Category — Erectile Dysfunction Research

Diabetes Self Manag. 2008 Mar-Apr;25(2):29-30, 32.
Ezzell A, Baum N.18630374 [PubMed - indexed for MEDLINE]

Ned Tijdschr Geneeskd. 2008 Jun 7;152(23):1322.
[Article in Dutch]

ten Duis K, van Dalen T.

Diakonessenhuis, afd. Heelkunde, Utrecht. kajtenduis@hotmail.com

A 50-year-old man presented with a sacral tumour due to a sacrococcygeal chordoma.

JAMA. 2008 Jul 23;300(4):395-404.
Nurnberg HG, Hensley PL, Heiman JR, Croft HA, Debattista C, Paine S.

Department of Psychiatry, University of New Mexico School of Medicine, 2400 Tucker NE, MC 09 5030, Albuquerque, NM 87131-0001, USA. gnurnberg@salud.unm.edu

CONTEXT: Antidepressant-associated sexual dysfunction is a common adverse effect that frequently results in premature medication treatment discontinuation and for which no treatment has demonstrated efficacy in women. OBJECTIVE: To evaluate the efficacy of sildenafil for sexual dysfunction associated with selective and nonselective serotonin reuptake inhibitors (SRIs) in women. DESIGN, SETTING, AND PARTICIPANTS: An 8-week prospective, parallel-group, randomized, double-blind, placebo-controlled clinical trial conducted between September 1, 2003, and January 1, 2007, at 7 US research centers that included 98 previously sexually functioning, premenopausal women (mean [SD] age 37.1 [6] years) whose major depression was remitted by SRIs but who were also experiencing sexual dysfunction. INTERVENTION: Forty-nine patients were randomly assigned to take sildenafil or placebo at a flexible dose starting at 50 mg adjustable to 100 mg before sexual activity. MAIN OUTCOME MEASURES: The primary outcome measure was the mean difference in change from baseline to study end (ie, lower ordinal score) on the Clinical Global Impression sexual function scale. Secondary measures included the Female Sexual Function Questionnaire, the Arizona Sexual Experience scale-female version, the University of New Mexico Sexual Function Inventory-female version, a sexual activity event log, and the Hamilton Depression Rating scale. Hormone levels were also assessed. RESULTS: In an intention-to-treat analysis, women treated with sildenafil had a mean Clinical Global Impression-sexual function score of 1.9 (95% confidence interval [CI], 1.6-2.3) compared with those taking placebo (1.1; 95% CI, 0.8-1.5), with a mean end point difference of 0.8 (95% CI, 0.6-1.0; P = .001). Assigning baseline values carried forward to the 22% of patients who prematurely discontinued resulted in a mean end point in the sexual function score of 1.5 (95% CI, 1.1-1.9) among women taking sildenafil compared with 0.9 (95% CI, 0.6-1.3) among women taking placebo with a mean end point difference of 0.6 (95% CI, 0.3-0.8; P = .03). Baseline endocrine levels were within normal limits and did not differ between groups. The mean (SD) Hamilton scores for depression remained consistent with remission in both groups (4.0 [3.6]; P = .90). Headache, flushing, and dyspepsia were reported frequently during treatment, but no patients withdrew because of serious adverse effects. CONCLUSION: In this study population, sildenafil treatment of sexual dysfunction in women taking SRIs was associated with a reduction in adverse sexual effects. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00375297.

Mayo Clin Health Lett. 2008 Jul;26(7):8.
[No authors listed]18688991 [PubMed - indexed for MEDLINE]

Mayo Clin Proc. 2008 Aug;83(8):890-6.
Munger MA, Stoddard GJ, Wenner AR, Bachman JW, Jurige JH, Poe L, Baker DL.

Department of Internal Medicine, Universityof Utah, Salt Lake City 84112-5820, USA. mmunger@hsc.utah.edu

OBJECTIVE: To determine the safety of a US-based, state-regulated Internet system vs a multispecialty primary care system for prescribing phosphodiesterase type 5 (PDE-5) inhibitors for erectile dysfunction. PATIENTS AND METHODS: From January 1, 2001, through December 31, 2005, 500 e-medicine clients (mean+/-SD age, 47+/-11 years; hypertension, 60%; type 2 diabetes mellitus, 2%; mean+/-SD number of medications, 0.4+/-0.8) vs 500 traditional medicine patients (mean+/-SD age, 57+/-12 years; hypertension, 50%; type 2 diabetes mellitus, 23%; mean+/-SD number of medications, 5.1+/-3.1) with erectile dysfunction symptoms were assessed. Noninferiority safety was assessed in this retrospective, cross-sectional study with stratified random sampling by identification of prescribing in the presence of clinically important PDE-5 inhibitor drug interactions with or without high-risk cardiovascular disease, by asking about diagnostic symptoms specific to erectile dysfunction, and by determining frequency of patient counseling. RESULTS: Noninferiority of the e-medicine system was shown for the 6 safety end points, relative to a traditional medicine system. Numbers of inappropriate prescriptions, after correction for disease and medication covariates, did not differ between systems. Medication counseling showed superiority of the e-medicine system. Standard diagnostic questions were required for e-medicine prescribing but were infrequently asked in traditional medicine. CONCLUSION: Safety in prescribing PDE-5 inhibitors for erectile dysfunction was similar between a US-based, state-regulated Internet prescribing system and a multispecialty primary care system.

BJU Int. 2008 Aug 5;102(5):592-6.
Ohebshalom M, Parker M, Waters B, Flanagan R, Mulhall JP.

Department of Urology, Weill Cornell Medical Center, New York, NY, USA.

OBJECTIVE: To define haemodynamic changes after radical retropubic prostatectomy (RP) and the predictive value of these for the outcome of erectile function (EF), as although there are predictors of the recovery of EF, penile vascular changes might also affect the recovery of EF. PATIENTS AND METHODS: Prospective data were analysed from men who had RP followed by duplex penile Doppler ultrasonography (DUS) within 6 months of RP. All men had functional erections before RP, based on self-report and partner corroboration, and all completed the International Index of Erectile Function (IIEF) questionnaire serially after RP. The EF, based on IIEF scores, was then correlated with the penile DUS results. RESULTS: In all, the study included 111 patients; 32 (29%) had normal erectile haemodynamics after RP, while 79 (71%) had abnormal haemodynamics. Twelve patients (11%) had a venous leak. There were no differences in mean patient age or comorbidity profile between those with and without haemodynamic changes. Comparing those with normal and abnormal haemodynamics, the mean IIEF EF domain scores were 25 and 17 (P = 0.025), the percentages of erectile rigidity at 18 months was 66% vs 35% (P = 0.013), the percentage of patients with normal EF domain scores was 28% vs 6% (P < 0.01), the percentage of patients with functional erections permitting sexual intercourse unassisted by pharmacological agents was 47% vs 22% (P = 0.018), and the percentage of patients responding to sildenafil citrate, as defined by vaginal penetration, was 72% vs 43% (P = 0.03), respectively. CONCLUSIONS: The results of this prospective study indicate that a patient’s penile vascular status is correlated with their EF after RP.18694409 [PubMed - indexed for MEDLINE]

Curr Drug Saf. 2007 Jan;2(1):5-8.
B?hm M, Burkart M, Baumann G.

Department of Medicine, Cardiology, Angiology and Pneumology, University Hospital Charit?, Berlin, Germany. Marko.Boehm@charite.de

Erectile dysfunction occurs extensively among patients with arterial hypertension. We investigated the safety of sildenafil for patients with and without antihypertensive medication. Our study included data from 35 double-blind, placebo-controlled, and randomized investigations, with a total of 8115 patients. The term of therapy was between 6 weeks and 6 months, for both the sildenafil group (5-200 mg, n=4819) as well as the placebo group (n=3296). We studied the adverse events in the men who received 1 or more hypertensives (n=2388), and in those who took no antihypertensive medication (n=5727). Our findings disclosed equal frequency of adverse events in both groups, without influence by the number of different antihypertensives administered. The occurrence of AEs associated with blood pressure was slight, and was comparable between the individual groups. These results support the conclusion that sildenafil is also well tolerated by patients taking one or more antihypertensives. Patients being treated with alpha blockers should be stable on this therapy in order to minimize the possibility of orthostatic hypotension. An initial dose of 25 mg should furthermore be considered for these patients.

BJU Int. 2008 Aug 5;102(5):637-8.
Wyllie MG.

Global Pharma Consulting Ltd, 61 Abbey Street, Faversham, Kent, ME13 7BN, UK. m.wyllie@globalpharma.co.uk18694411 [PubMed - indexed for MEDLINE]

Johns Hopkins Med Lett Health After 50. 2008 Jul;20(5):8.
[No authors listed]18711833 [PubMed - indexed for MEDLINE]

MMW Fortschr Med. 2008 Apr 10;150(15):41-3.
[Article in German]

Stadler TC, Becker AJ, Stief CG.

Urologische Klinik und Poliklinik der Universit?t M?nchen, Klinikum Grosshadern. thomas.stadler@med.uni-muenchen.de18510118 [PubMed - indexed for MEDLINE]

J Fam Health Care. 2008;18(2):44.
Scowen P.

Int J Radiat Oncol Biol Phys. 2008 Jul 1;71(3):960; author reply 960-1.
Comment on:

• Int J Radiat Oncol Biol Phys. 2008 Mar 1;70(3):752-9.

Langsenlehner T, Kapp KS, Langsenlehner U.

Curr Urol Rep. 2007 Jul;8(4):281-8.
Jacobsen SJ.

Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. jacobsen@mayo.edu

This review summarizes recent findings regarding risk factors for benign prostatic hyperplasia (BPH), including new data on hormonal factors, growth factors, comorbid conditions and lifestyle, diet, and exercise as they relate to BPH. In addition, it addresses the design and measurement issues that influence the inference that can be drawn from those studies. Most of the population-based studies on BPH have provided only modest insight into risk factors for BPH. The relationships with circulating levels of steroid hormones and growth factors are still unclear, whereas the association between sexual function and BPH is fairly consistent. Whether this represents a cause and effect relationship or is due to some unobserved confounding factor remains uncertain. There are few data on lifestyle factors that may be amenable to intervention. As future studies aim to address these issues, they should be carried out with rigorous methods, bypassing as many of the methodologic shortcomings of past studies as possible.

Circulation. 2008 Jun 10;117(23):3020-30. Epub 2008 Jun 2.
Diller GP, van Eijl S, Okonko DO, Howard LS, Ali O, Thum T, Wort SJ, B?dard E, Gibbs JS, Bauersachs J, Hobbs AJ, Wilkins MR, Gatzoulis MA, Wharton J.

Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK. g.diller@imperial.ac.uk

BACKGROUND: Impaired endothelial homeostasis underlies the pathophysiology of pulmonary arterial hypertension (PAH). We speculated that PAH patients are deficient in circulating endothelial progenitor cells (EPCs), potentially contributing to endothelial dysfunction and disease progression. METHODS AND RESULTS: We recruited 41 patients with Eisenmenger syndrome (13 with Down syndrome), 55 with idiopathic PAH, and 47 healthy control subjects. Flow cytometry and in vitro assays were used to quantify EPCs and to assess cell function. The number of circulating CD34+, CD34+/AC133+, CD34+/KDR+, and CD34+/AC133+/KDR+ progenitor cells was low in Eisenmenger patients compared with healthy control subjects, and those with Down syndrome displayed even fewer EPCs. Reductions in EPC numbers correlated with New York Heart Association functional class, 6-minute walk distance, and plasma brain-type natriuretic peptide levels. The capacity of cultured peripheral blood mononuclear cells to form colonies and incorporate into tube-like structures was impaired in Eisenmenger patients. Idiopathic PAH patients had reduced numbers of EPCs, and the number of circulating EPCs correlated with invasive hemodynamic parameters in this cohort. Levels of immune inflammatory markers, cGMP, stable nitric oxide oxidation products, and asymmetric dimethylarginine were abnormal in patients with PAH and related to numbers of EPCs. Within the idiopathic PAH population, treatment with the phosphodiesterase inhibitor sildenafil was associated with a dose-dependent rise in EPC numbers, resulting in levels consistently above those found with other therapies. CONCLUSIONS: Circulating EPC numbers are reduced in 2 well-characterized forms of PAH, which also exhibit raised levels of inflammatory mediators. Sildenafil treatment may represent a pharmacological means of increasing circulating EPC numbers long-term.

Arterioscler Thromb Vasc Biol. 2008 Jul;28(7):1207-8.
Comment on:

• Arterioscler Thromb Vasc Biol. 2008 Jul;28(7):1244-50.

Schleicher M, Sessa WC.

J Nerv Ment Dis. 2008 Jun;196(6):496-500.
Orr G, Seidman SN, Weiser M, Gershon AA, Dubrov Y, Klein DF.

Department of Psychiatry Sheba Medical Center, Tel-Hashomer, Israel. orrg@netvision.net.il

Late onset dysthymic disorder (DD) in middle-aged and elderly men responds poorly to established antidepressants. Previous studies noted an improvement in mood accompanying sildenafil citrate treatment for erectile dysfunction. We sought to evaluate whether sildenafil’s mood effects were independent of the effect on erectile function. A 6-week open label study was conducted with 20 male participants, aged 41-60 who were diagnosed with DD and who had normal erectile function. Participants were treated with sildenafil citrate 25 mg per day for 6 weeks. The primary outcome measure was the 21-item Hamilton Depression Rating Scale. Depressive and sexual symptoms were also evaluated using self-report questionnaires. Treatment with sildenafil resulted in a significant reduction in Hamilton Depression Rating Scale mean scores: from 14.61 +/- 3.5 at baseline to 6.39 +/- 5.13 at end of study (F(3,51) = 32.52, p </= 0.001). No changes in sexual functioning were detected. Significant improvement was also noted on the self-report measures of depressive symptoms. Sildenafil citrate might have an antidepressant effect on late onset DD, that is not attributable to improvement in erectile function. Possible explanations for this effect are offered. Larger placebo controlled studies are warranted.

Aging Male. 2008 Jun;11(2):101-6.
Behre HM, Heinemann L, Morales A, Pexman-Fieth C.

Centre of Reproductive Medicine and Andrology, University Hospital Halle, Germany.

Hypogonadism is associated with a range of disease states that have significant effects on morbidity and mortality, and also affect quality of life. The ESPRIT study (Energy, Sexual desire and body PropoRtions wIth AndroGel, Testosterone 1% gel therapy) is a 6-month, multinational, open label, observational study in hypogonadal men being treated with transdermal AndroGel in usual daily clinical practice; 1,700-2,400 patients will be enrolled in Canada, Germany, Central and Eastern Europe, Russia and the Middle East. The main objective will be to evaluate the effect of AndroGel on symptoms of hypogonadism and quality of life as assessed by the Aging Males’ Symptoms scale. Further objectives include evaluating the effect and time to onset of improvement in erectile dysfunction and libido/sexual desire (International Index of Erectile Function), fatigue (Multi-dimensional Fatigue Index) and body composition (waist circumference, body mass index). Subgroup analyses will be performed: <50 years versus > or = 50 years; absence versus presence of metabolic syndrome. The safety of AndroGel will also be assessed. The study population will consist of newly diagnosed hypogonadal men (age > or = 18 years), in whom testosterone deficiency has been confirmed by clinical features and biochemical tests according to international guidelines, who are currently being prescribed AndroGel (testosterone 1% gel, starting dose 50 mg testosterone per day).

BJU Int. 2008 Jul;102(2):259; author reply 259-60.
Comment on:

• BJU Int. 2008 Mar;101(5):581-7.

Sed? J.

N Engl J Med. 2008 Jul 10;359(2):200-1; author reply 201-2.
Comment on:

• N Engl J Med. 2008 Mar 20;358(12):1250-61.

Arap W.

BJU Int. 2008 Jun;101(11):1336-8. Epub 2008 Apr 14.
Ritchie RW, Lindfield DM, Lockyer CR, Adamson A.

Department of Urology, Churchill Hospital, Oxford, UK. robritchie@doctors.org.uk18422763 [PubMed - indexed for MEDLINE]