PDE5i Use Research Articles

Surgical Correction of Peyronie's Disease via Tunica Albuginea Plication or Partial Plaque Excision with Pericardial Graft: Long‐Term Follow Up

Limited publications exist regarding long-term outcomes of surgical correction for Peyronie's Disease (PD). To report on long-term postoperative parameters including rigidity, curvature, length, sensation, function, and patient satisfaction in men with PD treated surgically via Tunica Albuginea Plication (TAP) or Partial Plaque Excision with Tutoplast Human Pericardial Grafting (PEG). Objective and subjective data regarding patients who underwent either TAP or PEG. We report on 142 patients (61 TAP and 81 PEG) with both objective data and subjective patient reports on their postoperative experience. Patients underwent either TAP or PEG following our previously published algorithm. Data was collected via chart review and an internally generated survey, in which patients were asked about their rigidity, straightness, penile length, sensation, sexual function and satisfaction. Average follow up for TAP patients was 72 months (range 8-147) and 58 months (range 6-185) for PEG patients. At survey time, 93% of TAP and 91% of PEG patients reported curvatures of less than 30o. Rigidity was reportedly as good as or better than preoperative in 81% of TAP and 68% of PEG patients, and was adequate for coitus in 90% of TAP and 79% of PEG patients with or without the use of PDE5i. Objective flaccid stretched penile length measurements obtained pre and postoperatively show an average overall length gain of 0.6 cm (range -3.5-3.5) for TAP and 0.2 cm (range -1.5-2.0) for PEG patients. Sensation was reportedly as good as or better than preoperative in 69% of both TAP and PEG patients; 98% of TAP patients and 90% of PEG are able to achieve orgasm. 82% of TAP patients and 75% of PEG patients were either very satisfied or satisfied. Our long-term results support both TAP and PEG as durable surgical therapy for men with clinically significant PD.

Combined use of phosphodiesterase-5 inhibitors and selective serotonin reuptake inhibitors for temporary ejaculation failure in couple undergoing assisted reproductive technologies

To explore the drug treatment for temporary ejaculation failure in couple undergoing assisted reproductive technologies (ART). Case report. Andrology unit, center for reproductive medicine. Five patients suffering from temporary ejaculation failure during ART. Assisted reproductive technology. Semen samples were collected by masturbation. The combined use of phosphodiesterase-5 inhibitor (PDE5-I; vardenafil, 10 mg) and selective serotonin reuptake inhibitor (SSRI; sertraline, 50 mg) to treat patients who failed to collect semen on the day of egg retrieval. Five patients with unexpected ejaculation failure during ART treatments were identified; two patients could not produce spermatozoa 3 h after taking PDE5-I (sildenafil, 50 mg), However, the use of PDE5-I (vardenafil, 10 mg) plus SSRI (sertraline, 50 mg) enabled them to provide spermatozoa successfully. It suggested that the combined protocol could be more efficient for temporary ejaculation failure than sildenafil alone. On the day of the egg retrieval, we directly prescribed vardenafil and sertraline for the other three patients and got sperm samples without difficulty 2 h later. The results indicate that the combined protocol of vardenafil plus sertraline could resolve the unpredictable ejaculation failure during ART. We presume that it might be helpful for attenuating the patients' stress and anxiety.

Update on erectile dysfunction treatment for aging men

Summary Recent epidemiological studies clearly indicate that the incidence of erectile dysfunction increases with age. Thus, healthcare professionals managing the aging population should be prepared to properly diagnose and manage erectile dysfunction. There is no doubt that the introduction of type 5 phosphodiesterase inhibitors (PDE5Is) has revolutionized the management of erectile dysfunction. Currently, in the absence of contraindications, all three available PDE5Is, namely sildenafil, tadalafil and vardenafil are first line therapy for erectile dysfunction. Clinicians should be aware of the potential adverse events associated with the use of PDE5Is when counselling patients. Other adjunctive and second/third-line therapies for erectile dysfunction, including intracavernosal injection, transurethral application of medication, testosterone replacement therapy, vacuum construction device, sex therapy and penile prosthesis, have been used long before PDE5Is were available and continue to serve as safe and efficacious forms of erectile dysfunction management, even in cases that are refractory to PDE5Is. Clinicians should thus be aware of these various forms of management to help patients select the most appropriate forms of therapy for their erectile dysfunction.