygenation, which may prevent corporeal fibrosis. Early penile rehabilitation with intracavernosal injections or vacuum constriction devices should be encouraged to increase chances for recovery of rigid erections. In patients with some preservation of nerve tissue, oral sildenafil may be effective in promoting an earlier return of erectile function. The potential impact of sildenafil and other new oral therapies should encourage urologists to continue to perform and perfect the nerve-sparing approach.
[Viagra is first choice preparation in the treatment of erectile dysfunction. Access to a variety of methods makes individual treatment possible].
Several pharmacological treatments for erectile dysfunction (ED) have recently been introduced. This study performed during 1999 shows that in Sweden mostly men in their 60's, often with circulatory disease and/or diabetes, where the ones who were treated for ED. The most frequently used drug (80%) is sildenafil (Viagra). The mean consumption is 4.8 tablets per month, the same consumption as for intracavernous prostaglandin injections. The pattern of prescription doesn't differ between general practitioners and urological surgeons. No evidence for "overconsumption" became evident in the study. Presently, the majority of men who seek help for ED are middle-aged, have circulatory disease and are prescribed sildenafil (Viagra).
Is there a common pathophysiology of erectile dysfunction and how does this relate to new pharmacotherapies?
Many basic and clinical studies show erectile dysfunction (ED) to be caused by a wide variety of factors. Although these factors can be divided into psychological and organic origins and these too can further be subdivided, many patients will show complex patterns of causes for ED ('mixed ED'). Many of these factors will have a direct or indirect impact on the efficacy of centrally and peripherally acting drugs, thus necessitating a variety of drugs with different modes of action and different modes of application to ensure appropriate therapy for many patients. However, some factors will render all imaginable forms of pharmacological options totally inefficient, thus necessitating forms of treatment other than pharmacotherapy.
[Diagnosis of venous insufficiency in erectile dysfunction: comparative studies of cavernosonography and Doppler sonography].
In 26 out of 214 patients with erectile dysfunction and venous insufficiency proven by cavernosography, bidirectional Doppler ultrasound was also performed to demonstrate venous leakage in addition. Except for one, all 25 cases of leakage in the superficial and deep dorsal veins could be demonstrated, as could four of six cases of cavernosoglandular shunts. Using bidirectional Doppler ultrasound, it was possible to visualize a continuous orthograde blood flow from the sulcus coronarius to the root of the penis in superficial and deep dorsal penile veins, as well as in ectopic penile veins, and a retrograde blood flow in the sulcus coronarius in cavernosoglandular shunts.
An investigation into the relationship between prostate size, peak urinary flow rate and male erectile dysfunction.
This study sought to identify whether a true relationship exists between benign prostatatic hyperplasia (BPH) and erectile dysfunction (ED). In a community-based study, 427 men underwent transrectal ultrasound (TRUS), uroflow studies and a questionnaire concerning erectile function. ED had a significant correlation to age (r = 0.19, P < 0.001). But comparisons of prostate volume and analysis of maximum flow rate showed no significant difference between three erectile functional groups; ranging from no ED to complete ED, (one way analysis of variance). However when these two parameters were correlated to age a significant association was found to exist (log prostate volume; r= 0.26, P < 0.001, log maximum flow rate; r= -0.13, P= 0.02). Prostate size and uroflow studies show no correlation with ED, but ED and BPH had a significant correlation with ageing. This makes a direct association between male ED and BPH unlikely but supports the theory that the association between the two pathologies could be due instead to the common link of ageing.
Visual erotic and vibrotactile stimulation and intracavernous injection in screening men with erectile dysfunction: a 3 year experience with 406 cases.
To establish the number of patients with erectile dysfunction (ED) who appear to be sexually potent when exposed to visual erotic (VES) and vibrotactile stimulation (VIB) and to investigate whether or not older patients are less responsive to VES/VIB than young patients. Retrospective analysis of data on 406 consecutive patients screened for ED with VES, VES + VIB, VES + Intracavernous injection (ICI). Partial or full erection was obtained in 34% of patients with VES, 52% with VES + VIB, 82% with VES + ICI. Men < 40 y (n = 86) responded better than men > 40; between 40 and 80 no differences in penile responses were found. 50% of patients who reported no morning/night erections appeared to have good, rigid nocturnal penile tumescence (NPT). The use of VES, VES + VIB, VES + ICI is strongly recommended in the screening of men with ED of all ages; up to 80% will respond with a good erection. Only a positive penile response has diagnostic significance. The positive results reduce the necessity for further invasive investigations.
Duration of action of sildenafil citrate in men with erectile dysfunction.
INTRODUCTION: Viagra (sildenafil citrate) has a rapid onset of action for the treatment of erectile dysfunction (ED). However, its duration of action has not been thoroughly investigated. Practical knowledge of the time window available for sexual intercourse would be valuable for couples planning sexual activity. AIM: We investigated the duration of action of sildenafil in men with ED. METHODS: This was a double-blind, randomized, placebo-controlled, four-way crossover study of 16 men, mean age of 55 years (range, 36-68 years) with ED of no known organic cause. Participants received oral sildenafil (100 mg) or placebo 1, 8, or 12 hours before visual sexual stimulation (VSS). Measurements included the duration of erections of >or= 60% rigidity, assessed by penile plethysmography (RigiScan), and the proportion of sildenafil responders, defined as patients with erections of >or= 60% rigidity for >or= 4 minutes and >or= 50% improvement over erections achieved in their placebo arm. Self-assessed duration of grade 3 (hard enough for penetration) or grade 4 (fully hard) erections was also recorded. RESULTS: At 1, 8, and 12 hours after dosing with sildenafil, the mean duration of erections with >or= 60% rigidity was 26, 11, and 8 minutes, respectively, compared with only 3 minutes after placebo dosing (P < 0.05). However, the mean duration of self-assessed erections was 33, 23, and 16 minutes, respectively, compared with 7 minutes after placebo dosing (P < 0.05), and was greater than that assessed by RigiScan. Of the 69% sildenafil responders at 1 hour, 82% responded at 8 hours and 45% responded at 12 hours after sildenafil administration. CONCLUSION: Sildenafil improved objective and self-assessed erectile function in men with ED, and the duration of action of sildenafil was longer than that previously reported. These data suggest that sildenafil may be effective in a significant proportion of men with ED up to 12 hours after being taken.
[Assessment of curative effect on erectile dysfunction of two drugs].
OBJECTIVES: To further discuss the method of evaluating curative effect on erectile dysfunction(ED). METHODS: Clinical trials(Phase II) of sildenafil and phentolamine were both 8-week-long, randomized, double-blind and placebo-controlled. Not only the curative effect between each treatment group and placebo group but also between the treatment groups were compared. The dosage of sildenafil and phentolamine was respectively 50-100 mg and 40 mg. RESULTS: Efficiency, success rate of sexual intercourse and general curative effect in sildenafil and phentolamine groups were respectively 79.17%, 75.00%, 83.33% and 52.38%, 85.71%, 52.38%. The result revealed a statistically significant (P < 0.05) improvement over placebo. But no obvious differences were shown between the two treatment groups(P > 0.05). CONCLUSIONS: Most assessments of curative effect of ED drugs come from questionnaires answered subjectively by patients. The Lack of objective assessment criteria way lead to the non-conformity between trial results and clinical practices. So the curative effect of drugs shall be assessed more accurately and from more perspectives.
The acceptance and satisfaction of Saudi males to vasoactive autoinjection intracavernous therapy, external negative pressure device and penile prosthesis in the treatment of erectile dysfunction.
BACKGROUND: The aim of the study was to determine the acceptance and satisfaction of Saudi impotent male patients to intracavernous vasoactive autoinjection therapy, external negative pressure device and penile prosthesis insertion in the treatment of their impotence. SUBJECTS AND METHODS: The medical records of 210 Saudi patients who presented with erectile dysfunction and were offered intracavernous vasoactive autoinjection therapy, external negative pressure device or penile prostheses for the treatment of their erectile dysfunction were retrospectively analyzed to determine the acceptance and satisfaction of their selected treatment modalities. RESULTS: Intracavernous vasoactive autoinjection therapy was the most acceptable treatment option, followed by negative pressure device, and then insertion of penile prosthesis. About 11.9% of patients refused all treatment options. Only 40% and 12% of patients who were treated with intracavernous vasoactive autoinjection therapy and external negative pressure device, respectively, were satisfied with their treatment modality. After one year of follow-up, insertion of penile prosthesis had the highest satisfaction rate among the treatment modalities, with 92% and 87% of patients being satisfied at 3 and 12 months' follow-up, respectively. CONCLUSION: Intracorporeal vasoactive autoinjection therapy had the highest acceptance rate compared with external negative pressure devices and penile prosthesis, however, it had low satisfaction rate and the dropout rate was high. External negative pressure devices are generally poorly accepted and are rarely satisfactory in our patient population. Penile prosthesis insertion is poorly accepted, however, it has the highest satisfaction rate. Such information will allow patients under treatment for impotence and their treating physicians to make better, educated choices on the mode of treatment.
Incidence of erectile dysfunction after open abdominal aortic aneurysm repair.
The aim of this study is to document the incidence of erectile dysfunction (ED) following open abdominal aortic aneurysm (AAA) repair using a modified International Index of Erectile Function questionnaire (IIEF). An IIEF was mailed to 175 married male patients (mean age +/- SD: 71 +/- 8 years) who had an open AAA repair by one of four board-certified vascular surgeons between 1994 and 1998. The IIEFs were anonymous and asked patients to recall their sexual function before and 3 months after repair. ED was defined in patients with IIEF scores <11 (range 1-30). The overall response rate was 39% (68/175). A comparison of the IIEF results showed that 67/68 patients reported worsening erectile function (p < 0.00001); one respondent reported improved erectile function. On the basis of the IIEF scores, 20/68 patients (29%) were found to have ED and 48/68 patients (71%) had normal function prior to repair. Of the 48 patients with normal function prior to surgery, 83% (40/48) had ED after surgery. ED rates were similar between tube grafts 82% (23/28) and bifurcated grafts 85% (17/20) p = ns. The ED rate after open AAA repair is alarmingly high and prospective follow-up with IIEF will be necessary to better assess true ED rates after conventional open AAA repair.
Patient-acquired hepatitis B and HIV following erectile dysfunction therapy.
This is believed to be the first reported case of HIV and hepatitis B acquired heterosexually using erectile dysfunction drugs.
[Factors affecting clinical application of sex therapy for erectile dysfunction].
OBJECTIVE: To discuss the factors that affect the clinical application of sex therapy for erectile dysfunction (ED). METHODS: Urological researchers recommended free sex therapy to ED patients and their partners in the outpatient department and studied the factors affecting the patients of Medicaid their partnersology, acceptance of sex therapy by interview and observation. RESULTS: Many patients refused sex therapy. Only 11 pairs of volunteers underwent it, of whom 5 pairs gave up halfway, 1 pair were stopped by the therapist due to the breakup of their marriage, and merely 5 pairs accomplished the whole course. Among the 5 pairs of quitters, 2 pairs thought of their problem as organic and turned to drug therapy, 1 pair withdrew because the patient's girlfriend broke up with him, 1 pair gave up because they lived in another city too far away from the clinic, and the other pair discontinued because they could not spare the time from their work. CONCLUSIONS: Many factors affect the clinical application of sex therapy for ED in China. Apart from the shortage of qualified professional sex therapists, some factors from the patients and their partners are at work, such as stress of work, lack of time, home location, education background, relationship between the patient and his partner, attitude to sex therapy, and so on.
The neuropathy of erectile dysfunction.
These studies were intended to explore the relationship between autonomic neuropathy and erectile dysfunction (ED). Sensory thresholds reflecting the integrity of both large diameter, myelinated neurons (ie pressure, touch, vibration) and small diameter axons (ie hot and cold thermal sensation) were determined on the penis and finger. Data were compared across subjects with and without ED, controlling for age, hypertension and diabetes. The correlation of specific thresholds scores and IIEF values were also examined. Seventy-three patients who visited the academic urology clinics at Montefiore hospital were evaluated. All patients were required to complete the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire: 20 subjects had no complaints of ED and scored within the 'normal' range on the IIEF. Patients were subsequently tested on their index finger and glans penis for vibration (Biothesiometer), pressure (Semmes-Weinstein monofilaments), spatial perception (Tactile Circumferential Discriminator), and warm and cold thermal thresholds (Physitemp NTE-2). Sensation of the glans penis, as defined by the examined sensory thresholds, was significantly diminished in patients with ED and these differences remained significant when controlling for age, diabetes and hypertension. In contrast, thresholds on the index finger were equivalent in the ED and non-ED groups. Threshold and IIEF scores were highly correlated, consistent with an association between diminished sensation and decreasing IIEF score (worse erectile functioning). These relations also remained significant when controlling for age, diabetes and hypertension. The findings demonstrate dysfunction of large and small diameter nerve fibers in patients with ED of all etiologies. Further, the neurophysiologic measures validate the use of the IIEF as an index of ED, as objective findings of sensory neuropathy were highly correlated with worse IIEF scores. The sensory threshold methods utilized represent novel, non-invasive and relatively simple procedures, which can be used in a longitudinal fashion to assess a patient's neurological response to therapies.