[Modernity in the treatment of erectile dysfunction: Levitra (vardenafil) in the form of oral dispersible tablet].

Due to high efficiency, prompt action and low incidence of side effects, phosphodiesterase type 5 inhibitors are the drugs of first choice in the treatment of erectile dysfunction (ED). One of the most widely used drugs in this group currently is vardenafil. Vardenafil has a number of properties that distinguish it from other drugs in this group: high selectivity and the highest inhibitory activity. Recently, new form of this drug, an oral-dispersible tablet (Levitra ODT) was developed. It dissolves in the mouth for a few seconds and does not required to drink water. This feature Levitra ODT enables easy administration of the drug, which provides the desired effect at any time and in any circumstances. Studies have shown that of simplicity of drug intake is one of the most important characteristics of the "ideal" treatment for erectile dysfunction from the point of view of patients. Currently, Levitra ODT is available at a dose of 10 mg. Two large, randomized, double-blind placebo-controlled studies, POTENT I and POTENT II, with participation of more than 700 patients with erectile dysfunction divided into 2 age groups, have shown a high efficacy and good tolerability of Levitra ODT in both groups. Thus, Levitra ODT is a new and promising form of the drug vardenafil, more convenient to use. There is no doubt that Levitra ODT will occupy an important place in the arsenal of modern methods of treatment of erectile dysfunction due to its high efficacy, good tolerability and usability.

[The role of angiotensin-converting enzyme gene polymorphism in development of erectile dysfunction in patients with metabolic syndrome].

To ascertain relations between angiotensin converting enzyme (ACE) gene polymorphism and erectile dysfunction (ED) in male citizens of Russia with metabolic syndrome, we made a retrospective comparative analysis of ACE gene polymorphism incidence rate in two groups of males with metabolic syndrome: with ED (n=385) and free of ED (n=152). We discovered that ED patients have DD genotype and D-allele more frequently (68.3 vs. 38.2%, p < 0.001 and 81.3 vs 63.8%, p < 0.001, respectively). Moreover, severe ED is associated with significantly more frequent incidence of genotype DD compared to moderate and mild ED. Incidence of allele D is also more frequent in patients with severe ED (93.4%). Thus, D-allele of ACE gene is an ED risk factor in males with metabolic syndrome. Therefore, ED can be considered as one of vascular complications of metabolic syndrome.

[On extended biopsy of the prostatic gland].

The aim of our trial was to investigate correlation between the size of the prostate and probability of cancer detection with transperineal biopsy. Transperineal 12-sample biopsy of the prostate was made in 203 men aged 48-58 years (mean age 68.0 +/- 8.6 years) suspected of having prostatic cancer (PC). Total detection of cancer was 33.5%. PC patients had higher levels of PSA, more frequent alterations at rectal palpation and transrectal ultrasound investigation, while mean size of the prostate was the same in cancer and cancer-free patients. Differences in PC detection rate in patients with different sizes of the prostate were statistically insignificant. Use of sextant biopsy could not detect PC in 15 males (22.1%) cases. Thus, there is no correlation between the size of the prostatic gland and diagnostic value of transperineal biopsy obtaining 12 tissue samples. The above data do not support the necessity of extended biopsy in patients with large prostate.

[Vardenafil (levitra): new aspects of clinical efficacy].

Vardenafil (levitra, Bayer Schering Pharna, Germany) is a 5-phosphodiesterase inhibitor which proved highly effective and safe in the treatment of erectile dysfunction. Special techniques were used to study sexual satisfaction of female partners of men treated with vardenafil. It was found that vardenafil raises significantly sexual satisfaction of female partners of men treated with vardenafil and prolongs erection. This is a new aspect of vardenafil efficacy.

[Efficacy of phosphodiesterase inhibitors in the treatment of patients with organic erectile dysfunction: a comparative study].

Currently available three highly selective and effective PDE-5 inhibitors (sildenafil, tadalafil and wardenafil) are comparable by PDE-5 inhibition and selectivity of action on PDE-5 but their differences in activity, interaction with food and alcohol, biological half-life and other characteristics make their use individual for certain clinical situations. Our trial with participation of 575 patients (mean age 57.73 +/- 12.33 years) with arteriogenic erectile dysfunction and great number of vascular risk factors has shown that wardenafil was most popular among our examinees as it is more effective and begins acting faster. Further studies in optimization of the above drugs administration may perfect treatment of erectile dysfuncion.

[Local anesthesia with block of the sexual nerve in conduction of transperineal biopsy of the prostate].

We studied 137 males (mean age 68 +/- 8.6 years) with suspected prostatic cancer who had undergone transperineal biopsy of the prostate (12 tissue samples). The biopsy was made under local anesthesia either as paraprostatic block (n=76, group 1) or paraprostatic block in combination with block of the sexual nerve (n=61, group 2). Pain intensity was evaluated with visual analogue scales. Induction of anesthesia was more painful in group 2, three other stages--in group 1. Mean pain at biopsy was significantly (p < 0.001) lower in group 2. Thus, addition of sexual nerve blockade to standard paraprostatic block increases efficacy of anesthesia in conduction of transperitoneal biopsy of the prostate.

[Levitra (wardenafil) effects on endothelial function of brachial and cavernous arteries].

We studied effects of oral PDE-5 inhibitor wardenafil (levitra, Bayer & GlaxoSmithKline) on endothelial function of cavernous and brachial arteries in males with normal erectile function and in patients with erectile dysfunction (ED). Endothelial function of the brachial and cavernous arteries was studied in 75 males with ED and 20 healthy volunteers before and after wardenafil intake in a dose 20 mg using ultrasound examination of postcompression diameter changes. The results show that wardenafil improves endothelial function of cavernous and brachial arteries. The degree of the positive effect depends on baseline condition of the endothelial function of the vessels. The highest activity of the drug was seen in patients with arteriogenic ED who had significant decline of endothelial function of both cavernous and brachial arteries. The dependence of wardenafil effect on baseline condition of the endothelial function is confirmed by negative correlation between changes in postcompression artery dilatation after the drug intake and baseline values. This evidences for wardenafil ability to correct disturbed endothelial function of the arteries.

[The pathogenesis of erectile dysfunction in metabolic syndrome].

The aim of the study was to investigate the pathogenesis of erectile dysfunction (ED) in men with metabolic syndrome (MS). The subjects of the study were 385 men with ED and MS and 210 patients with organic ED (control group). The results of a complex clinical and andrological examination demonstrated that the fundamental pathogenetic factor of ED in patients with MS was the alteration of arterial blood circulation in the cavernosal tissue. The most valuable method in the diagnosis of this form of ED was ultrasonographic measurement of postocclusive changes in the diameters of cavernous arteries, reflecting local endothelial function. In addition, in a substantial portion of MS patients, hormonal and neurological disturbances were found, which also contributed to the pathogenesis of ED in this category of patients.

Association between the insertion/deletion polymorphism of the angiotensin-converting enzyme gene and erectile dysfunction in patients with metabolic syndrome.

This study was designed to investigate whether angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism is associated with erectile dysfunction (ED) in Russian men with metabolic syndrome (MS). A total of 331 men with MS were studied. All patients underwent complex evaluation including the International Index of Erectile Function (IIEF) questionnaire. The ACE I/D polymorphism was determined by polymerase chain reaction. Overall, 182 men (55.0%) had ED according to the IIEF erectile function domain score. In the ED group, the prevalence of DD genotype was found to be significantly higher compared to the non-ED group (P<0.001). In both groups, patients with DD genotype were significantly younger than patients with other genotypes (P<0.001). In addition, in the ED group, the disease affected patients with DD genotype at a significantly younger age (P<0.001). Obtained results give evidence to support the finding that the D allele is a risk factor for the micro- and macrovascular diseases.

[The role of testosterone drugs in combined therapy of erectile dysfunction in patients with metabolic syndrome].

The aim of the trial was assessment of efficacy of combined therapy with testosterone drug (androgel) and wardenafil in patients with erectile dysfunction (ED) and metabolic syndrome (MS). The trial included 16 males with organic ED, laboratory and clinical symptoms of hypogonadism and MS (mean age 63.8 +/- 8.4) who had failed monotherapy with phosphodiesterase of type 5 (FDE-5). Both routine methods and special methods of ED and MS diagnosis with application of International Index of Erectile Function were used in examination. MS was diagnosed according to the criteria of the National Cholesterol Educational Program. Wardenafil was given in a dose 20 mg 1 hour before coitus, but not less than 4 tablets a month. Androgel applications were given in a daily dose 50 mg. The treatment lasted for 3 months. The combined treatment significantly reduced body mass index, waist circumference, improved erectile function and libido. Erectile function normalized in 3 (18.75%) patients. Carbohydrate and lipid metabolism improved, the levels of total and free testosterone normalized. Elevation of sexual hormones concentration eliminated clinical hypogonadism symptoms in 68.75% patients. Thus, combined treatment with FDE-5 inhibitor wardenafil and testosterone drug androgel is effective, safe, improves erectile function, hormonal, lipid and carbohydrate blood profile and can be used in patients with MS, ED and hypogonadism.

[Diagnosis of arteriogenic erectile dysfunction at the level of primary health care].

AIM: To study relations between endothelial function of the brachial and cavernous arteries (BA and CA). MATERIAL AND METHODS: The trial was made in 148 males with erectile dysfunction (ED) aged 21 to 80 years (a mean age 52.6 years) and 40 males aged 24 to 76 years (a mean age 50.2 years) with normal erection (the control group). A pathogenetic form of ED was determined in each patient. CA endothelium function was estimated in the patients and controls by an original technique of ultrasonic investigation of postcompression changes in CA diameter. Such changes were also estimated for BA diameter. RESULTS: The correlation analysis of BA and CA endothelial function has not found significant correlations between BA and CA endothelial functions both in the groups and in all the examinees. Prevalence of systemic endothelial dysfunction in the controls and patients with psychogenic, neurogenic and vein-occusive ED was maximum 30% while in arteriogenic ED endothelial dysfunction was discovered in all the examinees. CONCLUSION: In diagnosis of arteriogenic ED the study of BA endothelial function can not adequately replace such of CA, but the presence of BA endothelial dysfunction may be associated with CA endothelial dysfunction.

[Prediction of clinical efficacy of levitra (vardenafil) in patients with arteriogenic erectile dysfunction].

Oral inhibitors of phosphodiesterase of type 5 (PDE-5) are drugs of choice in therapy of erectile dysfunction (ED). However, 20-30% patients do not respond to them. We studied potentialities of ultrasonic investigation (UI) of postcompression increase in cavernous arteries diameter (PICAD) after intake of vardenafil (levitra, Bayer&GlaxoSmithKline) which is a PDE-5 inhibitor in prediction of clinical efficacy of this medicine. A total of 75 males with ED participated in the study. Significant correlations were found between PICAD after vardenafil administration and clinical efficacy of the drug in patients with arteriogenic ED. The highest response to the drug was observed at PICAD value > or = 50%. High sensitivity and specificity of the PICAD threshold value obtained indicate high potentialities of the method in decision making on treatment policy in patients with organic ED.

[Comparative assessment of the results of ultrasonic measurements of postocclusive alterations in the brachial and cavernous arteries].

We compared the results of functional endothelial tests of the cavernous penile arteries by the modified by us method with results of the study of endothelial function of the brachial artery. The analysis of the results of examination of 116 patients with endothelial dysfunction of various genesis and 14 men free of endothelial dysfunction has not found a correlation between the tests, but all the patients with postocclusive increase in the diameter of the cavernous artery by less than 50% indicating arteriogenic endothelial dysfunction had signs of endothelial dysfunctions in the study of brachial artery. This suggests the presence of systemic endothelial dysfunction in all the examinees with arteriogenic endothelial dysfunction supporting its role in pathogenesis of this form of endothelial dysfunction.

[Levitra-test in diagnosis of vasculogenic erectile dysfunction].

Dopplerography in artificial erection induced by intracavernous injection of drugs is now the most common method of diagnosis in examination of patients with erectile dysfunction (ED). We studied possibility of inducing erection by the novel potent and selective oral drug levitra (vordenafil) from the group of inhibitors of phosphodiesterase of the 5th type. The comparison of the dopplerographic results of two methods (erection induced by intracavernous injection of prostaglandin E and levitra) showed no statistical differences between the two methods. Thus, levitra-test is a highly informative technique in diagnostic examination of patients with erectile dysfunction with the same pharmacodopplerographic efficacy as intracavernous injection of vasoactive drugs.