Abstract

IntroductionSildenafil (Viagra®) is one of the drugs used in the first line therapy of male erectile dysfunction (MED). We have recorded outcomes, adverse events and acceptability of Sildenafil (Viagra) therapy in an unselected group of men presenting with ED to a British district general hospital.MethodsIn this prospective observational study, 147 men with ED were seen since Oct 1999. Study patients were reviewed at 4, 12 and 52 weeks. All the patients filled the International Index of Erectile Function (IIEF) questionnaire and were asked about their willingness to pay (WTP) for treatment.ResultsAll suitable men accepted Viagra as first line therapy. 91% of our patients found sildenafil treatment successful. 80% of these patients were willing to continue with sildenafil therapy. Side effect profile of sildenafil was different in this study with much higher incidence of headache, dyspepsia, flushing and abnormal vision. 92% of men with ED expect to be treated by the NHS. Of those men eligible for treatment in the NHS, 30% qualify under the clinical categories and 18% under the 'distress' category. Only 55% of those with cardiovascular risk factors qualify for NHS treatment.ConclusionsSildenafil is widely accepted as first line therapy among British men with ED and has a success rate of 91%. Nearly half of men with ED qualify for NHS treatment. Nearly half of those with vascular risk factors do not qualify for NHS treatment. Most men with ED could possibly be managed in primary care.

Highlights

  • Sildenafil (Viagra®) is one of the drugs used in the first line therapy of male erectile dysfunction (MED)

  • Sildenafil works by blocking the effects of the enzyme Phosphodiesterase 5 (PDE-5), so prolonging the effects of Nitric Oxide (NO) released in the penile cavernosal tissues from relevant nerve endings

  • After Visit 3, 84 men continued with sildenafil, out of whom 10 dropped out of the study by Visit 4 (6 – lost to follow-up, 1 – lack of partner, 2 – prostate cancer surgery undertaken, 1 – not interested)

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Summary

Introduction

Sildenafil (Viagra®) is one of the drugs used in the first line therapy of male erectile dysfunction (MED). A substantial body of evidence has accumulated demonstrating the beneficial effects of phentolamine, papaverine, and prostaglandin E1 (PGE1) when injected intracavernously. Both the method of administration (self-injection) and the risks of major adverse events, such as intracorporeal fibrosis and priapism [3], strongly suggested the need for further therapeutic advances in the treatment of impotence. The profile of oral sildenafil (ViagraTM) to date is that of an effective and well tolerated on-demand pharmacological treatment for men with erectile dysfunction [6]

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