Sildenafil citrate response correlates with the nature and the severity of penile vascular insufficiency
ABSTRACT Sildenafil citrate is a highly effective erectogenic agent. However, predicting which patients will respond to this agent is often difficult. While the patient response to this agent is dependent on the nitric oxide-guanylate cyclase-cyclic guanosine monophosphate cascade, the integrity of penile arterial flow and venocclusive mechanism is also important. Duplex Doppler penile ultrasonography can reliably document penile hemodynamics. This study aimed at defining response rates based on degree of penile vascular sufficiency.
This study enrolled patients who met strict criteria for sildenafil citrate response who had also undergone penile ultrasound. Correlation was drawn between the nature and the severity of the vascular insufficiency and the response rate to sildenafil citrate.
The distribution of vascular diagnoses was arteriogenic 64%, venogenic 6%, mixed vascular insufficiency 18%, and normal 12%. The best response was seen in those men with normal vascular studies, 80% responding. Fifty-three percent of all men with any abnormality on penile ultrasound responded; 65% of men with arteriogenic erectile dysfunction (ED), 25% of patients with venogenic ED, and 6% of men with a mixed vascular insufficiency were responders. There was a correlation between the degree of vascular impairment and the response rate. All men with venogenic ED who responded had mild leak.
These data demonstrate a correlation between the nature and severity of penile vascular disease and the ability to respond to sildenafil citrate. These data may be useful to the sexual medicine practitioner when counseling patients regarding oral erectogenic therapy.
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ABSTRACT: PURPOSE OF REVIEW: Radical prostatectomy, regardless of the technology used intraoperatively, induces erectile dysfunction for most men who undergo the procedure. For many men, this proves to be transient. Penile rehabilitation strategies have been developed with the goal of increasing the probability and speed of return of sexual function. The purpose of this work is to review the fundamentals of erectile dysfunction relevant to the postprostatectomy patient as well as the components that are often included in penile rehabilitation strategies. RECENT FINDINGS: Preservation of smooth muscle tissue is the key to preserving erectile function. This can be accomplished by providing the penis with regular exposure to oxygenated blood through intracaversonal injection therapy or vacuum erection device therapy. Dietary supplementation aimed to increase the nitric oxide production can also be beneficial. As well, chronic administration of PDE5 inhibitors may also help maintain the smooth muscle/collagen ratio in the corporal tissue. SUMMARY: These findings have led to the development of our management model that includes daily vacuum erection device therapy, dietary supplementation and PDE5 inhibitors which is described in detail. The success of any rehabilitation strategy is dependent on the patient compliance which needs to be facilitated by care-giver encouragement and the setting of realistic expectations.Current opinion in urology 01/2013; 23(2). DOI:10.1097/MOU.0b013e32835d4d41 · 2.12 Impact Factor
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ABSTRACT: Cancer is a major health concern in the United States and in other countries: not only is cancer the second leading cause of death in the United States, accounting for one of every four deaths, but also its treatment may be associated with significant morbidity . Cancers involving the male pelvic organs and their treatments are notoriously associated with erectile dysfunction (ED) . Such cancers include prostate, bladder, and ano-rectal cancers. Prostate cancer is the second most common cancer and the third most common cause of cancer-related death among men. According to the American Cancer Society, it is estimated that in 2009, 192,280 new cases will be diagnosed (25% of all new cancer cases) and 27,360 deaths (9% of cancer-related deaths) will be attributed to prostate cancer . Currently, with prevalent testing for early detection, men are diagnosed in their fifth or sixth decades. The vast majority (91%) of men diagnosed with prostate cancer present with localized disease and have excellent chances of long-term survival . Treatment of prostate cancer includes radical pelvic surgery to remove the prostate and the seminal vesicles – radical prostatectomy (RP), prostate irradiation (radiotherapy), delivered using various techniques or hormonal manipulation, aimed at suppression of testosterone, the principal male hormone. Reported ED incidence after RP varies greatly, from 14 to 90%, with a combined incidence reported by a recent meta-analysis to be 58% . A recent prospective study reported an ED incidence of 47% a year after external beam radiotherapy for prostate cancer, however, it is must be remembered that radiation-induced damage may take more than a year to be fully manifested, thus, the eventual incidence is probably higher . A long-term sexual function follow-up of men who had radiation for localized prostate cancer revealed that at 15 years from treatment the vast majority of men (78%) were not sexually active compared with 38% of controls and that 94% had severe ED compared to 64% of controls . The addition of hormonal therapy, even short term, exerts additional deleterious effects on erectile function . Bladder and ano-rectal cancers are less common, accounting for 7 and 0.3% of all male cancers, respectively, and their treatment may include extensive pelvic surgery, radiotherapy, and/or chemotherapy .