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PubMedDate not supplied

Erectile dysfunctions.

Erectile dysfunction is one of the prime challenges confronting the treating physician. Its prevalence is directly proportional to aging. It is imperative to comprehend the intricate mechanism of erection in order to individualize the approach to management. Thus, it is appropriate to evaluate the etiology of erectile dysfunction. Normal aging, as well as psychogenic, vascular, neurogenic, and endocrinologic causes and/or those due to structural abnormalities of the penis should be considered when evaluating details to determine its probable cause. An increasing use of drugs, a legacy of civilization, has considerably compounded the problem. Therapy for erectile dysfunction, apart from psychosexual counseling, includes medical treatment by alpha adrenoceptor antagonists, dopamine agonists, phosphodiesterase type 5 inhibitors, sublingual apomorphine hydrochloride, or hormone therapy. Transdermal or transurethral corporeal drug delivery are other possible treatment modalities. Vacuum devices and surgical approaches are considered relevant only in refractory cases.

Adult↗
PubMed2000

Non-surgical management of erectile dysfunction.

Erectile dysfunction is a common and distressing medical condition that is now highly amenable to treatment almost irrespective of the cause. Safe, non-surgical treatments with unequivocal efficacy are psychological therapy, intracorporeal injection of vasoactive drugs, transurethral vasodilators and oral sildenafil, all of which have been reported to have a 50-70% overall response rate. Vacuum constriction devices are acceptable for some, usually older patients and oral yohimbine is thought to have marginal efficacy. Local creams to induce or enhance erectile function are currently being investigated. There is no place for androgen supplementation unless the patient is profoundly hypogonadal. Treatment of hyperprolactinaemia is very effective but is a rare cause of erectile dysfunction. As intercourse may entail an unfamiliar level of physical activity, it is sensible to ensure that the patient is able to climb a flight or two of stairs comfortably without provoking undue breathlessness or chest pain and to provide suitable advice about technique before commencing treatment. Once it is clear to the patients that erectile dysfunction can be satisfactorily overcome, the long-term use of treatments to do so tends to wane. Thus, although the prospect of effective treatment for what had been for many a distressing life sentence has the potential to place new demands on the health service, there is no evidence that restrictions on prescribing will prove economically rational.

Administration, Topical↗
PubMed1995

Reduction of penile nitric oxide synthase in diabetic BB/WORdp (type I) and BBZ/WORdp (type II) rats with erectile dysfunction.

Erectile dysfunction occurs frequently in human diabetes, and it is sometimes associated with hypogonadism. These conditions also develop in a model of insulin-dependent (type I) diabetes, the BB/WORdp (diabetic prone) rat but have not yet been investigated in the model of insulin-resistant (type II) diabetes, the BBZ/WOR rat. It is also unknown whether diabetes-related impotence is due to reduced levels of the mediator of penile erection, nitric oxide, caused by a decrease of nitric oxide synthase (NOS) in the penis. To clarify these questions, groups (n = 5-6) of diabetic BB/WORdp (insulin-maintained) and BBZ/WOR rats were age-matched with diabetic-resistant BB/WORdr and non-diabetic BB/WORdp rats and submitted to determinations of serum glucose, testosterone, and penile reflexes (cups and flips). Erectile dysfunction was found in all of type I and in most of type II diabetic animals (glycemias of 25.0 and 31.1 mM), at the selected mean ages of 310 and 180 days old, respectively. This was evidenced by over 95% decreases of erectile reflexes in both types of diabetes and was accompanied by 75% reduction of serum testosterone. Soluble NOS activity was measured in penile tissue from the diabetic rats with impaired erectile reflexes and in the corresponding controls, by the (3H)-L-arginine/citrulline conversion assay. The neuronal NOS isoform (nNOS) content was determined by a semiquantitative western blot assay. Both types of diabetes showed a marked decrease of penile NOS activity (74 and 55%, respectively), and a lower reduction of penile nNOS content (47 and 33%, respectively). No endogenous NOS inhibitor was detected in the diabetic type I penile cytosol by cross-mixing NOS activity assays. Our data support a common etiology for erectile dysfunction present in rats with types I and II diabetes mellitus and suggest that the etiology is related to a decrease of penile NOS derived in part from serum androgen deficiency.

Animals↗
PubMed1995

[Study of sexual function in male hemodialysis patients--analysis of the cause of erectile dysfunction].

Erectile dysfunction is a well documented complication among male hemodialysis patients. The cause has been reported to be related to multiple factors, including neurological, endocrinological and vasculogenic elements. The purpose of this study was to identify the factors which most greatly determine erectile dysfunction in hemodialysis patients. Male hemodialysis patients without diabetes mellitus and severe anemia (Hb value < 8.0 g/dl) were entered into the study. We measured nocturnal penile tumescence (NPT) values in these patients and carried out neurological studies (measurement of the penile dorsal nerve conduction velocity and the bulbocavernosus reflex (BCR) latency). a vasculogenic study (measurement of the penile blood pressure index (PBPI) and endocrinological studies (measurement of serum free testosterone levels and serum prolactin levels before hemodialysis). NPT values (maximum penile circumference changes) in hemodialysis patients decreased compared with those in healthy males. In both hemodialysis patients and healthy males, NPT values decreased with age. NPT values in hemodialysis patients were significantly lower than those in healthy males in the fifties and sixties. 32.2% of hemodialysis patients had severe penile neurological disorder. 55.6% of them showed abnormal NPT. PBPI was low in only 10.0% of hemodialysis patients. However, there was a significant correlation between PBPI and the NPT value (r = 0.387). Serum free testosterone levels in hemodialysis patients were significantly lower than those in healthy males. There was a significant correlation between the serum free testosterone level and the NPT value (r = 0.328). However, there was no correlation between the serum prolactin level and the NPT value. To identify the factors which most greatly determine erectile dysfunction in hemodialysis patients, we carried out multivariate analysis. The criterion variables in this analysis were NPT values. The coefficient of determination was highest for a neurological disorder (30.7%), followed by an endocrinological disorder (a reduction in the serum free testosterone level) (11.6%) and a vasculogenic disorder (a reduction in PBPI) (4.2%).

Adult↗
PubMedDate not supplied

Hypertension, antihypertensive therapy, and erectile dysfunction.

Erectile dysfunction represents a common problem in the male hypertensive population. Both erectile dysfunction and hypertension share common pathophysiologic pathways such as atherosclerosis and endothelial dysfunction. Furthermore, traditional cardiovascular risk factors affect both conditions. Notably, several antihypertensive medications seem to adversely affect erectile function whereas others may exert neutral or even favorable effects. Thus, the regular and meticulous clinical evaluation of hypertensive patients, as well as individualization of anti-hypertensive therapy, are important steps in the effective management of such patients. In addition, the administration of phosphodiesterase-5 inhibitors or apomorphine has excellent efficacy and safety profile in hypertensive patients irrespective of taking or not taking antihypertensive medications.

Antihypertensive Agents↗
PubMed2006

[Advances in diabetic erectile dysfunction].

Erectile dysfunction is common complication of diabetes mellitus. The incidence of diabetes mellitus induced erectile dysfunction (DMED) is 20% - 75%. DMED appears to be due to vascular-neuropathic and corpus cavernosum smooth muscular damage. To control blood glucose, blood pressure and blood lipids is the basis of DMED therapy. In 50% of the patients with DMED, the phosphodiesterase 5 inhibitors is effective, while intracavernous pharmacotherapy is effective for more than 90%. Penile prosthesis implantation continues to be the treatment of choice in case of other therapy failure.

Animals↗
PubMed2000

[Epidemiology and age-related risk factors of erectile dysfunction].

Erectile dysfunction (E. D.) affects millions of men in the whole world. The prevalence of erectile dysfunction in the best conducted study, the Massachusetts Male Aging Study (MMAS), was 52% of male subjects aged 40 to 70 years. ED is strongly associated with age. Multiple risk factors, such as chronic illness, hypertension, diabetes, medication, operation in the pelvis, smoking and alcohol consumption, have a negative influence on erectile function.

Adult↗
PubMedDate not supplied

The complementary role of different neurophysiological methods to demonstrate organicity in male with premature ejaculation and erectile dysfunction.

Erectile dysfunction and premature ejaculation are the most common male sexual disorders. Generally, it is considered that erectile dysfunction is related to organic factors whilst premature ejaculation is related to psychological factors. A detailed history along with physical examination such as using penile doppler, penile tumesans and ultrasonography are insufficient for differential diagnosis in 15-20% of cases. Therefore the role of neurophysiological techniques are important. In this study urological and biochemical investigations were used in conjunction with other neurophysiological methods. According to our results, using a neurophysiological test study on its own was ineffective. As a conclusion our study has shown that neurophysiological methods are important differential diagnosis of revealing suspicious organicity--generally believed to be due to psychological factors- in male sexual disorders.

Adult↗
PubMed1996

Erectile dysfunction.

Erectile dysfunction affects millions of men in this country. Impairment of neurologic, hormonal and vascular function can inhibit the corporal smooth muscle relaxation necessary for erectile function. Physicians should employ a diagnostic work-up that proceeds from a history and physical examination to laboratory studies and physiologic testing. Treatment, which should be prescribed with constant patient input, is successful in a high percentage of cases. For erectile dysfunction with psychogenic or hormonal etiologies, treatments target the specific underlying problem. For dysfunction caused by nonspecific vascular and neurogenic problems, useful treatments include medication, vacuum devices, intracavernosal injections and penile implants.

Erectile Dysfunction↗
PubMed1999

The impact of first-line antihypertensive drugs on erectile dysfunction.

Erectile dysfunction, a problem estimated to affect up to 30 million American men, is associated with a number of systemic illnesses and drugs. Age is not thought to be an independent risk factor for the disorder, but accompanying illnesses and their treatments may contribute to its onset. Newer classes of antihypertensive agents are less frequently associated with sexual dysfunction than diuretics or beta-blockers. However, nearly every first-line antihypertensive drug has been reported to cause some degree of erectile dysfunction. Management options include lifestyle modification, dosage reduction, discontinuation of the offending agent, switching to an alternative drug, and pharmacologic therapy.

Antihypertensive Agents↗
PubMed2003

Oral agents for erectile dysfunction.

Erectile dysfunction is a common disease affecting the lives of millions of men worldwide. Sildenafil was the first oral treatment licensed for male erectile dysfunction. However, there are now a number of other options available. In this article the currently available oral treatments are reviewed.

Administration, Oral↗
PubMed1998

Self-esteem and depression in men who present with erectile dysfunction.

Erectile dysfunction always has a psychologic component in addition to the underlying physical cause. The extent of depression and reduced self-esteem in patients who present with erectile dysfunction are explored in this study. Suggestions are given for how urologic nurses can overcome patients' fears and concerns.

Adult↗
PubMed2005

[Oral sildenafil demonstrates the effectiveness and well tolerance in the treatment of patients with erectile dysfunction].

Erectile dysfunction (ED) is a common disease in male populations, and the morbidity is increasing. Currently, sildenafil is the first line oral therapy in the treatment of erectile dysfunction, and widely used by the patients from different areas, who are variable in ages, etiologies and degrees of severity, and by the patients with different diseases such as cardiovascular problems, diabetes mellitus and nephropathy. The drug manifests the effectiveness and well tolerance. In this paper, we review and summarize some relevant articles published to share information with the medical colleagues.

Administration, Oral↗
PubMed2000

[Physiology and pathophysiology of erectile dysfunction].

Erectile dysfunction is an entity associated with age but is not necessarily a consequence of aging. During erection the penis acts as a capacitor--accumulating blood under pressure. Erectile function is, therefore, dependent on the integration and regulation of functional interplay between psychologic, neurologic, endocrine and vasoactive factors. Any imbalance in the integration of these factors will result in erectile dysfunction. Trabecular smooth muscle is an important structure, which contributes to control of detumescence and erection. The smooth muscle tone is mediated by many hormones and vasoactive factors (e.g. norepinephrine, acetylcholine, NO, VIP, prostaglandins etc.) but its functioning is also dependent on a sufficient oxygenation to prevent the fibrosis of this important structure. This oxygenated state is achieved during erections. So we can conclude: Erections are good for erections.

Adult↗
PubMed2001

Computational tools in rehabilitation of erectile dysfunction.

Erectile dysfunction (ED) is defined as the inability to achieve and maintain an erection adequate for satisfactory intercourse. It is a common problem among approximately 50% of men between the ages of 40 and 70. Erectile dysfunction is not only stressful to both the affected individual and his partner, but it can also negatively affect self-esteem. Biomechanical models have recently been developed to study both the structural and hemodynamic factors involved in normal and pathological erectile conditions. These computational models, which are reviewed in the present paper, allow for better understanding of the mechanisms acting in ED and provide a suitable basis for development of state-of-the-art interdisciplinary treatment approaches aimed to improve the quality of life for these men.

Adult↗
PubMed1999

Medical treatment of erectile dysfunction.

Erectile dysfunction (ED) is defined as the consistent inability to obtain or maintain an erection for satisfactory sexual relations. Data from the Massachusetts Male Aging Study have indicated that the prevalence of erectile dysfunction of any degree is 39% in 40-year old men, and 67% in those aged 70 years. Effective therapy has been available for some time, but it has commonly involved surgery, external devices or penile self-injection. For many men, these represent unacceptable barriers to seeking therapy. Recently, however, an effective oral medication has become available. This article reviews the physiology and pharmacology of ED. The literature currently available on the effectiveness and safety of various drugs used for ED is summarized, with particular attention to newly available oral agents. Guidelines for work-up and drug treatment of patients with ED are given. Detailed history and physical examination are crucial to the safe and effective treatment of men with erectile impotence. An extensive review of the literature shows that based on safety, effectiveness and ease of use, oral sildenafil citrate is an excellent choice for first-line therapy. Patients who use organic nitrates of any kind in any capacity should not be offered sildenafil. Based solely on effectiveness intracavernosal injection therapy remains the golden standard and should also be offered as an option for first-line therapy for the appropriate patients. Many alternatives are available for men who cannot use sildenafil or injection therapy. A thorough knowledge of existing medications is essential for proper treatment of ED.

Adrenergic alpha-Antagonists↗
PubMedDate not supplied

Pelvic floor exercises as a treatment for men with erectile dysfunction.

Erectile dysfunction was defined by a National Institutes of Health conference in 1993 as 'the inability to achieve or maintain an erection sufficient for satisfactory sexual performance (for both partners)' (National Institutes of Health, 1993). The degree of erectile dysfunction may be graded according to the number of satisfactory attempts out of 10 (mild 7-8, moderate 4-6, and severe 0-3) (Albaugh and Lewis, 1999).

Clinical Trials as Topic↗
PubMed2004

[Advances in pathogenesis and treatment of diabetic erectile dysfunction].

Erectile dysfunction is a familiar complication of diabetes mellitus, which results from combined factors of impairment to the vascular structure of the penis, the pathological changes in neural system and neural transmitters, and endocrine disorders. There are numerous therapeutic options for the treatment of diabetic erectile dysfunction, including medicines like PDE5 inhibitors, insulin, androgen, surgical therapy and gene therapy.

Androgens↗