Traitement des troubles érectiles du blessé médullaire par les inhibiteurs de la phosphodiestérase

Abstract

Objective: To assess the efficacy and safety of phosphodiesterase (PDE5) inhibitors for erectile dys- function in spinal cord injured (SCI) patients. Setting: Home- and clinic-based assessments in the outpatient department of Centre Bouffard Vercelli, Cerbere, France. Methods: Clinical trials of sildenafil (Viagra ® )i n 120 patients, tadalafil (Cialis ® ) in 54 patients and vardenafil (Levitra ® ) in 66 patients were performed. The response to treatment was assessed at home in 90 patients (57 patients receiving sildenafil, 12 patients vardenafil and 21 patients tadalafil) using the international index of erectile function (IIEF). Results: In clinical trials, PDE5 inhibitors were effective in more than 72% of the patients, with a mean duration of erection above 26 minutes. Adverse effects were mild, usually attenuated with continued dosing. More than 70% of the patients receiving either vardenafil or tadalafil required higher doses of 20 mg, whereas 50 mg of sildenafil was effective in 55% of the patients. Two-thirds of the patients receiving tadalafil reported a duration of action longer than 24 hours. Presence of upper motor neuron damage was significantly associated with therapeutic success, while lower motor neuron damage and cauda equina were indicators of poor response. In the follow-up visits, the IIEF global scores and three IIEF domains (erectile function, intercourse satisfaction and overall satisfaction) were significantly improved in all patients. Patients receiving sildenafil showed a significant improvement in orgasmic function, ejaculation (question 9) and orgasm (question 10). Conclusion: Sildenafil, vardenafil and tadalafil are all effective and well tolerated treatments for erectile dysfunc- tion in SCI patients. These results suggest that sildenafil is more effective in treating erectile dysfunction.