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Speciality Spotlight
Erectile
Dysfunction
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Goldstein, for the Sildenafil Study Group [Broston Univ; et al]
Oral Sildenafil in the Treatment of Erectile Dysfunction
N Engl J Med 338: 1397-1404, 1998
Introduction – Sildenafil [Vaigra],a selective and potent inhibitor of cyclic guanosine monophosphate in the corpus cavernosum, restores the natural erectile response to sexual stimulation in men with erectile dysfunction. The oral therapy offers advantages over previously available treatments that required injections, prostheses, or surgery. Two sequential studies evaluated the efficacy and safety of sidenafil in men with erectile dysfunction of organic, psychogenic, or mixed causes.
Methods – 2 studies were conducted, a study of dose response and a dose escalation study. In a study of dose response, efficacy, and safety ,532 men were randomly assigned to receive 25, 50 or 100 mg of sildenafil or placebo for 24 weeks. Tablets were to be taken approximately 1 hour before sexual activity. The 12 week dose -escalation study included 329 different men, randomly assigned to receive placebo or 50 mg of sildenafil 1 hour before activity. Participants were able to double or reduce the dose by 50% according to therapeutic response and adverse effects. The men were questioned about their frequency of penetration and maintenance of erections after penetration.
Results – The dose response study showed an association between improved erectile function and increasing doses of oral sildenafil. Regarding achievement of erections, men who received 100 mg of the drug increased their mean score by 100% [to 4.0 after treatment vs. 2.0 at baseline, from a possible score of 5.0].
In the dose-escalation study, 69% of attempts at sexual intercourse during the last 4 weeks of the study were successful in the sildenafil group. The success rate in the placebo group at this time was only 22%.
The mean number of successful attempts at sexual intercourse was 5.9 per month in the sildenafil group vs. 1.5 per month in the placebo group.
10% of men in the sildenafil group and 17% in the placebo group stopped treatment because of adverse effects; corresponding figures for the dose-escalation study were 6% and 8%.
The most common adverse effects, reported by 6% to 18% of men, were headache, flushing and dyspepsia.
Discussion – Sildenafil improved sexual function in men with erectile dysfunction, causing erection in response to sexual stimulation. The therapeutic response to the drug was similar in men with various causes of erectile dysfunction. Increasing doses, from 25 to 100 mg, improved the frequency of penetration. Sildenafil is simple to use and is generally well tolerated.
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Lue TF, EI-Sakka Al [Univ of California, San Francisco]
Venous Patch Graft for Peyronie’s Disease: Part I: Technique
J Urol 160: 2047-2049, 1998
A circumcision incision is made for dorsal curvature, the deep dorsal vein is resected.
For ventral curvature, the corpus spongiosum is dissected off of the cavernosa.
An H-shaped relaxation incision is made, transverse for curvature and longitudinal for hour-glass deformity. The defect is measured on a stretched penis to determine graft size.
The graft is harvested from the saphenous vein and sutured to the defect, endothelial side down.
Saline is injected to evaluate the deformity.
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El-Sakka Al, Rashwan HM, Lue TF [Univ of California, san Francisco]
Venous Patch Graft for Peyronie’s Disease: Part II, Outcome Analysis
J Urol 160: 2050-2053, 1998
Results : This report presented details of treatment of Peyronie’s disease with the tunical incision and venous graft patch technique described in the last abstract.
After venous grafting 96% of patients had a straight penis and in 83% the length was not reduced. Of the patients who were potent preoperatively 88% remained potent postoperatively.
Postoperatively 6-8 months later 90% expressed satisfaction over the results.
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Smith CP, Kraus SR, Boone TB [Baylor College of Medicine, Houston]
Management of Impending Penile Prosthesis Erosion With a Polytetrafluoroethylene Distal Wind Sock Graft
J Urol 160: 2037-2040, 1998
Distal erosion of penile prostheses requires prosthetic removal, with scarring that often prevents re-implantation.
The corpus is entered ventrolaterally through a transverse penoscrotal incision and the prosthesis removed. A 14 mm PTFE tube graft is tailored to fit the tip of the prosthesis. The prosthesis is pulled into the distal windsock and the assembly passed into the corpora.
Conclusion : Impending penile prosthetic erosion can be managed safely and effectively with PTFE distal wind sock grafting.
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M.A. Khan, C.S. Thompson, J.Y. Jeremy, F.H. Mumtaz, P. Mikhailidis and R.J. Morgan, Department of Urology, Molecular Pathology and Clinical Biochemistry. Royal free and university College Medical School [ University College London], Royal Free Campus. The Royal Free Hampstead NHS Trust, and Department of Cardiac Surgery, Bristol Royal Infirmary, Bristol, UK]
The Effect of Superoxide Dismutase on Nitric Oxide- Mediated and Electrical Field-Stimulated Diabetic Rabbit Cavernosal Smooth Muscle Relaxation
BJU International, volume 87, Number 1, January 2001, Pg.Nos. 98-103
Conclusion : nitrous oxide and electrical field stimulated- mediated cavernosal smooth muscle relaxation is impaired in a rabbit model of diabetes but SOD significantly reversed the impaired relaxation. Therefore, in diabetes, the generation of reactive oxygen species may play an important role in the development of erectile dysfunction.
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M. Brake, H. Loertzer, R. Horsch and H. Keller (Division of Urology and Paediatric Urology, Klinikum Offenburg, Offenburg, Germany)
Treatment of Peyronie’s Disease with Local Interferon-a 2b
BJU Intl. May 2001 Vol. 87 (7) Pg. 654-657
Conclusion : Subcutaneous interferon-a 2b is safe, well tolerated and relieves pain.
However, with no objective reduction in penile deviation and plaque size, the outcome of interferon-a 2b therapy is generally unconvincing and the drug cannot be recommended for the conservative treatment of Peyronie’s disease.
