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PubMed2004

Prevalence of erectile dysfunction among 7689 patients with diabetes or hypertension, or both.

OBJECTIVES: To survey the presence of, and attitudes toward, erectile dysfunction (ED) among patients with hypertension and/or diabetes mellitus who sought general medical care for any reason. METHODS: The abbreviated five-item version of the International Index of Erectile Function (IIEF-5) was used to determine the presence of ED. A patient questionnaire was used to assess attitudes about ED. RESULTS: We surveyed 7689 patients (mean +/- SD age 58.9 +/- 9.2 years), including 6719 (87%) in a stable sexual relationship. In patients with hypertension alone (n = 3906) and diabetes alone (n = 2377), ED was reported by 2379 (61%) and 1603 (67%) and was present in 2634 (67%) and 1677 (71%), respectively, as defined by an IIEF-5 score of less than 21. The corresponding mean scores were 12.0 (+/-4.6) and 11.5 (+/-4.6) in patients with ED and 20.5 (+/-3.6) and 20.2 (+/-3.8) in those without ED. Prevalence was affected by disease characteristics and history, and the number and type of antihypertensive medications. ED was reported by 924 (78%) of 1186 patients with both diseases and was present in 917 (77%) according to the IIEF-5 score. Overall, ED was reported by 5063 patients (66%) with hypertension and/or diabetes, was present in 5391 (70%) according to the IIEF-5 score, and increased in prevalence with age. ED was fairly to very bothersome in 4027 (80%) but untreated in 3312 (65%), of whom 2278 (69%) wanted treatment. Most of those wanting treatment would have welcomed discussion with their physician (1861 [82%] of 2278), and most wanted their physician to broach the subject (1292 [69%] of 1861). CONCLUSIONS: Our study results have shown that patients with diabetes and/or hypertension have a high prevalence of bothersome untreated ED and want their general practitioner to initiate a discussion and provide treatment.

Aged↗
PubMed2003

Vardenafil: a new approach to the treatment of erectile dysfunction.

Vardenafil is a phosphodiesterase type-5 (PDE-5) inhibitor developed as an oral therapy for erectile dysfunction (ED). Multiple phase 3 clinical trials have been completed and vardenafil is expected to launch worldwide in 2003. Two pivotal, randomized, double-blind, multicenter studies have evaluated the use of vardenafil in men with ED. Vardenafil improved the rate of achieving and maintaining an erection during sexual intercourse. Improvement also was noted in other aspects of sexual function, including confidence, orgasmic function, and overall satisfaction. Vardenafil produces clinically and statistically significant improvements in erectile function regardless of age, baseline severity, and etiology and is efficacious for the treatment of ED in diabetic and postprostatectomy patients. Vardenafil has a rapid onset of action and completion of successful sexual intercourse is possible for some patients 16 minutes after its administration. Twenty milligrams of vardenafil has sustained long-term efficacy by providing up to 92% of patients with improved erections during more than 2 years of treatment. Vardenafil is well tolerated, with an adverse event profile typical of the class of PDE-5 inhibitors. The most common adverse events were headache, flushing, rhinitis, and dyspepsia, which were mild or moderate and generally decreased with continued treatment. Vardenafil may be associated with transient reductions in blood pressure and commensurate increases in heart rate, with the overall incidence of cardiovascular-related adverse events similar to that of placebo.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMed2003

Sildenafil: a 4-year update in the treatment of 20 million erectile dysfunction patients.

Sildenafil citrate, the first internationally approved and widely used oral agent for the treatment of erectile dysfunction (ED), has revolutionized the treatment of ED throughout the past 5 years. This phosphodiesterase type-5 (PDE-5) inhibitor is selective for corpus cavernosum smooth muscle tissue and produces excellent erectile function. Its efficacy and safety over a wide variety of etiologies of ED and severities of ED demonstrates its usefulness in the clinical treatment of these patients. More than 20 million men have been treated worldwide with sildenafil with excellent results. ED caused by difficult-to-treat etiologies such as radical prostatectomy, severe diabetes, and spinal cord injury have demonstrated efficacy. Although sildenafil citrate, like all PDE-5 inhibitors, is contraindicated in patients taking nitrate medications for cardiac disease, it is effective and safe for those cardiovascular patients who are not taking nitrate medications. The incidence of adverse cardiovascular events in patients taking sildenafil does not differ from those of the general population. Investigations into the pharmacologic effect of sildenafil on coronary myocardial tissue further supports the safety of this medication. Sildenafil has been safe and effective in patients taking various medications including multiple antihypertensive drugs, selective serotonin reuptake inhibitors, cardiac, and diabetic medications.

3',5'-Cyclic-GMP Phosphodiesterases↗
PubMedDate not supplied

[Intracavernous injection of prostaglandin E1 as a diagnostic test in erectile dysfunction].

Pharmacologically-induced erection is commonly utilized as a diagnostic test in the work up of erectile disorders. Our experience using prostaglandin E1 (PGE1) to induce erection for diagnostic testing is described. The present study, which had been carried out in 24 patients with different etiologies (9 neurologic, 7 arterial, 1 hormonal and 7 with no known disorder), showed PGE1 to be a good inductor of erection, well-tolerated and with no adverse effects. Because this drug can induce erection with a high degree of safety and patient tolerance, it is considered to be useful as a diagnostic procedure in erectile dysfunction.

Adult↗
PubMed2006

Sildenafil citrate improves self-esteem, confidence, and relationships in men with erectile dysfunction: Results from an international, multi-center, double-blind, placebo-controlled trial.

INTRODUCTION: Erectile dysfunction (ED) can significantly impact a man's relationships and well-being. AIM: We assessed changes in self-esteem, confidence, sexual relationship satisfaction, and overall relationship satisfaction in men with ED using the validated Self-Esteem And Relationship questionnaire (SEAR). METHODS: This was a 12-week, double-blind, placebo-controlled, flexible-dose (25, 50, 100 mg, as needed) international study of sildenafil in men > or =18 years of age in Mexico, Brazil, Australia, and Japan. MAIN OUTCOME MEASURES: The primary study outcome was change in self-esteem from baseline to the end of treatment. Secondary study measures were changes in other SEAR components, International Index of Erectile Function (IIEF) domains, percentage of intercourse attempts that were successful, and the response to a global efficacy question at the end of treatment. RESULTS: Patients were well balanced for age and duration of ED (placebo = 149 and sildenafil = 151). Compared with placebo, sildenafil significantly improved self-esteem, confidence, sexual relationship satisfaction, and overall relationship satisfaction (P < 0.0001). The psychosocial measures of well-being assessed with the SEAR were positively correlated (range 0.60-0.86, P < 0.0001) with erectile function, the frequency of achieving erections that allowed satisfactory sexual intercourse, the percentage of successful sexual intercourse attempts, and global treatment efficacy. CONCLUSIONS: Significant improvements in self-esteem, confidence, sexual relationship satisfaction, and overall relationship satisfaction after treatment of ED with sildenafil were consistent among countries. These data suggest a substantial cross-cultural improvement in well-being after successful treatment of ED with sildenafil.

Adult↗
PubMed1989

[Treatment of erectile dysfunction with a penile prosthesis].

From 1973 to February 1989 a total of 309 patients with erectile dysfunction were treated with hydraulic penile prostheses. In 169 patients a hydraulic prosthesis type AMSIPP700 was implanted; with this prosthesis the primary success rate was 91.1%. As a result of technical improvements to the device the revision rate, initially 52.3% has fallen to 3.3%. Patient acceptance is better with hydraulic prostheses, which provide optimal simulation of the physiological processes of erection and detumescence, than with any other type of prosthesis.

Adult↗
PubMed2003

[Prostate carcinoma and erectile dysfunction. Which therapy when?].

The quality of life of patients after radical prostatectomy is mainly influenced by erectile dysfunction (ED) and incontinence. New criteria for treatment and patient selection give us the opportunity to restore sexual function in more patients. When ED is present, we should not wait for 24 months for natural restitution. PDE-5-inhibitors, intracavernosal self injection therapy and the vacuum constriction device are effective and conform to both patient and economic preference.Therefore, every urologists should be able to offer his patients an individual and successful approach to the therapy of ED after prostate cancer.

Erectile Dysfunction↗
PubMed1994

[Evaluation of preoperative cavernosometry and cavernosography in erectile dysfunction of presumed venous origin].

During the period November 1988 to September 1992, 42 patients with erectile dysfunction underwent preoperative dynamic cavernosometry and cavernosography. Radiologically visible venous leakage was demonstrated in all cases but one. At a maintenance flow of more than 20 ml/min, venous leakage was always demonstrable and the types of veins opacified were stereotype. Therefore, clinically relevant leakage can be documented on the basis of cavernosometry. A surgical approach to penile venous leakage with resection of the deep dorsal vein and ligation of all superficial anastomoses including the superficial dorsal vein will eliminate the most common types of radiologically visible veins.

Adult↗
PubMed2000

Review of intraurethral suppositories and iontophoresis therapy for erectile dysfunction.

This brief review examines the history of the intraurethral (IU) pharmacotherapy for the treatment of erectile dysfunction (ED). Emphasis is placed on the design, study endpoints and results of a limited number of clinical trials undertaken with PGE(1)-MUSE to demonstrate the efficacy of this unique delivery system. Next, the theory of the iontophoretic technique of drug delivery is discussed. Clinical data collected while applying these methods are presented, but are thus far limited to treatment of patients with Peyronie's disease. Iontophoresis as a drug delivery alternative may gain popularity with ED patients who fail other types of therapy or in patients with other penile disorders. International Journal of Impotence Research (2000) 12, Suppl 4, S86-S90.

Alprostadil↗
PubMed2000

Hemodynamic insult by vascular risk factors and pharmacologic erection in men with erectile dysfunction: Doppler sonography study.

To evaluate the penodynamic impact of known vascular risk factors in men with erectile dysfunction, we obtained thorough medical histories covering diabetes, hypertension, heart disease and hypercholesterolemia, alcohol ingestion, and smoking in 265 consecutive patients. We also measured their penile hemodynamic parameters by color duplex ultrasonography after intracavernous prostaglandin E1 injection. In patients with vascular risk factors there was a statistically significant decrease in the peak systolic velocity and increase in the end-diastolic velocity of the cavernosal artery (P < 0.01). Those men who had diabetes had higher average end-diastolic velocities and lower resistance indices (P < 0.01). Smoking and alcohol use also affected penile hemodynamics (P < 0.05). These data confirm that vascular risk factors do increase the likelihood of vasculogenic impotence and that diabetes plays a major role in veno-occlusive dysfunction in the penis.

Adolescent↗
PubMed1992

Twelve-month comparison of two treatments for erectile dysfunction: self-injection versus external vacuum devices.

This study directly compared two nonsurgical treatments for erectile dysfunction, self-injection of papaverine/phentolamine and external vacuum devices, in terms of usage rates, effectiveness, side effects, dropout rates, and impact on patient sexual and psychologic functioning. Both alternatives were regularly, successfully, and safely used by patients, though dropout rates were higher for self-injection. Both produced erections of improved quality, and effected sustained improvements in frequency of intercourse, orgasm, and sexual satisfaction. Spontaneous erections also improved with both treatments. General psychiatric symptomatology was decreased, and anxiety was improved. There were no differences between the two treatments in sexual or psychologic impact. Relative contraindications and esthetic considerations are presented.

Coitus↗
PubMed1995

Accuracy of the initial history and physical examination to establish the etiology of erectile dysfunction.

OBJECTIVES: Because of its implications for possible therapy, the ability to establish a diagnosis of erectile dysfunction (ED) solely on the basis of history and physical examination has been a matter of controversy. The determination of the etiology of ED based on history and physical examination is evaluated in this present study. METHODS: Consecutive patients presenting for evaluation of ED were evaluated by careful history, physical examination, psychologic evaluation, and RigiScan monitoring. They were then stratified into either organic or psychogenic groups based on each of these modalities. These diagnoses were then compared to a final diagnosis obtained through additional testing. RESULTS: History and physical examination had a 95% sensitivity but only a 50% specificity in diagnosing organic ED. The accuracy rates of history and physical examination in diagnosing ED were 80% and 60%, respectively. CONCLUSIONS: A multifaceted comprehensive approach is required to evaluate fully and to diagnose ED.

Adult↗
PubMed2003

Methylene blue as a means of treatment for priapism caused by intracavernous injection to combat erectile dysfunction.

OBJECTIVE: The authors observed priapism as a side effect occuring during the intracavernous treatment of erectile dysfunction. Earlier priapism had been treated with an intracavernous injection of sympatomimetics; unfortunately several complications and contraindications were found. PATIENTS AND METHODS: Methylene blue was applied in the treatment of five patients. First a corpus cavernosum punction was performed and some blood was aspirated from the penis. Finally 100 mg of Methylthionin Chlorati was injected into the corpus cavernosum. RESULTS: A sufficient detumescence was observed in all of these cases. There were no complications. The method was applied effectively in two cases after an unsuccessful punction. CONCLUSION: The autors recommend intravenous methylene blue for the treatment of priapism. According to their experience this method is free of complications and as effective as a sympathomimetics treatment. As they think, it can be recommended in any manifestations of priapism because its force of action appears to be both chemically and biologically clear.

Enzyme Inhibitors↗
PubMed1998

The role of estradiol in the maintenance of secondary hypogonadism in males in erectile dysfunction.

The occurrence of secondary hypogonadism is a common finding in males who seek help with erectile dysfunction, although the relationship to diminished testosterone is unclear. Two possibilities exist regarding both the genesis and maintenance of the hypogonadotropic hypogonadal state. First, a defect in hypothalamic function, resulting in downregulation as well as in alterations of anterior pituitary function; second, estradiol inhibition of gonadotropin release, both of which result in decreased testosterone production. As testosterone levels decrease and estradiol levels increase, the ratio of free testosterone to estradiol reaches a critical point and the estrogenic gonadotropin suppressive effects predominate. This ratio may signal the biological point of no return and could become one of the criteria for defining the separation of the transitional hypogonadal state from the final 'end stage' hypogonadotropic hypogonadal state. As the aging process continues, there is a relative accumulation of fatty tissue, and aromatization accelerates the conversion of testosterone to estradiol. This additional secondary estradiol inhibition results in the maintenance of the testosterone deficient state, and the aging process continues uncontested.

Aging↗
PubMed2002

Erectile dysfunction--the effect of sending a questionnaire to patients on consultations with their family doctor.

BACKGROUND: Erectile dysfunction (ED) is a common problem among male adults that generally has been ignored by family practitioners. OBJECTIVE: Our aim was to assess the effect of a mailed questionnaire about ED on the readiness of patients to raise the subject with their family doctor. METHODS: The study population included all men aged 40 years and over on the patient list of a family practitioner. A control group made up of males of similar ages was chosen in another family practice. The patient files were reviewed for ED. Anonymous questionnaires including questions about sexual dysfunction and satisfaction with sex life, as well as demographic and medical details, were sent to the study population. Patients who suffered from ED were invited to visit their family doctor. In the following 2 months, the study and control group populations' visits to the family practitioner were monitored for complaints of sexual dysfunction. RESULTS: In the 2 years prior to the study, 14/205 (6.8%) of the study population had complained to their family practitioner of ED in comparison with 6/205 (2.9%) in the control group (P = NS). In the 2 months following the sending of the questionnaire, 23 patients consulted their family practitioner with ED, 19 of whom had not discussed their problem with the family practitioner previously; only a further two patients went to discuss ED in the same period in the control group (P < 0.001). A total of 85/205 (41.5%) patients returned the questionnaire and 35/85 (42.5%) said they suffered from ED. Of 35 patients who reported ED, 15 had been for a consultation; only six of them consulted their family doctor. CONCLUSION: ED is reported infrequently to family doctors. Sending an anonymous questionnaire on the subject increases awareness of the problem and in turn increases the number of cases that can be treated.

Aged↗
PubMed2004

Development and validation of the Self-Esteem And Relationship (SEAR) questionnaire in erectile dysfunction.

Development and validation of a patient-reported measure of psychosocial variables in men with erectile dysfunction (ED) is described. Literature review, focus groups, and medical specialists identified 86 potential items. Redundant, ambiguous, or low item-to-total correlation items were removed. Data from 98 men reporting diagnosed ED and 94 controls assisted in final item selection and psychometric evaluation. Treatment responsiveness was evaluated in 93 men with ED in a 10-week open-label trial of sildenafil citrate (Viagra). The 14 chosen items resolved into two domains: Sexual Relationship (eight items) and Confidence (six items), the latter comprising Self-Esteem (four items) and Overall Relationship (two items) subscales. The resulting Self-Esteem And Relationship (SEAR) questionnaire demonstrated validity and reliability. The intervention study demonstrated responsiveness to beneficial treatment with significant improvement in scores (P=0.0001). The SEAR questionnaire possesses strong psychometric properties that support its validity and reliability for measuring sexual relationship, confidence, and particularly self-esteem.

Adult↗
PubMed2003

Prevalence of erectile dysfunction and its correlates in Egypt: a community-based study.

We evaluated the prevalence of erectile dysfunction (ED) in a cross-sectional community-based random sample of Egyptian men. ED was correlated with the socioeconomic status, risk factors and quality of life. Married men in Ismailia province were interviewed at home. Data were processed for 805 men with mean age of 43.58 y (s.d. 11.03). There is a fair correlation between ED and increasing age (< or = 0.001). Males with complete ED comprised 13.2% of the sample, 26% of men in their 50s, 49% of men in their 60s and 52% of those 70 y or older. The state of better erection correlated fairly with sexual desire and sexual satisfaction (< or = 0.01). ED was associated with living in rural areas and lower socioeconomic level (< or = 0.01), with smoking, diabetes, heart disease, hypertension, liver disease, arthritis, peptic ulcer and renal disease (< or = 0.05). ED was negatively associated with good quality of life (< or = 0.001). These results indicate that ED is a common problem among married Egyptian men.

Adult↗