Alternate-day tadalafil in the management of honeymoon impotence.

INTRODUCTION: Sildenafil has been used successfully in the treatment of honeymoon impotence. However, no study investigated the potential effect of tadalafil in the treatment of honeymoon impotence. AIM: The aim of this study is to evaluate the effectiveness of alternate-day tadalafil therapy in the management of unconsummated marriages. METHODS: This is a descriptive study comprised of a series of 45 patients. The time frame for the study was 2 years. Forty-five consecutive patients underwent a complete medical and sexual history as well as a focused physical examination. Education about the male and female genital anatomy and the sexual response cycle was carried out. Alternate-day tadalafil 10-mg therapy was administered for 2 weeks with the duration extended as needed. MAIN OUTCOME MEASURES: Primary efficacy endpoints were successful vaginal intromission and change in the abridged version of the International Index of Erectile Function (IIEF-5). RESULTS: Of 45 patients included in our study, 41 (91%) were able to achieve vaginal intromission and perform sexually. Thirty-four patients (76%) needed tadalafil for less than 1 month, five (11%) for up to 3 months, and two (4%) for more than 3 months. Four patients (9%) were unsuccessful. IIEF-5 improved significantly with alternate-day tadalafil treatment in this subgroup of patients (P < 0.001). Treatment failures were managed by intracavernous injection therapy, combined with psychosexual therapy, depending on the cause. CONCLUSIONS: Tadalafil therapy was safe and effective in the short-term management of this selected group of honeymoon impotence patients. Controlled studies are needed to further confirm these findings.

Assessment of seminal plasma laminin in fertile and infertile men.

AIM: To assess laminin levels in the seminal plasma of infertile and fertile men, and to analyze the correlation of laminin levels with sperm count, age, sperm motility and semen volume. METHODS: One hundred and twenty-five recruited men were equally divided into five groups according to their sperm concentration and clinical examination: fertile normozoospermia, oligoasthenozoospermia, non-obstructive azoospermia (NOA), obstructive azoospermia (OA) and congenital bilateral absent vas deferens (CBAVD). The patients' medical history was investigated and patients underwent clinical examination, conventional semen analysis and estimation of seminal plasma laminin by radioimmunoassay. RESULTS: Seminal plasma laminin levels of successive groups were: 2.82 +/- 0.62, 2.49 +/- 0.44, 1.77 +/- 0.56, 1.72 +/- 0.76, 1.35 +/- 0.63 U/mL, respectively. The fertile normozoospermic group showed the highest concentration compared to all infertile groups with significant differences compared to azoospermic groups (P<0.05). Testicular contribution was estimated to be approximately one-third of the seminal laminin. Seminal plasma laminin demonstrated significant correlation with sperm concentration (r = 0.460, P < 0.001) and nonsignificant correlation with age (r = 0.021, P = 0.940), sperm motility percentage (r = 0.142, P = 0.615) and semen volume (r = 0.035, P = 0.087). CONCLUSION: Seminal plasma laminin is derived mostly from prostatic and testicular portions and minimally from the seminal vesicle and vas deferens. Estimating seminal laminin alone is not conclusive in diagnosing different cases of male infertility.

Intracavernous chlorpromazine versus phentolamine: a double-blind clinical comparative study.

INTRODUCTION: Intracavernous pharmacotherapy is one of the most common treatment modalities of erectile dysfunction (ED). There are different drugs that are used for intracavernous injection including papaverine, phentolamine, prostaglandins E1, phenoxybenzamine, and moxisylate. AIM: The aim of this study is to evaluate the efficacy of chlorpromazine as an intracavernous vasoactive agent alone or with other drugs. METHODS: This study was performed on 50 patients presenting to our department complaining of ED. Patients were divided into three groups according to the type of intracavernous drug injected. Group A included 20 patients who received an intracavernous injection of 1 mL bimix (30 mg papaverine + 1 mg phentolamine) followed a week later by intracavernous test dose using a 1 mL mixture of papaverine and chlorpromazine (30 mg papaverine + 2.5 mg chlorpromazine). Group B included 20 patients who received an intracavernous injection of 1 mL trimix (30 mg papaverine + 1 mg phentolamine + 10 microg PGE1). A week later they received another intracavernous test dose using a 1 mL mixture of papaverine, PGE1, and chlorpromazine (30 mg papaverine + 2.5 mg chlorpromazine + 10 microg PGE1). Group C included 10 patients who received various intracavernous injections of chlorpromazine in doses 1 mg, 2 mg, 5 mg, and 10 mg. RESULTS: There was no significant difference in erection response and erection duration between phentolamine and chlorpromazine. Prolonged erection occurred in two patients of group B and postural hypotension occurred in three patients of group C. CONCLUSION: Chlorpromazine can be used as an intracavernous vasoactive agent; it is similar to phentolamine in efficacy and short-term side effect profile.