Is Sildenafil Citrate an Alternative Agent in the Evaluation of Penile Vascular System with Color Doppler Ultrasound?

Abstract

Introduction: The ideal diagnosis and therapeutic agent for erectile dysfunction (ED) would be an oral drug taken prior to color Doppler ultrasound (CDU) examination and sexual intercourse. In the present study we have investigated if the efficacy of oral sildenafil is optimal in the diagnosis of underlying pathology of ED. Material and Methods: The study group comprised of 41 patients with ED. Firstly, all patients underwent CDU examinations after the combined intracavernosal injection of 60 mg of papaverine and sexual stimulation (CIS). Secondly, these patients were examined after taking 50 mg of oral sildenafil citrate combined with self-manual and visual sexual stimulation. Results: The differences of peak systolic velocity values were statistically significant between CIS and sildenafil (right: 40.7 ± 2.9 vs. 28.7 ± 3.3; left: 41.2 ± 3.3 vs. 25.7 ± 2.4; p < 0.001) in patients with normal penile vascular system. However, end-diastolic velocity and resistance index values were not significant between the same groups. In addition, there were not significant differences for peak systolic and end-diastolic blood flow velocities and resistances index with CIS and sildenafil in cases with vasculogenic ED. Conclusions: Sildenafil citrate plus visual sexual stimulation is not reliable as CIS to make accurate interpretation of penile vascular status using CDU. On the other hand, in some cases suspected of psychogenic ED after detailed sexual history, sildenafil might be tried as an initial step of the functional evaluation with CDU in order to prevent prolonged erection risk with intracavernosal injection of vasoactive agents.

Pharmaco-induced erections for penile color-duplex ultrasound: oral PDE5 inhibitors or intracavernosal injection?

“…However, there were also studies that showed different opinions. The study by Erdogru et al 11 indicated that sildenafil citrate plus visual sexual stimulation was not as reliable as ICI and genital sexual stimulation for creating an accurate interpretation of penile vascular status using CDU. Copel et al 9 also found more patients responded to ICI of the combination of three drugs (papaverine, prostaglandin E1 and phentolamine) than to sildenafil, and the clinical response was significantly better.…”

“…However, the results remain controversial. 9,10 Moreover, studies have focused on sildenafil 11 and vardenafil. 12 Therefore, the purpose of our study was to prospectively evaluate and compare the clinical responses and PCDU results of oral administration of sildenafil (100 mg) and tadalafil (20 mg) with papaverine ICI and to evaluate whether these PDE5-Is could be used as alternatives to vasoactive agent injections.…”

Efficacies of papaverine and sildenafil in the treatment of erectile dysfunction in early-stage paraplegic men

“…Therefore, we evaluated T11-L2 lesions as a different group in our study. In addition, the T6 level or above SCI patients were excluded from our study, because of possible autonomic dysreflexia, autonomic dysregulation, or hypotension [cardiovascular development during the application of methods could make the results of PCDU inaccurate (-) or in the wrong direction (+)] (Diederichs et al, 1991;Erdogru et al, 2002).…”

“…In recent years, the number of studies involving oral sildenafil citrate administration before the PCDU procedure has been on the rise, as the use of oral sildenafil citrate is a noninvasive method with fewer complications than intracavernosal papaverine HCl injection, which is a painful and invasive method (Arslan et al, 2001;Bacar et al, 2001;Erdogru et al, 2002). The effects of sildenafil occur only with the release of nitric oxide caused by various sexual stimulations.…”

Wie wirksam sind die PDE-5-Hemmstoffe?

“…man auf subjektive Angabe der Patienten angewiesen.Eine objektive Wirksamkeitsbeurteilung beim individuellen Patienten durch visuelle sexuelle Stimulation nach Einnahme einer Testdosis, wie sie beispielsweise von einer türkischen Arbeitsgruppen vorgeschlagen wurde [5], ist in der urologischen Praxis in Deutschland nicht umsetzbar, auch wenn die Untersu- Der Unterbereich Erektionsfähigkeit des IIEF umfasst 6 Fragen: ob Erektionen überhaupt möglich waren,die Erektionshärte, ob Penetration möglich war, ob Erektion nach Penetration aufrecht erhalten werden konnte, wie schwierig es war, Erektionen aufrecht zu erhalten, und die Zuversicht, eine Erektion zu bekommen. Es können 1-30 Punkte erreicht werden; eine höhere Punktzahl entspricht einer besseren Erektionsfähigkeit.…”