Sildenafil Citrate (Viagra) and vacuum constriction device combination enhances sexual satisfaction in Erectile Dysfunction after radical prostatectomy.

OBJECTIVES: To assess the effectiveness of combining Sildenafil Citrate (Viagra) with a vacuum constriction device (VCD) in men (after radical prostatectomy) unsatisfied with the results of the VCD alone. METHODS: A total of 31 patients unsatisfied with the early use of VCD alone after radical prostatectomy (mean follow-up of 4.5 months) were instructed to take 100 mg ofSildenafil Citrate (Viagra) 1 to 2 hours before VCD use for sexual intercourse. Patients used combination therapy for a minimum of five attempts before assessment with the abridged International Index of Erectile Function (IIEF) questionnaire and a visual analogue scale to gauge rigidity. The effect of combination therapy on the total IIEF-5 score and penile rigidity score were assessed. RESULTS: Of the 31 patients, 7 (22%) had no improvement with the addition ofSildenafil Citrate (Viagra) with VCD and discontinued the drug, and 24 (77%) reported improved penile rigidity and sexual satisfaction. The IIEF-5 score revealed statistically significant improvement in each domain, and patients reported thatSildenafil Citrate (Viagra) enhanced their erections 100% of the time. The penile rigidity scores on a scale of 0 to 100 with the VCD alone averaged 55% (range 23% to 85%) for the men and 59% (range 26% to 90%) for their partners. With the addition of sildenafil, it increased to 76% for the men and 82% for their partners. Of the 24 men, 7 (30%) reported a return of natural erections at 18 months using combination therapy, with 5 of 7 reporting erections sufficient for vaginal penetration. CONCLUSIONS: In this study, the addition ofSildenafil Citrate (Viagra) with VCD improved sexual satisfaction and penile rigidity in patients unsatisfied with VCD alone after radical prostatectomy

N-3-substituted imidazoquinazolinones: potent and selective PDE5 inhibitors as potential agents for treatment of Erectile Dysfunction.

Phosphodiesterase type 5 (PDE5) inhibitors with improved PDE isozyme selectivity relative toSildenafil Citrate (Viagra) may result in agents for the treatment of male Erectile Dysfunction (MED) with a lower incidence of PDE-associated adverse effects. This paper describes the discovery of 14, a PDE5 inhibitor with improved potency and selectivity in vitro compared to sildenafil. This compound shows activity in a functional assay of erectile function comparable to that ofSildenafil Citrate (Viagra)

Effect of vaginalSildenafil Citrate (Viagra) on the outcome of in vitro fertilization (IVF) after multiple IVF failures attributed to poor endometrial development.

OBJECTIVE: To evaluate the effects of vaginally administeredSildenafil Citrate (Viagra) on endometrial thickness and IVF outcome in a large cohort of infertile women with poor endometrial development. DESIGN: Retrospective cohort analysis. SETTING: Private practice setting. PATIENT(S): A cohort of 105 infertile women aged <40 years, with normal ovarian reserve and at least two consecutive prior IVF failures attributed to inadequate endometrial development. INTERVENTION(S): Patients underwent IVF using a long GnRH-a protocol with the addition ofSildenafil Citrate (Viagra) vaginal suppositories (25 mg, 4 times per day) for 3-10 days. MAIN OUTCOME MEASURE(S): Peak endometrial development, pregnancy, and implantation rates. RESULT(S): Of 105 patients, 73 (70%; Group A), attained an endometrial thickness of >/=9 mm, whereas 32 (30%; Group B) did not. Implantation and ongoing pregnancy rates were significantly higher for Group A (29% and 45%) than for Group B (2% and 0). Of 11 women in Group B who had embryos transferred in that cycle, only one conception occurred, which resulted in a miscarriage. In Group B, 59% of women had a history of endometritis, compared with 44% in Group A. CONCLUSION(S): Vaginal administration ofSildenafil Citrate (Viagra) enhanced endometrial development in 70% of patients studied. High implantation and ongoing pregnancy rates were achieved in a cohort with a poor prognosis for success. Previous endometritis may decrease the response toSildenafil Citrate (Viagra)

Clinical efficacy and safety of Sildenafil Citrate (Viagra) in a multi-racial population in Singapore: A retrospective study of 1520 patients.

BACKGROUND: Sildenafil Citrate (Viagra) (Viagra), a selective inhibitor of cGMP-specific phosphodiesterase type-5, has been used as an oral therapeutic drug for Erectile Dysfunction. The present paper is a clinical study of the success rate and side-effects of the use ofSildenafil Citrate (Viagra) in a multi-racial population in Singapore. METHODS: From April 1999 to May 2000, 1520 patients were given Sildenafil Citrate (Viagra). Of these, 912 patients (mean age, 54.6 years; age range, 22-99 years) were followed up and evaluated for clinical efficacy and safety of the drug. The mean duration of Erectile Dysfunction (ED) and follow-up periods were 31.5 and 3.0 months, respectively. RESULTS: Satisfactory erections assessed by single global efficacy question (GEQ) occurred in 83% of patients, major side-effects in the form of flushing (3.48%), headache (1.97%), blurred vision (1.25%), giddiness (1.18%), warmth (1.11%) and others (4.92%) were recorded in 127 patients (13.9%). Racially, Chinese men with ED had higher efficacy (85.7%), compared to Indian men (74.2%) and Malay men (72.8%). With respect to comorbid profiles, an efficacy of 77.8% (n = 271), 83.9% (n = 292), 86.4% (n = 44) and 83.3% (n = 199) was recorded in diabetic, hypertensive, ischemic heart disease patients and in benign prostatic hyperplasia patients, respectively. Patients who smoked (n = 135) and drank alcohol (n = 118) showed an efficacy of 80%. Baseline hormonal profiles of luteinizing hormone, follicle stimulating hormone, testosterone and prolactin did not affect the success rates of Sildenafil Citrate (Viagra). Many patients had earlier received other forms of treatment (medicated urethral suppository for erection (MUSE; 84.9%); vacuum devices (86.8%), traditional medicines (100%) and other oral medications (89.2%)), but this did not influence the success rate of Sildenafil Citrate (Viagra). But patients previously treated with prostaglandin-E intracavernosal injections were less successful on Sildenafil Citrate (Viagra) (77.3%). In the total cohort, 50 mg Sildenafil Citrate (Viagra) was an effective dose in 49% of patients and 46.5% patients needed 100 mg Sildenafil Citrate (Viagra), while 4.1% of the total cohort needed only 25 mg Sildenafil Citrate (Viagra). CONCLUSION: Oral Sildenafil Citrate (Viagra) has been shown to be an effective, safe and well tolerated drug in Singaporean men with ED, as in men from other parts of the world

Increasing incidence and importance of HIV/AIDS and gonorrhea among men aged >/= 50 years in the US in the era of Erectile Dysfunction therapy.

OBJECTIVE: With the advent of effective pharmacotherapy for Erectile Dysfunction, the risk of sexually transmitted diseases is a possible consequence, especially in the older population. We wanted to review the incidence of sexually transmitted diseases in the older population in an attempt to correlate this with the advent of these new drugs. MATERIAL AND METHODS: Publicly available information on the incidence of HIV, AIDS and gonorrhea was retrieved from the websites of the Centers for Disease Control (CDC), the State of Florida Department of Health, the Senior HIV Intervention Project and the National Association on HIV Over Fifty. National case incidences of HIV and AIDS in men between 1996 and 2000 were examined for trends. National and Florida state trends were compared and, in Florida, Palm Beach, Broward and Dade counties in particular were selected because of their traditionally large retiree population. In addition, the national and Florida state incidences of gonorrheal infection were examined for trends. Statistics on national Sildenafil Citrate (Viagra) prescriptions were obtained via a personal communication with a regional healthcare representative from Pfizer. RESULTS: According to the CDC, at the end of 1998 >10% of new AIDS cases nationally were in individuals aged >50 years. In the late 1990s, new AIDS cases rose faster in middle-aged and older adults than in people aged >40 years. Many of the newly diagnosed cases of AIDS may have contracted HIV before the age of 50 years; however, many individuals are newly becoming infected above the age of 50 years. Of the reported AIDS cases in 1996 in individuals aged >/= 50 years, 48% were aged 50-54 years, 26% were aged 55-59 years, 14% were aged 60-64 years and 12% were aged >/= 65 years; 84% of these cases were male, and blacks accounted for the greatest proportion of cases (43%). In the US, 7.5 million prescriptions forSildenafil Citrate (Viagra) were written in 1998, 9.5 million in 1999, 12 million in 2000 and 15.5 million in 2001. The age breakdown for these prescriptions was as follows: 40-49 years, 23%; 50-59 years, 35%; and 60-69 years, 25%. CONCLUSIONS: The past decade saw rises in heterosexual transmission of HIV and i.v. drug use, especially in the population aged >50 years. The CDC reports that the incidence of new HIV infection is stabilizing in men aged 30-39 years and even falling in men aged 20-29 years. Gonorrhea is well known to increase infectivity for HIV and other STDs. Although the rates of gonorrhea infection fell throughout the early 1990s, they increased by 9% between 1997 and 1999. The number ofSildenafil Citrate (Viagra) prescriptions has increased by almost 80% over the last few years. Although there may be multiple contributory factors for these findings, to our knowledge this is the first paper in the urologic literature to examine such trends in the older male population, especially in the light of newly available medications for Erectile Dysfunction

Sildenafil influences lower urinary tract symptoms.

OBJECTIVE: To assess the possible relationship between Erectile Dysfunction (ED) and lower urinary tract symptoms (LUTS) in men, and whether treatment of their ED withSildenafil Citrate (Viagra) influences their LUTS. PATIENTS AND METHODS: In all, 112 men with ED attending the andrology outpatient clinic were offered oralSildenafil Citrate (Viagra) and reviewed 1 and 3 months after treatment. They completed the International Index of Erectile Function and the International Prostate Symptom Score (IPSS) questionnaires at baseline and each review. Scores were designated to indicate the visit number and differences between the visits calculated. RESULTS: A third of the men had an initial IPSS of > 7; there was no relationship between baseline urinary and sexual function scores. After treatment with sildenafil, the urinary scores at 3 months correlated strongly with the sexual function scores. There was a significant inverse relationship between the baseline IPSS and sexual function scores after treatment. The overall trend in the IPSS was towards improvement after treatment with sildenafil. CONCLUSIONS: In men with ED there is no relationship between sexual function scores and urinary symptom scores before treating ED. Treatment withSildenafil Citrate (Viagra) appears to improve urinary symptom scores. A lower IPSS at baseline appears to predict a better response to ED therapy withSildenafil Citrate (Viagra)

Fatal variceal rupture afterSildenafil Citrate (Viagra) use: Report of a case.

Sildenafil may increase the risk of variceal bleeding in portal hyptertension by increasing splanchnic blood flow. We report herein the second case of variceal rupture afterSildenafil Citrate (Viagra) use

Immediate and long-term hemodynamic and clinical effects ofSildenafil Citrate (Viagra) in patients with pulmonary arterial hypertension receiving vasodilator therapy.

OBJECTIVE: To determine the immediate and long-term effects of adding sildenafil, a phosphodiesterase-5 inhibitor, to the medical regimen of patients with pulmonary arterial hypertension (PAH). PATIENTS AND METHODS: Thirteen patients with PAH received empirical adjunctiveSildenafil Citrate (Viagra) treatment at the Mayo Clinic in Rochester, Minn, between November 1, 2000, and August 31, 2001. All received a 25-mg dose of sildenafil, increased by 25 mg at 8-hour intervals, if tolerated, up to 100 mg during hemodynamic monitoring for 24 to 48 hours. Long-term effects on right heart hemodynamics were assessed by noninvasive right ventricular systolic pressure, right ventricular index of myocardial performance, and a 6-minute walk test. RESULTS:Sildenafil Citrate (Viagra) significantly increased cardiac output (CO) (P = .04) and decreased pulmonary artery systolic pressure, mean pulmonary artery pressure, pulmonary vascular resistance, and mean arterial pressure (P < or = .01) at peak measurements (obtained 1-2 hours after highest dose). At trough measurements (obtained 8 hours after highest dose),Sildenafil Citrate (Viagra) significantly decreased pulmonary artery systolic pressure, mean pulmonary artery pressure, and mean arterial pressure (P = .01). Ten patients discharged from the hospital were taking the highest-tolerated dose ofSildenafil Citrate (Viagra) every 8 hours. The right ventricular systolic pressure and right index of myocardial performance showed no significant improvement at follow-up (117 +/- 70 days), although concomitant treatment with epoprostenol could be tapered in 2 patients. Changes in New York Heart Association classes were inconsistent, and improvements in the 6-minute walk test were not significant. CONCLUSION:Sildenafil Citrate (Viagra) has an immediate pulmonary vasodilator effect in patients already receiving vasodilators for PAH. Its long-term effects on right heart function and functional status are equivocal. A large, prospective, well-designed study is needed to determine the effects ofSildenafil Citrate (Viagra) on PAH, both in untreated and concurrently treated patients