Tadalafil For Erectile Dysfunction Research Articles

Role of the Triglyceride-Glucose Index as a Predictor of Therapeutic Response to Tadalafil in Patients With Erectile Dysfunction.

The triglyceride-glucose (TyG) index is an easily calculable indicator of endothelial dysfunction. We aimed to evaluate the effect of the TyG index on treatment response in patients using tadalafil for the treatment of erectile dysfunction (ED). The data of patients who used tadalafil for ED in our urology clinic between January 2018 and January 2023 were reviewed. The patients completed the 5-item International Index of Erectile Function (IIEF-5) questionnaire before treatment and in the 3rd month of treatment. Response to tadalafil treatment was accepted as an increase in IIEF category. Patients were divided into 2 groups according to treatment response. Factors affecting response to treatment were evaluated with a multivariate analysis. Of the 134 patients included in the study, 99 (73.3%) responded to tadalafil treatment. Mean age and body mass index (BMI) of the patient group responding to treatment were significantly lower than in the untreated group. The rates of diabetes mellitus (DM) and metabolic syndrome (MetS) were significantly lower in the group responding to treatment. Fasting glucose, triglyceride and total cholesterol values were significantly lower in the group responding to treatment than in the treatment-resistant group. The TyG index was 130.0 (102.0-180.0) in the group responding to treatment and 245.0 (182.0-320.0) in the treatment-resistant group (p=0.001). In the multivariate analysis, age, BMI, DM, MetS, and TyG index were affecting treatment response. A high TyG index negatively affects the response to treatment in patients using tadalafil for ED. In addition, age, BMI, presence of DM and MetS are other factors affecting the response to treatment.

(112) Penile Rehabilitation by Daily Intake of 5 mg Tadalafil for Erectile Dysfunction After Penile Fracture

Abstract Introduction Penile fracture is a rare complication to penile trauma, characterized by a sudden injury of the tunica albuginea of one or both corpora cavernosa of the penis. This commonly occurs during the erect state, when the tunica is thinner and under tension of fully engorged corpora cavernosa. Erectile dysfunction (ED) may occur in up to 12% of these patients due to organic and psychosexual factors including penile fibrosis. Objective This study aimed to assess the potential predictors of erectile dysfunction in patients who had penile fracture repair and the role of rehabilitation course of daily tadalafil 5 mg in management of ED following penile fracture. Methods From January 2022 to February 2023, 25 patients were included. Patients' baseline data as well as history including the time of presentation, the pattern and length of the tunical tear, and the presence of urethral injury, were obtained. After a week, all patients were followed up on and told to resume intercourse after at least two weeks if their wound had epithelialized. Only patients with a complaint of a weak erection, as determined by the Arabic validated version of the international index of erectile function (ArIIEF-5), were started on daily tadalafil 5 mg as a penile rehabilitation for at least one month, or until they regained their normal erection. The Hospital Anxiety and Depression Scale (HADS) was used for assessing patients. Patients with confounding disease as metabolic syndrome or mental illness were eliminated. Results Significant indicators predicting erectile dysfunction, according to the multiple logistic regression model, are the patients' age and the length of the tunical tear. A 1% increase in age was linked with a 73.6% rise in the probability of erectile dysfunction (p = 0.046), and a 1 cm increase in tunical tear length was associated with a 20.04 times increased risk of erectile dysfunction (p = 0.04). With a mean score of 20 on the Arabic-approved version of the internal index of erectile function, 5 of 9 patients with erectile dysfunction (55%) had improved erections after one month of penile rehabilitation, while only 4 of 9 patients (44%) required an additional month of treatment. Conclusions We propose that patients with penile fractur be counselled about erectile dysfunction and begin penile rehabilitation as soon as possible following repair to regain a normal erection. Disclosure No.

Chinese herbal medicine combined with tadalafil for erectile dysfunction: a systematic review and meta-analysis.

Erectile dysfunction (ED) is a tough problem in medicine. This article aims to provide the latest evidence for the efficacy and safety of traditional Chinese medicine (TCM) combined with tadalafil in treatment of erectile dysfunction. All randomized controlled trials that Chinese herbal medicine combined with tadalafil for erectile dysfunction were included in databases of China National Knowledge Infrastructure (CNKI), Wanfang, Weip Database, ChinaBiology Medicine disc (CBM), MEDLINE, EMBASE, and Cochrane Library. The quality of the included articles was evaluated using Cochrane Reviewer's Handbook 5.3, and meta-analysis was performed using Stata 13.1. A total of 11 studies including 451 cases in the treatment group and 452 cases in the control group were obtained. Compared with tadalafil alone, meta-analysis suggests there were statistically significant differences in International Index of Erectile Function-5 (IIEF-5), effective rate, Sexual Encounter Profile questions 2 and 3 (SEP-Q2, SEP-Q3) between traditional Chinese medicine combined with tadalafil, and no statistically significant differences in side effects between the two groups. All included studies were tested for publication bias, and the results indicated that there was no significant bias. Two of the articles mentioned the scheme that traditional Chinese medicine combined withlow-dose tadalafil for erectile dysfunctionby down stairs. Traditional Chinese medicine combined with tadalafil has significant efficacy in the treatment of ED with no increase in side effects. The specific implementing regulations and effect of de-escalation therapy still need more long-term, multicenter, randomized, and double-blind clinical trials.

MON-352 Feminizing Adrenal Adenoma in an Adult Man Presenting with Gynecomastia and Hypogonadism

Introduction: Feminizing adrenal tumors (FAT) are a rare cause of gynecomastia and hypogonadism in men. Most FATs are malignant and secrete other adrenal hormones and precursors. Rarely, benign adenomas solely secreting estrogens have been described. We present a patient with an estrogen-secreting adrenal adenoma with benign histology without secretion of other hormones or precursors. Case: A 43-year-old man presented with complaints of fatigue and erectile dysfunction for 24 months and painful bilateral breast growth for 12 months. Mammography revealed bilateral gynecomastia, and he was initially treated with tadalafil for erectile dysfunction. Due to persistent symptoms, labs were obtained revealing a low total testosterone level of 56 ng/dL (250-827 ng/dL). Further labs were obtained after an endocrinology evaluation: total testosterone 28 ng/dL, estradiol 44 pg/mL (≤29 pg/mL), estrone 192 pg/mL (≤68 pg/mL), estriol <0.10 ng/mL, FSH 0.8 mIU/mL (1.6-8.0 mIU/mL), and LH 3.1 mIU/mL (1.5-9.3 mIU/mL). Serum prolactin, β-hCG, AFP, ACTH, TSH and IGF-1 were all within normal ranges. Testicular ultrasound showed a left-sided varicocele. Adrenal protocol CT showed a 2.8 cm left adrenal nodule with characteristics of an adenoma (round, homogenous, pre-contrast Hounsfield units: 10, absolute washout: 68%). DHEAS, androstenedione, 11-deoxycortisol, 17-hydroxprogesterone, renin and aldosterone were all within normal ranges. 24-hour urine for cortisol, metanephrines and 17-ketosteroids were normal. He underwent laparoscopic left adrenalectomy. Pathology revealed a 2.5 cm well-circumscribed adrenal adenoma. Features favoring a benign histology included <1 mitotic figure/50 HPF, no atypical mitotic figures, no necrosis, and no capsular invasion. Repeat hormonal workup after surgery showed total testosterone 223 ng/dL, free testosterone 58 pg/mL (35-155 pg/mL), estradiol 16 pg/mL, estrone 39 pg/mL, and FSH 3.3 mIU/mL. On follow-up, the patient reported improvement in fatigue, decreased breast tenderness, and a slight decrease in breast size. Discussion: FATs most commonly present with painful gynecomastia and hypogonadism in males. Cosecretion of other adrenal hormones or precursors is suggestive of malignancy. Most FATs are malignant, and benign adenomas solely secreting estrogen are extraordinarily rare. Unfortunately, a benign appearance on histology may not predict a benign course. A case was previously reported with a young male child with FAT and initial benign histology, who later developed malignant metastases several years after the initial surgery. This demonstrates the importance of post-operative surveillance with imaging and serial hormonal evaluations.

Efficacy of tadalafil treatment on erectile dysfunction in patients under dutasteride treatment: A prospective non-randomized comparative study.

In this study, we aimed to evaluate the efficacy of tadalafil in the management of erectile dysfunction in patients under dutasteride medication for bladder outlet obstruction. In this study the data of consecutive patients that admitted to our outpatient clinics treated with dutasteride for bladder outlet obstruction and tadalafil (10 or 20 mg on demand) for concomitant complaint of erectile dysfunction (ED) between October 2013 and March 2016 were evaluated. An age-matched control group of patients treated with tadalafil for ED but did not receive any other medication for either lower urinary tract symptoms (LUTS) or ED was also included. Groups were compared for tadalafil efficacy with International Index of Erectile Function (IIEF) scores. Each one of the dutasteride and control groups included 104 patients. The groups were similar for pretreatment IIEF score, serum cholesterol, low-density lipoprotein (LDL), triglyceride and testosterone measurements. The number of hypertensive patients was comparable between two groups but the number of diabetic patients were significantly higher in the control group. IIEF score improved significantly in both groups following tadalafil treatment but the difference between the two groups was not statistically significant. Tadalafil treatment provides significant improvement in erectile functions of patients under dutasteride treatment for bladder outlet obstruction. However, the current study does not focus on a population of dutasteride induced ED and therefore a further prospective study on this issue would be helpful.

Trends in Urological Direct-to-Consumer Advertising during Prime-Time Television News Programs

IntroductionThe purpose of this study is to characterize contemporary trends in direct-to-consumer advertising of urological pharmaceutical products on American prime-time television programs. Television is the highest expenditure segment of the consumer drug marketing industry. The extent of advertising in urology and its potential impact on patients are not well understood. MethodsWe retrospectively analyzed an indexed database of prime-time news broadcasts on 5 national networks in the United States. The database was queried with the names of 77 urological pharmaceutical products to identify all commercials that aired during a 36-month period between 2010 and 2013. Noncommercial segments were excluded. Descriptive and linear regression analysis was performed. ResultsWe analyzed 4,574 broadcasts, representing 3,067.5 hours of prime-time television. A total of 2,068 commercials for 8 products and 4 urological indications were aired, including sildenafil and tadalafil for erectile dysfunction; 2 testosterone products for hypogonadism; fesoterodine, oxybutynin and solifenacin for overactive bladder; and sipuleucel-T for metastatic castration resistant prostate cancer. Commercials for male oriented indications accounted for 90% of the sample. At least 1 urological advertisement was contained in 1,744 broadcasts (38%). The introduction of television marketing for newly approved testosterone supplementation products in 2012 corresponded to strongly linear growth in overall urological advertising, reaching peak levels in 2013. ConclusionsUrological pharmaceutical products have been consistently advertised on television. Commercials have extensively targeted male oriented indications. Viewers of national news programs were exposed to urological advertising during about 40% of broadcasts with steadily increasing exposure since 2012. Providers should be aware of these trends to contextualize demand and monitor prescribing patterns.

INTERACTION BETWEEN THE PHOSPHODIESTERASE 5 INHIBITOR, TADALAFIL AND 2 α-BLOCKERS, DOXAZOSIN AND TAMSULOSIN IN HEALTHY NORMOTENSIVE MEN

Tadalafil, a phosphodiesterase type 5 inhibitor, is effective therapy for erectile dysfunction (ED). Men with ED have a high incidence of comorbid conditions including cardiovascular disease, diabetes mellitus and benign prostatic hyperplasia. Although phosphodiesterase type 5 inhibitors are safe when administered with most medications, sildenafil given with doxazosin and vardenafil given with terazosin evoke orthostatic hypotension in some patients. We examined the hemodynamic interactions of tadalafil with the alpha-blockers doxazosin and tamsulosin. In separate double-blind, placebo controlled, randomized crossover studies (18 patients in each study) we evaluated the hemodynamic effects of doxazosin 8 mg with tadalafil 20 mg, and tamsulosin 0.4 mg with tadalafil 10 and 20 mg. Blood pressure (BP) and heart rate were recorded before dosing and for 24 hours after dosing. Tadalafil 20 mg augmented the hypotensive effect of doxazosin by producing a mean maximal decrease in standing systolic BP (SBP) that was significantly greater than placebo (a mean difference of 9.8 mm Hg). Analysis of BP outliers showed that the number of subjects with a standing SBP of less than 85 mm Hg was greater after doxazosin plus tadalafil (28%) versus doxazosin plus placebo (6%). In subjects on tamsulosin, tadalafil 10 and 20 mg produced mean maximal decreases in standing SBP that were similar to placebo (mean difference of 1.7 and 2.3 mm Hg, respectively). No subject taking tamsulosin had a decrease in standing SBP less than 85 mm Hg. Tadalafil augmented the hypotensive effects of doxazosin but had little hemodynamic interaction with tamsulosin. In patients taking tadalafil for ED, tamsulosin 0.4 mg may be given for the treatment of benign prostatic hyperplasia.

Integrated analysis examining first-dose success, success by dose, and maintenance of success among men taking tadalafil for erectile dysfunction

Objectives To examine, in a post-hoc, integrated analysis, the first-dose success, cumulative success by dose, and maintenance of success among men taking tadalafil. Early treatment success is important to men with erectile dysfunction. Methods In five double-blind, placebo-controlled, 12-week studies, men were randomized to placebo (n = 308), tadalafil 10 mg (n = 321), or tadalafil 20 mg (n = 258) as a fixed dose. The Sexual Encounter Profile (SEP) diary questions assessed success from three perspectives: (a) first-dose success; (b) cumulative proportion of men with first success by dose; and (c) maintenance of success among men with first-dose success. Results With the first dose, significantly greater proportions of men taking tadalafil 10 and 20 mg versus placebo achieved successful erection (SEP-Q1: 85% and 90% versus 66%, respectively), successful penetration (SEP-Q2: 74% and 79% versus 47%, respectively), successful intercourse (SEP-Q3: 56% and 67% versus 31%, respectively), and were satisfied overall with their sexual experience (SEP-Q5: 36% and 47% versus 15%, respectively; all P <0.001). The proportion of men achieving first success increased with continued dosing, reaching a plateau between doses 4 and 8 at approximately 95% (SEP-Q2), 90% (SEP-Q3), and 81% (SEP-Q5). For men with first-dose success, the subsequent success rate during the 12-week period was significantly greater for men taking tadalafil 10 and 20 mg versus placebo (all P <0.001; SEP-Q2: 85% and 91% versus 75%; and SEP-Q3: 81% and 88% versus 64%, respectively). Conclusions Most men taking tadalafil achieved successful erection, penetration, and intercourse after one dose and maintained the success over time. Because success increased with continued use, men who do not respond initially should continue treatment to increase the likelihood of treatment success.