Male impotence

Abstract

Author's replySir—As André Guay points out, the response rate for any treatment will vary with the population being studied. The key concept with sildenafil is that we now have an oral, relatively safe medication that is effective for individuals with a wide range of medical conditions, and in both psychogenic and organic impotence. With regard to intraurethral alprostadil, it is important to recognise that a positive response as defined by the clinician may not correspond to a satisfactory treatment as determined by the patient. A man may develop some rigidity with treatment, but it may still be inadequate for intercourse—or the patient may find the treatment intrusive or unpleasant. In my own practice, only 15 of the first 100 patients treated with intraurethral alprostadil under optimal conditions (in-office testing and training with a nurse specialist followed by a home trial) found the treatment satisfactory. This treatment has a definite, but limited, role in the management of impotence. Author's reply Sir—As André Guay points out, the response rate for any treatment will vary with the population being studied. The key concept with sildenafil is that we now have an oral, relatively safe medication that is effective for individuals with a wide range of medical conditions, and in both psychogenic and organic impotence. With regard to intraurethral alprostadil, it is important to recognise that a positive response as defined by the clinician may not correspond to a satisfactory treatment as determined by the patient. A man may develop some rigidity with treatment, but it may still be inadequate for intercourse—or the patient may find the treatment intrusive or unpleasant. In my own practice, only 15 of the first 100 patients treated with intraurethral alprostadil under optimal conditions (in-office testing and training with a nurse specialist followed by a home trial) found the treatment satisfactory. This treatment has a definite, but limited, role in the management of impotence. Male impotenceAbraham Morgentaler (Nov 13, p 1713)1 provides a clear and concise account of the anatomy, physiology, and pathophysiology of male erectile dysfunction. The panel listing the medical risk factors associated with erectile dysfunction puts the problem in context, and it is important to stress that erectile dysfunction may presage cardiovascular disease because both have many risk factors in common. Full-Text PDF