Tuesday, July 15, 2008

Treatment for Erectile Dysfunction in Patients with Diabetes

cialis In This ArticleAbstract and IntroductionPatients and MethodsResultsDiscussionTablesReferencesRelated Links

Patients and Methods

The study group consisted of 284 consecutive patients with DM referred to our tertiary center for the treatment of ED between 1998 and 2002. All patients had DM type II that was diagnosed before the entrance into the study according to fasting glucose level or oral glucose tolerance test. The demographic characteristics of the patients as well as the data regarding the duration of DM and their comorbidities are presented in Table 1 . In all, 43 patients (15.1%) were treated by insulin alone or with combination with oral hypoglycemic agents at the time of the study. The rest of the patients received oral hypoglycemic agents only. DM was relatively controlled.

The diagnosis of ED was based on the International Index of Erectile Function (IIEF).[17] Medical, social and psychosexual history of the patients and their partners were taken. Physical examination, nocturnal penile tumescence test with Rigiscan, penile color Doppler ultrasound and penile electrothermometry[18] were performed. Complete blood count, electrolytes, glucose level, liver enzymes, urea and creatinine, level of prostate-specific antigen, prolactin and total testosterone were checked. No untreated hormonal disbalances in the hypothalamic-hypopituitary-testicular axis were found in our study group, because our department is a tertiary center and all the possible hormonal problems were identified and treated before the reference.Procedure

A positive response at all phases of the program was defined as an erection sufficient for vaginal penetration.

Phase 1. Patients without contraindications[19] were offered sildenafil citrate (Viagra), one tablet at 1 h before coitus, 2-3 h after a meal, at a starting dose of 25-50 mg, depending on age. The dose was increased to 50 and 100 mg at intervals of 2-4 days, depending on response, age, and general state of health.

Phase 2. Patients with contraindications to sildenafil, adverse drug effects, or a negative response (to at least 3-5 doses of 100 mg) were offered vacuum therapy with the VED. Details of its applications were explained to the patients individually before commencing. Silicone cream or lubricating gel was applied around the root of the penis, and the cylinder (with constriction rings) was opened and placed on the penis. Negative pressure was applied slowly and gradually over 2-3 min. When the patient reported pain, we removed the cylinder, but left the constriction rings in place for an additional 1-2 min. Two sessions were conducted by the same operators at intervals of 2-3 days. In patients with a positive response, the device was recommended for use at home before coitus.

Phase 3. VED failures were switched to ICI with cocktail of trimix of vasoactive drugs: papaverine 12-25 mg+phentolamine 1.0-2.0 mg+prostaglandin E1 6-25 µg. In patients who complained of pain during erection, the prostaglandin E1 dose was decreased and the doses of the other drugs were increased.

Phase 4. Patients who failed to respond to the ICI were given sildenafil citrate 50-100 mg followed 40-55 min later by a ICI of papaverine 25 mg+phentolamine 2 mg+prostaglandin E1 6-25 µg.

Phase 5. In patients who failed phase 4, we attempted ICI with papaverine, 16 mg, phentolamine 1.5 mg, and prostaglandin E1 15-25 µg, followed 5-10 min later by the VED.

Phase 6. In patients who did not respond to phase 5, we recommended penile implant surgery.Follow-up

All patients were followed for 2 y. ED treatment was changed during follow-up, as necessary, according to the same 6-phase program. Follow-up consisted of physical examinations for general state of health, IIEF score, and laboratory tests. In patients receiving the ICI, the physical examination also included a search for palpable fibrotic nodules. Penile Doppler color ultrasound and nocturnal penile tumescence test were repeated.Statistical Analysis

The results immediately after treatment and at the end of follow-up were analyzed according to Bland.[20] Arithmetic mean values and errors of the mean or median values were calculated. Statistical differences were determined with Student's t-test. Values of P<0.05 were considered significant.Previous PageSection 2 of 4Next Page: Results
Int J Impot Res.  2005;17(5):431-436.  ©2005 Nature Publishing Group

This is a part of article Treatment for Erectile Dysfunction in Patients with Diabetes Taken from "Cialis Viagra Levitra Effects" Information Blog


IsaacD said...

A majority of the consumers of the ED drugs are more often than not quite satisfied by their effects. This can be seen from the huge numbers of orders for the ED drugs that the only pharmacies receive. People do not have much of the inhibitions regarding the ED drugs. However, one should have a good look at the online pharmacy before they actually buy the ED drugs. http://www.levitrabliss.com

Wilbur Mills said...

Cialis is a drug used to treat Erectile Dysfunction and impotence. It is, by means of its chemical composition, a PDE-5 inhibitor pharmaceutical, and works by blocking the PDE-5 enzyme, resulting in increased blood flow to the penis. It can, at times work in less than 30 minutes, which means that you do not have to wait for the right moment to strike and with a long window of the effect, you can engage in a sexual intercourse at whatever point you choose to, without planning. http://www.besthealthmed.com/cialis_side_effects.html

viagra said...

Amongst all the anti-impotency medicines available in the market, Viagra is the most highly sought after medication as it is the first FDA (Food and Drugs Administration) approved drug for treating erectile dysfunction in men. Moreover, viagra is famous worldwide for accelerating smooth blood flow to the penis and making men capable of triggering off erections required for sexual intercourse. Hence, you should get hold of Viagra as soon as you fall prey to erectile dysfunction and for more information on Viagra, visit the website http://www.viagraforce.com.

goooooood girl said...

your blog is feel good......

Anton L. said...

I think your blog is fantastic

Toni said...

+1 here is interesting post