[Benign prostatic hyperplasia and erectile dysfunction--erectile dysfunction following transurethral prostatectomy].
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Erectile Dysfunction↗
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Standards for clinical trials in male sexual dysfunction: erectile dysfunction and rapid ejaculation.
INTRODUCTION: The introduction of safe and effective therapies for sexual dysfunctions depend upon appropriate clinical protocol design, study procedures, data collection and analysis. AIM: To provide recommendations/guidelines concerning state-of-the-art knowledge for standards for clinical trials in sexual dysfunction in men, particularly in the areas of erectile dysfunction and rapid ejaculation. METHODS: An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Standards for Clinical Trials in Male Sexual Dysfunction Committee, there were six experts from four countries. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. RESULTS: Drug development requires a multiphased approach. Phase 1 studies investigate multiple-dose safety, tolerability and pharmacokinetic issues. Phase 2 programs explore dose ranging (lowest effective, maximally tolerated and toxic doses). Phase 3 trials provide the substantial evidence including drug-drug interaction data and studies in special populations. Clinical studies require validated outcome assessment instruments conducted in defined but representative patient populations. Daily diaries or per-event questionnaires are patient-reported outcomes that assist in retrospective questionnaire interpretation. A qualified biostatistician should calculate the sample power for the trial, type of statistical model and design employed, use of covariate or subgroup analyses, and calculation of effect sizes. CONCLUSIONS: More research is needed in developing standards for use in the development of clinical trials and outcomes assessment researching either erectile dysfunction or rapid ejaculation.
Consensus↗
Endothelial dysfunction, erectile dysfunction, and coronary heart disease: the pathophysiologic and clinical linkage.
Our rapidly expanding knowledge regarding the biology of the endothelial cell and the pathophysiology of coronary heart disease (CHD) and endothelial dysfunction indicates important common factors and overlapping clinical presentations. We are, in effect, presented with a new paradigm-that of varying vascular manifestations of disease linked to the functioning of endothelial cell lining. This article reviews these areas of advancement and addresses their clinical implications regarding erectile dysfunction and CHD, as well as the role of the phosphodiesterase-5 inhibitor sildenafil.
Journal Article↗
Sexual dysfunction: erectile dysfunction in the man with diabetes.
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Adult↗
Marital sexual dysfunction: erectile dysfunction.
All clinicians are occasionally consulted by men complaining of impotence. The history is the most important step in the differential diagnostic process for this symptom. Answers to four basic questions enable the physician to recognize classic psychologic and organic patterns. In addition, these questions provide clues as to the cause of the dysfunction. Physical and laboratory examinations are usually required to identify the specific organic cause. Traditional prevalence figures for impotence may no longer be valid. This topic awaits epidemiologic data that reflect current diagnostic sophistication. Individual treatment approaches to both organic and psychologic impotence must counteract the adverse influence of performance anxiety.
Adult↗
[The value of color-coded duplex ultrasound as standard assessment in erectile dysfunction].
Erectile dysfunction has taken on increasing importance in urologic practice. Still open is the question of which tests are mandatory for adequate clinical assessment of erectile dysfunction. One accepted standard modality is the intracavernous pharmacotest with vasoactive agents. In contrast, color duplex sonography is not considered mandatory although it reveals detailed information about penile vessels and functional implications. The question remains whether the information gained by color duplex sonography is relevant for therapy, making it an indispensable standard procedure. Patients with erectile dysfunction were evaluated, without preselection, by extensive history, clinical evaluation, laboratory tests, tumescence and rigidity measurements, intracavernous administration of vasoactive drugs and color duplex sonography. Seventy-nine patients were available for final analysis. Color duplex sonography revealed 39 normal tests, 16 arterial impairments. 19 venous leakages and 5 arteriovenous fistulae. Intracavernous vasoactive agents (pharmacotest) revealed 44 reactions sufficient for intercourse and 35 insufficient responses. In 89% of patients, the diagnoses on color duplex sonography and intracavernous pharmaco-testing were similar. The accuracy of the two methods in diagnosing erectile dysfunction was not statistically different (McNemar's test). In contrast to intracavernous pharmaco-testing, color duplex sonography permitted further etiologic subdivision into arterial disease, venous leakage, arteriovenous fistula and normal result. This was made possible by measuring significantly (P < 0.01) different arterial peak flow velocities, end-diastolic velocities and calculated resistance index. These data did not imply direct clinical consequences. Color duplex sonography and intracavernous pharmacotesting reveal comparable results concerning the diagnosis of an erectile dysfunction. In contrast to pharmacotesting, color duplex sonography reveals details of the nature of the erectile dysfunction. Because this information has no profound implications for the choice of therapeutic procedure, color duplex sonography can not be recommended as a standard procedure in the evaluation of erectile dysfunction.
Adolescent↗
Cloning of rat and human inducible penile nitric oxide synthase. Application for gene therapy of erectile dysfunction.
Erectile dysfunction is mainly due to the inability of the cavernosal smooth muscle of the penis to undergo complete relaxation. In the aging rat model, erectile dysfunction is accompanied by a reduction of penile smooth muscle compliance and, in very old animals, by a decrease in penile nitric oxide synthase (NOS), which is responsible for the synthesis of the mediator of penile erection, nitric oxide (NO). We have investigated whether the stimulation of penile NOS expression by local induction or gene therapy can mitigate erectile dysfunction in the aged rat. A mix of iNOS (inducible NOS) inducers was continuously delivered to the penises of 5- ("adult"), 20- ("old"), and 30- ("very old") mo-old rats for 3-6 days, and the erectile response to electrical field stimulation of the cavernosal nerve was measured. The erectile dysfunction observed in old and very old rats as compared to adult animals was ameliorated by treatment with iNOS inducers. Penile iNOS was detectable in the penis of these rats by Western blot, NADPH diaphorase, and NOS activity assays. Inducible NOS was inducible in vitro in both rat and human corpora cavernosal tissue and in rat penile smooth muscle cells (RPSMC), as shown by Western blots. However, NO synthesis in cavernosal tissue upon iNOS protein induction remained low, indicating that the increased NOS levels were under physiological control. The iNOS cDNA was cloned from induced RPSMC mRNA and generated by reverse transcriptase polymerase chain reaction (RT-PCR) from induced human penile smooth muscle cells and corporal tissue. The coding regions from both the rat (RPiNOS) and human (HPiNOS) penile iNOS showed several amino acid differences from their analogous isoform in nonpenile tissues. RPiNOS cDNA injected into the penis mitigated the aging-associated erectile dysfunction. The iNOS construct was detected in cavernosal tissue by PCR, and its expression by RT-PCR and Western blots. These results open the way for the possible use of NOS isoforms in the management of erectile dysfunction.
Aging↗
[Current opinions on the relationships between atherosclerosis, type 2 diabetes mellitus and erectile dysfunction].
Erectile dysfunction is often associated with diabetes mellitus and athero-thrombotic diseases, such as coronary heart disease, stroke, peripheral vascular disease. An association between erectile dysfunction and asymptomatic coronary artery disease angiographically verified has been recently shown in diabetic patients. Several pathophysiological mechanisms may explain the relationship between erectile dysfunction and athero-thrombosis, especially in diabetic subjects. Among these mechanisms, it is of interest to consider a common pattern of cardiovascular risk factors, the presence of autonomic neuropathy and endothelial dysfunction. The strong association between erectile dysfunction and athero-thrombosis may have some important clinical implications. In particular, erectile dysfunction may be used as a predictor of silent or early athero-thrombotic diseases, especially in diabetic patients.
Arteriosclerosis↗
Physician-patient dialogue and clinical evaluation of erectile dysfunction.
Erectile dysfunction affects 31% to 52% of all men. Although considerable advances have been made in the diagnosis and management of erectile dysfunction, the inadequate knowledge of erectile dysfunction by health care providers still precludes them from initiating candid discussions with their patients. This article provides the health care professional with the ability to establish comfortable doctor-patient dialogue and to clinically evaluate erectile dysfunction in a goal-directed manner. The goal of evaluation is to find the appropriate treatment for the individual, dictated primarily by factors like the patients' preferences, comfort, cost, and the availability of treatment modalities.
Erectile Dysfunction↗
Drug-related erectile dysfunction.
Erectile dysfunction is a highly prevalent medical problem affecting a significant proportion of men. It is important for a number of reasons, causing impairment of quality of life and, if related to drug therapy, leading to non-compliance. Drug therapy accounts for erectile dysfunction in approximately 25% of cases and is mostly readily reversible when the offending agent is stopped, or a suitable alternative is substituted. Many classes of drug may be responsible, interfering with the normal physiological processes leading to penile erection in a dose-related fashion, and in ways which can usually be predicted from their pharmacology. The most commonly implicated classes of drug include antihypertensives such as thiazide diuretics and beta-adrenoceptor antagonists and psychotherapeutic drugs, especially selective serotonin reuptake inhibitor (SSRI) antidepressants. We review the agents which can cause erectile dysfunction, the evidence for this adverse effect and the physiological mechanisms involved. We present an approach to the management of the patient with erectile dysfunction in whom concomitant drug therapy may be responsible. We recommend that drug therapy should always be considered as a possible cause of erectile dysfunction before specific investigation and therapy is considered.
Adrenergic beta-Antagonists↗
Rho-kinase as a potential target for the treatment of erectile dysfunction.
Erectile dysfunction is a condition that is estimated to affect more than 30 million men in the United States alone. The prevalence of erectile dysfunction is increased with age and is often secondary to diseases such as depression, hypertension and diabetes. Causes of erectile dysfunction include physical injury to the cavernosum and abnormal cerebral and peripheral nervous system functioning. However, many cases of erectile dysfunction are the result of dysfunctional signaling in the cavernosal vasculature. This article will detail the important role of a vasoconstrictor mechanism mediated by the small G-protein RhoA and a downstream serine/threonine kinase, Rho-kinase, in the maintenance of penile flaccidity. Recent evidence demonstrates that inhibition of endogenous Rho-kinase initiates an erectile response in an in vivo rat model. These initial findings introduce a novel potential therapeutic approach for the treatment of erectile dysfunction.
Journal Article↗
Characteristics of men interested in evaluation of erectile dysfunction.
Erectile dysfunction is a common disorder. However, not all dysfunctional men want to pursue evaluation. To delineate the characteristics of men interested in evaluation of erectile dysfunction, we conducted a mailed survey of 1031 randomly selected male veterans aged 30-99 years. We received 427 completed surveys. Using logistic regression, we found loss of sexual pleasure, loss of stiffness and duration of erection, and the ability to have orgasm to be predictors of which men were interested in evaluation of erectile dysfunction. Age, functional status, availability of a partner, marital status, sexual interest, partner's sexual interest, and duration of dysfunction were not significantly different between men interested and not interested in evaluation of erectile dysfunction.
Adult↗
Diagnostic evaluation of erectile dysfunction.
Erectile dysfunction, the persistent inability to attain or maintain penile erection sufficient for sexual intercourse, affects millions of men to various degrees. The majority of cases have an organic etiology, most commonly vascular disease that decreases blood flow into the penis. Regardless of the primary cause, erectile dysfunction can have a negative impact on self-esteem, quality of life and interpersonal relationships. The initial step in evaluation is a detailed medical and social history, including a review of medication use. Discussion with the patient's sexual partner may clarify exacerbating issues. The physical examination focuses on the cardiovascular, neurologic and urogenital systems. Laboratory tests are useful to screen for common etiologic factors and, when indicated, to identify hypogonadal syndromes. Appropriate evaluation of erectile dysfunction leads to accurate advice, management and referral of patients with erectile dysfunction.
Algorithms↗
[Therapy for organic erectile dysfunction].
Erectile dysfunction is a common disease of men. It is associated with various comorbidities and has a prevalence of about 50% in the 7th decade. Erectile dysfunction often affects the quality of life of the patient and his partner, and it is very important to offer adequate therapy that respects the individual circumstances of each patient. The mandatory diagnostic work-up includes a medical and psychosexual history, a physical examination and routine laboratory tests. Besides psychotherapy, oral pharmacotherapy with oral PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) is the most effective therapy for erectile dysfunction and is superior to centrally acting drugs (yohimbine). In cases of failure or contraindication of oral pharmacotherapy, local pharmacotherapy is the second-line therapy. The third-line options are vacuum erectile devices and penile implants, and these have a high patient satisfaction. New therapeutic strategies such as anti-serotoninergic substrates and growth hormone offer a promising future for the therapy of erectile dysfunction but remain to be evaluated.
Erectile Dysfunction↗
Future strategies for treating erectile dysfunction.
Erectile dysfunction affects over half of all men between 50 and 70 years of age, and by the age of 40, about 40% of men may suffer from some form of erectile dysfunction. Many disease states, such as diabetes, hypertension, depression, and vascular disease, are associated with the condition, which may occur many years prior to the onset of these disorders. The phenomenal success of sildenafil in improving erections in men with erectile dysfunction is due to the fact that the drug, as a phosphodiesterase inhibitor, improves the relaxation of smooth muscle cells, which become dysfunctional with the aging process. However, not everyone responds to this medication, mainly because the efficacy of the drug is directly dependent on the release of nitric oxide from the nerve terminals of the cavernosal nerve, and this may become defective with aging/certain disease states. The goal of gene therapy for organic impotence is to allow the patient to sustain physiologically elicited erections without resorting to pharmacological treatment immediately prior to the sexual act. Experimental efforts in gene therapy for erectile dysfunction are likely to continue intensively in a series of directions, some specific to the nature of the selected gene to be manipulated or the physiology of the corpora cavernosa itself, and others extrapolatable from the advancement of gene therapy in general.
Journal Article↗
Use of oral sildenafil (Viagra) in the treatment of erectile dysfunction.
Erectile dysfunction is a common problem affecting men. Sildenafil (Viagra) is the first oral medication approved for the treatment of erectile dysfunction. It has proven to be an effective option in the treatment of erectile dysfunction of different etiologies.
Clinical Trials as Topic↗
The ageing male and erectile dysfunction.
Erectile dysfunction is common in the ageing man and reliable therapies are needed. The pathophysiology of erectile dysfunction in this group mainly includes chronic ischaemia, which triggers the deterioration of cavernosal smooth muscle and the development of corporeal fibrosis. Assessing the ageing man with erectile dysfunction who seeks medical treatment should comprise a thorough medical and sexual history, a systemic and focused physical examination and selected blood tests. Oral drug therapy represents a safe and effective option for most ageing men.
Age Factors↗
The ageing male and erectile dysfunction.
Erectile dysfunction (ED) is common in the ageing man and reliable therapies are needed. The pathophysiology of erectile dysfunction in this patient group mainly includes chronic ischaemia, which triggers the deterioration of cavernous smooth muscle and the development of corporeal fibrosis. The assessment of the ageing man with erectile dysfunction who seeks medical treatment should include a thorough medical and sexual history, a systemic and focused physical examination and selected blood tests. An extensive discussion of the various therapeutic options should follow in order to allow the patient to identify the most suitable alternative. Oral drug therapy represents a safe and efficacious option for most elderly patients.
Aging↗