Introduction The high incidence of erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) in aging men and the same pathophysiology make probable to treat both disorders with the same treatment. Numerous authors evaluated the actions of PDE5i in improving the LUTS/(benign prostate hyperplasia) BPH. Aim To assess the efficacy and safety of tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus tadalafil 20 mg/day in patients with LUTS in a crossover design study. Main Outcomes Measures International Prostate Symptoms Score (IPSS), IPSS Quality of Life (IPSS-QOL), maximum flow rate (Qmax), post-void residual volume (PVR), International Index of Erectile Function-Erectile Function Domain (IIEF-EF), Global Assessment Quality (GAQ). For the statistical analysis, a Tukey-Kramer multicomparison test was used. Methods A randomized, double-blind, crossover study was conducted from September 2007 to February 2008 in one center. Thirty men, older than 50 years old, with a history of LUTS/BPH of at least 6 months, were randomized into two groups to receive tamsulosin 0.4 mg/day vs. tamsulosin 0.4 mg/day plus tadalafil 20 mg/day for 45 days, and then switched to the other treatment mode for other 45 days. Results Twenty-seven patients completed the study. Improvements of IPSS score and IPSS-QOL were significant with both treatments but greater with the drug combination. Both regimens similarly improved the Qmax and decreased the PVR volume from baseline (P < 0.001) with no significant differences between tamsulosin alone vs. tamsulosin and tadalafil (P > 0.05). The IIEF improved with tamsulosin plus tadalafil (P < 0.001) but not with tamsulosin alone (P > 0.05). The GAQ showed that all patients preferred the combination scheme. Both treatments were well tolerated. Conclusion Tamsulosin 0.4 mg/day plus tadalafil 20 mg/day was more effective than tamsulosin 0.4 mg/day alone to improve LUTS and erectile dysfunction and was also well tolerated. Large-scale, randomized, placebo-controlled studies are needed to further assess the long-term safety and effectiveness of these agents in treating LUTS/BPH with or without ED.

Introduction In recent years, PDE5 inhibitors (PDE5i) use has become more popular among men without ED to enhance sexual performance. However, reports in the literature are scarce. Aim The aim of this study was to evaluate the recreational use of PDE5i in healthy young men. Main Outcome Measures We evaluated the recreational use of PDE5i among young and healthy men, their main reasons for use, how they were obtained these drugs, and the combination with alcohol or other drugs. Methods Descriptive, transversal study consisting in 400 brief surveys with structured multiple choice and open questions. Nonprobability samples (quota samples) included young men between 18 and 30 years of age in a public area (high schools, universities, and gyms) between August and November 2009. Collecting the questionnaires in a sealed box enforced confidentiality. The survey included demographic and sexual health data and PDE5i use characteristics. For statistical analysis we used Fisher’s exact and Mann–Whitney tests. Results A total of 321 questionnaires were appropriate for the purposes of evaluation. Mean age and standard deviation were 25.1 ± 3,3 years old. Regarding PDE5i use, 69 men (21.5%) mentioned trying the pill (being sildenafil the most commonly used one) at least one time in their lives and 37 (53.4%) men combined it with alcohol or drugs. Referred sources of acquisition PDE5i were 75.4% (N = 52) from a friend, 17.4% (N = 15) from a pharmacy/drugstore without a medical prescription, 4.3% (N = 3) prescribed by a physician and 2.9% (N = 2) through Internet. There were several reasons for taking PDE5i related to sexual confidence, erection quality, and better sexual performance. Conclusion According to our results, 21.5% of healthy men between 18 and 30 years old used PDE5i as a recreational drug, mostly associated with alcohol or other drugs without medical control. This could have led to misuse and a public health problem. Further studies are needed to evaluate not only PDE5i recreational use prevalence, but also psychosocial determinants, long term safety, misuse, and abuse related to it.

IntroductionLow-intensity shockwave therapy (LISWT) has recently emerged as a promising method in the treatment of erectile dysfunction (ED).AimTo assess the long-term results of the effectiveness and safety of LISWT in patients with ED who are non-responders to phosphodiesterase type 5 inhibitor (PDE5i) treatment.MethodsThis open-label, longitudinal, and observational study investigated an uncontrolled population of 50 consecutive patients whose ED was unresponsive to PDE5i treatment. Patients were treated with a four-session LISWT protocol. During active treatment and follow-up, all patients remained on their regular high on-demand or once-daily PDE5i dosing schedules.Main Outcome MeasuresEffectiveness was assessed according to the International Index of Erectile Function erectile function domain, questions 2 and 3 of the Sexual Encounter Profile, Erection Hardness Scale, and Global Assessment Question scores at baseline and at 3, 6, 9, and 12 months after treatment. Patients were considered responders whenever they showed improvement in erection parameters in all four assessments and responded positively to the Global Assessment Question. Adverse events were recorded. Statistical variables were applied and findings were considered statistically significant at a P value less than < .05.ResultsEighty percent (mean age = 64.8 years) completed the 12-month follow-up. Positive response rates were 60% of available subjects at the end of the study and 48% of the intent-to-treat population. After the 12-month follow-up, 91.7% of responders maintained their responses. No patient reported treatment-related adverse events.ConclusionLISWT in patients with ED unresponsive to PDE5i treatment was effective and safe in 60% of patients treated. The efficacy response was maintained for 12 months in most patients.

Introduction Female sexual dysfunction and its therapeutic approach is a growing area. Aim We aimed to assess the subjective and objective changes of the female sexual response, in patients with orgasmic sexual dysfunction using 3 mg SL Apomorphine (APO). Methods Twenty-four patients (mean age 32 years old, SD: 9.69) were included in a prospective randomized cross-over protocol. Sexual response was evaluated objectively (duplex ultrasound) and subjectively (self-reported questionnaire) following vibrator stimuli with the addition of 3 mg SL APO or placebo. Main Outcome Measure Sexual response objective (PSV, EDV, RI) and subjective (arousal and lubrication degree and orgasm achievement). Adverse events were also recorded. Results Clitoral hemodynamical changes, particularly peak systolic velocity (PSV), were significantly higher with APO (P = 0.003), mean increase of PSV poststimulus was 72.50% with placebo (from 9.7 cm/second to 17.0 cm/second) and 139.14% with APO (from 9.7 cm/second to 21.4 cm/second). Subjective changes (arousal and lubrication) were also significative with APO (P &lt; 0.05). Conclusion According to our observations, APO seemed to produce more subjective and objective changes in the sexual arousal phase of women with orgasmic sexual dysfunction than placebo. Future research is needed to evaluate the place of this drug in the treatment of the female sexual dysfunction.

Introduction Peyronie’s disease (PD) is a localized fibrosis that affects the tunica albuginea of the penis. Its origin can be associated with coital penile trauma in men with autoimmune hypersensitivity and a presumed genetic predisposition. Aim To identify clinical and traumatic risk factors in a patient population with PD, when compared to a control group. Methods From November 2007 to March 2010, 317 patients sought medical attention for PD. As control group, 147 consecutive patients, who came for a prostate exam, were studied. Clinical, traumatic, and sexual history of these patients was gathered. Risks factors were considered only if they had been present before the onset of PD symptoms. Main Outcome Measure The International Index of Erectile Function and the International Prostate Symptoms Score. A univariate logistic regression model (chi-square) (odds ratios [ORs] and 95% confidence intervals [CI] ) was used to estimate the association of risk factors with PD; and the Student’s t-test was implemented for age. Results The mean age of patients with PD and control group was 56.7 and 58.8, respectively (P &lt; 0.923). The mean evolution time of the disease was 17.7 months (2–48). Erectile dysfunction (ED) and coital trauma constituted the only two independent risk factors for PD compared to the control group (P &lt; 0.05 and 0.002, respectively) with an OR of 1.5 (95% CI 1.0–2.3) and 2.69 (95% CI 1.41–5.21), respectively. Patients with ED and diabetes mellitus and with a mild-to-moderate ED also presented a higher predisposition (P = 0.008 and 0.00001), with an OR of 3.64 (95% CI 1.33–10.79) and 5.58 (95% CI 3.03–10.42), respectively. Conclusion Erectile dysfunction and coital trauma have proven to be independent risk factors for the development of PD.