CP/CPPS treated with saw palmetto had no appreciable long-term improvement. In contrast, patients treated with finasteride had significant and durable improvement in all various parameters except voiding. Further studies are warranted to ascertain the mechanism and reproducibility of these effects in a placebo controlled trial.

No abstract

Objective To evaluate the outcome of combined therapy (using intraurethral alprostadil and oral sildena®l) in private and clinic patients with erectile dysfunction, and thus assess predictors of satisfaction. Patients and methods In all, 360 men were treated for erectile dysfunction using single and/or combined therapy, comprising 214 private-practice and 166 clinic patients. Responses were evaluated using the International Index for Erectile Function (IIEF) questionnaire before and after treatment. Serum testosterone levels, education and socio-economic status were also assessed. Group 1a consisted of 33 private patients and Group 1b of 24 clinic patients who tried the maximum dose of intraurethral alprostadil monotherapy initially, followed by the maximum dose of sildena®l monotherapy, and remained dissatis®ed. Group 2a consisted of 32 private patients and group 2b of 31 clinic patients who tried the maximum dose of sildena®l monotherapy initially, followed by the maximum dose of alprostadil monotherapy, and were also dissatis®ed. These two groups of 65 private and 55 clinic patients then underwent combined therapy. Results The mean (SD) score for erectile function was 24.1 (2) for combined therapy (a 123% improvement), and 19.8 (1.8) (83% improvement) and 15.2 (1.6) (41% improvement) for sildena®l and alprostadil monotherapies (P<0.05 for both patient groups). The men also reported an improvement in their satisfaction with intercourse. However, at 18 months, 60 of the 65 private patients but only 40 of the 55 clinic patients continued with combined therapy; thus, the discontinuation rate was three times greater among clinic than among private patients. Furthermore, the private patients had an overall improvement in the satisfaction score of 128%, compared with 51% for the clinic patients. Conclusion Although there were no signi®cant differences in erectile function improvement within the two satis®ed combined therapy groups, the differences in overall satisfaction and long-term withdrawal rates suggests that other factors beside motivation must be involved for success, e.g. education, persistence, realistic expectations, and certain psychological factors. Combined therapy should be considered for those patients who have a suboptimal response to monotherapy and refuse or are not candidates for surgical options. Generally, those patients with a higher education, greater persistence and more realistic expectations were more satis®ed with combined therapy.