Duration Of Erectile Dysfunction Research Articles

RISK FACTORS IN SEVERE ERECTILE DYSFUNCTION POPULATION

Objective: To find the risk factors of severe erectile dysfunction. Material & methods: This Cross sectional study subjects completed the questionnare at the time of diagnosing Erectile Dysfunction (ED). Amount of 297 ED patients with mean age of 49.08 ± 13.69 years were enrolled consecutively at Urology Outpatient Clinic from 2005 to 2012. The questionnaire consisted of marital status, educational status, and occupation, comorbidities, habits, and International Index of Erectile Dysfunction-5 (IIEF-5) questionnare. We compared population proportion of ED severity (severe vs not severe) between sociodemographic, comorbidities and habits group and we also compared the mean of ED onset age and ED duration between those groups. Results: Of the patients, 29.3% were classified as severe ED, and 70.7% were classified other than severe ED (mild, mild-moderate, etc). The median of ED onset age was 47 years (46.64 ± 13.77 years) and the median of ED duration was 52 weeks (126.75 ± 167.69 weeks) ranged from 1 to 1040 weeks. We found status of low education level, unemployed, not married and having diabetes mellitus could increase the risk of having severe ED in ED population with each prevalence ratio was 1.44 (1.12-1.87), 2.02 (1.20-3.42), 1.91 (1.10-3.30), 2.01 (1.30-3.12). Not married group was also found have an earlier mean of ED age onset (mean difference 6.78 (2.37-11.19) years. Conclusion: We found that education level, occupation status, marital status and diabetes mellitus contributes in determining ED severity.

Clinical predictive factors of sildenafil response: a penile hemodynamic study.

Phosphodiestrase-5 inhibitors are an important line of treatment for erectile dysfunction (ED). To detect the clinical and hemodynamic predictors of sildenafil response, we conducted this study on 124 Egyptian men with ED. All patients were evaluated by thorough history and clinical assessment with measurement of the abridged international index of erectile function-5 (IIEF-5) score. All patients were then subjected to intracavernosal injection (ICI) of trimix and pharmaco-penile duplex ultrasonography (PPDU). Patients were then classified into sildenafil responders and non-responders after six consecutive doses of 100 mg sildenafil. On doing the binary logistic stepwise regression analysis, only ED duration, IIEF-5 score, and response to ICI were the significant independent predictors of sildenafil response. These three parameters together correctly predicted the sildenafil response by 81.5% (p value <0.001). With the receiver operator characteristic curve analysis, the cut-off value of ED duration was 2.5 years and it was 14 for the IIEF-5 score. These findings indicate that ED duration, the IIEF-5 score and response to ICI are more significant predictors of sildenafil response than the more expensive and time-consuming PPDU testing.

Erectile dysfunction in a sub-saharan African population: Profile and correlates in a tertiary care hospital

Background: Erectile dysfunction (ED) is a common complaint in general medical practice. This study describes the clinicodemographic features of ED. Materials and Methods: Two hundred and twelve subjects in the outpatient clinic of a tertiary care hospital were interviewed for demographic data, tobacco smoking, alcohol consumption, history of medications, previous abdominal surgery, history of diabetes mellitus, hypertension and ED, duration of ED if present, self-assessment of the level of sexual satisfaction, partner's assessment of the level of sexual satisfaction, type of remedies sought and used for ED in the past, whether or not subject has discussed the problem and patients' perception of the cause of the ED, all were interviewed with the international index of erectile function questionnaire for ED. Data was analyzed as appropriate. Results: Forty-two (19.8%) had ED and ED score was associated with age (P = 0.013), educational level (P < 0.001), monthly income (P < 0.001), alcohol consumption (P = 0.026), type of abdominal surgery done in the past (P = 0.002), self-rating of ED (P < 0.0001), partner rating (P < 0.0001), partner complaint (P < 0.0001), and frequency of complaint (P < 0.0001), it was however not significantly associated with marital status (P = 0.133), tobacco smoking (P = 0.259), quantity of tobacco smoked in pack years (P = 0.370), duration of ED (P = 0.141), drugs taken (P = 0.680). 77 (36.3%) never discussed ED before, 40 (19%) claimed that someone else was responsible, and only 15 (7.1%) had taken a phosphodiesterase inhibitor. ED score correlated negatively with fasting blood sugar with a trend toward significance (r = −0.134, P = 0.064). Conclusion: ED may be more frequent in the population studied considering the level of knowledge and attitude.

Frequency and determinants of erectile dysfunction in Turkish diabetic men.

Erectile dysfunction (ED) or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance. ED is observed more frequently and manifests earlier in diabetic patients compared to the normal population. One hundred and seventeen consecutive male type 2 diabetes patients seen in our Diabetes Outpatient Clinic were included in our study and these patients were evaluated in terms of the presence and duration of ED, treatment and response to treatment of ED, duration of diabetes mellitus, HbA1c levels, and the presence of microalbuminuria, estimated from 24-hour urine collections. The patients included in our study were divided into three groups: Patients with no ED, mild-to-moderate ED, and severe ED. Twenty-nine patients (24.8%) fell in the no ED group, 28 (23.9%) in the mild-to-moderate ED group, and 60 (51.3%) in the severe ED group. There were statistically significant differences between these three groups in terms of age ( P = 0.015) and duration of diabetes mellitus ( P = 0.03). The groups were similar in terms of microalbuminuria measured from 24-hour urine collections and HbA1c levels ( P = 0.328 and P = 0.905, respectively). Twenty-three of the 88 patients with ED (26.1%) were on ED treatment and 43.5% of these patients reported benefit from the therapy. Age and duration of diabetes were the main determinants of the presence and severity of ED in male Turkish type 2 diabetic patients. The HbA1c levels were higher in patients with ED, but the differences in levels between the groups did not reach statistical significance.

Combined sildenafil with vacuum erection device therapy in the management of diabetic men with erectile dysfunction after failure of first-line sildenafil monotherapy.

To evaluate the efficacy and safety of combination therapy of sildenafil plus vacuum erection devices in men with type 2 diabetes mellitus with moderate to severe erectile dysfunction who are dissatisfied with the results of using sildenafil alone. The study included 66 diabetes mellitus patients presenting erectile dysfunction for at least 6 months and dissatisfied with the use of 100 mg sildenafil monotherapy. The patients were randomized in two groups. Those in group A (n = 33) were instructed to use a vacuum erection device only, whereas those in group B (n = 33) were treated with combination therapy, including sildenafil 100 mg and a vacuum erection device. Erectile function was evaluated subjectively using the International Index of Erectile Function, Sexual Encounter Profile questionnaire questions 2 and 3 at visit 1 (baseline; study entry), visit 2 (4 weeks after baseline), and visit 3 (12 weeks after baseline; study end). There were no significant differences in average patient age, duration of diabetes, duration of erectile dysfunction, baseline International Index of Erectile Function scores, hypertension, blood testosterone, smoking and alcohol consumption between two groups. Mean International Index of Erectile Function scores were significantly higher for group B at the 1-month (14.86 ± 2.17 vs 12.41 ± 2.63; P < 0.0001) and 3-months (17.53 ± 2.95 vs 14.29 ± 2.81; P < 0.0001) visits. Men in group B had better successful penetration (73.3% vs 46.6%) and successful intercourse (70% vs 46.6%) at 3 months compared with group A. Combined use of sildenafil and vacuum erection device therapy significantly enhances erectile function, and it is well tolerated by diabetes mellitus patients not responding to first-line sildenafil alone.

The use of phosphodiesterase type 5 (pde-5) inhibitors in treatment of erectile dysfunction in patients with diabetes mellitus of different age groups

Aim. To study the effect of phosphodiesterase type 5 inhibitors used to treat the erectile dysfunction in patients of different age groups with concomitant diabetes mellitus. Methods. The study included 293 patients with diabetes mellitus type I and II aged 17-60 years, with duration of diabetes varying from 6 months to 29 years, duration of erectile dysfunction - from 6 months to 12 years. To diagnose the erectile dysfunction, an international index of erectile function, together with routine and special methods were used. Patients were administered phosphodiesterase type 5 inhibitors: sildenafil, taladafil and vardenafil. The control group included men with the erectile dysfunction without diabetes. To identify the male hypogonadism, patients were examined depending on the age group: 18-29 years, 30-39 years, 40-49 years, 50-59 years. Patiens were tested for sex hormones level, male ageing questionnaires were administered. Results. The increased rate of hypogonadism (from 12.5 to 54%) was associated with older age in patients with diabetes mellitus. The androgen status index in patients with diabetes mellitus, according to the Aging Males’ Symptoms rating scale, was 37.1±1.4 points. Phosphodiesterase type 5 inhibitors were more effective in younger age groups (57.1-91.7%) compared to older (36.8-67.3%). When comparing the study drugs, vardenafil showed better effect and relatively few side effects. Conclusion. Androgen deficiency, developing with increasing age is accompanied by a decrease in phosphodiesterase type 5 inhibitors efficiency. The use of small doses of these drugs corresponding the circadian rhythm of testosterone in males with normal testosterone blood level has the same effect as large doses.

Should men with mild erectile dysfunction be closely evaluated for cardiovascular diseases in the Korean population?

This study compared demographic characteristics and prevalence of cardiovascular comorbidities between men with mild erectile dysfunction (ED) and men with more severe ED. Men with 6-month history of ED and in monogamous heterosexual relationships were included. Non-responders to type 5 phosphodiesterase inhibitors or patients receiving regular treatment with nitrate, anticoagulants, androgens, and anti-androgens were excluded. ED was defined according to the International Index of Erectile Function questionnaire score: no ED (≥26), mild ED (22–25), and others (<22). The review identified 70 patients with mild ED (6.0%, group A) and 1098 patients with more severe ED (94.0%, group B) were included. Of the patients in group B, 365 had mild-to-moderate ED (30.5%), 505 had moderate ED (43.2%), and 233 had severe ED (20.0%). Mean ages and body mass indices showed no differences between groups A and B. Group A had shorter mean duration of ED (p = 0.025). Although patients in group A had milder ED with shorter duration than group B patients, cardiovascular risk factors such as diabetes, hypertension and lipid disorder were still common for group A. The most common comorbidity was diabetes, which was twice as likely for patients in group B. Except for diabetes the prevalence of all diseases was comparable between the two groups. In conclusion, patients with mild ED should be closely evaluated for cardiovascular comorbidities.

Characteristics of Testosterone Deficiency Syndrome in Men With Chronic Kidney Disease and Male Renal Transplant Recipients: A Cross-Sectional Study

ObjectivesTestosterone deficiency syndrome (TDS) is common among male patients with chronic kidney disease (CKD). We compared the characteristics of TDS in men with CKD versus renal transplantation (RT) with those of age-matched normal controls. Materials and MethodsThe 129 patients were: RT recipients (n = 25) group I, CKD patients (n = 37) group II, and controls (n = 67). We performed estimates of testosterone, hemoglobin (Hgb), hematocrit (Hct), glucose, creatinine, and lipid profile. Self-assessment questionnaires—International Index of Erectile Function (IIEF), Aging Males' Symptoms (AMS), Center for Epidemiologic Studies Depression Scale—were used to evaluate erectile function, testosterone deficiency, and depression, respectively. We also investigated morning erection as well as the presence and duration of erectile dysfunction (ED). ResultsGroup I (RT) showed significantly higher serum testosterone levels than group II (CKD), who displayed significantly worse erectile function, more severe testosterone deficiency symptoms, and a greater trend toward depression. Similarly, the prevalences of ED and TDS were significantly greater in group II than group I. Group I and controls differed significantly only in the results of serologic tests, such as serum creatinine, Hgb, and glucose and lipid profiles, but not in serum testosterone levels, scores of self-assessment questionnaires, or prevalence of ED or TDS. Serum testosterone levels correlated significantly with scores on the IIEF and AMS questionnaires in both group II and controls, but not group I. ConclusionsRT recipients showed higher serum testosterone levels and a lower prevalence of TDS with milder symptom severity than CKD patients. RT recipients beyond the early acute posttransplant period, displayed serum testosterone levels and TDS prevalence similar to those of healthy controls. Unlike CKD patients and normal controls, serum testosterone did not significantly influence TDS symptoms in RT recipients.

Exploring the Association Between Erectile Rigidity and Treatment Adherence with Sildenafil

Erection hardness has been shown to correlate with increased self-confidence, sexual satisfaction, and improvement in psychosocial factors such as sexual and overall relationship. It is estimated that one-third of men using phosphodiesterase type 5 inhibitors (PDE5) cease use of medication after one prescription and one-half cease use by 6 months. This study was undertaken to explore the link between erection hardness and treatment adherence. Men presenting with erectile dysfunction (ED) who were candidates for PDE5 therapy constituted the study population. They were assessed at the baseline regarding their erectile function (EF) and rigidity using autoquestionnaires. Patients then received regular follow-up using the same assessment tools and were also asked about continued use of PDE5. The final patient assessment was conducted at a time point no sooner than 12 months after commencing PDE5. Multivariable analysis was conducted to define predictors of continued PDE5 use. Patients were assessed using the International Index of Erectile Function (IIEF) questionnaire and the Erection Hardness Score (EHS). Adherence was defined as continued use of PDE5 at least once per month. One hundred eighty-six men were analyzed. The mean age and the duration of ED were 61 ± 22 and 2.2 ± 2.9 years, respectively. Sixty-three percent were married or partnered. The mean partner age was 52 ± 8 years. Of the 186 patients, 32% had one vascular comorbidity, 34% had two vascular comorbidities, 26% had three vascular comorbidities, and 6% had ≥ 4 vascular comorbidities. All patients were treated with sildenafil and were sexually active. The mean time to end-of-treatment (EOT) interview and repeat completion of questionnaires was 17 ± 4 months. At the baseline, 26% were EHS 3 (mild ED), 42% were EHS 2 (moderate ED), and 32% were EHS 1 (severe ED). The mean baseline EF domain score was 14 ± 10, and at the EOT, it was 22 ± 5 (P < 0.01). At the follow-up interview, 4% were EHS 1, 12% were EHS 2, 28% were EHS 3, and 56% were EHS 4. Overall, 67% of the men continued to use PDE5 at follow-up. The distribution of patients continuing to use PDE5 after commencement was 15% of those achieving EHS 1, 30% for EHS 2, 66% for EHS 3, and 82% for EHS 4. Based on logistic regression analysis, the factors predictive of continued PDE5 use were being partnered, partner age, frequency of sexual activity, a shift of ≥ 2 points on the EHS, and reaching level 4 on the EHS scale. There is an excellent relationship between erection hardness and adherence to PDE5 treatment. Driving men to greater erectile rigidity appears to translate into lower dropout rates.

The assessment of vascular risk in men with erectile dysfunction: the role of the cardiologist and general physician

Erectile dysfunction (ED) and cardiovascular disease (CVD) share risk factors and frequently coexist, with endothelial dysfunction believed to be the pathophysiologic link. ED is common, affecting more than 70% of men with known CVD. In addition, clinical studies have demonstrated that ED in men with no known CVD often precedes a CVD event by 2-5years. ED severity has been correlated with increasing plaque burden in patients with coronary artery disease. ED is an independent marker of increased CVD risk including all-cause and especially CVD mortality, particularly in men aged 30-60years. Thus, ED identifies a window of opportunity for CVD risk mitigation. We recommend that a thorough history, physical exam (including visceral adiposity), assessment of ED severity and duration and evaluation including fasting plasma glucose, lipids, resting electrocardiogram, family history, lifestyle factors, serum creatinine (estimated glomerular filtration rate) and albumin:creatinine ratio, and determination of the presence or absence of the metabolic syndrome be performed to characterise cardiovascular risk in all men with ED. Assessment of testosterone levels should also be considered and biomarkers may help to further quantify risk, even though their roles in development of CVD have not been firmly established. Finally, we recommend that a question about ED be included in assessment of CVD risk in all men and be added to CVD risk assessment guidelines.

A 6-month, prospective, observational study of PDE5 inhibitor treatment persistence and adherence in Middle Eastern and North African men with erectile dysfunction

Background:Erectile dysfunction (ED) negatively impacts quality of life. Phosphodiesterase type 5 inhibitors (PDE5Is) are effective in treating ED; however, rates of discontinuation remain high.Objectives:To assess on-demand PDE5I treatment persistence and adherence through 6 months in Middle Eastern and North African (MENA) men with ED in a prospective, non-interventional, observational trial.Research design and methods:Enrolled men were ≥18 years old from Saudi Arabia, Egypt, and the United Arab Emirates, PDE5I naïve, and sexually active. PDE5Is were selected per routine clinical practice. Persistence was defined as use of ≥1 dose during the prior 4 weeks, adherence as compliance with dosing instructions during the most recent dose. Logistic regression models were used to identify factors associated with persistence and adherence.Main outcome measures:Persistence and Adherence Questionnaire; Partner Relationship Questionnaire; Self-Esteem and Relationship Questionnaire; International Index of Erectile Function (IIEF); Erectile Dysfunction Inventory of Treatment Satisfaction.Results:Patients’ (n = 493) mean age was 49.8 years, mean BMI was 29.3, and the majority (n = 354, 71.8%) were from Saudi Arabia. Tadalafil was the most prescribed PDE5I (69.6%), versus sildenafil (15.4%), or vardenafil (15.0%). Patients’ mean IIEF–Erectile Function scores improved from moderate to mild and Erection Hardness Scores (SD) improved from 1.8 (1.0) at baseline to 3.5 (0.7) at 6 months. At 6 months, 64.9% of patients were treatment persistent (tadalafil, 68.8%, sildenafil, 65.8%, and vardenafil, 45.9%) and 59.6% were adherent. Factors significantly predictive (p < 0.05) of persistence at 6 months included age, employment status, and ED severity. Factors significantly predictive of adherence were age, employment status, and duration of ED. Interpretation of differences between drugs was limited by substantial differences in prescription rates between countries.Conclusions:At 6 months, 64.9% of men were treatment persistent. In this study, age, employment status, ED severity, and duration of ED were associated with persistence and/or adherence.

A 6 month, prospective, observational study of PDE5 inhibitor treatment persistence and adherence in Latin American men with erectile dysfunction

Objectives:To assess persistence/adherence rates of phosphodiesterase type-5 inhibitor (PDE5I) on-demand dosing in Latin American men with erectile dysfunction (ED), and explore patient characteristics and treatment factors that may be predictive for PDE5I persistence and adherence.Methods:Men from Brazil, Mexico, and Venezuela with ED who were naïve to PDE5Is were prescribed sildenafil, tadalafil, vardenafil, or lodenafil on-demand dosing and asked to provide information about PDE5I use at baseline and at 1, 3, and 6 months. Patients were persistent if they used ≥1 dose during the 4 week period prior to each evaluation. Patients were adherent if they complied with dosing instructions during most recent dose. Main outcome measures included Persistence and Adherence Questionnaire (PAQ), Partner Relationship Questionnaire (PRQ), Self-Esteem and Relationship (SEAR) Questionnaire, and International Index of Erectile Function (IIEF). Multivariate logistic regression was used to identify factors associated with persistence and adherence.Results:A total of 511 men were enrolled; most had mild to moderate ED (77.1%); 317 patients (62.0%) were prescribed tadalafil, 116 (22.7%) sildenafil, 75 (14.7%) vardenafil, and 3 (0.6%) lodenafil (not further analyzed). A total of 340 patients (66.5%) were ‘persistent’ at 6 months; 345 (67.5%) were ‘adherent’. Persistence and adherence were associated with age, education level, and ED duration. Reasons for non-persistence included medication cost and lack of efficacy. Study limitations included its design, brief observation period, its bias observed toward tadalafil selection; its dependence on patient self-reporting, limited number of factors that were analyzed for persistence/adherence association, its small number of participating patients and Latin American countries, and inherent differences in PDE5I preference and medical practices.Conclusion:Approximately two-thirds of PDE5I-naïve, Latin American men with ED were persistent and adherent after 6 months of therapy. Factors like education level, ED severity, and ED duration were associated with persistence and adherence; additional study is warranted to investigate the predictive value of these factors.

Prevalence of internal pudendal artery disease in diabetic patients with erectile dysfunction and angiographically documented multi-vessel coronary artery disease

Objectives We set out to explore the prevalence of significant atherosclerotic disease of the internal pudendal arteries (IPA) in diabetic men with erectile dysfunction (ED) and angiographically documented multi-vessel coronary artery disease (CAD). Background ED shares common risk factors of CAD, and is increasingly recognized as a well established risk factor for future cardiovascular events. Methods We enrolled 30 consecutive diabetic patients with ED undergoing elective coronary catheterization. Erectile function was evaluated using the abbreviated 5-item questionnaire known as the Sexual Health Inventory for Men.Distal aortography was first performed, followed by selective internal iliac arteriography. Significant IPA disease was defined as 50% or more luminal obstruction seen in the projection that best delineates the takeoff of the artery. Results The mean age of the whole series was 59.6 ± 8.4 years. The mean duration of diabetes mellitus was 8.1 ± 7.1 years, and the mean duration of ED was 4.3 ± 3.2 years. Significant IPA disease (stenosis/occlusion) was found in 11 (36.7%) patients; unilateral in 6 (20%) patients, and bilateral in 5 (16.7%) ones. Significant internal iliac artery disease (stenosis/occlusion) was found in 6 (20%) patients; unilateral in 4 (13.3%) patients, and bilateral in 2 (6.7%) ones. Significant IPA disease correlated positively with age and negatively with estimated creatinine clearance (p Conclusions In diabetic male patients with ED who have angiographically documented multi-vessel CAD, significant IPA obstruction (stenosis/occlusion) is rather frequent, and it correlates positively with age, and negatively with the estimated creatinine clearance.

Prevalence of internal pudendal artery disease in diabetic patients with erectile dysfunction and angiographically documented multi-vessel coronary artery disease

We set out to explore the prevalence of significant atherosclerotic disease of the internal pudendal arteries (IPA) in diabetic men with erectile dysfunction (ED) and angiographically documented multi-vessel coronary artery disease (CAD). ED shares common risk factors of CAD, and is increasingly recognized as a well established risk factor for future cardiovascular events. We enrolled 30 consecutive diabetic patients with ED undergoing elective coronary catheterization. Erectile function was evaluated using the abbreviated 5-item questionnaire known as the Sexual Health Inventory for Men. Distal aortography was first performed, followed by selective internal iliac arteriography. Significant IPA disease was defined as 50% or more luminal obstruction seen in the projection that best delineates the takeoff of the artery. The mean age of the whole series was 59.6 ± 8.4 years. The mean duration of diabetes mellitus was 8.1 ± 7.1 years, and the mean duration of ED was 4.3 ± 3.2 years. Significant IPA disease (stenosis/occlusion) was found in 11 (36.7%) patients; unilateral in 6 (20%) patients, and bilateral in 5 (16.7%) ones. Significant internal iliac artery disease (stenosis/occlusion) was found in 6 (20%) patients; unilateral in 4 (13.3%) patients, and bilateral in 2 (6.7%) ones. Significant IPA disease correlated positively with age and negatively with estimated creatinine clearance ( p < 0.05 for both). In diabetic male patients with ED who have angiographically documented multi-vessel CAD, significant IPA obstruction (stenosis/occlusion) is rather frequent, and it correlates positively with age, and negatively with the estimated creatinine clearance.

Can the Mean Platelet Volume Be a Risk Factor for Vasculogenic Erectile Dysfunction?

PurposeThe mean platelet volume (MPV) is a marker of the platelet activity and is reported to increase in vascular diseases. We aimed to investigate the association between MPV and vasculogenic erectile dysfunction (ED).Materials and MethodsMPV and platelet (PLT) levels were measured in 50 cases of ED and 40 healthy controls. The diagnosis of vasculogenic ED was based on a detailed sexual history, physical examination, laboratory assessment, and color Doppler ultrasonography. The results are given as mean±standard deviation of the mean.ResultsThe mean ages of the patient and the control groups were 53.70±12.39 years (range 24~77 years) and 53.85±9.5 years (range 30~73 years), respectively (p=0.947). The MPV and PLT values were significantly higher in the patients with ED than those of the controls (7.49±1.4), (6.85±1.2), (262.97±68), (252.89±82) respectively, p<0.001). However, the MPV values were not statistically significantly different in the patients with severe ED according to the International Index of Erectile Function than in those with mild ED, p>0.05), and there was no correlation between MPV and either age of patients (p=0.905) or duration of ED (p=0.583).ConclusionsThe platelet count and MPV was detected to be increased in patients with vasculogenic ED. This finding suggests a role for platelets in the pathogenesis of vascular complications and that the MPV would be useful in monitoring disease progression.

Daily Use of Sildenafil Improves Endothelial Function in Men With Type 2 Diabetes

Diminished vascular endothelial function results in decreased vasodilator capacity and is associated with erectile dysfunction (ED) in patients afflicted with type 2 diabetes. The current study was designed to evaluate whether daily use of sildenafil could alter endothelial function and improve penile rigidity in a group of patients with diabetic ED. A double-blind, placebo-controlled, prospective trial was conducted with 24 men with type 2 diabetes who were randomized into 2 groups: one receiving daily sildenafil (50 mg, n = 12) and the other placebo (n = 12) for 10 weeks. Erectile function was captured subjectively using the International Index of Erectile Function (IIEF-5), and endothelial function was objectively monitored via brachial artery flow-mediated dilation. Among the placebo and sildenafil groups, there were no significant differences in average patient age, time from type 2 diabetes diagnosis, duration of ED, or baseline IIEF-5 scores. Past medical histories, including smoking, alcohol consumption, hypertension, and hyperlipidemia, were also similar. At the conclusion of the 10-week trial, patients who received daily sildenafil had significantly improved erectile rigidity as captured by IIEF-5 (P < .001) and increased endothelial function via brachial artery flow-mediated dilation (P < .01). Endothelial function in men with type 2 diabetes was enhanced with daily sildenafil. Improved erectile rigidity and enhanced vascular circulation was noted after 10 weeks of daily sildenafil use.

Minimal Clinically Important Differences in the Vaginal Insertion and Successful Intercourse Items of the Sexual Encounter Profile

Despite adoption of the successful vaginal insertion (Q2) and intercourse (Q3) items of the sexual encounter profile (SEP) as end points in clinical trials, there are no objective data on what constitute minimal clinically important differences (MCIDs) in these items. The objective was to estimate the MCID for SEP Q2 and Q3. Using data from 17 randomized, controlled trials of the phosphodiesterase type 5 inhibitor tadalafil, we estimated MCIDs for the SEP using anchor-based approaches. The 17 studies included 3,345 patients treated for 12 weeks. The anchor for the MCID is the minimal improvement measure calculated using change from baseline to 12 weeks on the following question: "Over the past 4 weeks, when you attempted sexual intercourse how often was it satisfactory for you?" MCIDs were developed using analysis of variance- and receiver operating characteristic (ROC)-based methods in a subset of studies (N = 11) by comparing patients with and without minimal improvement (N = 863). MCIDs were validated in the remaining six studies (N = 377). The main outcome measures of this study are SEP Q2 and Q3. Using the ROC-based approach, the MCID for SEP Q2 was 21.4%, with estimated sensitivity of 0.55 and specificity of 0.73; the MCID for SEP Q3 was 23.0%, with estimated sensitivity of 0.72 and specificity of 0.78. MCIDs for SEP Q2/Q3 varied significantly (P < 0.001) according to baseline erectile dysfunction (ED) severity. MCIDs distinguished between patients in the validation sample classified as no change or minimally improved in each ED etiology, ED duration, and age group, but less well across geographic regions. The contextualization of treatment-related changes into clinically relevant terms is essential to understanding treatment efficacy, interpreting results across studies, and for effective patient management. Overall, there was a better balance between sensitivity and specificity of the MCIDs using the ROC-based approach for the SEP intercourse success item than for the vaginal insertion item.

1539 IS IIEF-EF A PROXY OF GENERAL MALE HEALTH STATUS?

You have accessJournal of UrologySexual Function/Dysfunction/Andrology: Evaluation1 Apr 20111539 IS IIEF-EF A PROXY OF GENERAL MALE HEALTH STATUS? Andrea Salonia, Antonino Saccà, Matteo Ferrari, Umberto Capitanio, Rayan Matloob, Fabio Castiglione, Lorenzo Rocchini, Giuseppe Zanni, Luigi Barbieri, Renzo Colombo, Patrizio Rigatti, and Francesco Montorsi Andrea SaloniaAndrea Salonia milan, Italy More articles by this author , Antonino SaccàAntonino Saccà milan, Italy More articles by this author , Matteo FerrariMatteo Ferrari milan, Italy More articles by this author , Umberto CapitanioUmberto Capitanio milan, Italy More articles by this author , Rayan MatloobRayan Matloob milan, Italy More articles by this author , Fabio CastiglioneFabio Castiglione milan, Italy More articles by this author , Lorenzo RocchiniLorenzo Rocchini milan, Italy More articles by this author , Giuseppe ZanniGiuseppe Zanni milan, Italy More articles by this author , Luigi BarbieriLuigi Barbieri milan, Italy More articles by this author , Renzo ColomboRenzo Colombo milan, Italy More articles by this author , Patrizio RigattiPatrizio Rigatti milan, Italy More articles by this author , and Francesco MontorsiFrancesco Montorsi milan, Italy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1534AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To assess whether erectile function [as defined with the IIEF-erectile function domain score (IIEF-EF)] is associated with health-significant comorbidities scored with the Charlson Comorbidity Index (CCI). METHODS Clinical and ultrasound variables of the last 100 consecutive patients who underwent penile duplex Doppler ultrasounds performed for erectile dysfunction (ED) at a single Institution by 3 expert technicians (ie, each performing >50 evaluations per year) were considered. Patients were comprehensively assessed with a detailed medical and sexual history, including data on duration of ED, ED severity (as defined with the IIEF-EF). As a proxy of general health status, we scored health-significant comorbidities with the CCI. Descriptive statistics and either logistic or linear regression models tested the association between clinical and ultrasounds variables and CCI. CCI was included in the model both as continuous and categorized variable (namely, 0 vs. ≥1). RESULTS Complete data were available for 99 (99%) [mean (SD) age: 45.9 (13.2) yr; range: 23–75; BMI: 26.7 (6.9); CCI: 0.6 (1.08); range: 0–5; CCI≥1: 35/99 (35.4%)] patients. Mean ED duration was 3.7 (4.7) yr. Mean IIEF-EF was 12.9 (9.3); according to IIEF-EF, patients had no ED, mild ED, mild-to-moderate ED, moderate ED, and severe ED in 9 (9.1%), 20 (20.2%), 9 (9.1%), 16 (16.2%), and 45 (45.5%) patients, respectively. The linear regression analysis showed that CCI linearly increased with ageing (Beta 0.33; p=0.001) and linearly decreased with IIEF-EF (Beta −0.25; p=0.01). Acceleration time parameters were also inversely associated with CCI (all Beta −0.31; all p≤0.04). No clear linear association emerged between BMI, PSV and RI and CCI. At logistic regression analysis age (OR=1.05; p=0.004) and IIEF-EF (OR=0.95; p=0.04) were significantly associated with categorized CCI, after accounting for all other variables. CONCLUSIONS Severity of ED, as objectively interpreted with IIEF-EF, emerged as a significant proxy of general male health status. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e618 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Andrea Salonia milan, Italy More articles by this author Antonino Saccà milan, Italy More articles by this author Matteo Ferrari milan, Italy More articles by this author Umberto Capitanio milan, Italy More articles by this author Rayan Matloob milan, Italy More articles by this author Fabio Castiglione milan, Italy More articles by this author Lorenzo Rocchini milan, Italy More articles by this author Giuseppe Zanni milan, Italy More articles by this author Luigi Barbieri milan, Italy More articles by this author Renzo Colombo milan, Italy More articles by this author Patrizio Rigatti milan, Italy More articles by this author Francesco Montorsi milan, Italy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Men with Mild Erectile Dysfunction Benefit from Sildenafil Treatment

Sildenafil treatment has not been evaluated in a double-blind, placebo-controlled (DBPC) trial specific to men with mild erectile dysfunction (ED), defined by a 22-25 score on the International Index of Erectile Function-erectile function domain (IIEF-EF). To assess sildenafil efficacy in sexually dissatisfied men with mild ED. Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS), IIEF, Quality of Erection Questionnaire (QEQ), Erection Hardness Score (EHS 4=completely hard/fully rigid), general efficacy questions (GEQs), event log questions (hardness sufficient for penetration, duration sufficient for successful intercourse, ejaculation/orgasm, and second erection within 24 hours), and analog scales (erection firmness, reliability, and maintenance, and general sexual performance). Eight-week DBPC flexible-dose (25, 50, or 100 mg) trial with 6-week, open-label (OL) extension. One hundred and seventy-six men were randomized (mean±standard deviation: age, 50±12 year; ED duration, 3.5±3.2 year). Most had organic or mixed ED. For sildenafil vs. placebo, 66% vs. 89% titrated to 100 mg and efficacy at DBPC end was better, including the EDITS Index score (least squares mean [standard error], 80.3 [2.3] vs. 62.1 [2.5]; P<0.0001); treatment satisfaction (EDITS Index score >50 in 89% vs. 63%; P=0.0001); no ED (IIEF-EF ≥26 in 58% vs. 39%; P<0.05); GEQs (≥4.9-fold greater odds of improved erections and ability to have sexual intercourse); and EHS 4 (47.2% vs. 25.2% of occasions; P<0.0001). At OL end, 93% of men were satisfied (EDITS Index score>50), 77% had no ED, and ≥89% were GEQ responders; mean scores on IIEF domains, the QEQ, and analog scales were >80% of the maximum; 60% of occasions had EHS 4; and event log responses were positive on >80% of occasions, except for second erections (41.9%). Headache, nasal congestion, and flushing, mostly mild to moderate, were the most common adverse events. Men with mild ED derive substantial benefit from sildenafil treatment.

Tadalafil and vardenafil vs sildenafil: a review of patient‐preference studies

The immediate objective of phosphodiesterase type 5 (PDE5) inhibitor treatment is to restore the ability of a man to achieve and/or maintain an erection adequate for sexual intercourse. As erectile dysfunction (ED) generally develops in the second half of life, the ultimate objective generally is not procreation, but quality of sexual life. Indeed, ED is known to impair quality of life considerably; two-thirds of men report that ED has impaired their self-esteem and nearly a third claim that it has damaged the relationship with their partner. It follows that the therapeutic success of PDE5 inhibition has an important subjective component, which is compounded by the subjective nature and complexity of sexual life in humans. This makes it very difficult for physicians to be certain that they have selected the optimal therapy for a couple, even after a thorough evaluation. The 2007 European Association of Urology Guidelines stress the importance of educating the patient and claim that 'the patient will choose the final drug after his own experience'. However, PDE5 inhibitors are typically used twice a week, so a patient would have to spend approximately 3 months trying the various compounds and dosages to achieve adequate exposure to all three PDE5 inhibitors; this would seem an unrealistic strategy in normal clinical practice. The acknowledgement that the patient has an important role in therapeutic decisions for ED has fuelled interest in the concept of patient preference. It has been established that patient preference depends on three factors, i.e. personal characteristics, e.g. age, duration of ED, frequency and dynamics of sexual relations, and the characteristics of their partners, e.g. age, menopausal status and level of interest in sexual activity and medication profile. Medication features of interest include efficacy in terms of quality of erection, consistency of effects, rapid onset of action, long duration of action, side-effect profile and route of administration; drug costs must also be considered if the medicinal product is not reimbursed.