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PubMed2005

[Measures for optimizing the efficacy of sildenafil on patients with erectile dysfunction].

Incorrect drug administration, lack of sexual stimulation, the way of obtaining sildenafil and associating risk factors of erectile dysfunction like severe cardiovascular or neurogenic diseases were the common causes of initial sidenafil failure. To improve the therapeutic efficacy for patients with initial sidenafil failure, education about how to use sildenafil properly plays an important role. Moreover, dose titration, more attempts, a good follow-up and sildenafil taking on a daily basis will yield a high response rate to sildenafil rechallenge.

Adult↗

PubMed2002

Management of erectile dysfunction by combination therapy with testosterone and sildenafil in recipients of high-dose therapy for haematological malignancies.

Erectile dysfunction (ED) is a well recognised complication of bone marrow transplantation, which affects quality of life in adult patients. Although the major contributory factors include hypogonadism and psychogenic factors, the best treatment still remains to be established due to the complex aetiopathology of the condition. Here, we report our preliminary results in eight patients treated with testosterone replacement therapy and sildenafil. We studied eight male recipients of BMT aged 22-58 years, presenting with clinical features of hypogonadism, ED, diminished libido and ejaculatory disorders. ED was assessed clinically and by colour flow Doppler studies of the cavernosal vessels. Testicular function was assessed by testicular volume, FSH, LH and testosterone (T) measurements. Erectile performance, libido and ejaculatory function were determined by a structured interview. Patients had severe primary hypogonadism as evidenced by low mean testicular volume, elevated gonadotrophins and low normal mean testosterone levels compared with controls. All had Leydig cell insufficiency (LCI) with or without frank serum testosterone insufficiency. All except one had cavernosal arterial insufficiency. All patients received intramuscular injections of testosterone cypionate (250 mg 4 weekly) for 6 months and 50-100 mg of sildenafil orally, one to two times per week. All patients responded favourably as substantiated from the NIH consensus criteria. Our preliminary results suggest that this combined therapy is a safe and effective therapeutic approach in recipients of high-dose therapy presenting with ED after transplant.

Administration, Oral↗

PubMed2003

Prevalence and risk factors for erectile dysfunction in primary care: results of a Korean study.

In order to assess the prevalence and associated factors for erectile dysfunction (ED) in primary care, a cross-sectional study was undertaken by questionnaire distributed to consecutive adult male attendees at 32 family practices. ED was assessed by the Korean five-item version of the International Index of Erectile Function (IIEF-5). In total, 3501 completed questionnaires were available for analysis. The prevalence of ED was severe (IIEF-5 score: 5-9) in 1.6% of cases, moderate (10-13) in 10.2%, mild (14-17) in 24.7%, and normal (18-25) in 63.4%. The prevalence of ED increased with age, lower educational status, heavy job-related physical activity, and lower income. ED prevalence was significantly higher in patients with chronic diseases such as diabetes, depression, and anxiety. These results suggest that the age-adjusted prevalence of ED among Korean men can be estimated as 32.2% (95% CI 30.6-33.7). Low socioeconomic status and several diseases such as diabetes, anxiety, and depression, as well as age, were associated with ED.

Adult↗

PubMed2003

A comparison of the International Index of Erectile Function and erectile dysfunction studies.

OBJECTIVE: To evaluate the ability of the five-item version of the International Index of Erectile Function (IIEF-5) to diagnose the vascular aetiology and severity of erectile dysfunction (ED), and to compare it with pharmacological testing and duplex Doppler ultrasonography, as such questionnaires are widely used by the pharmaceutical industry to categorize the severity of ED and to assess the efficacy of drug therapy. PATIENTS AND METHODS: In all, 80 patients (mean age 45.2 years, sd 14.0; mean duration of ED 3.5 years) were reviewed by an examiner unaware of their IIEF scores during testing. Penile blood flow was assessed in each patient after an intracavernosal injection with prostaglandin-E1 (10 micro g), with self-stimulation in privacy. The peak systolic velocity, end diastolic velocity and resistive index were measured for the vascular diagnosis. Visual ratings of erectile responses were also used for analysis. RESULTS: Of the 80 patients, 30 had a normal vascular response, 38 arterial insufficiency and 12 were diagnosed with venous leakage. There was no significant difference in the IIEF scores among patients with a normal vascular response, arterial insufficiency or venous leakage. Analysis of visual ratings of erections showed no difference in IIEF scores among the different groups of patients. CONCLUSION: The IIEF was designed and developed specifically for assessing and evaluating sexual function in clinical trials. However, as shown here, the IIEF cannot and should not be used as a tool to diagnose or compare specific vascular causes of ED.

Erectile Dysfunction↗

PubMed2004

Specific aspects of erectile dysfunction in endocrinology.

Prominent diseases of the endocrine system, such as diabetes mellitus, hypogonadism, and hyperprolactinemia, may cause erectile dysfunction (ED). ED affects about 50% of male diabetic patients possibly due to the vascular and neuropathic complications. Metabolic control and selective phosphodiesterase type 5 inhibitors are therapies of choice for controlling ED. By correcting hypogonadism, testosterone levels are restored. This, and the use of dopaminergic drugs, which normalize prolactin levels in male hyperprolactinemia, may be effective in reversing ED in these endocrine disorders.

Diabetic Angiopathies↗

PubMed2005

Erectile dysfunction prevalence and sexual function status in patients with chronic obstructive pulmonary disease.

PURPOSE: We determined sexual status and erectile dysfunction (ED) in outpatients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Between October 2002 and June 2003 a total of 60 successive outpatients with COPD enrolled in the study with written informed consent. Patients completed International Index of Erectile Function (IIEF) and Duke Activity Status Index questionnaires. They also underwent physical examination including urogenital examination and pulmonary assessment with spirometry, 6-minute walk test and arterial blood sample. COPD severity was determined according to Global Initiative for Chronic Obstructive Lung Disease criteria. RESULTS: After exclusion criteria 53 patients were assessed for statistical analysis. Mean patient age was 63.4 +/- 7.3 years. COPD severity in these patients was mild in 13.2%, moderate in 34%, severe in 49.1% and very severe in 3.8%. Nearly half of the patients (49%) had no comorbid disease for ED and the most common comorbid disease was hypertension (34%). According to the erectile function domain of IIEF 75.5% of patients were found to have ED with varying degrees (severe 28.3%, moderate 11.3%, mild to moderate 15.1% and mild 20.8%). Mean scores of all IIEF domains except sexual desire decreased with the increasing disease severity. A correlation was determined between severity and physical restrictions of COPD, and ED severity. CONCLUSIONS: The limitation of physical activity due to COPD also diminishes the sexual function of patients. This point must be kept in mind in the evaluation of patients with COPD.

Aged↗

PubMed2005

Phosphodiesterase type 5 inhibitors for erectile dysfunction.

The cyclic nucleotide signalling pathway mediates the smooth-muscle relaxing effects of nitric oxide necessary for normal erectile function. Down-regulation of this pathway is central to the pathophysiology of many forms of erectile dysfunction (ED), which is often associated with other chronic diseases (e.g. hypertension, type 2 diabetes mellitus) and treatments (e.g. certain drugs, radical prostatectomy). Conversely, selective inhibition of the enzyme that catalyses the degradation of cGMP (phosphodiesterase type 5, PDE-5) promotes erectile responses to sexual stimulation. The successful launch and commercialization of the selective PDE5 inhibitor (PDE5I) sildenafil transformed the treatment of ED, not only by providing an effective, well tolerated oral ED therapy, but also by fostering greater candour about the problem among men. Sildenafil is highly effective in promoting erectile responses across a wide spectrum of severity and causes of ED, including patients with ED that is often refractory to treatment. The recent advent of vardenafil, which has the highest in vitro potency of all available PDE5Is, and tadalafil, which has a prolonged half-life that may enable couples to have sexual activity with less planning, represent further advances. Other PDE5Is offering further potential improvements are under active investigation.

3',5'-Cyclic-GMP Phosphodiesterases↗

PubMedDate not supplied

Distress: associated variables of erectile dysfunction post-acute myocardial infarction. A pilot study.

This study aimed to identify the associated variables of erectile dysfunction (ED) in post myocardial infarction (MI) patients without previous sexual dysfunction (SD). Out of the 37 patients, 15 (40%) had ED. Patients significantly reduced the frequency of coitus (P<0.05). Out of nine patients with distress, eight presented ED, and of 28 patients without distress, seven presented ED (89 versus 25%, P=0.001). The two groups (distress versus without distress) were similar regarding confounding variables. We concluded that patients without SD prior the MI had a significant incidence of ED and distress was an associated variable of ED post-infarction.

Adult↗

PubMed1981

Characteristics of erectile dysfunction as a function of medical care system entry point.

The scientific literature on the treatment of penile erectile dysfunction contains numerous contradictory reports on the relative frequency of organic causes of impotence and the treatment results of behavioral sex therapy. One explanation for these contradictory findings is the hypothesis that different investigators are studying different subsamples of the symptomatic population. This study investigated differences in characteristics of men who initially consulted a urologist with a complaint of impotence versus those who self-referred themselves to a sexual dysfunction clinic. Self-referred sexual dysfunction patients were more often white, more often had psychogenic etiologies to their difficulties, were more often of higher socioeconomic class, and had a much better response to psychological interventions. This study suggests that future studies concerning the etiology and treatment of impotence need to specify population characteristics such as referral source and screening criteria. It may be necessary to develop alternative treatment techniques for men who present to nonpsychiatric sources for help with psychogenic impotence.

Erectile Dysfunction↗

PubMed2004

Prevalence and risk factors of erectile dysfunction in Japanese men with type 2 diabetes.

This study aimed to elucidate the prevalence and clinical risk factors of erectile dysfunction (ED) in Japanese male diabetics. Questionnaires were administered to 82 male diabetics and 25 male non-diabetics (controls), to determine the international index of erectile function (IIEF). This index consists of five parts, with questions related to erectile function (EF), intercourse satisfaction (IS), orgasmic function (OF), sexual desire (SD), and overall satisfaction (OS). IIEF scores were compared between diabetics and controls, and were also analyzed in relation to clinical factors. Although EF, IS, and OF scores (physical factors) in diabetic men were significantly lower than those of age-matched controls, no significant differences were apparent in SD and OS scores (psychological factors). All patients with EF score > or = 18 reported being able to achieve sexual intercourse, we determined the criterion for ED as EF < 18. The prevalence of ED in diabetics and age-matched controls was 60% and 20%, respectively. EF score decreased with duration of diabetes and progression of retinopathy, proteinuria, ischemic heart disease, delayed nerve conduction, orthostatic intolerance, and attenuated heart rate variability. ED was found to be common in Japanese male diabetics. Possible influences of both microangiopathy and macroangiopathy on ED are suggested.

Diabetes Mellitus, Type 2↗

PubMed2005

The hemodynamics of erectile dysfunction following external beam radiation for prostate cancer.

INTRODUCTION: Radiation to the pelvis is associated with erectile dysfunction (ED). The mechanisms include neural injury, vascular alterations, and corporal smooth structural changes. There exists little data on the vascular assessment of men who present with ED following radiation therapy for prostate cancer. This study was conducted to evaluate the erectile hemodynamics in such a patient population. METHODS: Men who presented for the evaluation of ED following radiation therapy for prostate cancer underwent vascular evaluation in the form of dynamic infusion cavernosometry and cavernosography (DICC). Established parameters were recorded to define arterial insufficiency and venocclusive function including cavernosal artery occlusion pressure, flow-to-maintain, and pressure decay. RESULTS: Sixteen men with a mean age of 61 years presenting with ED after radiation underwent DICC at a mean duration post radiation of 11 months. All of the patients in whom arterial hemodynamics were measurable had abnormal arterial parameters, and 85% had abnormal venocclusive parameters. Of the patients who could undergo cavernosography, 80% had venous leak, most commonly from the crura. CONCLUSIONS: Men presenting with ED following radiation therapy for prostate cancer are likely to have significant alterations in erectile hemodynamics, often of a combined arterio-venogenic nature. In patients with venous leak the majority had venocclusive dysfunction with venous leak emanating from the crura.

Aged↗

PubMed2002

[Determination of sildenafil in medicines for erectile dysfunction by capillary electrophoresis].

A method has been developed for the determination of sildenafil in the medicines for erectile dysfunction by capillary electrophoresis. The samples were analyzed with 60 mmol/L NaH2PO4(pH 5.0) running buffer at 35 degrees C capillary temperature and 30 kV voltage. A linear calibration was obtained from 0.07 g/L to 1.05 g/L of sildenafil (r = 0.9985) with the RSD of 4.7% for peak area, and the average recovery was 97.4%. The results were compared with those of HPLC, showing that the method is precise, simple and cost-effective, and can be used as a complementary method to HPLC.

Calibration↗

PubMed1990

[Use of semirigid penile prosthesis in the treatment of erectile dysfunction].

Implantation of a pair of semirigid penile prosthesis is a simple and satisfactory mode of treatment for erectile dysfunction in selected patients. Though the functional cavernous tissue is destroyed by implantation of the prosthesis into the cavernous body, the sensitive nerves are not damaged by the procedure. Therefore, the sensitivity of the penis, as a factor important for further sexual life, remain intact. The authors report their own clinical experience with implantation of semirigid silicone penile prostheses, made in Czechoslovakia. In 26 out of 28 patients they observed good functional and cosmetic results and the treatment allowed the patients to return to the active sexual life. The advantages of the used Czechoslovak prostheses, which are not to be neglected, are their availability and relatively low price.

Adult↗

PubMedDate not supplied

Psychotherapy for erectile dysfunction: now more relevant than ever.

The introduction of sildenafil in 1998 dramatically altered the treatment landscape for erectile dysfunction (ED). Although physicians now have a simple, efficacious, and safe treatment for ED, psychosocial barriers interfere with patients making effective use of these interventions. The role of psychotherapy is clearer than ever before in optimizing therapeutic outcome. The four goals of psychotherapy for ED are to identify and work through the resistances to medical intervention that lead to premature discontinuation; to reduce or eliminate performance anxiety; to understand the context in which men make love; and to implement psychoeducation and modification of sexual scripts. This article discusses three factors that make psychotherapy effective as well as outcome studies evaluating psychotherapy. By providing patients with an integrated medical/psychologic treatment, clinicians are likely to increase significantly the effectiveness of their treatment interventions for ED.

Anxiety↗

PubMed2002

[The rat model of erectile dysfunction caused by cavernous nerve injury].

OBJECTIVES: To identify rat cavernous nerve and establish a rat model of erectile dysfunction (ED) caused by injury of cavernous nerve. METHODS: Twenty rats were undergone dissections. Cavernous nerves were identified with the aid of operating microscope and confirmed by electrical stimulation. Then, 42 experimental rats were randomized into 3 groups, including sham operated controls, unilateral and bilateral cavernous nerve ablation groups. Three weeks after surgery, rat models were evaluated with Apomorphine Test. RESULTS: The major pelvic ganglion lies on either side of the dorsolateral lobes of the prostate. It includes 2 inflows, one called hypogastric nerve and another is pelvic nerve. The largest outflow is termed as cavernous nerve. Stimulus parameters which could induce obvious penile erection were 5 volts, frequency of 20 Hertz and duration of 5 milliseconds. Three weeks after surgery, apomorphine could induce penile erection of each rat in controls with mean (2.57 +/- 1.40) erections in 30 minutes, while there were no erections (0.00 +/- 0.00) either in unilateral or bilateral group. CONCLUSIONS: The rat of larger ganglion and its cavernous nerve can be easily identified, obvious response to electrical stimulation, low cost of animal purchase, easy housing and availability made rat as an ideal animal for establishing ED model caused by cavernous nerve injury. In addition, our study showed in the early period of cavernous nerve injury, either unilateral or bilateral, all rats lost their erectile function.

Animals↗

PubMed2003

[Three-piece inflatable penile prosthesis implantation for the treatment of penile erectile dysfunction].

OBJECTIVES: To introduce the method and experience of three-piece inflatable penile prosthesis for treatment of erectile dysfunction (ED). METHODS: Both AMS700CX/CXM and MENTOR ALPHA I three-piece inflatable prosthesis were used for 48 cases of ED. RESULTS: There were no rejection, mechanical problems, urethral injury and penile skin necrosis after surgery. All patients had satisfaction of sexual life. Only one case had trauma of tunica albuginea (2.08%) and the implantation had to be cancelled. There were 2 cases of post-operative infection (4.17%), 10 cases of prepuce edema(20.8%), 8 cases of penile pain(16.67%). The effective rate was 97.9% and satisfaction rate was almost 100%. CONCLUSIONS: Three-piece inflatable penile prosthesis was more compatible to human physiology. It is natural, easy to hide and use, and it caused little trauma in surgery with high rate of successful implantation and patient satisfaction. It was indicated for all kinds of ED, especially suitable for refractory and drug incurable ED patients.

Adolescent↗

PubMed2002

Prevalence of erectile dysfunction: a systematic review of population-based studies.

A systematic review was conducted on the prevalence of erectile dysfunction (ED) in the general population. Studies were retrieved which reported prevalence rates of ED in the general population. Using a specially developed criteria list, the methodological quality of these studies was assessed and data on prevalence rates were extracted. We identified 23 studies from Europe (15), USA (5), Asia (2) and Australia (1). On our 12-item criteria list, the methodological quality ranged from 5 to 12. The prevalence of ED ranged from 2% in men younger than 40 y to 86% in men 80 y and older. Comparison between prevalence data is hampered by major methodological differences between studies, particularly in the use of various questionnaires and different definitions of ED. We stress the importance of providing all necessary information when reporting on the prevalence of ED. Moreover, international studies should be conducted to establish the true prevalence of ED across countries.

Age Distribution↗

PubMedDate not supplied

Pharmacologic erection programs: a treatment option for erectile dysfunction.

Pharmacologic erection programs involve the self-injection of vasoactive agents directly into the penis to create an erection. Used with success for erectile dysfunction, this technique has provided another nonsurgical option for rehabilitation patients experiencing sexual dysfunction. The use of these vasoactive agents also has altered understanding of erectile physiology and the associated ability to make accurate diagnoses.

Erectile Dysfunction↗