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PubMedDate not supplied

Comparison of finasteride and alpha-blockers as independent risk factors for erectile dysfunction.

There are insufficient data on the effects of alpha-blockers and finasteride on erectile function in men who have other risk factors for erectile dysfunction (ED). This study was conducted to compare the relative effects of these medications on ED in men who may be on other medications or have other risk factors for ED. Patients attending urology and primary care clinics were asked to complete an IRB-approved questionnaire that combined the validated Sexual Health Inventory for Men (SHIM) and a detailed medical history. A total of 123 patients completed the questionnaire. The age range was 28-88 years (mean: 68 years). Eighty-one per cent of patients had SHIM scores <21, indicating some degree of ED. The average SHIM scores in a population of patients with similar age and risk factors who had been on finasteride or alpha-blockers indicated the presence of ED but did not reveal a significant difference between the two groups. The scores were no different from an age-matched group of patients who were not on either medication, demonstrating the relatively greater importance of various other risk factors for ED. There was an inverse linear relationship between the number of ED risk factors and SHIM scores. There does not appear to be a significant difference between alpha-blockers and finasteride as independent risk factors for ED. Age and other risk factors (heart disease, diabetes, hypertension, smoking, and hypercholesterolaemia) tend to have a much stronger influence on the severity of ED as assessed by SHIM scores.

Adrenergic alpha-Antagonists↗
PubMed2001

Cigarette smoking: a risk factor for erectile dysfunction in diabetics.

OBJECTIVES: Diabetes is one of the systemic disorders most frequently associated with erectile dysfunction (ED). An extensive literature documents well the relationship between ED and several factors related to diabetic pathology, but the role of risk factors mainly related to life-style, e.g. cigarette smoking, is still not defined. METHODS: Eligible for the study were men aged 20-70 years with a diagnosis of insulin-dependent (type 1---IDDM) or non-insulin-dependent (type 2--NIDDM) diabetes who were observed on randomly selected days in 178 diabetes centers in Italy. ED was defined as a failure to achieve and maintain an erection sufficient for satisfactory sexual performance. RESULTS: The study population consisted of 9,670 diabetic men. Of these 2,962 (30%) were never smokers, 2,877 (30%) current smokers and 3,831 (40%) ex-smokers. After taking into account the effect of age, the odds ratios of ED in comparison with never smokers was 1.4 (95% confidence interval 1.3-1.6) for smokers and 1.5 (95% confidence interval 1.3-1.6) for ex-smokers. Duration and intensity of the smoking habit was associated with an increased risk of ED. Among ex-smokers, the risk of ED significantly decreased; with increase in the number of years since the patient quit smoking. CONCLUSION: The study offers an assessment of the association between smoking habit and ED and its potential interaction with other risk factors in diabetic men.

Adult↗
PubMed2006

Depression and lower urinary tract symptoms: Two important correlates of erectile dysfunction in middle-aged men in Hong Kong, China.

AIM: To evaluate the correlates of erectile dysfunction (ED) in Hong Kong middle-aged Chinese men aged 45-64 years. METHODS: A community-based cross-sectional household survey was performed in Hong Kong. The Chinese abridged version of the International Index of Erectile Function (IIEF-5) was used to measure erectile function. The International Prostate Symptom Score (IPSS) was used to measure lower urinary tract symptoms (LUTS) and depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale (CES-D). Demographic and lifestyle data were also collected. The association between ED and its correlates was analyzed using bivariate and multivariate analyses. RESULTS: Of the 545 subjects who agreed to participate in the survey, 75 refused to answer questions about their sexual activities and function. Out of those who responded, 118 (22%) subjects were not sexually active (not sexually active over the past 4 weeks). Out of 352 subjects, 60.3% suffered from some degree of ED. Age, presence of depression defined by CES-D and moderate LUTS were associated with increased odds of having ED. In multivariate analysis, depressive symptoms identified by CES-D (OR = 2.3, CI: 1.2-4.6) and moderate LUTS (OR = 3.7, CI: 1.6-8.3) were independently associated with increased odds of having ED. CONCLUSION: ED is an important public health problem in Chinese middle-aged men, with more than half suffering from some degree of ED. Depression and LUTS were significant and important risk factors associated with ED.

Cross-Sectional Studies↗
PubMed2006

Cardiovascular drug use and the incidence of erectile dysfunction.

It is unclear whether high blood pressure per se or antihypertensive drug use causes erectile dysfunction (ED). The aim of this study was to investigate the effect of cardiovascular diseases and their concomitant medications use on the incidence of ED. The target population consisted of men aged 55, 65 or 75 years old residing in the study area in Finland in 1999. Questionnaires were mailed to 2837 men in 1999 and to 2510 of them 5 years later. The follow-up sample consisted of 1665 men (66% of those eligible) who responded to both baseline and follow-up questionnaires. Men free of moderate or severe ED at baseline (N=1000) were included in the study. ED was assessed by two questions on subject ability to achieve or maintain an erection sufficient for intercourse. Poisson regression model was used in the multivariable analyses. The risk of ED was higher in men suffering from treated hypertension or heart disease than in those with the untreated condition. The risk of ED was higher in men using calcium channel inhibitor (adjusted relative risk (RR)=1.6, 95% confidence interval (CI) 1.0-2.4), angiotensin II antagonist (RR=2.2, 95% CI 1.0-4.7), non-selective beta-blocker (RR=1.7, 95% CI 0.9-3.2) or diuretic (RR=1.3, CI 0.7-2.4) compared with non-users. ED was not associated with using organic nitrates, angiotensin-converting enzyme inhibitors, selective beta-blockers and serum lipid-lowering agents. In summary, calcium channel inhibitors, angiotensin II antagonists, non-selective beta-blockers and diuretics may increase the risk of ED.

Aged↗
PubMed2001

Prevalence and correlates of erectile dysfunction: results of the Brazilian study of sexual behavior.

OBJECTIVES: To determine the prevalence of erectile dysfunction (ED) and explore its potential sociodemographic, medical, and lifestyle correlates. METHODS: While attending the "Health Awareness Fair" in nine major cities in Brazil, 1286 men completed a questionnaire regarding ED, demographic data, and medical conditions. ED was assessed by a single global self-rating question, in which subjects were asked to describe themselves as able to achieve and maintain an erection good enough for sexual intercourse always, usually, sometimes, or never, and the responses were used to classify the subjects as having no, minimal, moderate, or complete ED, respectively. Age-adjusted bivariate and multivariate analyses were carried out to calculate the prevalence odds ratios and 95% confidence intervals for the potential covariates. RESULTS: Overall, 46.2% of men reported some degree of ED (minimal 31.5%, moderate 12.1%, complete 2.6%). The prevalence of complete ED increased 10 times from 1% to 11% between subjects younger than 40 and older than 70 years; moderate ED rose from 8% to 27%, and minimal ED remained constant at approximately 31%. In bivariate age-adjusted analyses, low educational attainment, black race/ethnicity, homo/bisexuality, and a history of diabetes, hypertension, or depression were significantly (P <0.05) associated with an increased prevalence of ED. In the multivariate logistic regression model, these variables remained significantly associated with ED. CONCLUSIONS: The results of our study show that ED is a major health problem in Brazil and both the severity and prevalence increase with age. The medical, sociodemographic, and lifestyle variables associated with ED may alert physicians to patients who are at risk of ED, as well as offer clues to the etiology of ED.

Adult↗
PubMed2003

Erectile dysfunction in spontaneously hypertensive rats: pathophysiological mechanisms.

Hypertensive men have a higher prevalence of erectile dysfunction (ED) than the general population. Experimental evidence of ED in hypertensive animals is scarce. This study evaluates the erectile function of spontaneously hypertensive rats (SHR) and age-matched normotensive Wistar-Kyoto rats (WKY) in vivo by the increase in intracavernosal pressure after electrical stimulation of the cavernous nerve (CN) and by isometric tension studies on corporal strips. Frequency-dependent erectile responses to CN stimulations were reduced in SHR. Phenylephrine induced lower corporal contractions in SHR although pD2 values were similar to WKY. Endothelium-dependent relaxations to ACh were impaired significantly in SHR, and indomethacin improved these relaxations in both WKY and SHR, the latter thus reaching values similar to WKY. Corporal relaxations to sodium nitroprusside were enhanced in SHR. Thus a dysfunctional alpha-adrenergic contraction of the corporal smooth muscle, an increased cyclooxygenase-dependent constrictor tone, and/or a defect in endothelium-dependent reactivity are associated with the altered erectile mechanisms in SHR. Drugs targeting endothelial dysfunction may delay the occurrence of ED as a complication of hypertension.

Acetylcholine↗
PubMed2006

A comparison of the efficacy and tolerability of tadalafil 10 mg and 20 mg in Japanese patients with severe erectile dysfunction.

INTRODUCTION: Tadalafil is a phosphodiesterase type 5 inhibitor with documented efficacy in the treatment of erectile dysfunction (ED). AIM: To compare the efficacy and tolerability of tadalafil 10 mg and 20 mg in men with severe ED. METHODS: A prespecified subgroup analysis was conducted to compare the efficacy of tadalafil 10 and 20 mg measured by the International Index of Erectile Function (IIEF) erectile function (EF) domain and Sexual Encounter Profile (SEP) among patients with severe ED (EF domain score = 1-10) in a Japanese placebo-controlled study (PCT). We also analyzed the efficacy of the two doses in men with severe ED post hoc by pooling data from three tadalafil clinical trials that evaluated these doses using a similar study design (three placebo-controlled trials), and evaluated (post hoc) the presence of organic comorbidities in patients with different levels of response to tadalafil 10 or 20 mg. MAIN OUTCOME MEASURES: Mean change in the IIEF-EF domain and mean per-patient changes in percent "yes" responses to SEP Question 2 (SEP2) and Question 3 (SEP3). RESULTS: Patients with severe ED in the Japanese study experienced numerically greater increases (improvements) when taking tadalafil 20 mg compared with 10 mg in the IIEF-EF domain (14.3 vs. 12.4; P = 0.355), SEP2 (60% vs. 57%; P = 0.781), and SEP3 (61% vs. 49%, P = 0.196). When sufficiently powered, these observations reached statistical significance in the three PCTs: patients with severe ED experienced greater increases when taking tadalafil 20 mg compared with 10 mg in the IIEF-EF domain (13.6 vs. 10.4; P = 0.014) and SEP3 (56% vs. 43%, P = 0.019). Both doses were well tolerated. CONCLUSIONS: Patients with severe ED, and especially those with an organic comorbidity, may derive greater clinical benefits from tadalafil 20 mg compared with 10 mg.

Adult↗
PubMed2006

Incidence of erectile dysfunction in 800 hypertensive patients: a multicenter Egyptian national study.

OBJECTIVES: To evaluate the incidence of erectile dysfunction (ED), its severity, and other sexual function domains in 800 Egyptian patients with hypertension. METHODS: All patients completed a detailed questionnaire addressing their general medical history, with special emphasis on hypertension (ie, duration of hypertension, type of antihypertensive treatment, compliance, and presence of any complications). Sexual function was evaluated with the International Index of Erectile Function. RESULTS: The mean +/- SD patient age was 59.2 +/- 2.3 years (range 28 to 75). Of the 800 patients, 739 (92.3%) had regular sexual activity (one to two times per week) and 346 (43.2%) had ED. Of the 346 men, 40 (5%), 96 (12%), and 210 (26.2%) had mild, moderate, and severe ED, respectively. A highly statistically significant correlation was found between the duration of hypertension and the duration of weak erections. Only 41 patients (12%) with ED reported receiving erectogenic drug therapy. CONCLUSIONS: Our results have shown a greater prevalence of ED in the Egyptian hypertensive population. The presence of another risk factor in addition to elevated blood pressure can increase the incidence of ED further.

Adult↗
PubMed2005

Association between comorbidity and erectile dysfunction in patients with diabetes.

The aims of this study were to determine the prevalence of erectile dysfunction (ED) and its relationship with comorbidity in patients with diabetes. The study population comprised of 312 consecutive patients aged 20 years or over residing in the city of Hamadan in Iran in 2005. Depression was assessed by the modified version of the Beck Depression Inventory (BDI-II) and ED by the short form of the International Index of Erectile Function (IIEF-5) questionnaire. Potential confounding was controlled by stratification and by a logistic regression model. The prevalence of moderate or complete ED (IIEF score <or=11) was 34% and that of moderate or severe depressive symptoms 30%. Each 1-year increment in diabetes duration was associated with a 10% higher risk of ED. The risk of ED was higher in men with depression (odds ratio (OR)=10.7, 95% CI 5.4-21.1) and in those with cardiovascular disease (CVD) (OR=2.0, 95% CI 1.1-3.6). CVD was associated with ED only in elderly men, whereas depression was related to ED in both young and older subjects. The risk of ED was higher in subjects with both depression and CVD (OR=17.2, 95% CI 6.8-43.1 compared with men free from both diseases). Subjects who consumed fruits weekly or seldom had a higher risk of ED (OR=3.2) compared with those who consumed daily. Our study shows a strong association between depressive symptoms and ED. The association is much stronger for older men. Depression and CVD may interact with one another in relation to a higher risk of ED. A diet rich in fruits may have a beneficial effect on erectile function.

Adult↗
PubMed2004

[Erectile dysfunction induced by pelvic fracture urethral injury].

OBJECTIVE: To explore the aetiology, diagnosis,and treatment of erectile dysfunction (ED) after a pelvic fracture urethral injury. METHODS: Rigiscan and Duplex ultrasound were used to determine the causes of ED induced by pelvic fracture urethral injury in 29 patients and the therapeutic means were also analyzed. RESULTS: Of the 29 patients, 1 was psychological, 28 were physical, 7 vascular, and 15 neurological. Rigiscan and Duplex ultrasound revealed the cause of erectile failure as neurogenic in 15. Twenty-three cases were effective by the therapy. The injection with vasoactive agents (prostagland in E1) was successful in 15, Viagra in 2, Befar in 5, and revascularization of epigastric artery-dorsal artery anastomosis in 1. CONCLUSION: Disruption of the cavernous nerves lateral to the prostatomembranous urethra is the most likely cause of ED in this injury. Intracavernous injection of prostaglandin E1 is believed to be safe and effective for ED.

Adult↗
PubMed2002

Guidelines on erectile dysfunction.

The introduction of new oral therapies has completely changed the diagnostic and therapeutic approach to erectile dysfunction. A panel of experts in this field have developed guidelines for clinical evaluation and treatment based on the review of available scientific information.

Adult↗
PubMed2006

Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction.

AIM: To examine the treatment efficacy of Korean Red Ginseng (KRG) in impotent men with erectile dysfunction (ED). METHODS: A total of 60 patients presenting mild or mild to moderate ED were enrolled in a double-blind, placebo-controlled study in which the efficacies of KRG and a placebo were compared. The patients received either 1,000 mg (3 times daily) of KRG or a placebo. RESULTS: The five-item version of the International Index of Erectile Function (IIEF-5) score after the treatment was significantly higher in the KRG group compared with that before the treatment (from 16.4 +/- 2.9 to 21.0 +/- 6.3, P < 0.0001). In contrast, there was no difference before and after the treatment in the placebo group (from 17.0 +/- 3.1 to 17.7 +/- 5.6, P > 0.05). In the KRG group, 20 patients (66.6%), reported improved erection, significant in the global efficacy question (P < 0.01); in the placebo group there was no significance. Scores on questions 2 (rigidity), 3 (penetration), 4 and 5 (maintenance), were significantly higher for KRG than those for the placebo when those questions were answered after 12 weeks of each treatment (P < 0.01). When the score in the KRG group was compared to the placebo group after the treatment, there was a significant improvement in total score (IIEF-5 score) in questions 3 and 5 for the KRG-treated group (P < 0.001 and P < 0.0001, respectively). The levels of serum testosterone, prolactine and cholesterol after the treatment were not statistically significant different between the KRG and the placebo group (P > 0.05). CONCLUSION: Our data show that KRG can be an effective alternative to the invasive approaches for treating male ED.

Adult↗
PubMed2002

The choice of antihypertensive drugs in patients with erectile dysfunction.

It is well established that hypertension and the more traditional anti-hypertensive drugs are associated with erectile dysfunction (ED). There is evidence showing that two antihypertensive drugs--doxazosin and losartan--have a positive effect on erectile function. Therefore these drugs may decrease the incidence of ED in patients who need treatment for hypertension. Doxazosin and/or losartan can also be beneficial in patients who develop ED after starting treatment with other antihypertensive drugs. These options could, in turn, ensure better compliance and blood pressure control. A fall in the overall cost of treatment will also be anticipated if there is a reduced need for drugs prescribed for ED in patients with hypertension.

Aged↗
PubMedDate not supplied

Erectile dysfunction: to prescribe or not to prescribe?

Even with the help of modern pharmacology, treatment of erectile dysfunction often remains complex, and requires taking into account the social, psychological, and behavioral dimensions of the disorder. This brief report presents a case study highlighting this complexity.

Adult↗
PubMed2006

Erectile dysfunction after PlasmaKinetic vaporization of the prostate: incidence and risk factors.

PURPOSE: To determine the incidence of erectile dysfunction (ED) after PlasmaKinetic vaporization of the prostate (PKVP) using objective and subjective parameters and risk factors. PATIENTS AND METHODS: A total of 153 men completed a questionnaire detailing perceived sexual dysfunction and underwent nocturnal penile-tumescence testing using the RigiScan for three consecutive nights 3 or 4 days preoperatively and 3 months postoperatively. The International Index of Erectile Function (IIEF)-5 scores were obtained preoperatively and postoperatively. Full details of each operation were recorded, including grams of tissue resected, operative time, any short-term complications, especially emphasizing capsular perforation, and concomitant diseases such as diabetes and hypertension. The association of risk factors with the development of ED after PKVP was assessed. Complete data were available for 103 men (67.3%). Their mean age was 62.1 years (range 48-83 years). RESULTS: Postoperatively, 11 patients (10.6%) were found to have ED. Patients who developed ED postoperatively had a lower IIEF-5 score and penile-tumescence parameters preoperatively (for all parameters, P < 0.0001). As risk factors, diabetes, capsular perforation, and an IIEF-5 score <21 were found to be significant. CONCLUSIONS: The incidence of ED after PKVP measured objectively was 10.6%. In the absence of the risk factors, PKVP is a safe therapeutic strategy with regard to sexual function.

Aged↗
PubMed2006

Prevalence of erectile dysfunction in patients with metabolic syndrome.

AIM: We wished to investigate the relationship between metabolic syndrome and erectile dysfunction (ED). MATERIALS AND METHODS: A total of 268 patients were included in this study. All of the patients were asked to fill in an International Index for Erectile Function (IIEF) questionnaire. The presence of metabolic syndrome was determined when any three or more of the five risk factors were present according to the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP)-III. The relationship between risk factor for metabolic syndrome and ED status was determined according to logistic regression analysis. RESULTS: Eighty-nine patients (33%) constituted the metabolic syndrome group. IIEF-EF domain scores of patients with and without metabolic syndrome were 17.7 +/- 7.9 and 21.7 +/- 7.5, respectively (P < 0.001). Seventy-four percent of patients with metabolic syndrome and 50% of patients without metabolic syndrome had ED (P < 0.001; odds ratio 2.9; 95% CI 1.7-5.0). Erectile function domain scores significantly decreased as the number of metabolic risk factors increased (P < 0.001). Patients with the risk factor of fasting blood glucose (FBG), waist circumference (WC), or hypertension (HT) had lower erectile function domain scores than the patients with other metabolic risk factors. Logistic regression analysis revealed that FBG and WC were the most important criteria for ED. CONCLUSIONS: Metabolic syndrome seems to be a potential risk factor for ED. We recommend patients with metabolic syndrome should be questioned about ED, and WC measurement might take part in the evaluation of ED.

Erectile Dysfunction↗
PubMed2002

The epidemiology of erectile dysfunction and its correlates in men with chronic renal failure on hemodialysis in Londrina, southern Brazil.

Erectile dysfunction (ED) is a common condition in aging men, but little is known about the prevalence of ED in some specific groups of patients such as those with end-stage renal disease (ESRD). A cross-sectional study was conducted to determine the prevalence of ED in ESRD patients undergoing hemodialysis in two clinics of Londrina, Brazil. The prevalence and severity of ED were assessed using the International Index of Erectile Function and a single global question. The dependence of ED on independent variables was evaluated by logistic regression. Some degree of ED was found in 86.4% of our sample (n=118). Complete ED was reported by 25.4% of subjects, moderate ED by 35.4%, and minimal ED by 24.6%. Subjects < 50 y old had a prevalence of moderate/complete ED of 52.6%, whereas in men > or = 50 y old, it was 70.5%. Age, diabetes, and low income were significantly associated with ED. Although highly prevalent, only a low percentage of uremic ESRD patients on hemodialysis were being treated for ED. Our data suggest that ED is related to uremia and other comorbid conditions that often accompany ESRD.

Adult↗