This is a post from Erectile Dysfunction Central

When Viagra doesn’t work. Treating erectile dysfunction.

• Evaluation and treatment of organic impotence in the male with diabetes mellitus.
• Diabetes quiz. How much do you know about treating impotence?
• New tools 2003.
• Testosterone and diabetes. What’s the connection?
• Say yes to intimacy. Treatment options for erectile dysfunction.

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.

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Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial.

• Efficacy and safety of sildenafil in men with serotonergic antidepressant-associated erectile dysfunction: results from a randomized, double-blind, placebo-controlled trial.
• Tadalafil for treatment of erectile dysfunction in men on antidepressants.
• Efficacy and safety of tadalafil in men with erectile dysfunction with a high prevalence of comorbid conditions: results from MOMENTUS: multiple observations in men with erectile dysfunction in National Tadalafil Study in the US.
• Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial.
• The efficacy of tadalafil in clinical populations.

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.

This is a post from Erectile Dysfunction Central

[Diagnostic image (376). A man with a tumour in the anal seam]

• [Intracavernous injections in erection disorders]
• [Somatization of erectile disorders by the introduction of sildenafil]
• [Drug treatment of sexual disorders in men]
• [Non-surgical treatment of erection disorders]
• [Total mesorectal excision: a new standard for the surgical treatment of rectal carcinoma]

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.

This is a post from Erectile Dysfunction Central

Safety of prescribing PDE-5 inhibitors via e-medicine vs traditional medicine.

• Safety of Internet Prescribed Erectile Dysfunction Drugs
• Pharmacokinetics, pharmacodynamics, and efficacy of phosphodiesterase type 5 inhibitors.
• A study of the management of erectile dysfunction in general practice.
• Pharmacotherapy of erectile dysfunction: focus on cardiovascular safety.
• [Advances in studies of Chinese herbs for improving relaxability of corporal smooth muscle]

This is a post from Erectile Dysfunction Central

Can Viagra really cause hearing and vision loss? If so, is this a reason to avoid using it?

• I’ve heard of an herbal alternative to Viagra for impotence. Does it work and is it safe?
• Do I need to see a doctor to get a prescription for Viagra? I’ve seen ads offering Viagra direct by mail.
• Standard bicycle seats can lead to erectile dysfunction.
• Beyond Viagra. What are your options?
• FDA approves impotence pill.

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.

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Sildenafil is well tolerated by erectile dysfunction patients taking antihypertensive medications, including those on multidrug regimens.

• Effect of sildenafil in patients with erectile dysfunction taking antihypertensive therapy. Sildenafil Study Group.
• Safety and efficacy of vardenafil, a selective phosphodiesterase 5 inhibitor, in patients with erectile dysfunction and arterial hypertension treated with multiple antihypertensives.
• Sildenafil citrate for erectile dysfunction in men receiving multiple antihypertensive agents: a randomized controlled trial.
• Cardiovascular effects of tadalafil in patients on common antihypertensive therapies.
• [Interaction between sildenafil and antihypertensive drugs: what is evidence-based?]

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]

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Erectile haemodynamic status after radical prostatectomy correlates with erectile functional outcome.

• The use of an erectogenic pharmacotherapy regimen following radical prostatectomy improves recovery of spontaneous erectile function.
• Sex inventories: can questionnaires replace erectile dysfunction testing?
• Vardenafil restores erectile function to normal range in men with erectile dysfunction.
• Comparison of international index of erectile function with nocturnal penile tumescence and rigidity testing in evaluation of erectile dysfunction.
• Reliability of remembered International Index of Erectile Function domain scores in men with localized prostate cancer.

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

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Prostaglandin revival?

• Up and along; sex is now as good as it gets.
• Another year, another AUA.
• Circumventing side-effects.
• Diagnostic potential unmasked.
• One drug fits all.

This is a post from Erectile Dysfunction Central

The patient information that came with my Viagra prescription warned of sudden vision or hearing loss. Should I be worried?

• Viagra: a blueprint for safety and reliability.
• Viagra’s other health benefits.
• Enjoying lifelong sexual vitality.
• Attention men: what you don’t know can hurt you.
• New laser treatments ease severe BPH symptoms.

High cholesterol isn’t a disease, but if you have it you’re at risk for some serious health conditions.

High cholesterol can manifest with or without symptoms. And the No. 1 danger of this condition is that it clogs arteries, resulting in a condition called atherosclerosis, which reduces blood flow and increases the risk of heart attack or stroke.

But the reduced blood flow caused by high cholesterol also has been linked to sexual disorders.

Dr. Michael Krychman, the executive director of the Southern California Center for Sexual Health and Survivorship, said high cholesterol causes fatty deposits that clog blood vessels leading to the pelvic area. Men with high cholesterol sometimes end up with erectile dysfunction because they are not receiving enough blood flow to the penis, he explained.

“As soon as a man presents with erectile dysfunction, we begin measuring cholesterol and blood pressure,” he said.

Cholesterol is a waxy, fat-like substance found throughout the body that is carried in blood particles called lipoproteins. An excess of cholesterol can lead to a complete blockage of the coronary artery, which will trigger a heart attack.

High cholesterol and its blood flow-restricting mechanisms long have been viewed as a factor in male sexual dysfunction but only recently emerged as culprits in female sexual disorders, Krychman said.

“In the past we used to think if a woman is having sexual problems, she’s frigid, and she needs to go home and have a glass of wine and relax,” Krychman said. “However, there is emerging data associating underlying medical causes with female sexual dysfunction.”

In women, the fatty deposits from high cholesterol may impact lubrication, causing painful intercourse and a lowered libido, said Krychman, who also is director of sexual medicine at Hoag Memorial Hospital.

Men and women who believe high cholesterol may be affecting their sex lives should consult a physician to rule out other causes, Krychman said.

Once cholesterol is determined to be the problem, doctors usually advise patients to seek dietary and lifestyle changes, such as eliminating saturated fat (found in fatty meat and eggs) from the diet, quitting smoking and increasing exercise.

If necessary, doctors may recommend a cholesterol-lowering medication, Krychman added.

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Is High Cholesterol Causing Your Erectile Dysfunction?

• Erectile dysfunction predicts heart problems: study
• Total cholesterol and high density lipoprotein cholesterol as important predictors of erectile dysfunction.
• Erectile dysfunction is associated with a high prevalence of hyperlipidemia and coronary heart disease risk.
• Vasodilating beta-adrenoceptor blockers as cardiovascular therapeutics.
• Sexual dysfunction in the United States: prevalence and predictors.

Can Viagra work for women?

By Margaret McCartney

Sex sells. I suppose this is why the results of a study entitled “Sildenafil Treatment of Women with Antidepressant Associated Sexual Dysfunction” were reported with great enthusiasm around the world after they were published in the Journal of the American Medical Association (Jama). Yet the study is interesting for a number of reasons.

Sildenafil was originally sold as Viagra. Despite its success in treating men, there has been no equivalent drug for women. In the UK, there is only one licensed drug, Intrinsa, which is used in specific circumstances for female libido problems after gynaecological surgery.

The lack of a “female Viagra” highlights questions over the broader issue of “female sexual dysfunction”. While men with sexual problems frequently respond to drugs, female sexual problems tend to be more complex and far less amenable to pharmacological treatment.

Indeed, as the British Medical Journal noted in 2003, when female sexual dysfunction as a disorder was mooted at an “international consensus development conference” on the subject, 18 of the 19 authors had “financial interests or other relationships with a total of 22 drug companies”. The obvious concern was that the potential for profit was being put higher than the likely benefit to women.

The latest Jama research seems to have found a use for sildenafil in women. Or has it? The women in the trial were experiencing “sexual dysfunction” as a side effect of taking medication – in this case antidepressants.

In order to take part in the trial, the women had to be sexually active before they became depressed, but to have experienced sexual problems for just four weeks – a relatively short space of time.

So how much difference did sildenafil make? When its effect was compared to that of a placebo, there was no difference in the women’s ratings of their desire or arousal and only a small, if statistically significant, effect on orgasm. Forty-three per cent of the women on sildenafil experienced headaches, and both groups had similar scores for depression at the end of the eight-week study.

The logic of using one drug to treat another one’s side effects may sound perverse, but it is frequently applied in the world of medicine. The issue is making sure that each is properly justified.

http://jama.ama-assn.org/cgi/content/short/300/4/395
http://www.bmj.com/cgi/content/full/326/7379/45

Margaret McCartney is a GP in Glasgow.

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Viagra for Women? revisited

• Viagra Improves Sexual Function In Women on Anti-Depression Drugs
• Sildenafil treatment of women with antidepressant-associated sexual dysfunction: a randomized controlled trial.
• What Malaysian women believe about Viagra: a qualitative inquiry.
• Viagra For Women, Not So Fast!
• Systematic review of randomised controlled trials of sildenafil (Viagra) in the treatment of male erectile dysfunction.

A innovative study published in this month’s issue of the Journal of Sexual Medicine examined if noseless bike seats would be effective against erectile dysfunction and groin numbness caused by traditional bicycle seats with a protruding nose extension.  The research revealed that men who switched from regular bike seats to noseless saddle seats had improved penile sensation and a reduction in erectile dysfunction (impotence).

Results from this research may be useful for all male recreational cyclists to alleviate perineal discomfort, potential erectile dysfunction and maintain sexual health.

The study tracked 90 bicycling police officers from 5 metropolitan regions in the United States.  The officers were evaluated using traditional saddles and then again after six months of using the noseless bicycle seat.  The noseless saddle seat reduces contact pressure in the perinieal region by cradleing the buttocks and providing freedom in the front.

Before switching seats, 82% of the 90 officers reported penile numbness while cycling.  After switching to the noseless saddle seats, only 27% reported numbness in the groin.

The findings show that use of the noseless saddle resulted in a reduction in saddle contact pressure in the perineal region and significant improvement in penile tactile sensation.  Use of the noseless saddle also resulted in significant increases in erectile function as assessed by the initial evaluation, but there were no significant changes to penile rigidity during sleep.  Officers who reported erectile dysfunction before switching saddles saw an improvement in the longevity of their bedroom encounters.

Most bicycle police officers were able to effectively use no-nose saddles in their police work, and 97 percent of officers completing the study continued to use the no-nose saddle afterward.

Researchers concluded that No-nose saddles are a useful intervention for bicycling police officers alleviating pressure to the groin and improving penis health. Different saddle designs may require some re-learning of ‘how to ride a bicycle,’ but the health benefits to having unrestricted vascular flow to and from the penis and less penile numbness is self-evident.

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Special Bicycle Seat May Prevent Erectile Dysfunction in Men

• Only the nose knows: penile hemodynamic study of the perineum-saddle interface in men with erectile dysfunction utilizing bicycle saddles and seats with and without nose extensions.
• Cycling and penile oxygen pressure: the type of saddle matters.
• Bicycle riding and erectile dysfunction: an increase in interest (and concern).
• Digital three-dimensional modelling of the male pelvis and bicycle seats: impact of rider position and seat design on potential penile hypoxia and erectile dysfunction.
• Erectile dysfunction after a long-distance cycling event: associations with bicycle characteristics.

In the August issue of Mayo Clinic Proceedings, researchers from Utah and several colleagues compare the relative safety of two systems — an online prescribing service versus traditional physician consultation — for patients seeking medication to treat erectile dysfunction.

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.

The Internet is rapidly becoming an important platform for health care communications. This technological advance is driven by the delivery of health care from single to multiple physicians, by direct-to-consumer advertising that empowers patients to make their own health care decisions, and by greater public demand for rapid delivery of health care information.

Unsurprisingly, the increase in demand for electronic health information has evolved in association with direct-to-consumer advertising of pharmaceuticals, which has led the public to seek Internet prescribing. However, prescribing via the Internet has resulted in legal, professional, confidentiality, and safety breaches that threaten public safety.⁴ In response to e-medicine prescribing, the health care industry has appropriately raised serious concerns about the safety of prescribing over the Internet.

The researchers randomly selected 1,000 patient medical records from patients seeking ED treatment from Jan. 1, 2001 to Dec. 31, 2005. Half (500) of these patients used the online prescriber (the e-medicine group), and 500 consulted a physician (the traditional medicine group) for treatment.

Phosphodiesterase type 5 (PDE-5) inhibitors were chosen for this study for several reasons. This drug class is safe and effective for erectile dysfunction, regardless of etiology, with clear contraindications. Further, recommendations for using the drug have been generally established by expert opinion, rather than by evidence, leading to variance in prescribing.

Using statistical analyses, the researchers compared the safety of both approaches — e-medicine versus traditional medicine — in treating patients who have ED. The safety comparisons looked at a number of criteria, including prescription appropriateness, how often the prescribers used a diagnostic tool called the International Index of Erectile Questions (IIEQs) and the level of patient education provided by prescribers.

Evaluating both systems for these safety criteria, the researchers concluded that the e-medicine system “outperformed the traditional system in most of the safety variables tested.” One area the e-medicine system appeared to excel was patient education. The authors noted that 100 percent of the e-medicine clients received written manufacturer product information, and 75.2 percent of e-medicine clients received tailored electronic messages. In comparison, study data showed that no medication instructions were recorded for 51.8 percent of patients who received prescriptions via a traditional physician consultation.

CONCLUSION

A state-regulated e-medicine system was shown to be similar to a traditional multidisciplinary primary care system for all safety end points in prescribing PDE-5 inhibitors. The e-medicine system outperformed the traditional system in most of the safety variables tested. Additional studies of e-medicine vs traditional medicine systems are needed to confirm our results.

See Here for Full Text Original Article: Safety of Prescribing PDE-5 Inhibitors via e-Medicine vs Traditional Medicine

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Safety of Internet Prescribed Erectile Dysfunction Drugs

• Safety of prescribing PDE-5 inhibitors via e-medicine vs traditional medicine.
• The role of the Internet in patient-practitioner relationships: findings from a qualitative research study.
• Internet-based prescription of sildenafil: a 2104-patient series.
• Drivers and barriers to seeking treatment for erectile dysfunction: a comparison of six countries.
• Internet websites selling herbal treatments for erectile dysfunction.

Tests in rats showed two erectile dysfunction drugs — Schering-Plough’s Levitra and Pfizer’s Viagra — helped carry a chemotherapy drug past the blood-brain barrier, the team at Cedars-Sinai Medical Centre in Los Angeles said.

Viagra (sildenafil) and Levitra (vardenafil) are known as PDE5 inhibitors because they block an enzyme, phosphodiesterase5, which interrupts a series of biochemical events that cause the decreased blood flow of erectile dysfunction. This laboratory rat study, published online ahead of print in the journal, found that similar biochemical interactions in the small vessels of the brain play a major role in the blood-brain tumor barrier, which impedes delivery of anti-tumor drugs into brain tumors. PDE5 inhibitors were found to open the barrier and increase drug transport in this early animal study.

“We chose adriamycin for this study because it is one of the most effective drugs against brain tumour cell lines in the laboratory but it has very little effect in animals and humans because it is unable to cross the blood-brain tumour barrier,” neurosurgeon Dr. Keith Black, who led the study, said in a statement.

“The combination of vardenafil and adriamycin resulted in longer survival and smaller tumour size,” Black said.

Although the researchers exposed the laboratory animals to doses of sildenafil and vardenafil that are comparable to the dose range approved for erectile dysfunction in humans, there were no detectable side effects in the rats, and neither drug increased transport of tracers into normal brain tissue.

The experiments were conducted at Cedars-Sinai Medical Center’s Maxine Dunitz Neurosurgical Institute and published in Brain Research.

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Erectile Dysfunction drugs help treat brain tumors: study

• Transient global amnesia after intake of tadalafil, a PDE-5 inhibitor: a possible association?
• [Epileptic seizures and vardenafil]
• [Drug counterfeiting--the risk to the public health]
• Testing of brain-stem function in 134 patients complaining of impotence.
• Pfizer’s Viagra - Tenth Anniversary of Little Blue Pill

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]

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[Modern treatment of erectile dysfunction]

• [Management of erectile dysfunction in the cardiac patient]
• [Benign prostatic syndrome (BPS). Ablative treatments]
• [The childless couple in the doctor's office. Andrological history]
• [Diarrhea, tachycardia, impotence. When the nerves fail in diabetic patients]
• [Erectile dysfunction--problem solved with sildenafil (Viagra)?]

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Re-education about erectile dysfunction.

• Masculinity and urogenital cancer: sensitive issues in health care.
• Men’s expectations of physicians in sexual health concerns.
• Coverage of erectile dysfunction therapies within the managed care community.
• The role of the Internet in patient-practitioner relationships: findings from a qualitative research study.
• UK department of health guidance on prescribing for impotence following the introduction of sildenafil: potential to contain costs in the average health authority district.

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

Langsenlehner T, Kapp KS, Langsenlehner U.

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TGFB1 single-nucleotide polymorphisms are associated with adverse quality of life in prostate cancer patients treated with radiotherapy. In regard to Peters et al. (Int J Radiat Oncol Biol Phys 2008;70:752-759).

• In regard to Selek et al. erectile dysfunction and radiation dose to penile base structures: a lack of correlation. IJROBP 2004;59:1039-1046.
• The need and prospect of individualized external beam radiotherapy dose escalation beyond 80 gy to treat prostate cancer: in regard to Eade et al. (Int J. Radiat. Oncol. Biol. Phys. 2007;68:682-689).
• Is it time to change the standard of care from CT to MRI for defining the apex of the prostate to accomplish potency-sparing radiotherapy?
• Selling sickness: the pharmaceutical industry and disease mongering.
• Vessel-sparing prostate radiotherapy: dose limitation to critical erectile vascular structures (internal pudendal artery and corpus cavernosum) defined by MRI.

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.

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Risk factors for benign prostatic hyperplasia.

• Do lifestyle changes work for improving erectile dysfunction?
• Lifestyle management of erectile dysfunction: the role of cardiovascular and concomitant risk factors.
• Lower urinary tract symptoms in patients with erectile dysfunction: analysis of risk factors.
• Prevalence and risk factors for erectile dysfunction in Korean men: results of an epidemiological study.
• Differential gene expression of growth factors in young and old rat penile tissues is associated with erectile dysfunction.

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.

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Circulating endothelial progenitor cells in patients with Eisenmenger syndrome and idiopathic pulmonary arterial hypertension.

• Circulating endothelial progenitor cells in subjects with erectile dysfunction.
• Circulating endothelial progenitor cells correlate with erectile function in patients with coronary heart disease.
• Relationship between vascular damage degrees and endothelial progenitor cells in patients with erectile dysfunction: effect of vardenafil administration and PDE5 expression in the bone marrow.
• Endothelial microparticles correlate with erectile dysfunction in diabetic men.
• Circulating endothelial progenitor cells and endothelial function after chronic Tadalafil treatment in subjects with erectile dysfunction.

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.

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An open-label pilot study to evaluate the efficacy of sildenafil citrate in middle-aged men with late-onset dysthymia.

• Treatment of erectile dysfunction in men with depressive symptoms: results of a placebo-controlled trial with sildenafil citrate.
• Efficacy and safety of fixed-dose oral sildenafil in the treatment of sexual dysfunction in depressed patients with idiopathic Parkinson’s disease.
• Use of sildenafil for safe improvement of erectile function and quality of life in men with New York Heart Association classes II and III congestive heart failure: a prospective, placebo-controlled, double-blind crossover trial.
• Depressive symptomatology and male sexual functions in late life.
• An open-label series using loratadine for the treatment of sexual dysfunction associated with selective serotonin reuptake inhibitors.