Treatment Of Vasculogenic Erectile Dysfunction Research Articles

Safety and efficacy evaluation of intracavernosal injection of platelets rich plasma in treatment of vasculogenic erectile dysfunction

ABSTRACT Objectives The study’s objective is to compare platelet-rich plasma (PRP) injections to placebo in terms of effectiveness and safety for patients with vasculogenic erectile dysfunction (ED). Methods This randomized placebo-controlled clinical trial was done on 50 male patients with organic vasculogenic ED and sexually active in a stable heterosexual relationship for a period of over three months. The patients were randomized into two main groups: Group (A) (n = 25) underwent PRP treatment. Group (B) (n = 25) control underwent placebo treatment. Results The two groups under study differed in a statistically significant way regarding the achievement of minimal clinically important differences (MCID) at 3 months and 24 months. Statistically significant variations existed between the mild subgroup and placebo regarding achieving MCID after 3 months and 24 months. The level of satisfaction was statistically significantly higher in the PRP group. A statistically significant variation was present between the mild subgroup and placebo at 3 months and 24 months in terms of changes from baseline in the erectile function domain of the International Index of Erectile Function (IIEF-EF) questionnaire score in each subgroup. Conclusions PRP is an effective alternative modality of treatment in cases of ED, and they offer an intermediate stage between pharmaceutical therapy and surgical interventions at least in mild and mild to moderate cases where unsatisfactory results or unpleasant side effects compel the patients to abandon all hope on medical treatment.

Modern methods of diagnosis and treatment of vasculogenic erectile dysfunction

A review of modern methods of diagnosis and treatment of vasculogenic erectile dysfunction is presented. Data regarding the diagnostic value of noninvasive and invasive diagnostic techniques are displayed: stamp test, Snap-Gauge test, use of the RigiScan and Androscan-MIT systems, intracavernous injections of vasoactive drugs, Doppler ultrasound of penile vessels, penile angiography, and magnetic resonance arteriography. The advantages and disadvantages of each of these tests are shown. The main directions of conservative and surgical treatment of vasculogenic erectile dysfunction are presented. Notably, early detection of erectile dysfunction with the prescription of appropriate treatment can improve the quality of life of patients and prevent life-threatening complications of cardiovascular conditions.

Recording method of nocturnal penile tumescence to evaluate the efficacy of X-ray endovascular treatment of vasculogenic erectile dysfunction

Background. The vasculogenic form of erectile dysfunction (ED) is the most widespread of all forms of ED. As a rule, young men in the initial stages of the disorder are not ready to accept phalloprosthetics, making it a relevant concern to search for alternative ways of their sexual rehabilitation, including X-ray endovascular surgery. No less relevant is further improvement of the quality assessment methods for erectile dysfunction both for diagnostic purposes and for determining of efficacy of the treatment provided.Aim. To assess the quality of erectile function by monitoring nocturnal penile tumescence (NPT) in patients after X-ray endovascular treatment of vasculogenic ED.Materials and methods. Over 560 patients with suspected vasculogenic erectile disorder have been examined since 2012, with X-ray endovascular treatment provided to 121 patients with confirmed veno-occlusive ED. To assess the quality of erectile function in patients, we monitored NPT using an Androscan MIT registrar from January 2022 to September 2023, in each case one month before and after the surgical treatment of vasculogenic ED. Included in the study were 40 patients who underwent surgery with us, aged 25 to 48 years old (34.3 ± 7.4 years on average) and having vasculogenic ED, including those with veno-occlusive erectile disorders (n = 33), arterial insufficiency of the cavernous bodies (n = 5), hemodynamic and clinical signs of arteriovenous ED in the subcompensation stage (n = 2). Data were compared on changes in the penile diameter and duration of rigidity during NPT, reflecting the main hemodynamic indicators of the penile blood flow.Results. In the compensated stage of ED, the increase in the penile diameter during NPT was 20–30 %, with duration of tumescence being 43.2 ± 20 min; in the subcompensated stage, 10–30 % and 23 ± 21 min respectively. One month after treatment, these indicators were 45 ± 15 % and 76.3 ± 21 min respectively. After surgery, all patients demonstrated a recovery of the erectile function, and the linear and angle-independent blood flow indicators tended to normalize. The data obtained from the monitoring of NPT helped identify a correlation between the linear blood flow indicators, their derivatives, as well as the time and character of penile rigidity during NPT, making it possible to differentiate the types of vasculogenic ED and the criteria for its clinical compensation.Conclusion. At present, the instrumental diagnostics of ED is limited to the Doppler sonography of the penile vessels, which does not consider the multifactorial nature of the causes of erectile disorders in men of various ages. Registration of NPT using a standalone device allowing to reconduct the examination and to record the results graphically as erectograms can be used for minimally invasive objectification to confirm the recovery of the erectile function in the event of compensated and subcompensated stages of vasculogenic ED. However, further research is required into vasculogenic erectile disorders and the capacities for their assessment using NPT monitoring.

Rationale and design of the sirolimus eluting balloon utilization for treatment of vasculogenic erectile dysfunction: the SUASION Registry.

Conventional angioplasty balloon catheter, drug coated balloon (DCB), or angioplasty with drug eluting stent (DES) have been used on the percutaneous treatment of erectile dysfunction (ED). Currently available DCBs are paclitaxel eluting balloon (PEB), very recently, sirolimus eluting balloon (SEB). Although endovascular revascularization with balloon resulted in improvement of ED, there have been no prior reports on the feasibility of SEB treatment for ED. We present an observational, retrospective-prospective multicentre registry in patients evaluating the use of SEB for the treatment of de novo stenosis in native internal pudendal arteries. We will include 100 patients affected by vasculogenic ED non responder to PDE5i with up to two lesions requiring treatment. ED patients should present a IIEF-5 Score<15, positive dynamic doppler (PSV <25 cm/s) and/or evidence at basal CT angiography. At 30 days, 180, 240, and 365 days following the index procedure, IIEF-5 score will be assessed, and medication regimen and adverse event monitoring will be assessed. At 8 months a dynamic Doppler will be performed. Patients will be followed up for 2 years. The primary endpoints are the Delta IIEF-5 Score and a Delta PSV between basal and 8 months follow-up. The secondary endpoint is the incidence of major adverse event (MAE), binary restenosis and late loss in patients who will repeat control angiography if clinically indicated. Considering the limitations and safety concerns of PEB, POBA and DES used so far in ED clinical investigations, we hypothesize that sirolimus nanocarriers-coated balloon can potentially be an improved next-generation treatment for ED patients.

The impact of extracorporeal shock wave therapy for the treatment of young patients with vasculogenic mild erectile dysfunction: A prospective randomized single-blind, sham controlled study.

Low-intensity extracorporeal shock wave therapy (ESWT) for the treatment of vasculogenic erectile dysfunction (ED) has emerged as a promising method directly targeting the underlying pathophysiology of the disease. To compare outcomes in ED patients after ESWT and placebo treatment. Prospective randomized placebo-controlled single-blinded trial on 66 patients with mild ED. The study comprised a 4-week washout phase, a 4-week treatment phase, and a 48-week follow-up. Inclusion criteria included age between 18 and 75years and diagnosis of mild ED (IIEF-EF score=17-25) being made at least six months prior to study inclusion and being confirmed by Penile Doppler ultrasonography (US) at baseline examination. Efficacy endpoints were changes from baseline in patient-reported outcomes of erectile function (International Index of Erectile Function domain scores [IIEF-EF]), as well as erection hardness and duration (Sexual Encounter Profile diary [SEP] and Global Assessment Questions [GAQ]). Safety was assessed throughout the study. A total of 66 enrolled patients were allocated to ESWT (n=44) or placebo (n=22). Mean age of ESWT and placebo group was 42.32±9.88 and 39.86±11.64 (p=0.374), respectively. Mean baseline IIEF-EF scores of ESWT group and placebo were 20.32±2.32 and 19.68±1.55 respectively (p=0.34). At 3-months follow-up, mean IIEF-EF scores were significantly higher in ESWT patients than in placebo patients (23.10±2.82 vs. 20.95±2.19, p=0.003), and IIEF-EF scores of ESWT patients remained high during the 6months (22.67±3.35 vs. 19.82±1.56) follow-up. The percentage of patients reporting both successful penetration (SEP2) and intercourse (SEP3) in more than 50% of attempts was significantly higher in ESWT-treated patients than in placebo patients (p=0.001). A minimal clinically important difference between the IIEF=EF baseline and 3-months follow-up was found in 74% of ESWT and 36% of placebo. No serious adverse events were reported. ESWT significantly improved the erectile function of relatively young patients with vasculogenic mild ED when compared to placebo and the beneficial effect of this treatment up to 6months. These findings suggest that ESWT could be a useful treatment option in vasculogenic ED.

Low-intensity shock wave therapy for the treatment of vasculogenic erectile dysfunction: a narrative review of technical considerations and treatment outcomes.

Erectile dysfunction (ED) impacts a significant portion of the aging male population. Standard treatments such as oral medications, intracavernosal injections, intraurethral suppositories, vacuum erection aids, and penile prosthesis placement have stood the test of time. Recently, there has been a growing interest in the concept of regenerative medicine with the goal of restoring or renewing functional tissue. Low intensity shock wave therapy (LiSWT) is one example of a regenerative therapy. A strong body of basic science data suggests that shockwaves, when applied to local tissue, will encourage blood vessel and nerve regeneration. Clinical evidence supports the use of LiSWT to treat conditions ranging from ischemic heart disease, musculoskeletal injuries, and even chronic non-healing wounds. LiSWT is also being used to treat male sexual dysfunction conditions such as Peyronie’s Disease and ED. The first studied application of LiSWT for ED was published in 2010. Since then multiple randomized, sham-controlled trials have sought to evaluate outcomes for this novel therapy in men with vasculogenic ED. Additionally, several meta-analyses are available with pooled data suggesting that LiSWT results in a significantly greater improvement in erectile function relative to sham-control. Despite these promising findings, the current body of literature is marred by significant heterogeneity relating to treatment protocols, patient populations, and follow-up duration. Further work is necessary to determine optimal device technologies, patient characteristics, and treatment duration prior to considering LiSWT as standard of care for men with ED.

Intra-cavernous injection of BOTOX® (50 and 100 Units) for treatment of vasculogenic erectile dysfunction: Randomized controlled trial.

Erectile dysfunction (ED) is a socioeconomic problem.There are several options for its management including intra-cavernosal injection (ICI). To compare the safety, efficacy, and durability of ICI of onabotulinum toxin-A (BTX) in different doses (50 and 100 U) against placebo (saline) in the management of vasculogenic ED non-responding to pharmacological therapy (phosphodiesterase type 5 inhibitors or/and ICI of trimix). A prospective randomized double-blind placebo-controlled trial was conducted between July 2016 and February 2019. A total of 176 patients were randomly assigned (1:1:1) to one of the treatment sequences: Botox 100 U group (BTX-100; 62 patients), Botox 50 U group (BTX-50; 59 patients), or placebo group (55 patients). All patients were followed up for 6 months. Significant improvement in all parameters, that is, SHIM score & Erection Hardness Score (EHS), Sexual Encounter Profile (SEP), Global Assessment Score (GAS), and Doppler parameters (p<0.001) was observed in patients of BTX-100 and BTX-50 groups with maximum improvement at 3rd month of treatment. Around 40% of patients were responders and were able to engage in sexual intercourse. Patients in placebo group did not experience significant improvement (p=0.264). It was noted that at the 2nd week and 3rd months after treatment, there was no statistically significant difference in the improvement of these parameters in BTX-100 and BTX-50 groups (p>0.05). In the 6th month, there was a statistically significant difference between the aforementioned groups in favor of BTX-100 (p<0.01). Only one-time ICI of BTX (50 U and 100 U) is effective and safe for the treatment of refractory ED. This agent has a considerable long duration of action, particularly BTX-100U seems to be more durable.

Обоснование оптимальной схемы ударно-волновой терапии при васкулогенных эректильных дисфункциях

Introduction. Shock wave therapy (SWT) has been used quite successfully to treat erectile dysfunction (ED). However, the question of the optimal SWT regimen for the treatment of erectile dysfunction remains unresolved and is the subject of discussion among both physicians and manufacturers of medical equipment. Purpose of the study. Develop and substantiate the most effective SWT regimen for the treatment of erectile dysfunction, based on the analysis of 28 scientific clinical studies. Metrials and methods. To solve the problem, we analyzed 28 scientific clinical studies containing data on the use of shock wave therapy in the treatment of vasculogenic ED in a clinical setting. Results. In the field of research, we developed and substantiated the SWT scheme for the treatment of vasculogenic ED. The scheme consists of a 9-week course (3 – therapy, 3 – break, 3 – therapy), contains 12 procedures (2 procedures per week); impulses are applied to 5 points, 500 impulses each (2500 per procedure); the total number of impulses per course is 30,000. Conclusions. Thus, we have proposed a differential approach to the choice SWT regimen for the treatment of vasculogenic ED. Conservative tactics involves the use of medications (primarily PDE-5). Nevertheless, SWT can and should be applied within the framework of this tactic, and the optimal scheme is established mathematically by analyzing the literature data. Within the framework of a differentiated approach, we have determined the optimal schemes for conducting shock wave therapy in the treatment of vasculogenic erectile dysfunction.

PS-5-10 Prepped: Platelet Rich Plasma for Erectile Dysfunction: A Randomised, Double- Blind Controlled Trial to Evaluate the Efficacy of Intracavernosal Infusion of Platelet Rich Plasma (PRP) Against Platelet Poor Plasma (PPP) in the Treatment of Vasculogenic Erectile Dysfunction

PS-5-10 Prepped: Platelet Rich Plasma for Erectile Dysfunction: A Randomised, Double- Blind Controlled Trial to Evaluate the Efficacy of Intracavernosal Infusion of Platelet Rich Plasma (PRP) Against Platelet Poor Plasma (PPP) in the Treatment of Vasculogenic Erectile Dysfunction

Determinants of Early Response to Low-Intensity Extracorporeal Shockwaves for the Treatment of Vasculogenic Erectile Dysfunction: An Open-Label, Prospective Study

The aim of this study was to expand existing literature on the effects of cardiovascular risk factors on the outcome of low-intensity extracorporeal shockwaves therapy (LIESWT), and to evaluate the role of hormone concentrations. Twenty patients with long-standing, PDE5i-resistant, vasculogenic erectile dysfunction (VED) were treated with six weekly sessions of LIESWT (9000 pulses). After a three-week break, four poor responders underwent another six weekly sessions. Rigidity score (RS) questionnaire was administered at baseline (T0), last session (T1), and three months after LIESWT (T2), while the Improvement component of the Clinical Global Impression of Change (CGIC-I) and the International Index of Erectile Function-5 (IIEF-5) questionnaires were administered at T1 and T2, and at T0 and T2, respectively. At T0 serum luteinizing hormone (LH), testosterone, sex hormone binding globulin (SHBG), calculated free testosterone, and prolactin levels were also recorded. At T1 and T2, 12/20 (60%) and 11/20 (55%) patients reached a RS ≥ 3; 16/20 (80%) and 13/20 (65%) improved their erections variably. Testosterone levels correlated positively with CGIC-I at T1. Patients < 65 years and those nonhypercholesterolemic had higher RS at T1 and T2. Age correlated negatively with RS at T1 and T2. At T0, diabetic patients had lower IIEF-5 scores, but those with RS ≥ 3 at T1 had higher IIEF-5 compared to those with RS < 3. Also, diabetes duration correlated inversely with IIEF-5 at T0. At T2, IIEF-5 improved significantly by an average of 2.8-points. We confirm safety and effectiveness of LIESWT for the treatment of VED. Age ≥ 65 years, diabetes, and hypercholesterolemia influence early and negatively the outcome of LIESWT.

Comparative Study between Intracavernosal Injection of Botulinum Toxin type A [50 and 100 unit], Efficacy and Durability in the Treatment of Vascular Erectile Dysfunction

Evidence has been arising suggesting that Botulinum toxin type A [BTX-A] injections can relax smooth muscles fibers in the treatment of obesity and Detrusor muscle over-activity, similar effect on cavernosal smooth muscles would help in the treatment of erectile dysfunction [ED] resistant to oral and intracavernous injection [ICI] therapy, thus it could be an alternative option for failed medical and other injectable therapy.. to compare safety, efficacy and durability of different doses of BTX-A [50 and 100 Unit] in the treatment of Vasculogenic Erectile Dysfunction after failure of other ICI therapy.. Forty-five patients with Vasculogenic erectile dysfunction who are failed treatment with non-surgical options were included at this study after elimination of all patients who are not matching eligible criteria or not complete the follow up program. The patients were randomized into 3equal groups, each group include 15 patients. Group [I] injected with 100U BTX-A, group [II] injected with 50U BTX-A and Control group injected with normal saline. All groups underwent follow up at 2 weeks, 3 months and 6 months intervals after injection, for assessment of all subjective data as, IIEF-5 Questionnaire [SHIM score], Erection hardness score [EHS], Sexual encounter profile [SEP 2 and 3], Global assessment score[ GAS 2 and 3]. Also assessment of objective data by penile Doppler details.. Although 25 patients [55.6%] respond to BTX-A injection subjectively and objectively {13 patients [28.9%] in group [I] and 12 patients [26.7%] in group [II]}, but this impressive effect was not durable especially in group [II] as 9 patients [20%] show lost effect through complete follow up till 6 month in comparison to 5 patients [11.1%] in group [I] show same lost effect. Besides that, 5 patients [11.1 %] not responding to this treatment option {two patients [4.4%] in group [I] and 3 patients [6.7%] in group [II], also patients in Control group show non-significant subjective improvement. BTX-A could be a potential but not durable therapy for erectile dysfunction, as BTX-A [50 and 100 Unite] show almost same efficacy but, with complete follow up through 6 months, BTX-A 100U is more durable than 50U

1220 - Autologous adipose tissue derived stromal vascular fraction for treatment of vasculogenic erectile dysfunction: Results of clinical trial phase I/II

1220 - Autologous adipose tissue derived stromal vascular fraction for treatment of vasculogenic erectile dysfunction: Results of clinical trial phase I/II

208 Low-Intensity Shock Wave Therapy for Treatment of Vasculogenic Erectile Dysfunction: Phase 1 Results of the Dornier Aries in the First United States Clinical Trial

208 Low-Intensity Shock Wave Therapy for Treatment of Vasculogenic Erectile Dysfunction: Phase 1 Results of the Dornier Aries in the First United States Clinical Trial

Antiplatelet (aspirin) therapy as a new option in the treatment of vasculogenic erectile dysfunction: a prospective randomized double-blind placebo-controlled study.

To investigate the efficiency of antiplatelet (aspirin) therapy in vasculogenic erectile dysfunction (VED) patients with a high mean platelet volume. A total of 184 patients diagnosed with VED between the ages of 18 and 76 were randomly divided into two groups and treated for 6weeks [group 1: 120 patients (mean age 48.3), aspirin 100mg/day; group 2: 64 patients (mean age 47.7), placebo 100mg/day]. The changes from baseline to end point in erectile function scores on the International Index of Erectile Function (IIEF-EF) and the number of patients who answered "yes" to questions 2 and 3 of the sexual encounter profile (SEP) were compared statistically. The mean baseline IIEF-EF scores in groups 1 and 2 were 14.1±4.9 and 14.3±5.2, respectively (p=0.7966), the number of patients who answered "yes" to SEP-2 was 62 (51.6%) in group 1 and 32 (50%) in group 2 (p=0.8366), and the number of patients who answered "yes" to SEP-3 was 38 (31.6%) in group 1 and 20 (31.2%) in group 2 (p=0.9557). In the aspirin group, the changes from baseline to end point in the IIEF-EF, SEP-2, and SEP-3 scores were 7.2, 36.6, and 46.6%, respectively. In the placebo group, these changes were 2.0, 9.4, and 12.5%, respectively. When compared with the placebo group, aspirin-treated subjects showed a significant improvement in all three efficacy measures (p<0.0001). 100mg of aspirin administered once a day significantly improved EF in men with VED.

Low-intensity extracorporeal shock wave therapy of vasculogenic erectile dysfunction - three-week treatment in a cohort of North Italian patients

Introduction/Objective. Although phosphodiesterase 5 (PDE 5) inhibitors represent the gold standard for medical treatment of erectile dysfunction (ED), they are not curative. Over the recent years, low-intensity extracorporeal shock wave therapy (LI-ESWT) has been proposed as a valid non-invasive therapy approach for ED. The aim of our work is to assess the shortened, three-week low-intensity extracorporeal shock wave therapy of vasculogenic ED. Methods. The study involved 32 patients with an International Index of Erectile Function (IIEF) score between 5 and 20, and whose vasculogenic ED had been proven through Doppler ultrasound. All the patients had a washout period of one month after previous therapy and agreed to discontinue the PDE5-I therapy during the follow-up. The LI-ESWT was applied for three weeks, twice weekly, without repeating. The patients were evaluated at baseline, after one, three, and six months with the IIEF, Doppler ultrasound, and the Beck Depression Inventory. Results. All investigated parameters (International Index of Erectile Function, Beck Depression Inventory and penile Doppler ultrasound parameters) showed statistically significant improvement just one month after the treatment, compared to pre-treatment values, in all investigated domains. The international index of erectile function passed from baseline values of 12.75 ? 4.62 to 14.87 ? 5.04 at one month after treatment (p &lt; 0.01). This trend remained positive in IIEF and all the parameters tested at the three-month and six-month follow-up. Conclusion. The shortened three-week low-intensity shock wave treatment of vasculogenic erectile dysfunction proved to be clinically effective.

PS-07-007 Autologous adipose tissue derived stromal vascular fraction of cells for treatment of vasculogenic erectile dysfunction

PS-07-007 Autologous adipose tissue derived stromal vascular fraction of cells for treatment of vasculogenic erectile dysfunction

Endovascular treatment of vasculogenic erectile dysfunction.

The treatment of erectile dysfunction (ED) has been a fascination involving multiple medical specialities over the past century with urologic, cardiac and surgical experts all contributing knowledge toward this multifactorial disease. With the well-described association between ED and cardiovascular disease, angiography has been utilized to identify vasculogenic impotence. Given the success of endovascular drug-eluting stent (DES) placement for the treatment of coronary artery disease, there has been interest in using this same technology for the treatment of vasculogenic ED. For men with inflow stenosis, DES placement to bypass arterial lesions has recently been reported with a high technical success rate. Comparatively, endovascular embolization as an approach to correct veno-occlusive dysfunction has produced astonishing procedural success rates as well. However, after a thorough literature review, arterial intervention is only recommended for younger patients with isolated vascular injuries, typically from previous traumatic experiences. Short-term functional outcomes are less than optimal with long-term results yet to be determined. In conclusion, the hope for a minimally invasive approach to ED persists but additional investigation is required prior to universal endorsement.

Expression of the Apelin–APJ Pathway and Effects on Erectile Function in a Mouse Model of Vasculogenic Erectile Dysfunction

Much attention has recently been focused on therapeutic angiogenesis as a treatment for erectile dysfunction (ED). The apelin and apelin receptor (APJ) system is known to cause endothelium-dependent vasodilatation and to be involved in angiogenesis. To examine the differential expression of apelin and APJ in animal models of vasculogenic ED and to determine whether and how enhancement of apelin-APJ signaling restores erectile function in hypercholesterolemic mice. Acute cavernous ischemia was induced in C57BL/6J mice by bilateral occlusion of internal iliac arteries, and chronic vasculogenic ED was induced by feeding a high-cholesterol diet or by intraperitoneal injection of streptozotocin. Messenger RNA (mRNA) levels of apelin and APJ were determined in cavernous tissue of each vasculogenic ED model by semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR). We evaluated erectile function by electrical stimulation of the cavernous nerve in hypercholesterolemic mice 1, 3, 7, and 14 days after a single intracavernous injection of apelin protein (5 μg/20 μL). The penis was harvested for histologic examinations and Western blot analysis. The cavernous mRNA expression of apelin and APJ was up-regulated in acute ischemia model and down-regulated in chronic vasculogenic ED models. A significant restoration of erectile function was noted 1 day after injection of apelin protein into the penis of hypercholesterolemic mice; however, erectile function returned to baseline values thereafter. The beneficial effects of apelin on erectile function resulted mainly from an activation of endothelial nitric oxide synthase and increase in nitric oxide bioavailability through reduction in reactive oxygen species-mediated endothelial apoptosis rather than through direct endothelial cell proliferation. These findings suggest that apelin-APJ signaling is a potential therapeutic target in the treatment of vasculogenic ED. Further studies are needed to develop a potent agonist for APJ and to determine the role of repeated dosing of apelin on long-term recovery of erectile function.

Penile revascularization in vasculogenic erectile dysfunction (ED): long‐term follow‐up

To determine the overall long-term success of penile revascularization surgery in the treatment of vasculogenic erectile dysfunction (ED) and also to investigate the effect of risk factors on the results of a modified Furlow-Fisher technique. Between 1999 and 2010, 125 men with a mean (sd, range) age of 43.2 (11.3, 23-69) years underwent penile revascularization surgery. In all, 110 men completed the long-term follow-up with a mean follow-up of 73.2 months. Diagnostic evaluations, penile colour Doppler ultrasonography, corpus cavernosum electromyography, and cavernosometry, were performed in all the men before surgery. The efficacy of the surgery was assessed as improvement or failure according to the change in the five-item version of the International Index of Erectile Function (IIEF-5). A ≥5 point increase in the IIEF-5 score during the latest patient visit after surgery compared with that before surgery was regarded as improvement (surgical success). The mean (SD) IIEF-5 score was 7.3 (3.2) before surgery and at the end of the follow-up period it was 16.8 (3.1). The success rates were 81.8% at 3 months, 77.2% at 1 year, 70% at 2 years, 66.3% at 3 years and 63.6% at 5 years after surgery in the men who achieved a no-ED threshold score of >26 in the IIEF-15. The success rate was the highest in the men with no risk factors (92.8%). Seven patients (6.36%) showed signs of glans hypervascularization as a major complication. Penile revascularization surgery has not been widely used by urologists probably due to the technical difficulties and the use of phosphodiesterase type 5 inhibitors. However, with reported high rates of noncompliance or failure of oral pharmacotherapy it seems likely that this surgery will become more popular in the near future.

The effect of sildenafil citrate and pentoxifylline combined treatment in the management of erectile dysfunction

In the present study, we evaluated the efficacy of sildenafil and pentoxifylline combined therapy in the treatment of vasculogenic erectile dysfunction. Sixty-eight patients with various degrees and types of vasculogenic erectile dysfunction were included in the study. The patients were recommended to take oral sildenafil (minimum two 50-mg tablets/week) 1 h prior to sexual intercourse for 4 weeks. After 4 weeks of washout period, patients were recommended to take combined therapy (minimum two 50-mg tablets/week sildenafil 1 h prior to sexual intercourse and 1.2 g of pentoxifylline/day divided into three doses) for an additional 4-week period. Both treatment regimes were evaluated with the international index of erectile function (IIEF). Mean IIEF score was higher after sildenafil treatment when compared to pre-treatment score (14.2+/-4.3 and 8.6+/-4.2, respectively, P<0.05). Likewise after the combination treatment, mean IIEF score was higher when compared to pre-treatment score (18.1+/-5.2 and 8.6+/-3.8, respectively, P<0.05). The increase in the IIEF score was 5.62+/-2.08 in the sildenafil only group whereas increase in the IIEF score was 9.51+/-3.77 in the combination therapy group. There was a statistically significant increase in the combination group when compared to the sildenafil only group (P<0.001). Our study suggests that use of sildenafil citrate and pentoxifylline combined therapy could be effective in the management of patients with vasculogenic erectile dysfunction.