Long‐term treatment of erectile dysfunction with a phosphodiesterase‐5 inhibitor and dose optimization based on nocturnal penile tumescence

Abstract

Study Type -Therapy (RCT) Level of Evidence 1b OBJECTIVETo test the hypothesis that a variable dosage of the oral phosphodiesterase type 5 (PDE5) inhibitor sildenafil (25, 50, 100 mg) or vardenafil (5, 10, 25 mg) determined according to results obtained from nocturnal penile tumescence and rigidity (NPTR, RigiScan), given nightly for 1 year, can improve spontaneous erectile function (EF) in men with mild-to-moderate arteriogenic erectile dysfunction (ED); this regimen was compared with a fixed daily dosage of sildenafil 25 mg or vardenafil 5 mg. PATIENTS AND METHODSIn a prospective open-label, parallel-group trial 154 men with ED were randomized either to fixed low-dose sildenafil 25 mg or vardenafil 5 mg (group 1) or to the lowest erectile dosage of sildenafil (25, 50 or 100 mg) or vardenafil (5, 10 or 20 mg) (group 2) provoking an erectile event as measured by NPTR nightly for 1 year. The EF domain of the International Index of Erectile Function (IIEF) was assessed before and 1 year after the beginning of treatment, and at 4 weeks after ending treatment. RESULTSAfter 1 year, 27 of 63 (64%) evaluable men in group 1 had an EF domain score in the normal range, vs 46 of 61 (75%) men in group 2. After the subsequent 4-week wash-out phase, both groups continued to have improved EF domain scores; 22 of 63 (35%) men in group 1 still had a score in the normal range, whereas 38 of 61 (62%) in group 2 had a normal score. The EF domain score in group 1 and 2 improved significantly after 1 year of treatment, from 13.6 to 18.9, and 15.1 to 23.9, respectively ( P < 0.01). After the subsequent 4-week wash-out phase, men from both

Toward a new ‘EPOCH’: optimising treatment outcomes with phosphodiesterase type 5 inhibitors for erectile dysfunction

“…In another, smaller trial, treatment with a statin for up to 12 weeks significantly improved EF (increase in EF domain score = 7.8; p = 0.04), and the clinical benefits of statins on EF were observed as early as treatment week 6 (140). Nightly treatment with a PDE5 inhibitor has also been shown to be effective in enhancing EF in patients with arteriogenic ED (141); many patients with inadequate responses to PDE5 inhibitors after prostatectomy have arterial insufficiency (142,143). Certain studies have suggested that enhanced control of cardiovascular risk factors and/or statin treatment may increase the efficacy of PDE5 inhibitors (vs. placebo + PDE5 inhibitors) (144,145).…”

Audiovisual Sexual Stimulation and RigiScan Test for the Diagnosis of Erectile Dysfunction

“…[ 12 14 ] Thereby the method that patients were given with three-dimensional AVSS and phosphodiesterase-5 inhibitor will not just avoid or reduce the defects of the conventional AVSS and but improve the diagnostic performance of AVSS. [ 12 14 15 18 19 20 ]…”

Erectile dysfunction and NO: variations of NO penile blood levels before and after sildenafil treatment

“…12,13,15,23 Abbreviations: Hb, hemoglobin; PP, penile blood before treatment; PS, penile blood after the treatment with sildenafil; SP, systemic blood before treatment; SS, systemic blood after the treatment with sildenafil. The treatment with sildenafil was performed during 6 weeks (50 mg thrice a week).…”

“…[8][9][10] The therapy of erectile dysfunction includes phosphodiesterase inhibitors (PDE-5), such as sildenafil and other compounds. 11 Recent evidence [12][13][14][15] suggests that a long-term treatment with these drugs may improve erectile function by influencing penile and systemic vascular parameters (endothelial rehabilitation), although no molecular mechanisms have been proposed for this action.…”