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Analysis of the parameters of RigiScan recordings in patients with organic impotence with the use of placebo (basal) or sildena®l
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We studied the effects of sildenafil on nocturnal penile erections. We prospectively evaluated 36 patients with organic or psychogenic impotence and 5 normal, potent men. All patients completed 3 sessions of consecutive nights using the RigiScan Plus device. The first two nights the patients were asked to take placebo before the session and to take...
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Context 1
... was a signi®cant increase of event duration (expressed as % of session) in the group of patients with pathologic RigiScan recordings (basal: 17.9 AE 8.9 and post sildena®l: 23.4 AE 11.2, P ` 0.01). Table 2 shows basal and post sildena®l adminis- tration values in the group with organic impotence. There was a signi®cant increase with sildena®l Sildena®l improves nocturnal penile erections in organic impotence C Terradas et al administration both in the tip and in the base in the following parameters: RAU, TAU, RAUah and TAUah. ...
Context 2
... was a signi®cant increase with sildena®l Sildena®l improves nocturnal penile erections in organic impotence C Terradas et al administration both in the tip and in the base in the following parameters: RAU, TAU, RAUah and TAUah. Table 3 shows the same parameters detailed in Table 2 but for the group with psychogenic impotence. In this group we did not ®nd signi®cant changes with the use of sildena®l, except for RAUah in the tip. ...
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... A study by Montorsi et al. showed that the number of RigiScan NPTR episodes increased after intake of sildenafil, but the recorded values did not reach statistical significance [23]. On the other hand, many researchers found a beneficial effect of sildenafil on almost all NPTR parameters in different patient groups, such as in cases of psychogenic ED not responding to sildenafil during awakening [8], in cases with organic ED [24] and even in healthy, potent volunteers [11]. Initially, PDE-5 inhibitors were used widely with the primary intention of compensating for a symptom rather than to correct the underlying pathophysiology in both psychogenic and organic ED. ...
... The physiologic role of NPTR is an issue that is still not completely determined, but NPTR may act to maintain oxygenation of erectile tissue, which is important to maintain a normal erectile response [27], especially in the absence of frequent sexual stimulation. Oxygen (O 2 ) is essential for synthesis of NO, and a low oxygen state inhibits nitric oxide synthase (NOS) [24]. The corpora cavernosa contains both smooth muscle and connective tissue content. ...
Sildenafil enhances the nitric oxide–cGMP pathway of erection, which is claimed to have a role in nocturnal penile tumescence and rigidity (NPTR). This study aimed to find whether RigiScan can predict the response to sildenafil among erectile dysfunction (ED) patients and to find which RigiScan parameter produces the best prediction. Medical records of 172 ED patients were revised regarding their full sexual history, standard andrology examination, NPTR monitoring by the RigiScan device, and the degree of response to sildenafil. Of 172 ED patients, 94 patients (54.7%) were sildenafil responders. All RigiScan parameters were higher in the sildenafil responder group. The RigiScan parameters with the most differentiating power between both sildenafil responders and non-responders were base rigidity (AUC 0.860) and then tip rigidity (AUC 0.831). The cut-off value of base and tip rigidity with the highest diagnostic accuracy was 42.5%. This finding was found to be more specific than the sensitivity in predicting a positive response to sildenafil (85.9% vs. 70.2% and 92.3% vs. 59.6%, for base and tip rigidity, respectively). Sildenafil response in ED cases can be predicted through NPTR monitoring using the RigiScan device and ED patients with RigiScan base or tip rigidity less than 42% are not expected to respond well to sildenafil.
... Moreover, the oxygen tension-dependent changes in the penis during erection are proposed to have an impact on corpus cavernosal structure by inducing various cytokines, vasoactive factors, and growth factors, which, in turn, alter smooth muscle metabolism and connective tissue synthesis [6]. Absence of regular sexually stimulated or nocturnal erections may result in an insufficient oxygen supply to the organ, and consequently increased fibrous tissue and decreased smooth muscle content, further aggravating ED [7]. To eliminate this pathophysiology, suggested preventative practices have been advocated that include increasing physical fitness, improving healthy dietary habits, and reducing obesity [8,9]. ...
To investigate the effects of phosphodiesterase type 5 (PDE5) inhibitors on erectile variables during a period with no sexual stimulation in a laboratory setting double-blind study.
In all, 80 men without erectile dysfunction (ED) but with lifelong premature ejaculation (PE) were included in the study. The men were divided equally in to four groups and received either placebo, vardenafil (10 mg), sildenafil (50 mg) or tadalafil (20 mg) in a double-blind study design. The men attended the laboratory following 3 days of sexual abstinence and placebo or one of the PDE5 inhibitors was ingested after ≥ 2 h of fasting and non-smoking. The men were then immediately placed in a silent room and real-time penile rigidity and tumescence monitoring with Rigiscan Plus (Rigiscan Plus® System, Osbon Medical Systems, Augusta, GA, USA) began. The men read some magazines or newspapers that contained no sexually stimulating material for 1.5 h. There was no interaction between the men and observer during the test period. Times to first measured and total durations of base and tip rigidities, and also total and per minute rigidity were evaluated.
The recorded base and/or tip rigidity ratios were 40% (eight of 20), 71% (12/17), 47% (nine of 19) and 70% (14/20) in men who took placebo, sildenafil, tadalafil and vardenafil, respectively (P = 0.126). The ratio of men who could obtain ≥ 60% base and/or tip rigidities were 10% (two of 20), 41% (seven of 17), 26% (five of 19) and 55% (11/20) in placebo, sildenafil, tadalafil and vardenafil groups, respectively (P < 0.05). The median time to first measured base rigidity was 58.0, 21.5, 54.5 and 57 min with placebo, sildenafil, tadalafil and vardenafil, respectively (P = 0032). The median total duration of recorded base rigidity was 4.0, 27.5, 10.0 and 11.5 min in men who took placebo, sildenafil, tadalafil and vardenafil, respectively (P = 0.013). The median total base rigidity (area under the curve) was 72.8, 699.0, 360.5 and 553.0 with placebo, sildenafil, tadalafil and vardenafil, respectively (P = 0.016).
Significant penile rigidities were obtained with PDE5 inhibitors during the short test period, with no sexual stimulation, in laboratory conditions. This finding might support the use of PDE5 inhibitors in men who need penile rehabilitation.
... Regaining Morning Erection PDE inhibitors were shown to improve penile erections not induced by sexual stimulation. Terradas et al. [51] studied the effects of sildenafil on nocturnal penile tumescence showing that in the organic ED, it induced a significant improvement in time of rigidity and tumescence activity in the tip and base. In the psychogenic ED, it caused significant improvement only in rigidity activity in the tip whereas in potent men, the changes were nonsignificant. ...
Introduction. Phosphodiesterase type 5 (PDE5) hydrolyses cyclic guanylate monophosphate (cGMP) specifically to 5′ GMP. PDE5 inhibitors were a breakthrough medication that addressed a previously unfulfilled medical need. They promoted vascular relaxation in the corpora cavernosa and penile erection during sexual stimulation. Sildenafil, vardenafil, and tadalafil were approved then introduced as effective treatments for male erectile dysfunction. This impact has stimulated academic, clinical, and industrial research. Aim. To highlight the nonerectogenic beneficial uses of oral PDE5 inhibitors. Method. A systematic review of published studies in this affair based on a Pubmed and medical subject heading databases search of all concerned articles. Main Outcome Measures. Demonstrated beneficial as well as applicable uses of oral PDE5 inhibitors. Results. As chemical molecules, these drugs were shown to exert potential nonerectogenic beneficial effects. They showed efficacy as a useful adjunct in the management of pulmonary hypertension. Additional uses were extended to different utilities: essential hypertension, benign prostatic hyperplasia, gastrointestinal disorders, endothelial dys-function, female sexual dysfunction, genital blood flow, exercise capacity, Raynaud's phenomenon, sperm motility, etc. Conclusion. Exploring PDE5 inhibitors for their possible medical applications in diverse specialties seems to be beneficial in making use of these molecules for the welfare of humanity. Mostafa T. Oral phosphodiesterase type 5 inhibitors: Nonerectogenic beneficial uses. J Sex Med 2008;5:2502–2518.
... In addition, increased fibrous tissue and decreased smooth muscle content might result from an insufficient oxygen supply to the organ in the absence of sexuallystimulated or nocturnal erections [3]. ...
... Longer-lasting effects on endothelial function have been described following the nightly intake of sildenafil 25 mg for a period of 2 weeks [5]. Moreover, nightly intaking of sildenafil at bedtime improves nocturnal erections in healthy men and men with ED [3,6,7]. Building on these results, we investigated the improvement and maintenance of improvement in erectile function (EF) and in penile arteriogenic reactivity after treatment for one year with sildenafil taken nightly at bedtime compared with sildenafil taken as needed for anticipated sexual activity, in men with mild-to-moderate arteriogenic ED who had responded to erectogenic treatment at baseline. ...
... In addition to improving endothelial function, sildenafil nightly might exert persisting improvements in EF by increasing tissue oxygenation through its erectogenic effect. Sildenafil nightly increases nocturnal erections [3,6,7]. Nocturnal erections are usually present during approximately 25% of sleep time (associated with REM sleep) [16] and, therefore, represent a significant portion of total erectile tissue activity, but are reduced in patients at risk for erectile disorders [17]. ...
To test the hypothesis that sildenafil (50 mg nightly for one year) can improve spontaneous erectile function (EF) in men with mild-to-moderate arteriogenic erectile dysfunction (ED) responsive to erectogenic treatment.
In a prospective open-label trial, 112 men with ED were randomized to sildenafil 50 mg nightly or sildenafil 50 or 100 mg as needed for 12 months, followed by one-month and 6-month non-medicated periods. Non-randomized, non-medicated men with ED were also assessed. The EF domain of the International Index of Erectile Function (IIEF EF) and the peak systolic velocity (PSV) of penile cavernous arteries were used to measure the efficacy.
After sildenafil treatment and a subsequent non-medicated month, IIEF EF was normal in 29 of 48 (60.4%, 95% confidence interval [CI]: 45.3-74.2%) of the nightly group vs. 4 of 49 (8.2%, 95% CI: 2.3-19.6%) of the as-needed group. PSV improved by 11.2 cm/s (95% CI: 4.7-21.4; P=0.012) in the nightly group but only by 3.4 cm/s (-5.1-14.7; P=0.435) in the as-needed group. IIEF EF normalized in 1 of 18 (5.6%, 95% CI: 0.1-27.3%) non-medicated men and the PSV declined slightly. Six months after treatment, the IIEF EF remained normal and PSV was stabilized in most (28/29, 97%) nightly group men who had initially normalized.
Sildenafil nightly for one year resulted in ED regression that persisted well beyond the end of treatment, so that spontaneous EF was characterized as normal on the IIEF in most men. The results from this open-label, randomized trial warrant verification under double-blind, placebo-controlled conditions.
... Sildenafil has been shown to be efficacious in men affected by erectile dysfunction (Boolell et al, 1996;Goldstein et al, 1998;Rendell et al, 1999;Lue, 2000). Sildenafil administered at bedtime also improves sleep-related erections in both eugonadal men affected by erectile dysfunction (Montorsi et al, 2000;Terradas et al, 2001) and healthy men (Rochira et al, 2002;Yaman et al, 2003). ...
... The first major outcome of this study is that sildenafil administered at bedtime improves sleep-related erections in men affected by hypogonadism, as in healthy subjects (Rochira et al, 2002;Yaman et al, 2003) and in subjects affected by erectile dysfunction (Montorsi et al, 2000;Terradas et al, 2001). Particularly, sildenafil increased all NPTRM parameters, except for total duration of increase in circumference, (Figures 2, 3, 5, 6) in hypogonadal men (HϪTϩS vs HϪTϩP), similar to the result when testosterone alone was administered, since no differences were found between HϪTϩS and HϩTϩP groups for all parameters (Figures 2 through 6). ...
To study the effects of sildenafil on human sleep-related erections according to the state of androgenization, we evaluated the effects of sildenafil on sleep-related erections in hypogonadal men before and during testosterone replacement treatment and in control subjects. We enrolled 24 hypogonadal men and 24 healthy men as a control group. All hypogonadal subjects had very low testosterone levels (<200 ng/dL [6.9 nmol/L]) [corrected] All subjects underwent nocturnal penile tumescence and rigidity monitoring (NPTRM) for 3 consecutive nights and were randomly assigned to consume either 50 mg of sildenafil or placebo 1 hour before bedtime on the second or third night of nocturnal penile monitoring. The hypogonadal subjects were tested twice, first without replacement treatment (H-T) and then after at least 6 months of testosterone replacement therapy (H+T). The subjects of the control group (C) were tested once. The following parameters of sleep-related erections were analyzed: total number of valid erections, total duration of both rigidity greater than or equal 70% and increase in penile circumference greater than or equal 30 mm, maximum rigidity, and maximum increase in penile circumference. NPTRM parameters were reduced in hypogonadal men before testosterone treatment (H-T+P) when compared with control subjects taking placebo (C+P). NPTRM parameters after testosterone (H+T+P) and sildenafil (H-T+S) administration were similar to that of control subjects taking placebo (C+P). When the statistical analysis was restricted to the hypogonadal men before testosterone treatment, sildenafil alone significantly increased NPTRM parameters when compared with placebo (H-T+S vs H-T+P). Testosterone restored normal erections when administered to hypogonadal subjects (H+T+P vs H-T+P); in hypogonadal men, however, the combined treatment (sildenafil plus testosterone) resulted in the maximum positive effect on NPTRM parameters. When the increase from baseline was analyzed, the effects of testosterone plus sildenafil were greater than the sum of the effects of each drug used alone. In conclusion, sildenafil administered at bedtime improves sleep-related erections in hypogonadal men, suggesting that the nitric oxide pathway may be pharmacologically enrolled and enhanced despite low serum testosterone. Furthermore, these data strongly support the idea of a synergic effect on sleep-related erections of sildenafil and testosterone.
... The psychogenic etiology of ED was objectively confirmed in the present study by pharmacotesting with duplex ultrasonography and interestingly by NPTR monitoring itself. Several studies have shown improvement in almost all parameters of NPTR monitoring among patients with organic ED. 8,9 Regarding the impact of sildenafil citrate on NPTR in potent men, controversial results were obtained. Montorsi et al 9 showed that sildenafil citrate did not significantly improve nocturnal penile activity, whereas Yaman et al, 10 conducting a similar study with a larger sample, concluded that sildenafil citrate can improve nocturnal erectile quality not only in patients with ED, but also in potent men. ...
... This could be attributed to the small sample size and to the wide Psychogenic erectile dysfunction MB Abdel-Naser et al variations between individual RigiScan recordings. 8,9,13 In contrast to these studies, however, the number of events was significantly improved, not only in the sildenafil citrate night, but also in night 4 in group I and in night 3 in group II. In group I, the improvement in night 4 when compared with that of night 3 (sildenafil citrate night) was insignificant. ...
Effects of sildenafil citrate on nocturnal penile tumescence and rigidity (NPTR) were evaluated among sildenafil non-responding patients with psychogenic erectile dysfunction. All patients (n=30), equally divided into groups I and II, completed four consecutive nights using the RigiScan Plus device. Sildenafil citrate (50 mg) was given in the third night in group I and in the fourth in group II, whereas a placebo was given in the remaining nights. Additional patients (n=12) receiving only a placebo served as a control group. Results of NPTR recordings revealed neither significant differences between the control and non-sildenafil nights of both test groups, nor between the corresponding values of both groups (P>0.05). On the other hand, when sildenafil citrate nights of groups I and II taken together were compared with placebo nights, a significant increase of total events duration (P<0.001), average rigidity of the tip (P<0.05) and base (P<0.01), and rigidity activity unit (RAU) and tumescence activity unit (TAU) of tip and base (P<0.001) was observed. These results suggest that performance anxiety may be responsible for failure of response during awakening.
... Terrades et al studied the effects of sildenafil on nocturnal penile erections of patients with organic or psychogenic impotence and normal potent men. 13 They found that sildenafil improved nocturnal penile erectile activity in patients with organic impotence. However, they also stated that this action could not be shown in patients with psychogenic impotence or in normal males. ...
We try to evaluate the effect of sildenafil on nocturnal penile erections of potent men. We recruited 22 potent men (eight medical students and 14 urology residents) 23-29 years old into the study. A disorder-free medical and sexual history and normal erectile functions were the only inclusion criteria. All subjects completed three sessions of consecutive nights using the RigiScan Plus device. After a first night of adaptation, night 2 recordings were their baseline values whereas they received sildenafil 100 mg on night 3. We observed statistically significant improvement with regard to those NPT parameters at the nights with sildenafil: number of erectile episodes; duration of tip rigidity >60%, RAU tip, RAU base and TAU tip (P<0.005). Although the duration of erectile episodes (min) and TAU base were greater during the sildenafil night, these did not reach statistical significance. In conclusion, our study showed that sildenafil can improve nocturnal erectile quality not only in patients with erectile dysfunction as previously published but also in potent males.
Awareness of the biological and the psychological considerations in sexual performance is crucial in the exploration of treatments that promote sexual enhancement. Biological factors include, but are not limited to, genetic makeup, physical health, and nutrition. Psychosocial factors involve upbringing, belief systems, self-efficacy, relationships, personality, and experiences. Improving and enhancing sexual function pharmacologically include approved and off-label medications and are based partly on research and partly on anecdotal reports. There is a growing body of literature describing pharmacological interventions, but in many cases their utility is hard to establish due to placebo responses, side effect profiles, and negative impact of comorbidities. Nevertheless, this chapter brings a collection of prescription medications for which the evidence for sexual enhancement exists.
Purpose of review This is an update of recent developments in the investigation of erectile dysfunction in the period since March 2002 Recent findings Three developments in the field of medical sexology redirected the approach towards the investigation of erectile dysfunction. First, the emergence of oral pharmacological therapy; second, the notion that sexual relationship issues have an important impact on the successful outcome of pharmacological therapy; and finally, the concept that erectile dysfunction is often a sequel or even a sentinel of cardiovascular disease. Consequently, the current evaluation of men with erectile dysfunction may be divided into two steps: a basic diagnostic evaluation for the majority of men, and specific diagnostic procedures for a small minority. The basic evaluation is aimed at the identification of the underlying pathological condition and erectile dysfunction-associated risk factors. Such screening may diagnose reversible causes of erectile dysfunction and also unmask medical and psychological conditions that manifest with erectile dysfunction. The basic evaluation consists of a comprehensive medical, sexual and psychosocial history and a physical examination. Patients who have failed first-line treatment or complicated cases qualify for specific diagnostic procedures, traditionally performed by urologists. Summary Current research into the investigation of erectile dysfunction emphasizes the notion that erectile dysfunction is often a result of an interplay between medical and psychosexual conditions. Recognition of the underlying conditions and an estimation of their relative contribution to the patient's and his partner's sexual problem are key issues in the current evaluation of the man with erectile dysfunction.
Phosphodiesterase-5 inhibitors: erectile quality and emotional correlates in men with erectile dysfunction and their partners This article aims to review the physiological determinants of penile rigidity in erection and its functional and emotional correlates in patients and their partners. Physiologically, the main neurotransmitter causing erections is nitric oxide (NO). The effects of this neurotransmitter arc due to cyclic GMP, whose activity is regulated by phosphodiesterase-5 (PDE5). PDE5 inhibition with sildenafil, tadalafil and vardenafil increases erectile quality by prolonging the bioactivity of NO. The tools for rigidity evaluation, both objectively (RigiScan (R)) and subjectively (Erection Hardness Scale, International Index of Erectile Function, Quality of Erection Questionnaire, Sexual Encounter Profile and Sexual Life Quality Questionnaire) and the emotional impact of erectile quality on patients and their partners were reviewed. In conclusion, erectile rigidity has functional repercussions (quality of erection) and emotional effects (confidence, self-esteem, sexual satisfaction and general satisfaction), both for the male and his partner.
