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Effect of sildenafil on erectile dysfunction in spinal Cord injured patients
B.K Manou, P.N Van Tam, M.B Sesay, P.A Joseph, D.A Alloh, J Bombo, J Kouakou, B.M Nandjui
Ghana Medical Journal , 2009,
Abstract: Background: Erectile dysfunction is a preoccupying issue, just like motor and bladder disability, in spinal cord injured (SCI) patients. This is particularly so because of the increasing prevalence of paraplegic and tetraplegic subjects and the fact that these patients are younger, and sexually active. Objective: To determine the effects of Sildenafil (Viagra ) on erectile dysfunction in SCI patients. Methods: After medical ethics committee approval and informed patient consent, we conducted a prospective inquiry between January and March 2007 in 16 SCI patients who were under Sildenafil treatment for erectile dysfunction. An abridged version of the International Index of Erectile Function (IIEF-5) questionnaire was completed the patients. Results: The mean age (range) of the patients was 32.75 yrs (21-53 yrs). The mean duration of their disability was 47.75 months (4 yr). Trauma was the etiology in 87.5% of the cases (44% were road accidents). 12/16 patients were paraplegics (10 above T10) and 4 were tetraplegics (1 above C4 and 3 below C5). The mean duration of sildenafil treatment was 18.75 months (17 days-7 yr). 70% of the patients were satisfied with their erection after treatment. However, 10/16 patients had concomitant treatment with alprostadil. Conclusion: Sildenafil is a vasoactive drug which can be used as a simple, discrete and effective treatment for erectile dysfunction in SCI patients. This approach is compatible with the efforts to improve the quality of life and rehabilitation of these patients.
Evaluation of Erectile Dysfunction in Spinal Cord Injured Patients  [cached]
Berrin Gündüz,Salih Baran,Belgin Erhan,Ay?e Nur Bardak
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2010,
Abstract: Objective: Spinal cord injuries affect sexual function and cause problems in erection, ejaculation, orgasm and fertility; erectile dysfunction is the most important one. The aim of this study is to evaluate the erectile dysfunction seen after spinal cord injury.Materials and Method: Sixty male patients with spinal cord injury, 20 above the level of T10, 20 between T11 and L2, 20 with conus/cauda equina lesions were included in this study. The patients were evaluated according to the American Spinal Injury Association (ASIA); 2002 standards of neurological examination and classification and they were interviewed by the same doctor for erectile dysfunction and type of erection. Erectile dysfunction was also assessed by the International Index of Erectile Function (IIEF).Results: Erectile dysfunction was observed in 85% of patients. Seventy-three percent of patients was found to have mild-severe erectile dysfunction according to the IIEF. Type of erection was associated with the level of the injury.Conclusion: Spinal cord injury usually affects young men; life expectancy for this group is getting longer, nearly reaching that of the normal population. Sexual and erectile dysfunctions are common among these patients. Better results can be achieved in rehabilitation of this group by paying attention to this problem. Turk J Phys Med Rehab 2010;56:71-4.
Role of clinical neurophysiological tests in evaluation of erectile dysfunction in people with spinal cord disorders  [cached]
Ashraf V,Taly Arun Kumar,Sivaraman Nair K,Rao Shivaji
Neurology India , 2005,
Abstract: BACKGROUND: While erectile dysfunction is frequent among people with disorders of the spinal cord, the role of various clinical neurophysiological tests in assessment is not clear. AIMS: To study the role of clinical neurophysiological investigations in assessing erectile dysfunction among men with spinal cord disorders. SETTING: National Institute of Mental Health and Neurosciences, India. DESIGN: Survey. MATERIALS AND METHODS: Subjects with a score of 21 or less on the International Index of Erectile Function-5 were classified as with erectile dysfunction and with a score of more than 21 as without erectile dysfunction. Clinical neurophysiological studies done were Sympathetic Skin Response from limbs, posterior tibial sensory evoked potential, pudendal sensory potential and bulbocavernous reflex. STATISTICAL ANALYSES: Chi-square test. RESULTS: Among 40 subjects 26 had erectile dysfunction. The frequency of abnormalities in clinical neurophysiological studies were: pudendal sensory evoked potentials - 16, posterior tibial sensory evoked potentials - 26, bulbocavernous reflex - 5, sympathetic skin response from sole - 24 and, sympathetic skin response from palm - 18. Significant associations were noted between erectile dysfunction and abnormal pudendal sensory evoked potentials (P=0.0479), and absent sympathetic skin response from palm (P=0.0279) and sole (P<0.001). There was no correlation between erectile dysfunction and posterior tibial sensory evoked potentials (P=0.133) or bulbocavernous reflex (P=0.418). Sympathetic skin response from sole was most sensitive (80.8%) and had best positive (87.5%) and negative predictive (68.8%) values. The specificity of these three tests was 78.6%. CONCLUSIONS: Sympathetic skin response from the sole of the foot was the most sensitive and specific clinical neurophysiological test for erectile dysfunction in spinal cord disorders.
Stress Affects a Gastrin-Releasing Peptide System in the Spinal Cord That Mediates Sexual Function: Implications for Psychogenic Erectile Dysfunction  [PDF]
Hirotaka Sakamoto, Ken-Ichi Matsuda, Damian G. Zuloaga, Nobuko Nishiura, Keiko Takanami, Cynthia L. Jordan, S. Marc Breedlove, Mitsuhiro Kawata
PLOS ONE , 2009, DOI: 10.1371/journal.pone.0004276
Abstract: Background Many men suffering from stress, including post-traumatic stress disorder (PTSD), report sexual dysfunction, which is traditionally treated via psychological counseling. Recently, we identified a gastrin-releasing peptide (GRP) system in the lumbar spinal cord that is a primary mediator for male reproductive functions. Methodology/Principal Findings To ask whether an acute severe stress could alter the male specific GRP system, we used a single-prolonged stress (SPS), a putative rat model for PTSD in the present study. Exposure of SPS to male rats decreases both the local content and axonal distribution of GRP in the lower lumbar spinal cord and results in an attenuation of penile reflexes in vivo. Remarkably, pharmacological stimulation of GRP receptors restores penile reflexes in SPS-exposed males, and induces spontaneous ejaculation in a dose-dependent manner. Furthermore, although the level of plasma testosterone is normal 7 days after SPS exposure, we found a significant decrease in the expression of androgen receptor protein in this spinal center. Conclusions/Significance We conclude that the spinal GRP system appears to be a stress-vulnerable center for male reproductive functions, which may provide new insight into a clinical target for the treatment of erectile dysfunction triggered by stress and psychiatric disorders.
Management of Sexual Disorders in Spinal Cord Injured Patients
Vafa Rahimi-Movaghar,Alexander R Vaccaro
Acta Medica Iranica , 2012,
Abstract: Spinal cord injured (SCI) patients have sexual disorders including erectile dysfunction (ED), impotence, priapism, ejaculatory dysfunction and infertility. Treatments for erectile dysfunction include four steps. Step 1 involves smoking cessation, weight loss, and increasing physical activity. Step 2 is phosphodiesterase type 5 inhibitors (PDE5I) such as Sildenafil (Viagra), intracavernous injections of Papaverine or prostaglandins, and vacuum constriction devices. Step 3 is a penile prosthesis, and Step 4 is sacral neuromodulation (SNM). Priapism can be resolved spontaneously if there is no ischemia found on blood gas measurement or by Phenylephrine. For anejaculatory dysfunction, massage, vibrator, electrical stimulation and direct surgical biopsy can be used to obtain sperm which can then be used for intra-uterine or in-vitro fertilization. Infertility treatment in male SCI patients involves a combination of the above treatments for erectile and anejaculatory dysfunctions. The basic approach to and management of sexual dysfunction in female SCI patients are similar as for men but do not require treatment for erectile or ejaculatory problems.
Effect of sildenafil in cavernous arteries of patients with erectile dysfunction
Claro, Joaquim A;Ximenes, Sérgio F;Nardozza Jr, Archimedes;Andrade, Enrico;Messina, Leonardo;Srougi, Miguel;
International braz j urol , 2003, DOI: 10.1590/S1677-55382003000400006
Abstract: introduction: sildenafil citrate is a type 5 phosphodiesterase inhibitor, which has demonstrated excellent results in the treatment of erectile dysfunction. the effect of sildenafil citrate in the cavernous arteries of patients with erectile dysfunction has not been established yet. the objective of this study was to assess the effect of sildenafil citrate in the cavernous arteries of patients with erectile dysfunction, following an intracavernous injection of alprostadil. materials and methods: 29 male patients, with mean age of 53.8 years (32 to 75 years), were prospectively evaluated. the mean time with complaint of erectile dysfunction was 50.5 months (6 to 168 months). each patient was his own control. patients underwent a measurement of peak systolic velocity before and after use of sildenafil citrate associated with 5 micrograms of alprostadil, through ultrasonic velocitometry knoll/midus? system. in the interval between measurements, approximately 15 days, patients used 3 tablets of sildenafil at home with their partners. results: using only 5 mcg of alprostadil, average peak systolic velocity was 23.9 cm/s, and when associated to 50 mg of sildenafil it was 24.8 cm/s. despite the increase in the flow rate caused by sildenafil, the difference was not statistically significant, zcalculated = - 0.695 ns (wilcoxon test). twenty one of the 29 patients (72.4%) showed global improvement in sexual performance with the use of sildenafil citrate at home. there was not a statistically significant correlation between the global response to sildenafil citrate and the increase in the peak systolic velocity. conclusion: we concluded that, even though the use of 50 mg of sildenafil citrate associated with 5 mcg of alprostadil provides an increase in the peak systolic velocity of the cavernous arteries, there was no statistic difference in relation to alprostadil alone. there was no correlation between the global response to sildenafil and the increase in the peak systolic v
Effect of sildenafil in cavernous arteries of patients with erectile dysfunction  [cached]
Claro Joaquim A,Ximenes Sérgio F,Nardozza Jr Archimedes,Andrade Enrico
International braz j urol , 2003,
Abstract: INTRODUCTION: Sildenafil citrate is a type 5 phosphodiesterase inhibitor, which has demonstrated excellent results in the treatment of erectile dysfunction. The effect of sildenafil citrate in the cavernous arteries of patients with erectile dysfunction has not been established yet. The objective of this study was to assess the effect of sildenafil citrate in the cavernous arteries of patients with erectile dysfunction, following an intracavernous injection of alprostadil. MATERIALS AND METHODS: 29 male patients, with mean age of 53.8 years (32 to 75 years), were prospectively evaluated. The mean time with complaint of erectile dysfunction was 50.5 months (6 to 168 months). Each patient was his own control. Patients underwent a measurement of peak systolic velocity before and after use of sildenafil citrate associated with 5 micrograms of alprostadil, through ultrasonic velocitometry Knoll/MIDUS system. In the interval between measurements, approximately 15 days, patients used 3 tablets of sildenafil at home with their partners. RESULTS: Using only 5 mcg of alprostadil, average peak systolic velocity was 23.9 cm/s, and when associated to 50 mg of sildenafil it was 24.8 cm/s. Despite the increase in the flow rate caused by sildenafil, the difference was not statistically significant, Zcalculated = - 0.695 NS (Wilcoxon test). Twenty one of the 29 patients (72.4%) showed global improvement in sexual performance with the use of sildenafil citrate at home. There was not a statistically significant correlation between the global response to sildenafil citrate and the increase in the peak systolic velocity. CONCLUSION: We concluded that, even though the use of 50 mg of sildenafil citrate associated with 5 mcg of alprostadil provides an increase in the peak systolic velocity of the cavernous arteries, there was no statistic difference in relation to alprostadil alone. There was no correlation between the global response to sildenafil and the increase in the peak systolic velocity
Erectile Function and Fertility in Patients With Spinal Cord Injury  [cached]
?etin DEM?RDA?,Bülent ALICI
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2012,
Abstract: Spinal cord injury (SCI) is predominantly seen in young men with the average patient age of 32 years. Ejaculation and erection disorders are common consequences of SCI, and result in decreased sexual satisfaction. Treatment modalities for erectile dysfunction in patients with SCI are similar to treatments for those without SCI. Some of the most common treatment modalities for the management of erectile dysfunction include penile implants, oral phosphodiesterase type 5 inhibitors, vacuum devices, intraurethral prostaglandins and intracavernous injections. Reproductive dysfunction in men with SCI is the result of combination of erectile dysfunction, ejaculatory failure, and abnormal semen parameters. The first line of therapy for infertility in men with SCI is collection of semen. Penile vibratory stimulation and electroejaculation are both effective in the treatment of ejaculatory dysfunction. In selected patients, intravaginal and intrauterine insemination and in patients with extremely low total motile sperm count, In vitro fertilization and intracytoplasmic sperm injection are feasible option for the treatment of infertility. Turk J Phys Med Re-hab 2012;58 Suppl 1: 33-7.
Coronary artery flow reserve in diabetics with erectile dysfunction using sildenafil
Ulrich Dietz, Hans-Peter Tries, Walter Merkle, Cornelia Jaursch-Hancke, Heinz Lambertz
Cardiovascular Diabetology , 2003, DOI: 10.1186/1475-2840-2-8
Abstract: We aimed to evaluate the effects of the phosphodiesterase 5 inhibitor sildenafil on CFR in diabetics with erectile dysfunction.Diabetics seeking diabetes refinement therapy were screened for vascular or neurogenic erectile dysfunction which was confirmed in 43 patients. No ischemic ECG changes were found in any of the ECG stress tests at the 100 W level. Cardiologic examinations raised suspicion of coronary artery disease in 16 patients; coronary angiography confirmed severe coronary artery lesions in 12, who were excluded from further analysis. CFR measurements were not possible in 10 participants. The 21 diabetics eligible for CFR measurements aged 60 years (50–69) had known diabetes for 11 years (3–30) and a BMI of 27 kg/m2 (24–36). CFR of the left anterior descending artery was assessed at baseline and 1 hour after 50 mg sildenafil, using transthoracic Doppler echocardiography.Baseline CFR was at the lower level of the normal range (median 245%, range 210 – 490%). After sildenafil administration, CFR decreased insignificantly (ΔCFR -10%, p = 0.3). Patients with a BMI > 25 kg/m2 and left ventricular hypertrophy exhibited the highest reduction of CFR after sildenafil. No decrease of CFR below 200 % was observed. Systemic blood pressure dropped from 130/80 mmHg to 120/72 mmHg (p < 0.002).Diabetics with erectile dysfunction exhibit a CFR in the lower normal range indicating severe microvascular disturbance. Sildenafil did not alter CFR in those patients. A high prevalence of severe coronary macroangiopathy was identified in asymptomatic diabetic patients screened for contraindications for sildenafil.Diabetic patients have a high prevalence of erectile dysfunction which is mainly caused by disturbance of the microvascular bed [1,2]. This disturbance can be enhanced by hypertension, hyperlipoproteinemia and smoking, which are also risk factors for macroangiopathy [3,4]. Therefore diabetics with erectile dysfunction and the presence of other cardiovascular risk factors
A Multicenter, Randomized, Open-Labeled, Parallel Group Trial of Sildenafil in Alcohol-Associated Erectile Dysfunction: The Impact on Psychosocial Outcomes  [PDF]
Alexander M. Ponizovsky,Lev Averbuch,Ira Radomislensky,Alexander Grinshpoon
International Journal of Environmental Research and Public Health , 2009, DOI: 10.3390/ijerph6092510
Abstract: To examine the effect of sildenafil on erectile dysfunction (ED) and psychosocial outcomes in alcohol-dependent (AD) men, 108 men with these diagnoses were randomly assigned to either take sildenafil (50 mg) as add-on to standard treatment for AD, or the same treatment without sildenafil, for 12 weeks. Only 50 patients in sildenafil group and 51 in control group twice completed the International Index of Erectile Function (IIEF) and a battery of self-report questionnaires. IIEF scores and psychosocial functioning, self-esteem and support from friends improved only for sildenafil-treated patients (P < 0.001). The high effect sizes suggest that the observed benefits are unlikely to be a placebo effect, although their unspecific nature could not be ruled out. In men with ED associated with AD, sildenafil improves both ED and psychosocial outcomes. Further placebo-controlled clinical trial is warranted.
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