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AIM: To review special safety topics associated with sildenafil and to document the tolerability of 50- and 100-mg doses, overall and by age, in men with erectile dysfunction (ED). METHODS: Data were collated from 67 double-blind placebo-controlled (DBPC) trials (> 14,000 men) conducted by the manufacturer and from the manufacturer's postmarketing safety database (39,277 patients). The DBPC data were stratified by dose, starting dose and age (> or = 65 and > or = 75 years). Special safety topics included cardiovascular risk, priapism, non-arteritic anterior ischaemic optic neuropathy (NAION), impaired renal and hepatic function, drug interactions (i.e. nitrates, cytochrome P3A4 inhibitors, other ED therapies and alpha-blockers) and incorrect use. RESULTS: Sildenafil was well tolerated at a dose of 50 or 100 mg in men with ED, overall, in those aged > or = 65 years, and in those aged > or = 75 years. Analyses of the databases did not reveal any causal link between sildenafil and cardiovascular events, or any new safety risks relating to cardiovascular events, priapism, NAION, hearing loss or drug interactions. In the small number of men with moderate impairment of renal function or hepatic function who were treated with sildenafil in DBPC trials, the safety profile was similar to that in men with no impairment of renal or hepatic function. Overdose with sildenafil was rare in the ED population. No new safety issues, emerging trends or adverse reactions were identified in conjunction with overdose, dependence, abuse or misuse. CONCLUSION: This collated review confirms generally the good tolerability and established safety profile of sildenafil 50 and 100 mg in men with ED and reveals no new safety issues.
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Disfunción Eréctil/tratamiento farmacológico , Inhibidores de Fosfodiesterasa/efectos adversos , Piperazinas/efectos adversos , Sulfonas/efectos adversos , Anciano , Enfermedades Cardiovasculares/etiología , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Interacciones Farmacológicas , Sobredosis de Droga/etiología , Disfunción Eréctil/mortalidad , Trastornos de la Audición/inducido químicamente , Humanos , Enfermedades Renales/complicaciones , Hepatopatías/complicaciones , Masculino , Persona de Mediana Edad , Inhibidores de Fosfodiesterasa/administración & dosificación , Piperazinas/administración & dosificación , Priapismo/complicaciones , Vigilancia de Productos Comercializados , Purinas/administración & dosificación , Purinas/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Citrato de Sildenafil , Sulfonas/administración & dosificación , Resultado del TratamientoRESUMEN
INTRODUCTION: Benign prostatic hyperplasia (BPH) is characterized by lower urinary tract symptoms (LUTS) that may cause ejaculatory disorders, although they could be also a consequence of alpha-blocker treatment. OBJECTIVES: To determine the prevalence of ejaculatory dysfunction in patients with HBP undergoing alpha-blocker therapy. Secondary objectives were to evaluate the effect of different drugs on normal ejaculation and the relationship of dysfunction degree to prognostic factors and BPH severity. MATERIALS AND METHODS: Epidemiologic, transversal, uncontrolled and open-label study in 1.177 patients older than 40, who had been diagnosed of BPH/LUTS with more than 6 months of evolution and treated with the same alpha-blocker for at least the last 3 months. Severity of ejaculatory dysfunction was determined by the domain on ejaculation of the Male Sexual Health Questionnaire (MSHQ). Results were stratified by age and BPH severity, determined by the International Prostate Symptoms Score (IPSS). RESULTS: The prevalence of ejaculatory dysfunction has been estimated to be 82.6% in patients with BPH/LUTS treated with alpha-blockers. Although usually mild, the dysfunction is considered as bothersome by a high percentage of those who suffer it. Advanced age is the most influential factor in the severity of both ejaculatory abnormalities and prostate symptoms. Moreover, a solid correlation between these two parameters has been established. Finally, among the analyzed alpha-blockers, alfuzosin has been associated with the best sexual function. CONCLUSIONS: More than 80% of patients with BPH suffer ejaculatory abnormalities, which are closely related to the severity of prostate symptoms and increased age. When initiating alpha-blocker treatment, we should consider that alfuzosin is the one with less negative impact on ejaculatory function.
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Antagonistas Adrenérgicos alfa/efectos adversos , Eyaculación , Hiperplasia Prostática/tratamiento farmacológico , Disfunciones Sexuales Fisiológicas/inducido químicamente , Disfunciones Sexuales Fisiológicas/epidemiología , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , PrevalenciaRESUMEN
BACKGROUND: It is necessary to have simple tools to screen erectile dysfunction (ED) in an easy, reliable and valid manner. The objective of this study was to develop and validate a short diagnostic questionnaire for erectile dysfunction [SQUED), easy to use in the primary care setting. SUBJECTS AND METHOD: The development of SQUED included: concepts identification, item generation and evaluation of contents and face validity through interviews with subjects to assess comprehension and idiomatic adequacy. The psychometric validation was conducted in an epidemiologic, observational, comparative and multicenter study. Participants should complete the questionnaire in primary care setting and send to the specialist to confirm the diagnosis by an in depth interview and the application of IIEF questionnaire. Internal consistency, test-retest reliability and sensitivity and specificity of SQUED was evaluated. RESULTS: Out of 405 subjects enrolled, 316 (208 ED and 108 non-ED) were evaluable. The SQUED questionnaire showed a high internal consistency (Cronbach's alpha = 0.92) and a good test-retest reliability (Kappa index = 0.77). Furthermore, the questionnaire showed a good diagnostic capacity with high values of sensitivity and specificity, 0.87 and 0.78, respectively, in relation to the diagnosis made by urologists. The cutting point was established at a score of 12. DISCUSSION: The SQUED questionnaire is a simple, easy to use and reliable instrument. It can become a useful tool, and the shortest validated, for primary care physicians to easily screen for ED patients. Its simplicity should facilitate an easy cultural adaptation and validation into other languages.
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Disfunción Eréctil/diagnóstico , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: [corrected] To compare the efficacy and safety of tadalafil 20 mg administered 3 times/week (SCH) vs. on demand (OD) in a cohort of Spanish men with erectile dysfunction (ED), since Tadalafil period of responsiveness lasts up to 36 hours post-dosing. MATERIAL AND METHODS: The 418 Spanish patients participating in the European multicenter, crossover, open-label SURE clinical trial (comprising 4262 men) were randomly assigned to one of the treatment sequences: tadalafil 20 mg SCH for 5-6 weeks followed by tadalafil 20 mg OD for 5-6 weeks, or the inverse sequence. At completion, patients were asked to select the regimen they preferred to receive in an extension phase. RESULTS: In both regimens, tadalafil led to a similar improvement in erectile function compared to baseline. However, the SCH regimen showed statistically significant higher scores for several IIEF questions (i.e. sexual desire domain). Normal erectile function (IIEF EF domain score > or = 26) was achieved by 69.3% of patients on SCH and 64.3 % on OD, with a sexual intercourse success rate (SEP3) of 75.6% and 72.2% respectively (p<0.05). Nevertheless, more patients preferred to receive tadalafil OD for the extension phase (55.9% vs 44.1%, p<0.05). Tadalafil was well tolerated in both regimens. The most common TEAEs (> or = 5%) were headache, dyspepsia and back pain. There were no clinically significant differences in the incidence of TEAEs between regimens. CONCLUSIONS: Tadalafil 20 mg is efficacious and well tolerated for the treatment of ED, regardless the regimen of administration (OD or SCH). Patients can choose the pattern of administration that fits better with their expectations.
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Carbolinas/administración & dosificación , Disfunción Eréctil/tratamiento farmacológico , Inhibidores de Fosfodiesterasa/administración & dosificación , Adulto , Anciano , Carbolinas/efectos adversos , Estudios Cruzados , Esquema de Medicación , Europa (Continente) , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Fosfodiesterasa/efectos adversos , España , TadalafiloRESUMEN
BACKGROUND AND OBJECTIVE: Erectile dysfunction (ED) is caused by a large range of organic, psychological, psychiatric, interpersonal and pharmacological factors. Numerous scientific publications mention the loss of self-esteem as a collateral effect of ED, with a very probable affectation of the subject's self-confidence. The objective of this study was to evaluate the self-esteem and self-confidence of subjects with ED and to compare them with a group of non-ED subjects. SUBJECTS AND METHOD: An epidemiological, cross-sectional, observational, comparative and multicentric study was conducted. General Practitioners selected 405 men older than 18 years in which they suspected ED. All the participants had to complete the self administered form of the Spanish version of the Rosenberg self-esteem scale and the Spanish culturally adapted version of the Johnson and McCoy self-confidence scale. After that, patients were referred to the urologist in order to confirm the ED diagnosis. RESULTS: The statistical analysis of the data showed that the subjects with ED obtained significantly lower scores in the self-confidence and self-esteem scales than the non-ED subjects (p < 0.01). DISCUSSION: The results of this study show the loss of self-confidence and self-esteem that suffer patients with ED.
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Disfunción Eréctil/psicología , Autoimagen , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
The urologist/andrologist is the specialist responsible for diagnosis and treatment of health problems related to the genitourinary tract, and his or her participation in comprehensive care for a patient with erectile dysfunction (ED) is fundamental and often indispensable. The urologists/andrologists should characterize the origin of ED because of their knowledge and familiarity of all diagnostic tests and second- and third-line therapy. The origin of ED is important to determine for various reasons, such as young people suitable for etiologic treatment, medicolegal reasons, or patients' wishes for a better understanding of their condition. A review of the diagnostic tests available as well as indications for second- and third-line therapy is presented. The close relationship between ED and urological disorders, such as benign prostatic hyperplasia, prostate cancer and their treatments, and renal failure, in association with penile conditions like Peyronie's disease, priapism, and possible androgen deficiency in men older than 50 years, places the urologist at the center of integrated treatment of male ED.
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Disfunción Eréctil/diagnóstico , Disfunción Eréctil/terapia , Actitud del Personal de Salud , Humanos , MasculinoRESUMEN
The aim of this Core Document of the Spanish Consensus on Erectile dysfunction (ED) is to offer guidance to the nonspecialist physician in the management of patients with ED. ED is one of the most frequent chronic health problems in men older than 40 y of age and may also act as a sentinel symptom for other important underlying diseases. Its etiology can be classified into organic, psychogenic, or mixed. In most cases, the underlying cause of ED is usually a chronic health problem (such as diabetes, hypertension, atherosclerosis, and so on) or an adverse drug effect. The initial step in the management is to assess erectile function in patients with risk factors for ED. Once ED has been established, a detailed sexual, medical, and social history, including a review of medications used, is the most important aspect of a patient's assessment. Generally, examination should be limited to the cardiovascular, neurological, and urogenital systems. Fasting glucose and blood lipid profile should be performed in every man with ED, and free testosterone levels in men older than 50 y or if hypogonadism is suspected; other diagnostic tests are optional and should be requested on an individualized basis. In many cases, the most likely cause of ED can be identified based on the above information. Therapeutic intervention should be patient-oriented and based on the expectations and wishes of the patient and his partner, who should be included in discussions whenever possible. Basic interventions common to any type of ED include sexual counseling, lifestyle modifications, treatment of associated medical conditions, and switching to alternative drugs with lower risk of ED. In certain cases, an etiologic treatment may be performed (sex therapy, revascularization surgery, and hormonal therapy). Most patients with ED will benefit from symptomatic treatments; first-line therapy may be prescribed by physicians who are not specialists in ED, and includes oral agents such as inhibitors of phosphodiesterase type 5, currently considered the drugs of choice for initial treatment of ED. Intracavernous drugs are the second-line therapy, and surgical treatments, such as implantation of penile prostheses, are reserved for urologists/andrologists who specialize in ED. Referral may be appropriate where indicated by age, clinical findings, or the patient's request.
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Disfunción Eréctil , Anamnesis , Derivación y Consulta , Disfunción Eréctil/diagnóstico , Disfunción Eréctil/etiología , Disfunción Eréctil/terapia , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Factores de RiesgoRESUMEN
Metastatic lesions of the penis are uncommon, only some 200 cases having been reported in the literature. Priapism is the most frequent symptom, although increased penis size, ulceration and nodes formation have also been described; metastasis happens simultaneously in 20% cases while in 50% of cases they appear 2 years after initial diagnosis. Survival of untreated patients has not exceed 24 weeks, whereas treated patients have survived 47 weeks.
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Neoplasias del Pene/secundario , Anciano , Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Pene/diagnósticoRESUMEN
It is now one year since we started our microsurgical venture. The idea was to round-off the care coverage of our Reproduction Unit since, in June 92, we had launched the FIV-TE program. The Unit Incorporates professionals from different services (urology, gynaecology, laboratory) imbued by the notion that it is not the isolated individual but the couple who, at any particular time, have a fertility problem. Approach to the study is, therefore, done in an integrate and concurrent way to both members of the couple, progressing then to establishment of diagnosis and the outline of a therapeutic alternative. We introduce below the case of a couple which may well be an example of the above statements. The couple refers a 4-year evolution of primary sterility. The 34-year-old male is a long-evolution insulin-dependent diabetic with erectile dysfunction and backward ejaculation. The erectile dysfunction is successfully managed with PGE1 self-injections. In their wish for fertility and after failure of spermatozoa recovery both in urine following orgasm and intravesical Menezo, we attempt MAE (12 million of spermatozoa with motility, after swim-up) + FIC-TE in a FSHp- and HCG-induced cycle, securing the uptake, by ultrasound-guided follicular puncture under local anaesthetics, of 5 mature ovocytes 4 of which were fertilized; the same four undergoing intrauterine transferral with the result of pregnancy, this being the second one to be accomplished in the country and the first one In our Unit, by microaspiration of spermatozoa at the deferent level In a situation of primary sterility by plain male factor.
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Embarazo , Espermatozoides , Adulto , Femenino , Fertilización In Vitro/métodos , Humanos , Infertilidad Masculina/cirugía , Masculino , Microcirugia , Succión , Conducto Deferente/cirugíaRESUMEN
Primary retroperitoneal tumours may arise from different structures as neural, mesodermal, urogenital ridge, or embryonic remnant tissues. Lymphangioma is a rare benign tumour of the lymphatic tissue. They result from a developmental failure of the lymphatic system. Although benign, they can compress and infiltrative vital structures. The size of the lesion is more important than its location to the symptomatology development. Intraabdominal and retroperitoneal lymphangioma are the rarest tumour, specially when occurring in adults. The tumour can occur at any age and most are asymptomatic. Preoperative diagnosis is facilitated by ultrasonography and computed tomography. In order to correctly diagnose of these neoplasms it is essential to carry on ultrasound and CT examination. Treatment of choice is always surgical and a complete extirpation should be performed, unless vital structures were are involved.
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Linfangioma Quístico , Neoplasias Retroperitoneales , Femenino , Humanos , Linfangioma Quístico/diagnóstico , Linfangioma Quístico/diagnóstico por imagen , Linfangioma Quístico/cirugía , Persona de Mediana Edad , Neoplasias Retroperitoneales/diagnóstico , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/cirugía , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Traditional management of vaginal fluid collections has always been surgery. The benignancy of this disease does not correspond with the morbidity caused by the anaesthetic techniques used. Over the last few years, sclerotherapy has become increasingly attractive as an alternative to hydrocelectomy. Indications are, nonetheless, restricted, presenting a relapse rate which varies according to the substance used and the operating team. The study proposes the use of local anaesthetics for the surgery of vaginal fluid collections so as to minimize the immediate postoperative period and thus the hospital stay. Between May and October 1991, 55 patients, 49 with hydrocele (4 bilateral) and 6 with sperm cord cyst, were treated in our Unit. Patients were monitored in the theatre (EKG, blood pressure and oximeter) to supervise their life constants, and 2% Mepivacaine (10-20 cc) was infiltrated into the sperm cord and the area of scrotal wall to be cut. Surgical techniques range from dissection to scission of the bag until partial eversion, requiring the use of reabsorbable suture and a careful haemostasis to avoid drainage. Anaesthetics tolerance has been highly satisfactory in 52 patients (94%), good in one patient (2%) and unsatisfactory in two cases (4%). Recorded complications include: severe bradycardia and hypotension in one case (2%), persistent right renoureteral pain in one case (2%), scrotal haematoma in 5 cases (9%) and suture dehiscence in another patient (2%). It is concluded that surgical management of vaginal collection with local anaesthetics is feasible, and reduces the immediate postoperative period also avoiding morbidity derived from a more aggressive anaesthetic technique.
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Quistes/cirugía , Enfermedades de los Genitales Masculinos/cirugía , Cordón Espermático/cirugía , Hidrocele Testicular/cirugía , Adolescente , Adulto , Anciano , Anestesia Local , Neoplasias de los Genitales Masculinos/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Erectile dysfunction (ED) is a worldwide health problem with an ever increasing prevalence, affecting the quality of life of many patients. OBJECTIVE: The aim of this study was to describe treatment effectiveness and patient satisfaction with ED treatment in the Spanish cohort of the EDOS study. MATERIAL AND METHODS: This observational, pan-European study, assessed treatment effectiveness and patient satisfaction with ED treatment under routine clinical settings, using standard questionnaires. Men > or =18 years about to initiate or change ED treatment were enrolled. Patients were assessed at baseline, 3 and 6 months. RESULTS: A total of 1,029 patients were analyzed (12.8% of the total European sample). In general, the Spanish population characteristics are consistent with the overall population. At baseline 56.6% of patients received tadalafilo, 16.6% sildenafilo, 19.6% vardenafilo, and 7.2% received other treatments. At 3 months, a higher proportion of patients on tadalafil reported improved erections (GAQ 1: 96.5% tadalafil, 85.7% sildenafil and 87.2% vardenafil), satisfaction with treatment (EDITS: 84.2% tadalafil, 75.0% sildenafil and 76.0% vardenafil), and sexual self confidence (SF-PAIRS: 2.73 tadalafil, 2.39 sildenafil and 2.55 vardenafil), in comparison with sildenafil and vardenafil. At 6 months, differences between treatments were not significant. The mean+/-SD time elapsed from drug intake to sexual intercourse was higher for patients on tadalafil (18.6+/-26.4 h) compared to sildenafil (3.6+/-7.5) and vardenafil (8.6+/-19.4). CONCLUSION: The longer duration of action for tadalafil, and thus, the longer period of time between dosing and sexual intercourse may contribute to enhance sexual spontaneity, patient satisfaction with the treatment and greater self-confidence.
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Satisfacción del Paciente , Inhibidores de Fosfodiesterasa/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Disfunción Eréctil , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , España , Adulto JovenRESUMEN
AIM: To assess the incidence of serious cardiovascular disease (CVD) events [i.e. myocardial infarction (MI) and stroke] and all-cause mortality in men with erectile dysfunction (ED) who received prescriptions for sildenafil. METHODS: The International Men's Health Study (IMHS) was a prospective, observational cohort study of patients with ED and a new or existing prescription for sildenafil. Baseline and follow-up questionnaires provided information on demographics, CVD risk factors and ED. Postevent questionnaires were mailed to patients following possible nonfatal CVD events to collect information related to exposure to sildenafil/ED treatments before the event. RESULTS: Thirty-five CVD events were reported in 30 patients in the analysis set (n = 3813). The incidence of all-cause mortality, MI and stroke was 0.4, 0.6 and 0.1 per 100 patient-years of observation respectively. Among the six men who reported using sildenafil in the month before a nonfatal CVD event, two reported use in the 24 h before the event. CONCLUSION: The results of the IMHS support previous reports that ED and CVD are often comorbid and share risk factors.
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Enfermedades Cardiovasculares/inducido químicamente , Disfunción Eréctil/tratamiento farmacológico , Inhibidores de Fosfodiesterasa/efectos adversos , Piperazinas/efectos adversos , Sulfonas/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/mortalidad , Estudios de Cohortes , Disfunción Eréctil/complicaciones , Humanos , Masculino , Salud del Hombre , Persona de Mediana Edad , Estudios Prospectivos , Purinas/efectos adversos , Factores de Riesgo , Citrato de SildenafilRESUMEN
AIMS: This report describes patterns of treatment changes with the phosphodiesterase type 5 (PDE5) inhibitors tadalafil, sildenafil and vardenafil, and variables associated with those treatment changes, during the 6-month, prospective, pan-European Erectile Dysfunction Observational Study (EDOS). METHODS: EDOS observed 8047 men > or = 18 years old with erectile dysfunction (ED), who began or changed ED therapy as part of their routine healthcare. Patients could change ED treatment at any time during EDOS. Data were collected at baseline and at 3 (+/- 1) and 6 (+/- 1) months. Analyses included ED treatment-naïve patients with complete follow-up who were prescribed a PDE5 inhibitor at baseline (n = 4026). RESULTS: Most patients, regardless of what PDE5 inhibitor they were prescribed at baseline, continued on that same PDE5 inhibitor throughout the study. Continuation rates were approximately 89% in the tadalafil cohort, vs. 63-64% in the sildenafil and vardenafil cohorts. The variables most strongly associated with increased risk of switching were prescription of sildenafil or vardenafil, vs. tadalafil, at baseline (odds ratios 4.43 and 4.14 respectively; p < 0.0001). Of patients who switched from tadalafil to another treatment, nearly 25% had switched back to tadalafil by study end. In contrast, of patients who switched from sildenafil or vardenafil, < 10% from each cohort had switched back to their original treatment by study end. CONCLUSION: The data suggest that tadalafil treatment in treatment-naïve ED patients may increase their likelihood of treatment continuation. These findings should be interpreted conservatively due to the observational nature of the study.
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Carbolinas/uso terapéutico , Disfunción Eréctil/tratamiento farmacológico , Imidazoles/uso terapéutico , Satisfacción del Paciente , Inhibidores de Fosfodiesterasa/uso terapéutico , Piperazinas/uso terapéutico , Sulfonas/uso terapéutico , Adolescente , Adulto , Anciano , Estudios de Cohortes , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Estudios Prospectivos , Purinas/uso terapéutico , Análisis de Regresión , Índice de Severidad de la Enfermedad , Citrato de Sildenafil , Encuestas y Cuestionarios , Tadalafilo , Factores de Tiempo , Resultado del Tratamiento , Triazinas/uso terapéutico , Diclorhidrato de VardenafilRESUMEN
OBJECTIVE: The purpose of this work was to assess the health-related quality of life factors associated with erectile dysfunction (ED). METHODS: 2476 non-institutionalised Spanish males, age ranging from 25 to 70 years, were interviewed. ED was defined using two instruments: a simple self-assessment question (ED-sq) and the International Index of Erectile Function (IIEF). Health-related quality of life (HRQoL) was measured through the SF-36 questionnaire. RESULTS: The severity of ED (measured both through the ED-sq and with the IIEF) increased as the scores of the scales of the SF-36 decreased (Mantel-Hänszel chi(2)-test statistic range: [26-305]; p<0.001). The two summary components (physical and mental) showed a downward trend, more for the physical than for the mental component. CONCLUSION: We found a clear pattern of negative association between self-perceived erectile dysfunction and HRQoL. This association was clearer when ED-sq (rather than IIEF) was used, and stronger for the physical summary component than for the mental one.
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Disfunción Eréctil/epidemiología , Calidad de Vida , Adulto , Distribución por Edad , Anciano , Emociones , Estado de Salud , Humanos , Relaciones Interpersonales , Masculino , Salud Mental/estadística & datos numéricos , Persona de Mediana Edad , Oportunidad Relativa , Vigilancia de la Población , Prevalencia , Valores de Referencia , Rol , Factores Socioeconómicos , España/epidemiologíaRESUMEN
PURPOSE: We determined the prevalence of and risks factors for erectile dysfunction in Spain in a cross-sectional study. MATERIALS AND METHODS: A total of 2,476 noninstitutionalized Spanish men 25 to 70 years old were interviewed at home and answered a self-administered questionnaire of 71 items, including 2 instruments to define erectile dysfunction, a simple self-assessment question to estimate erectile function and the International Index of Erectile Function. Data on disease, medication and toxic habits were also obtained. RESULTS: With an overall participation rate of 75% the prevalence of erectile dysfunction according to the simple question was 12.1%. According to the erectile function domain of the International Index of Erectile Function the overall prevalence was 18.9%. Several independent risk factors were significantly associated with the probability of erectile dysfunction. Some differences arose according to the tool used to define the condition. However, there was a strong relationship of patient age with frequency or severity no matter which instrument was used to define erectile dysfunction. Diabetes (age adjusted odds ratio 4), high blood pressure (odds ratio 1.58), high cholesterol (1.63), peripheral vascular disorder (2.63), lung disease (3.11), prostate disease (2.93), cardiac problems (1.79), rheumatism (2.37) and allergy (3.08) were significantly associated with erectile dysfunction. Drug intake, which respondents called medication for nerves and sleeping pills, correlated strongly (odds ratio 2.78 and 4.27, respectively), as did tobacco use (2.5) and alcohol consumption (1.53). CONCLUSIONS: This study provides data on the prevalence of and risks factors for erectile dysfunction in Spain. The relationship of erectile dysfunction with certain risk factors, such as cardiovascular risk factors and drugs intake, are well known and our study corroborates these associations. Other associations with erectile dysfunction, such as prostate disease, allergy and rheumatism, support findings in previous reports, although to our knowledge the pathophysiological mechanisms remain unclear. Estimating the strength of the association of erectile dysfunction with distinct risk factors in terms of odds ratios enabled us to identify the factors to pursue when seeking to prevent erectile dysfunction. Furthermore, the relationship of tobacco with erectile dysfunction, which has been controversial in previous series, was well characterized in our study.
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Disfunción Eréctil/epidemiología , Adulto , Factores de Edad , Anciano , Estudios Transversales , Complicaciones de la Diabetes , Disfunción Eréctil/etiología , Cardiopatías/complicaciones , Humanos , Hipercolesterolemia/complicaciones , Hipertensión/complicaciones , Enfermedades Pulmonares/complicaciones , Masculino , Persona de Mediana Edad , Prevalencia , Enfermedades de la Próstata/complicaciones , Factores de Riesgo , España/epidemiología , Enfermedades Vasculares/complicacionesRESUMEN
Many men with erectile dysfunction have been successfully treated with intracavernosal injection of prostaglandin E(1) (PGE(1)) but this treatment is ineffective in 30 to 40% of patients. The goals of this study were to characterize PGE(1)-induced relaxation of isolated human penile smooth muscle (penile arteries and trabecular strips), correlating this in vitro response with the clinical response to this drug, and to evaluate the effects of the combination of PGE(1) with S-nitrosoglutathione (SNO-Glu) on relaxation of isolated human penile smooth muscle. Large variability in the EC(50) and maximal relaxation induced by PGE(1) was observed between tissues of different patients. Patients with poor clinical response to intracavernosal alprostadil (PGE(1)) had significantly larger EC(50) values and smaller maximal relaxation compared with patients with partial or complete clinical response to this drug. SNO-Glu consistently produced complete or near complete relaxation of human corpus cavernosum strips and penile arteries, even when the tissue responded poorly to PGE(1). In trabecular strips, the combination of PGE(1) and SNO-Glu in a 1:100 ratio demonstrated a synergistic relaxation effect. The combination of PGE(1) and SNO-Glu simultaneously increased the levels of both cAMP and cGMP in human corpus cavernosum tissue. Our results suggest that the clinical effectiveness of intracavernosal administration of PGE(1) is related to the variability of the relaxation responses of human trabecular tissue and penile arteries to this drug. The synergistic interaction of PGE(1) and SNO-Glu makes this combination an effective method to cause penile smooth muscle relaxation, a necessary step to initiate and maintain penile erection.