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.

Could plaque excision surgery with sis graft induce a new fibrotic reaction in la Peyronie's disease patients?

OBJECTIVES: Peyronie's disease is an acquired disorder of tunica albuginea characterized by the formation of a fibrous plaque which may be associated with pain during erection, penile shortening and/or curvature, difficult vaginal penetration and erectile dysfunction. Severe deformity and/or intractable erectile dysfunction require surgical management. The plaque excision with grafting technique requires the complete excision of the fibrotic tissue and its replacement with an autologous or eterologous graft; among the latter, porcine small intestine submucosa graft is widely used. Nowadays, it is not known if the unsatisfactory results of this surgery caused by a fibrotic process are directly determined by the graft material. MATERIALS AND METHODS: A 50 year-old patient with a severe dorsal penile curvature (> 90 degrees) not allowing penetration, without erectile dysfunction underwent plaque excision surgery with porcine small intestine submucosa grafting. Soon after the surgical intervention a new and progressive penile shortening with a penile dorsal curvature and a erectile dysfunction appear, and thus, six months later, a new plaque excision surgery with saphenous vein graft and penile prosthesis implantation was performed. During the first intervention, plaque and peri-plaque tissue were excised and analyzed, whilst during the second intervention fibrotic tissue on the graft and tissue around it were excised and analyzed, too. RESULTS: In the tissues excised during the second intervention, fibrosis was present either in graft or in peri-graft tissue. Around the graft material, a gigantocellular reaction (foreing body-like) was present and ossification was present, too. DISCUSSION: This type of inflammatory cellular component is associated with foreign body reactions and was never described in Peyronie's disease. Our results suggest that plaque excision surgery with SIS graft could induce the formation of a new cicatritial plaque, not directly correlated to Peyronie's disease, causing the formation of a new plaque and a new penile curvature.

Implantation of AMS 700 LGX penile prosthesis preserves penile length without the need for penile lengthening procedures.

Implantation of an inflatable penile prosthesis (IPP) is a well-established definitive solution for erectile dysfunction when conservative treatments fail. Penile implants may shorten the penis. The AMS 700 LGX IPP is in common use but reports on its mechanical reliability, medium-term postsurgical patient satisfaction, and mean penile length preservation are lacking. We investigate the mean penile length, mechanical reliability, and patient satisfaction at 6 and 12 months after implantation of the AMS 700 LGX. This prospective study consecutively enrolled men undergoing first-time IPP implant surgery from February 2009 to April 2012. Stretched flaccid penile length, penile length at 50% and 100% of stiffness (P50 and P100) and International Index of Erectile Function (IIEF) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) scores, were measured at 6 and 12 months postsurgery. Of 45 patients who underwent AMS 700 LGX implantation (median age 61 years) and completed 6 months' follow-up, 36 (80%) completed the study. A significant difference in stretched flaccid penile length was seen between 6 and 12 months (P = 0.033). P100 was also significantly increased at 6 and 12 months, with a mean 10% increase (1.3 ± 0.4 cm) from baseline to 12 months. Differences in mean IIEF scores at 6 and 12 months were significant for the desired domain (P = 0.0001) and for overall satisfaction (P = 0.002); however, mean EDITS scores at 6 and 12 months were not significantly improved. AMS 700 LGX is a powerful tool for preserving penile length in men undergoing penile prosthesis implantation.