Evaluation and therapeutic regulation of Erectile Dysfunction with visual stimulation test. An objective approach by using Sildenafil Citrate (Viagra) test.

AIM: An objective evaluation of the psychogenic cause of Erectile Dysfunction by performing the visual stimulation tumescence and rigidity (VSTR) test and Sildenafil Citrate (Viagra) test, together with the effectiveness of Sildenafil Citrate (Viagra) medication on impotence caused by different etiologies. MATERIAL AND METHODS: Between 1998 and 2000, a total of 36 men (12 patients with diabetic etiology, 5 patients with vasculogenic risk factor) were enrolled in this study. The mean age of patients was 53 (27-67) years. Following standard questionnaires, including a detailed anamnesis from an andrologic viewpoint, VST was performed in an ambulatory setting and beginning with a test dose of 50 mg. At the end of 2 h, the data was evaluated with computer assistance (Rigiscan device) and if a satisfactory erection had not occurred, an additional second dose of Sildenafil Citrate (Viagra) (50 mg) was given until there was a satisfactory erection. Results obtained from VST: results were classified as group I (fully rigidity, >10 min erection, >70% of rigidity, possible vaginal penetration), group II (unstable erection, 5 min erection, >70% of rigidity, possible vaginal penetration) and group III (tumescence without rigidity, <5 min erection, <70% of rigidity, impossible vaginal penetration). The results obtained during the first 1 h of the VSTR test were regarded as the patient's own erectile condition and later data was accepted as the real effect of Sildenafil Citrate (Viagra). The Fisher exact test was used for statistical evaluation including pre- and post-sildenafil effect on erectile rigidity and duration of erection. RESULTS: The erection status of patients was sufficient in 17 (47.2%) in group I, it was insufficient but sufficient enough with an increased dose of Sildenafil Citrate (Viagra) in 10 (27.7%) in group II, and insufficient without/with full dose of Sildenafil Citrate (Viagra) in 9 (25%) in group III. Considering rigidity and total erectile period, there was a statistical significant difference between the first two groups with respect to the early and late Sildenafil Citrate (Viagra) effects on the VSTR test (p < 0.05). Again, 10 patients with known risk factors (diabetes mellitus 5 and vasculogenic 5) in the second group seemed to give a good response to repeated dosage of Sildenafil Citrate (Viagra) which has been found to be very interesting. However, the rest of the diabetic patients (n = 7) in the third group showed no erection despite the increasing and repeated doses of Sildenafil Citrate (Viagra). CONCLUSION: Sildenafil Citrate (Viagra) with the VSTR test has effective and reliable results which was regarded as very important to diagnose and determine objectively the amount of therapeutic doses in impotence. In accordance with the literature data, our results also confirm the reliability and the practical nature of the VSTR test, which is less time-consuming and cheaper than the nocturnal penile tumescence and rigidity (NPTR) test. In the VSTR test, necessary doses of medication needed for satisfactory erection were easily regulated in patients with certain kinds of impotence. Additionally, self-criticism advantage of the patients on erection and an unnecessary need for regular sexual partners may make this test preferable in the near future. However, we believe that a large group of patients with other definite parameters are certainly needed in order to obtain more reliable data.

Prescribing ofSildenafil Citrate (Viagra) by national insurance program physicians. What basic sexual medicine qualification is required?

The role ofSildenafil Citrate (Viagra) in the treatment of Erectile Dysfunction is discussed. Especially in primary care there is a necessity to weigh the individual cost-benefit-ratio. Functional analysis of Erectile Dysfunction, exclusion of psychiatric and organic comorbidity, identification of sexual deviance and couple counseling about the advantages and disadvantages ofSildenafil Citrate (Viagra) prescription are the core prerequisites ofSildenafil Citrate (Viagra) application in primary care. The counseling model of PLIS-SIT is proposed as a guideline for counseling process. Current approaches of education for general practitioners are reviewed and the integration in a recently developed training for management of psychiatry and psychosomatic illness in general medical settings is proposed. Finally open questions for research and quality management are discussed

Efficacy and safety of Sildenafil Citrate (Viagra) in the treatment of Erectile Dysfunction in patients with ischemic heart disease.

Erectile Dysfunction is a common condition in men with cardiovascular disease, probably as a result of shared factors that impair hemodynamic mechanisms in the penile and ischemic vasculature. Sildenafil Citrate (Viagra), an orally active, selective inhibitor of phosphodiesterase type 5 (PDE5), has demonstrated excellent efficacy and safety profiles in men with Erectile Dysfunction of various etiologies.Sildenafil Citrate (Viagra) administration is contraindicated in patients who are taking nitrates or nitric oxide donors. This retrospective subanalysis of data from double-blind, placebo-controlled studies assessed the efficacy (9 studies) and safety (11 studies) ofSildenafil Citrate (Viagra) in patients with Erectile Dysfunction and ischemic heart disease who were not taking nitrates. Of 3,672 patients randomized to receiveSildenafil Citrate (Viagra) (5-200 mg) or placebo for 4-24 weeks in 11 double-blind, placebo-controlled studies, 357 (10%) reported a history (past or present) of ischemic heart disease and were not taking nitrates. Efficacy was assessed using end-of-treatment responses to Question 3 (ability to achieve an erection) and Question 4 (ability to maintain an erection) of the International Index of Erectile Function (IIEF), scores for the 5 domains of male sexual function assessed by the IIEF (erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), and responses to a global efficacy question ("Did the treatment improve your erections?"). The responses to the 2 IIEF questions were graded on a scale of 1 (almost never or never) to 5 (almost always or always), with a score of 0 indicating no attempt at sexual intercourse. At the end of treatment, the mean scores for Question 3 and Question 4 of the IIEF for patients with Erectile Dysfunction and ischemic heart disease were significantly higher for theSildenafil Citrate (Viagra) group than for the placebo group (p <0.0001). Mean end-of-treatment scores for the IIEF domains also demonstrated significant increases for sildenafil-treated patients compared with those receiving placebo (p <0.05). At the end of treatment, improved erections were reported by 70% of patients who receivedSildenafil Citrate (Viagra) and by 20% of those in the placebo group p <0.0001). For theSildenafil Citrate (Viagra) group, the incidences of the most common adverse events (headache 25%, flushing 14%, and dyspepsia 12%) for patients with ischemic heart disease were similar to those in patients without this concomitant illness (21%, 15%, and 10%, respectively). Moreover, the overall incidence of cardiovascular adverse events other than flushing was comparable in patients with and without ischemic heart disease for both treatment groups. Since there is a degree of cardiac risk associated with sexual activity, clinicians should consider the patient's cardiovascular status before initiating any treatment for Erectile Dysfunction. Physicians should be aware that patients with underlying cardiovascular disease could be adversely affected by the vasodilator effects of sildenafil, especially in combination with sexual activity. The results of the present subanalysis indicate that oralSildenafil Citrate (Viagra) significantly improves erectile function and is well tolerated in patients with Erectile Dysfunction and ischemic heart disease who are not taking nitrate therapy

Patterns of use ofSildenafil Citrate (Viagra) among commercially insured adults in the United States: 1998-2002.

Sildenafil is increasingly being marketed to younger healthcare consumers. The purpose of this study was to profileSildenafil Citrate (Viagra) use in commercially insured, adult beneficiaries. Annual ambulatory prescription claims data from 1998 to 2002, for a nationwide, random sample of over 5 million life-years of commercially insured adults (aged > or =18 y), were examined retrospectively. The overall prevalence ofSildenafil Citrate (Viagra) use increased from 0.8% (1998) to 1.4% (2002), an 84% increase. While the growth in use slowed in older males, use became more pronounced in younger males and females and decreased in older females. The fastest growing segment of users was found to be males aged 18-45 y. The proportion of users who had two or more claims for a medication that is suspected of inducing Erectile Dysfunction (ED) and/or a marker for a suspected ED-inducing disease decreased over the study period. Our findings suggest that use may increase among younger male and female patients and those without an underlying etiologic reason for use

Effect of Sildenafil Citrate (Viagra) on an orthotopic prostate cancer growth and metastasis model.

PURPOSE: We characterized the effects of Sildenafil Citrate (Viagra) on the growth and metastasis of human prostate cancer cells in nude mice. MATERIALS AND METHODS: The androgen independent human prostate cancer cell line PC-3 was inoculated into the prostate of nude mice to produce orthotopic primary prostate cancers and metastases. Sildenafil Citrate (Viagra) gavage was started on day 31 after tumor cell inoculation and given every other day 15 times (30 days). The 7 mice in the low dose group received 25 mg/kg body weight Sildenafil Citrate (Viagra) per gavage, while the 7 in the high dose group received 50 mg/kg body weight Sildenafil Citrate (Viagra) and the 9 in the control group received water. Autopsy was performed on day 75 to evaluate primary tumor growth and metastasis. Plasma cyclic guanosine monophosphate concentrations were measured after the single dose of 50 mg/kg Sildenafil Citrate (Viagra) in the mice. RESULTS: Plasma cyclic guanosine monophosphate concentration increased 4-fold 1 hour after Sildenafil Citrate (Viagra) administration. The plasma concentration decreased rapidly and returned to normal after 8 hours. There was no significant difference in tumor weight between any of the 3 groups. The number of metastatic lymph nodes correlated significantly with primary tumor weight (p = 0.03) with a correlation coefficient of 0.454 but there was no significant correlation between the number of involved lymph nodes andSildenafil Citrate (Viagra) administration. Distant metastases were not significantly promoted bySildenafil Citrate (Viagra) administration. CONCLUSIONS: Incontinuous oral administration of Sildenafil Citrate (Viagra) did not promote primary tumor growth and metastasis in an orthotopic prostate cancer model

A retrospective, study of prescribing for Erectile Dysfunction in a UK population during 1997-2000: demand was neither excessive nor continuing to rise.

PURPOSE: The UK NHS restricted the prescription ofSildenafil Citrate (Viagra) to a range of clearly defined clinical situations. We describe the pattern of pharmaceutical management of Erectile Dysfunction (ED) during the period when the new drug was introduced and then regulated. METHODS: We studied the population of males aged over 16 (n = 121,783) who were continuously registered with 60 practices in Tayside between 1 October 1997 and 30 June 2000 using record linkage and case-note verification. The patients' GPs allowed a research nurse to examine the records of these patients for demographic details, comorbidities and resource use. RESULTS: Five hundred and fifty five patients received 2493 prescriptions for alprostadil or sildenafil. The addition of an oral agent to the available therapies in 1998 did lead to a more rapid rise in prescribed treatments but this reached a plateau 3.47 per 1000 adult males per quarter after 12-15 months. Fifty eight per cent of the men had a comorbidity associated with ED. More comorbidities were found in men aged 50-69 and those living in areas of greater deprivation. Depression was a more common comorbidity in younger patients and more men from affluent areas were prescribedSildenafil Citrate (Viagra) following prostatectomy. CONCLUSIONS: In the Tayside region of the UK, the introduction of an effective, acceptable oral therapy for Erectile Dysfunction led to a rise in prescriptions issued for ED. This rise appeared to stop after 12-15 months, perhaps partly because of the governmental restrictions imposed.

Sildenafil Citrate (Viagra) on nitrergic transmission in anococcygeus muscles from the urogenital system of male and female mice.

The effects ofSildenafil Citrate (Viagra) on nitrergic relaxations were compared in anococcygeus muscles from male and female mice. In muscles from both sexes,Sildenafil Citrate (Viagra) (10-300 nM) produced a weak, direct relaxation of carbachol-induced tone, and increased both the amplitude and duration of nitrergic relaxations. The most marked effect was on nitrergic duration (300-400% increase with 300 nM sildenafil); no differences in potency were observed between male (EC(50), 30 nM) and female (EC(50), 25 nM). The rate of onset for potentiation of nitrergic duration was similar in both sexes; but, on washout, the effects ofSildenafil Citrate (Viagra) declined more slowly in the male muscle. Relaxations to both nitric oxide (NO) and sodium nitroprusside were also increased in amplitude and duration by 50 nM sildenafil, while those to forskolin and papaverine were unaffected. The results demonstrate thatSildenafil Citrate (Viagra) causes a similar, potent and selective potentiation of nitrergic transmission in urogenital smooth muscle from both male and female mice

The effect ofSildenafil Citrate (Viagra) on gastric emptying in patients with end-stage renal failure and symptoms of gastroparesis.

BACKGROUND: Delayed gastric emptying is a common disorder among patients with end-stage renal failure (ESRF). Pyloric relaxation, a major determinant of gastric emptying, is a nitric oxide (NO)-mediated process. NO-induced smooth muscle relaxation is mediated through its second messenger cyclic guanosine monophosphate, which is broken by tissue phosphodiesterases (PDEs). Thus the inhibition of cyclic guanosine monophosphate breakdown by PDE inhibitors can potentiate NO-mediated responses and facilitate pyloric relaxation. In an animal model of diabetes mellitus, treatment withSildenafil Citrate (Viagra) (a PDE-5 inhibitor) restored NO-mediated pyloric relaxation and improved gastric emptying. The aim of our study was to examine the hypothesis thatSildenafil Citrate (Viagra) may improve gastric emptying in patients with ESRF and symptoms of gastric paresis. METHODS: We studied 12 patients with ESRF (6 men; age range, 54-80 years; 5 with diabetic nephropathy; 4 +/- 1 years receiving long-term renal replacement therapy) after either placebo or a 25-mg tablet ofSildenafil Citrate (Viagra) (Viagra; Pfizer Inc). Gastric emptying of a solid meal (one medium-sized fried egg mixed with 37 MBq [1 mCi] technetium Tc 99m phytate plus 1 slice of bread and 150 mL of water at the end of the meal) was assessed 1 hour after dosing by use of a single-headed camera. Images were acquired every 30 seconds for 90 minutes immediately after patients ate. RESULTS: The gastric emptying rate was decreased at baseline (after placebo), to 33% +/- 6% (normal, > or =50%). Treatment withSildenafil Citrate (Viagra) had no effect on gastric emptying rates after 90 minutes (from 33% +/- 6% after placebo to 30% +/- 6% after sildenafil, P =.9). CONCLUSIONS:Sildenafil Citrate (Viagra) did not improve gastric emptying in patients with ESRF and gastric paresis.Sildenafil Citrate (Viagra) may have opposing effects on gastric peristalsis (causing gastric relaxation) compared with its effects on pyloric relaxation. Studies combiningSildenafil Citrate (Viagra) with prokinetic drugs are of interest