Phosphodiesterase type 5 inhibitor treatment for erectile dysfunction in patients with end-stage renal disease receiving dialysis or after renal transplantation.

INTRODUCTION: The phosphodiesterase type 5 (PDE5) inhibitors are generally well tolerated and effective for treating erectile dysfunction (ED), including in patients with significant comorbidity. Because of this benign safety profile, investigators have used PDE5 inhibitors to treat patients with ED and severe renal disease or those who have received renal transplants. AIM: To assess safety and efficacy of PDE5 inhibitors in patients receiving dialysis or renal transplants. MAIN OUTCOME MEASURES: Erectile function as assessed by the International Index of Erectile Function (IIEF) and Global Assessment Questions; adverse events (AEs). METHODS: We reviewed published studies of PDE5 inhibitors in patients receiving dialysis or renal transplants. RESULTS: In double-blind, placebo-controlled studies in patients receiving dialysis or renal transplants, sildenafil significantly improved erectile function as assessed by the IIEF, and 75-85% of patients reported improved erectile function on Global Assessment Questions; efficacy was more variable in less well-controlled studies. In >260 patients undergoing dialysis who received sildenafil in clinical studies, there were only six reported discontinuations because of AEs (headache [N=3], headache and nausea [N=1], gastrointestinal [N=1], and symptomatic blood pressure decrease [N=1]). In approximately 400 patients with renal transplants who received sildenafil, only three patients discontinued because of AEs. Vardenafil improved IIEF scores of up to 82% of renal transplant recipients in randomized, controlled studies (N=59, total), with no reported discontinuations because of AEs. Limited data also suggest benefit with tadalafil. CONCLUSIONS: ED is common in patients undergoing renal dialysis or postrenal transplant and substantially affects patient quality of life. Sildenafil and vardenafil appear to be efficacious and well tolerated in patients receiving renal dialysis or transplant.

Quality of life in patients undergone oncopreventive intravesical treatment for superficial bladder cancer.

OBJECTIVES: Adjuvant intravesical therapy after TURB for superficial bladder cancer forces the patients to follow prolonged protocols of treatment. In our study we considered the quality of life of these patients. MATERIALS AND METHODS: We created a questionnaire of 52 items in order to analyse free time, working activity, sexual-relational activity, compliance and self esteem of patients undergone intravesical adjuvant therapy. We gave the questionnaires to 63 patients and, on the basis of results, we proposed a psychosexual support therapy according to alteration of Quality of Life (Q.o.L). After the therapy we reproposed the same questionnaires in order to establish the utility of this integrated treatment. RESULTS: We found that quality of life was greatly altered by oncopreventive intravesical therapy. We showed results of questionnaires before and after the multidisciplinary therapy. CONCLUSIONS: The analysis of our data confirme the importance of multidisciplinary approach in adjuvant treatment of superficial bladder cancer. The therapy proposed helps the patients to face neoplastic disease.