Evaluation of a progressive treatment program for erectile dysfunction in patients with diabetes mellitus

Abstract

The aim was to evaluate the effectiveness of a progressive program, starting with simple methods and, when not effective, moving to more complex methods, to treat erectile dysfunction (ED) in patients with diabetes mellitus. A total of 284 diabetic patients with ED entered into a 6-phase program starting with sildenafil citrate (Viagra). Those with contraindications, side effects, or negative response (erection insufficient for vaginal penetration) were switched to the vacuum erection device (VED), and then progressively (for failures) to intracavernous injection (ICI), sildenafil citrate þ ICI, ICI þ VED, and penile prosthesis. Patients were followed for 2 y. Of the 284 patients 276 patients were eligible for sildenafil citrate and 147 (53.3%) responded positively, but 25 (9.1%) patients stopped it soon due to adverse effects. Of 162 patients (129 nonresponders, eight noneligible for the sildenafil and 25 patients who dropped out due to adverse effects), treated with VED, 114 (70.4%) responded well, however, only 19 (11.7%) patients agreed to continue its use. Of the remaining 143 patients (nonresponders, noneligible for the previously mentioned treatments and patients who dropped out due to adverse effects), 103/143 (72%) responded to ICI, 27/40 (67.5%) to sildenafil þ ICI, and 9/13 (69.2%) to ICI þ VED. Four patients received a penile implant. At the 2 y follow-up, 81 of 284 patients who entered the study (28.5%) were still responding to sildenafil, seven (2.5%) to VED, 113 (39.8%) to ICI, 24 (8.5%) to sildenafil þ ICI, two (0.7%) to ICI þ VED; 15 (5.3%) had a penile implant. In all 17 (6%) patients reported spontaneous erections, 11 (3.9%) stopped the treatment due to family reasons and 14 (4.9%) failed the treatment. In conclusion, the progressive treatment program for ED seems to be very effective for diabetic patients, yielded a complete response for short-term and 91.2% rate of success at the end of 2 y follow-up.

Vacuum erection devices to treat erectile dysfunction and early penile rehabilitation following radical prostatectomy

“…In 2005, Israilov et al [38] reported on a study evaluating the effectiveness of a progressive program in ED patients with diabetes. Of those who were nonresponders or not eligible for oral treatment or who dropped out due to adverse effects, 9 of 13 (69.2%) responded to self-injection plus VED.…”

Phosphodiesterase type 5 inhibitor (Levitra): possibility of correction of erectile dysfunction in obese patients

“…Несмотря на то что в лите-ратуре встречаются отдельные публикации, посвя-щенные взаимосвязи ожирения и эректильной дис-функции (ЭД), нам не удалось обнаружить работ, посвященных эффективности лечения больных с эректильной дисфункцией и ожирением. Данные крупномасштабных научных исследований, посвя-щенных роли снижения массы тела в лечении других заболеваний, в частности таких, как сахарный диабет 2 типа, артериальная гипертензия, ишемическая болезнь сердца, дают основание полагать, что кон-троль массы тела и сопутствующих метаболических нарушений способны обеспечить значительное улуч-шение качества эректильной функции и эффектив-ность лечения ЭД [3,4,5,6].…”

Erectile Dysfunction in Diabetes

“…For those men who do not respond to oral PDE-5 inhibitors alone, there is some logic in combining agents (17,38), although direct evidence from randomized controlled trials is still lacking (level 1C evidence). Alternatives include vacuum-constriction devices and intracavernosal injection of vaso-active drugs (both level 1C evidence).…”

“…In the meantime, use of combination therapies in those who are nonresponsive to PDE-5 inhibitors alone appears sensible and may result in improved erections (17,38).…”

“…Many of the studies discussed below have only considered treatments on an individual basis. However, a recent study has confirmed the benefits of using a progressive step-wise treatment program, which may combine a number of the therapies listed below (17).…”