小剂量他达拉非联合疏肝益阳胶囊治疗轻中度勃起功能障碍的疗效分析

目的:观察每日1次小剂量他达拉非联合疏肝益阳胶囊治疗轻中度勃起功能障碍(ED)的临床疗效。方法:将90例轻中度ED患者随机分为疏肝益阳胶囊组(A组)、他达拉非组(B组)、他达拉非联合疏肝益阳胶囊组(C组)(每组各30例),于治疗前、治疗后第1月末和治疗后第3月末分别记录3组IIEF-5、简化式(15项)的心理和人际关系量表(SF-PAIRS)等各项积分,并观察疗效变化。结果:①3组治疗前IIEF-5评分依次为(10.13±1.55)、(11.00±1.60)、(10.73±1.91)分,3组相比差异均无统计学意义(P均0.05);治疗后第1个月末评分分别为(13.77±2.11)、(17.77±2.13)、(17.17±3.84)分,B组与C组无差别(P=0.411),但两组均优于A组,差异具有显著性(P0.001);治疗后第3个月末评分分别为(15.77±2.05)、(18.07±2.24)、(19.37±3.76)分,B组与C组均优于A组(P均0.001),C组优于B组(P0.05)。②A组治疗前SF-PAIRS的性自信、性自然指数、时间顾虑等3方面评分分别为(3.90±0.80,8.67±1.94,14.43±1.92),治疗后第1个月末评分分别为(5.83±1.02)、(9.90±1.75)、(11.17±1.68)分,治疗后第3个月末评分分别为(6.73±0.98)、(11.07±2.08)、(10.67±1.60)分;B组治疗前SF-PAIRS的性自信、性自然指数、时间顾虑等3方面评分分别为(4.17±0.87)、(9.37±1.43)、(14.47±1.57)分,治疗后第1个月末评分分别为(6.47±0.78)、(10.83±2.18)、(10.20±1.56)分,治疗后第3个月末评分分别为(6.83±0.91)、(11.30±1.88)、(9.47±1.57)分;C组治疗前SF-PAIRS的性自信、性自然指数、时间顾虑等3方面评分分别为(4.23±0.94)、(9.50±1.89)、(14.67±2.91)分,治疗后第1个月末评分分别为(8.03±1.67)、(13.43±1.10)、(9.70±1.21)分,治疗后第3个月末评分分别为(8.93±1.78)、(14.70±1.26)、(8.87±0.97)分。3组的SF-PAIRS评分治疗后各自较治疗前均有改善,差异具有统计学意义(P0.05);且治疗后C组的3方面评分与A、B两组相比差异均有统计学意义(P0.05)。结论:每日1次小剂量他达拉非联合疏肝益阳胶囊治疗ED不但能有效提高ED患者勃起功能,而且能显著增强患者性自信和性自然程度,同时减少时间顾虑,具有良好的临床疗效。     

Phosphodiesterase-5 inhibitors for the treatment of Raynaud's: a novel indication

Background: Raynaud's phenomenon is a common clinical condition characterized by significant morbidity, especially in patients who have an underlying connective tissue disorder. These patients suffer from a worse clinical phenotype that at times can lead to digital vessel occlusion. Current therapies are not optimal, and better therapeutic options are needed. Objective: To describe the up-to-date data available on the use of phosphodiesterase 5 inhibitors in the treatment of Raynaud's phenomenon. Methods: We performed a literature search of PubMed from 1990 – 2008, as well as a search of the abstracts presented at the American College of Rheumatology scientific meeting and the European League Against Rheumatism scientific meeting for the years 2001 – 2007. The search terms used were ‘Raynaud's’, ‘phosphodiesterase 5 inhibitors’, ‘ tadalafil’, ‘sildenafil’ and ‘vardenafil’. Results/conclusion: Based on current data from small clinical trials, open-label pilot studies and case series and reports, phosphodiesterase 5 inhibitors may help some patients with very serious Raynaud's. A large, well-conducted multicenter, double-blind study is needed to determine the benefit and risk of these agents in Raynaud's phenomenon.     

Seminal vesicles of infertile patients with male accessory gland infection: ultrasound evaluation after prolonged treatment with tadalafil,a selective phosphodiesterase‐5 inhibitor

The aim of this study was to investigate possible ultrasound seminal vesicle (SV) changes in infertile patients with ‘hypertrophic‐congestive’ (HCUF) or ‘fibro‐sclerotic’ (FSUF) ultrasound form of male accessory gland infection (MAGI) after prolonged administration of tadalafil (TAD), a selective phosphodiesterase‐5 inhibitor. Forty infertile patients with HCUF and 40 patients with FSUF and erectile dysfunction were selected and arbitrarily divided into two groups, who were prescribed TAD 5 mg daily for 3 months, the first 20 consecutive patients with HCUF (group A1) or FSUF (group A2) or placebo, the second 20 consecutive patients with HCUF (group B1) or FSUF (group B2). All patients underwent scrotal and prostate‐vesicular transrectal ultrasound evaluation and semen analysis (WHO, 2010) before and after treatment. Group A1 patients showed a significant reduction in fundus/body ratio and higher pre‐ and post‐ejaculatory body SV antero‐posterior diameter difference compared with the other three groups. These patients showed also a significant increase in SV ejection fraction and a significant improvement in the total sperm count, progressive motility, seminal levels of fructose and ejaculate volume. These results suggest that infertile patients with HCUF had an improvement in SV ultrasound features suggestive of chronic inflammation after daily treatment with low doses of TAD.     

Review of tadalafil in the treatment of erectile dysfunction

Approximately 150 million men worldwide experience erectile dysfunction (ED) whereby they are unable to achieve and maintain an erection adequate for satisfactory sexual performance. ED has a considerable impact on quality of life. Tadalafil (Cialis?, Eli Lilly & Co./ICOS) is a novel effective and safe phosphodiesterase type 5 inhibitor, a secondary messenger for the smooth muscle relaxing effects of nitric oxide, which plays a central role in the vasodilation of erectile tissues. It has a longer half-life than sildenafil. As head-to-head comparative trials are lacking, it is not clear what tadalafil offers over sildenafil. In terms of marketing, much is made of the ‘spontaneity’ achievable because of the (relatively) longer half-life of tadalafil.     

Tadalafil 5 mg Once Daily Improves Lower Urinary Tract Symptoms and Erectile Dysfunction: A Systematic Review and Meta‐analysis

Objectives

We carried out a systematic review and meta‐analysis to assess tadalafil 5 mg once‐daily for the treatment of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED).

Methods

A literature review was performed to identify all published randomized double‐blind, placebo‐controlled trials of tadalafil 5 mg once‐daily for the treatment of LUTS and ED. The search included the following databases: MEDLINE, EMBASE, and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated.

Results

Thirteen publications involving a total of 3973 patients were used in the analysis, including 13 RCTs that compared tadalafil 5 mg once‐daily with placebo. We found that tadalafil 5 mg once‐daily was effective in improving LUTS suggestive of BPH and treating ED over 12 weeks in our meta‐analysis. Total International Prostate Symptom Score (IPSS) (SMD = ? 2.02, 95% CI = ? 2.52 to ?1.53, P < 0.00001); Benign Prostatic Hyperplasia Impact Index (BPH‐II) (SMD = ?0.58, 95% CI = ?0.84 to ?0.33, P < 0.00001); International Index of Erectile Function‐erectile function (IIEF) domain (standardized mean difference [SMD] = 5.18, 95% confidence interval [CI] = 4.13–6.23, P < 0.00001) indicated that tadalafil 5 mg once‐daily was more effective than the placebo. Safety assessments included discontinuations due to adverse event (odds ratio (OR) = 1.79, 95% CI = 1.12–2.85, P = 0.01) indicated that tadalafil 5 mg once‐daily was well tolerated.

Conclusions

This meta‐analysis indicates that tadalafil 5 mg once‐daily to be an effective treatment for LUTS and ED with a low occurrence of side effects.