Abstract
To find pharmacological options in post-COVID 19 Sildenafil therapy failure in men with before-COVID 19 onset and treated ED, starting from the fact that published studies proves COVID 19 as a risk factor for ED, as well as for Sildenafil loss efficacy in before COVID 19 started ED treatment. From prior to 2020 Sildenafil treated ED's we selected 78 ED cases, recently claiming Sildenafil lack efficacy after a COVID 19 episode. According to optional recommendations, 42 cases (gr. A) have chose Avanafil instead to continue the ED therapy, whereas 36 cases (gr. B) preferred intra-urethral Alprostadil. The ED domain of International Index of Erectile Function (ED-IIEF), the erectile hardness score (EHS) and the Sexual Encounter Profile questions 2 (SEP2) and 3 (SEP3) were applied in 4 steps: V1=gr.A1/gr.B1 (first visit, presentation before COVID 19); V2=gr.A2/gr.B2 (second visit, before COVID 19 for Sildenafil benefit assessment); V3 gr.A3/grB3 (third visit, post-COVID 19, medical request for Sildenafil failure); V4=gr.A4/gr.B4 (forth visit, the assessment of the replacing Sildenafil new therapy). ED-IIEF: gr.A1/gr.B1 = 17.32/18.07 (P = 0.22); gr.A2/gr.B2 = 25.33/24.54 (P = 0.15); gr.A3/grB3 = 14.67/14.22 (P = 0.1); gr.A4/gr.B4 = 20.78/26.33 (P = 0.065). EHS: gr.A1/gr.B1 = 1.12/1.7 (P = 0.35); gr.A2/gr.B2 = 3.33/3.54 (P = 0.15); gr.A3/grB3 = 1.67/1.22 (P = 0.5); gr.A4/gr.B4 = 2.4/3.67 (P < 0.05). SEP 2: gr.A1/gr.B1 = 2.2/1.7 (P = 0.3); gr.A2/gr.B2 = 4.53/4.54 (P = 0.9); gr.A3/grB3 = 1.67/1.33 (P = 0.2); gr.A4/gr.B4 = 3.12/4.33 (P < 0.05). SEP 3: gr.A1/gr.B1 = 1.8/2.3 (P = 0.35); gr.A2/gr.B2 = 4.33/4.87 (P = 0.75); gr.A3/grB3 = 1.45/1.54 (P = 0.15); gr.A4/gr.B4 = 3.22/4.66 (P < 0.001). Sildenafil, as well as other PDE5I's, were already confirmed, as proper for treating ED. However, to correct COVID 19 induced Sildenafil failure, even Avanafil could represent another PDE5I option, the intra-urethral Alprostadil turned out to be a significantly better opportunity. none
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