Efficacy and safety of oral sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury

Derry, F.; Dinsmore, W W; Fraser, Matthew; Gardner, Brett O.; Glass, Clive; Maytom, M. C.; Smith, M. D.

doi:10.1212/wnl.51.6.1629

Cited by 137 publications

(92 citation statements)

References 3 publications

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“…1,2 Either or both psychogenic (nonsomesthetic supraspinally elicited) and reflexive (somesthetic spinally elicited) erections, confirmed by urodynamic and electrophysiologic findings, are necessary for response to sildenafil therapy. 3 In addition, sildenafil due to the positive effect on the quality of a partnership showed long-term compliance compared to invasive treatment such as intracavernosal injection of alprostadil.…”

Section: Introductionmentioning

confidence: 99%

Time/duration effectiveness of sildenafil versus tadalafil in the treatment of erectile dysfunction in male spinal cord-injured patients

Popolo¹,

Marzi²,

Mondaini³

et al. 2004

Spinal Cord

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Section: Introductionmentioning

confidence: 99%

Time/duration effectiveness of sildenafil versus tadalafil in the treatment of erectile dysfunction in male spinal cord-injured patients

Popolo¹,

Marzi²,

Mondaini³

et al. 2004

Spinal Cord

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“…2,[6][7][8]15,16 Such was the case that the monitoring of blood pressure and other side effects was performed in a setting lacking sexual stimuli. Neither the time or the site of the study were suitable for reliable assessments of efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…2,[6][7][8][13][14][15][16] In all these studies, sildenafil was reported to have notable efficacy for obtaining and maintaining an erection in patients with SCI. However, in many of these studies, 2,6,7 patients with neurological levels of SCI above T5 were systematically excluded due to the potential risk of autonomic dysreflexia and, especially, of hypotension. Similarly, many of the studies excluded individuals with hypotension (systolic/diastolic blood pressure o90/50 mmHg, respectively).…”

Section: Introductionmentioning

confidence: 98%

“…It has been used and its efficacy and good tolerance have been demonstrated in patients affected by ED of nearly all etiologies, [3][4][5] including patients with SCI. [6][7][8] Relaxation of smooth muscle in the corpus cavernosum is a prerequisite for normal erectile function. 9 Nitric oxide plays a key role as a mediator of smooth muscle relaxation in the corpus cavernosum and penile erection in response to sexual stimulation through a mechanism of induction of cyclic guanosine monophosphate (cGMP).…”

Section: Introductionmentioning

confidence: 99%

“…Similarly, many of the studies excluded individuals with hypotension (systolic/diastolic blood pressure o90/50 mmHg, respectively). 2,6,7,15 The hypotensive tendency of patients with SCI is widely known, which is more intense the higher the neurologic level affected and the greater the persisting muscular flaccidity. 17,18 This circumstance imposes certain restrictions on the use of sildenafil in SCI patients with cervical and high thoracic neurologic levels.…”

Section: Introductionmentioning

confidence: 99%

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Determination of changes in blood pressure during administration of sildenafil (Viagra®) in patients with spinal cord injury and erectile dysfunction

et al. 2005

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Study design:Prospective, open-label, comparative study, to assess the effects of sildenafil on blood pressure in a population of patients with spinal cord injury (SCI). Objectives: To determine the effect of sildenafil on blood pressure in patients with erectile dysfunction secondary to SCI by comparing changes in blood pressure in SCI patients with a neurologic level below T5 versus higher levels. To establish a relationship between the potential hypotensive effect and protective muscle spasm against blood pressure reduction. To assess the effects of age, complexity and duration of SCI on changes in blood pressure. To record any adverse effects occurring during the study. Setting: Spinal Cord Injury Unit, Insular University Hospital of Gran Canaria, Canary Islands, Spain. Subjects: In total, 22 male SCI patients aged 18 years or older with a history of SCI greater than 3 months in duration. Methods: Patients with erectile dysfunction secondary to SCI were induded in the study, without excluding patients with a neurologic level above 75 or asymptomatic low blood pressure. Patients with specific contraindications for use of the drug were excluded. A personal history was obtained, and the level of injury (ASIA/IMSOP scales of international standards), impairment grade (ASIA impairment scale), spasticity grade (modified Ashworth scale) and baseline sitting and supine blood pressure values were determined. A single dose of 50 mg of sildenafil was administered, and patients remained sitting at 451. Blood pressure was monitored every 10 min for 4 h and whenever the patient reported symptoms. Any relevant signs and symptoms manifested during the study period were also recorded. Analysis of the changes in blood pressure values was performed using a paired t-test in each group of patients according to neurologic level and spasticity grade. Results: A decrease in blood pressure was observed in all patients, although patients with a level of injury at T5 or above and those with a complete SCI showed a less intense decrease (Po0.05). The spasticity grade of the patients was protective against the fall in blood pressure, as it was less significant in patients with grade 3 (P40.1) than in those with grade 0. Adverse effects were few and transient. None were related to hypotension. Conclusion: Sildenafil caused a decrease in blood pressure in SCI patients with a neurologic level of injury above T5 and complete injuries (grade A), but did not have clinical implications in the patients studied. A higher spasticity grade tends to protect the patient from the fall in blood pressure. Age and duration of injury do not appear to influence this decrease.

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The Neurobiology of Sexual Function

Meston¹,

Frohlich²

2000

Arch Gen Psychiatry

369

234

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This article provides a review of the past and current literature on the neurobiology of sexual function. The influence of endocrine, neurotransmitter, and central nervous system influences on male and female sexual function are discussed for sexual desire, arousal, and orgasm or ejaculation stages of sexual responding. Endocrine factors reviewed include the following: androgens, estrogens, progesterone, prolactin, oxytocin, cortisol, and pheromones. Neurotransmitters and neuropeptides discussed include nitric oxide, serotonin, dopamine, epinephrine, norepinephrine, opioids, acetylcholine, histamine, and gamma-aminobutyric acid. Central nervous system influences on sexual function are discussed briefly with reference to brainstem regions, the hypothalamus, and the forebrain.

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Efficacy and safety of oral sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury

Abstract: Oral sildenafil, taken as required (not more than once daily), significantly improves the quality of erections and satisfaction with sex life in men with erectile dysfunction caused by a spinal cord injury between T6 and L5.

Cited by 137 publications

References 3 publications

Time/duration effectiveness of sildenafil versus tadalafil in the treatment of erectile dysfunction in male spinal cord-injured patients

Time/duration effectiveness of sildenafil versus tadalafil in the treatment of erectile dysfunction in male spinal cord-injured patients

Determination of changes in blood pressure during administration of sildenafil (Viagra®) in patients with spinal cord injury and erectile dysfunction

The Neurobiology of Sexual Function

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