西地那非治疗合并勃起功能障碍的早泄病人的临床观察

目的 :评价枸橼酸西地那非对合并勃起功能障碍 (ED)的早泄病人的临床疗效和安全性。　方法 :45例诊断为合并ED早泄病人 ,以西地那非片可调整用药方案治疗 1～ 3个月。以阴道内射精潜伏期及配偶性交满意度来评价早泄治疗效果 ,并评估ED的总体疗效和治疗满意度 ,比较治疗前后的国际勃起功能指数评分 5 (IIEF 5 )。　结果 :早泄改善者共 2 7例 ,有效率为 6 0 %。勃起功能改善者共 40例 ,改善率为 88.88%。 2 7例早泄有效者均为 5 0mg西地那非改善了勃起功能的病人 ,且满意率为81.48%;18例早泄无效者中ED治疗满意率仅为 5 .5 6 %。在早泄有效者和无效者间比较其治疗前、后IIEF 5评分及增加值 ,差异均有显著性 (P <0 .0 0 1)。不良反应共 9例(2 0 %) ,均为轻度或中度 ,未经特殊处理即自行缓解。　结论 :对合并ED的早泄病人 ,枸橼酸西地那非片能安全有效地改善其勃起功能 ,如获得满意疗效多能使病人早泄得到改善。     

西地那非在干预男性肾移植受者移植前后勃起功能时的安全性及有效性研究

目的 评价西地那非在干预男性肾移植受者手术前后勃起功能时的有效性及安全性.方法 选取年龄23～58岁、移植肾存活1年以上、血肌酐在移植后1年内维持在150 μmol/L以下的成年男性肾移植受者41人,所有患者在血液透析期间及移植后均口服两地那非两月,对患者血液透析期间、移植后6月及1年的勃起功能进行调查(依据国际问卷表IIEF-5),记录其各个时段的环孢素浓度、血压及血肌酐.结果 肾移植前与移植后6月及1年患者的ED发生率相比,有显著性差异(P<0.05);不论血液透析期间还是移植后,西地那非治疗后的勃起功能与服药前勃起功能相比,有显著性差异(P<0.05);不论血液透析期间还是移植后,西地那非治疗后的环孢素浓度、血压及肌酐与服药前组相比,无显著性差异(P>0.05).结论 肾移植后,患者的勃起功能得到了改善:不论对于尿毒症血液透析患者,还是肾移植受者,西地那非都可以改善患者的勃起功能,而且两地那非的应用具有安全性.     

男性患者肾移植前后的阴茎勃起功能研究

目的　探讨男性肾功能衰竭患者肾移植前后的阴茎勃起功能,以提高肾移植患者的生存质量。方法　50例男性肾功能衰竭患者在肾移植前后填写国际勃起功能指数(IIEF)调查表,并同时测定性激素水平。结果　肾移植前阴茎勃起功能障碍(ED)发病率为84 %,肾移植后肾功能正常时降至54 %(P<0.05);术前血液透析时间在6个月以内者IIEF评分高于透析时间在6~24个月和超过24个月者;不论患者的年龄大小,肾移植术后IIEF评分均有不同程度的提高(P<0.05);肾移植后血清睾酮水平上升(P<0.05),雌二醇和催乳激素明显下降(P<0.05, P<0.01)。结论　肾移植能有效改善肾功能衰竭患者的阴茎勃起状况,受者术后的心理疏导有助于降低ED发病率。     

西地那非治疗勃起功能障碍的临床疗效

目的 :观察西地那非对不同年龄和病因勃起功能障碍 (ED)病人的疗效。　方法 :88例ED病人口服不同剂量的西地那非 4～ 2 2周 ,以国际勃起功能指数 5 (IIEF 5 )评分为评估标准判断疗效 ,设对照组作比较。　结果 :西地那非治疗ED病人的总疗效率为 80 .7% ,IIEF 5值上升幅度与西地那非疗效呈正相关。不同年龄ED病人的疗效无明显差异。神经性ED病人的显效率和IIEF 5值与心因性病人差异显著。　结论 :西地那非治疗ED是安全有效的 ,IIEF 5可作为评判ED疗效的可靠指标。     

西地那非治疗长期透析ED患者有效且安全

男性透析患者中,常会发生勃起功能障碍(ED),为评估枸橼酸西地那非对此类ED患者的临床有效性,Chen J等人进行了一项相关研究。共35位行透析并伴有各种病因所致ED的男性患者(平均年龄60．7岁)服用西地那非25mg到100mg至少6个月。用国际勃起功能评分问卷(IIEF)、整体性评估问题、伴侣满意问题来评估西地那非的有效性,并记录治疗期间发生的任何不良反应。结果显示,根据国际勃起功能评分问卷和整体性评估问题的结果,治疗的有效性为80％(28/35)。伴侣满意度与IIEF     

肾移植病人的勃起功能障碍：西地那非的有效性

肾功能衰竭是引起勃起功能障碍（ED）的一个重要原因，随着医疗技术的发展，越来越多的肾功能衰患者能够接受肾移植手术治疗。 那么肾移植对已经存在ED的患者有何影响？肾移植后有多少患者会新发ED？而目前治疗ED的一线口服药西地那非对肾移植术后患者的勃起功能障碍的疗效和安全性又如何呢？Russo D等人对此进行了相关研究，他们首先对肾移植病人采用国际勃起功能指数（IIEF）评价其勃起功能。     

枸橼酸西地那非治疗勃起功能障碍的疗效和安全性评价

枸橼酸西地那非在广泛的临床应用中，被证明对治疗勃起功能障碍（ED）有效且安全。Benchekroun A等人通过对71名18岁以上ED患者的研究，进一步评估了西地那非的疗效和安全性。在这项对照、开放式、剂量可变的研究中，患者在服用安慰剂4周后，使用西地那非（25～100mg）治疗8周。评价指标包括国际勃起功能指数（IIEF）的第3、4个问题、其他IIEF项目、患者事件记录以及生活质量（QOL）评价。结果显示，IIEF各项评分均比治疗前或安慰剂治疗显著改善，总体QOL和特定性关系及社会关系也有明显改善。西地那非耐受性良好，仅一例因不良反应终止治疗。研究表明，口服西地那非是安全的，并对勃起功能和生活质量均有益。     

肾移植对男性勃起功能及性激素水平的影响

目的：探讨肾移植对男性勃起功能及性激素水平的影响。方法：对24例接受肾移植的已婚男性患者进行勃起功能国际问卷调查（IIEF）和手术前后性激素水平检测,调查肾移植前后不同阶段ED患病率;观察不同年龄、尿毒症病史和透析时间的患者在移植前后IIEF评分的变化;比较肾移植前后的性激素变化。结果：尿毒症期ED患病率高达87．5％,其中重度ED患病率达37．5％。肾移植术后ED患病率降低到45．9％,尤以病史短于3年、透析时间小于3个月和年龄大于46岁者勃起功能改善明显（P〈0．05）;肾移植后能明显降低男性患者泌乳素和雌二醇,升高睾酮。结论：肾移植能改善勃起功能,尤以病史和透析时间短的患者为明显;性激素水平的变化可能在其中发挥一定作用。     

老年ED患者使用西地那非的临床疗效及安全性

勃起功能障碍(ED)是一种影响老年男性的常见疾患,枸橼酸西地那非在治疗广谱病因的男性ED时显示了良好的有效性及耐受性。而老年男性伴随的健康问题比普通人群更多,西地那非在此类人群中的效果和安全性如何呢?FujisawaM等人对老年ED患者服用枸橼酸西地那非的有效性及安全性进行了研究。44名广谱病因的老年ED患者(60至78岁)使用25~50mg的枸橼酸西地那非进行治疗,平均随访(12.3±6.5)个月,治疗前检测血睾酮水平,在治疗前和治疗至少4周后进行IIEF-5评分。结果显示,在使用枸橼酸西地那非后,患者的IIEF-5评分从平均(8.2±3.6)分增高至(21.…     

用彩色多普勒超声论证西地那非对眼部血流灌注的影响

西地那非是治疗勃起功能障碍（ED）的一线口服药，该药的安全性对思者来说非常重要，Kurtulail E等人进行的一项视觉相关的研究进一步证实了西地那非的安全性。他们通过彩色多普勒超声检查（CDU）研究西地那非对眼部血液动力学的影响。首选，依据国际勃起功能指数（IIEF）和男性性健康评价表（SHIM）作为指标，诊断ED患者共38例。患者在服用100mg枸橼酸西地那非后60min和75min进行视网膜中央动脉CDU检查，于20、60、75min进行海绵体动脉CDU检查。     

High prevalence of erectile dysfunction after renal transplantation

BACKGROUND AND METHODS: A cross-sectional study of multifaceted male sexual function in 323 consecutive kidney transplant recipients was conducted by mail by means of the validated International Index of Erectile Function (IIEF). All five IIEF domains (IIEF-5), i.e., erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction, were scored for each responder. IIEF-5 scoring that conformed to the National Institutes of Health definition of erectile dysfunction (ED) was computed for all patients sexually active within the past 4 weeks. RESULTS: Two hundred and seventy-one patients replied. Compared to the controls used for IIEF psychometric validation, kidney transplant recipients gave lower erectile function (P<0.01) and intercourse satisfaction (P<0.05) scores, despite their being younger. ED, according to the IIEF-5 method, was demonstrated in 55.7% of the sexually active patients (n=212). Age, time on dialysis, and iterative transplants were significantly and negatively related to erectile dysfunction. CONCLUSION: IIEF proved to be a valuable means of unveiling highly prevalent erectile dysfunction in male kidney transplant recipients. The negative impact of the time on dialysis was emphasized in the results.     

Erectile dysfunction after kidney transplantation: our 22 years of experience

AIM: To evaluate the results of treatment of erectile dysfunction (ED) in kidney transplant recipients before and after the advent of sildenafil. MATERIALS AND METHODS: From 1981 through 2002, 971 male patients of mean age 53.4 years received a renal graft. Erectile dysfunction (ED) was investigated in all patients at the first urologic visit posttransplantation. Psycho-sexual support was offered to all patients. Before sildenafil use (1998), our diagnostic approach was complex. From 1998 we tested: serum levels of testosterone, prolactin, and glucose with penile duplex ultrasonography and NPT reserved for selected cases. RESULTS: From 1981 through 1998, 365 male kidney transplant recipients (45%) reported ED. Only 169 patients chose to be treated: 27 responded to psycho-sexual therapy; 3 received testosterone with benefit; 133 had a good results from intracavernosal injection of vasoactive drugs; and 6 received a penile prosthesis. Since 1998, 126 patients reported ED (78.3%). Only 78 chose treatment: 24 patients had a satisfactory response to sildenafil (65% with 50 mg and 35% with 100 mg). PGE1 alone or in combination with papaverine and phentolamine produced a good response in 37 patients; 17 patients did not respond to pharmacotherapy; and 5 received a tricomponent penile prosthesis without complications. The side effects of sildenafil and PGE1 therapy were similar to those reported in the literature. CONCLUSIONS: ED is an important problem in male renal transplant recipients. Cultural resistance to treatment is common. However, treatment with sildenafil citrate and intracavernosal self-injection of PGE1 are well accepted, and prosthetic devices may help in resistant cases.     

复方玄驹胶囊联合万艾可治疗万艾可渐进性失效勃起功能障碍的临床观察

目的:探讨复方玄驹胶囊联合万艾可治疗万艾可渐进性失效勃起功能障碍(ED)的临床疗效。方法:将符合万艾可渐进性失效ED诊断标准的36例患者随机分成两组,每组各18例。其中治疗组给予复方玄驹胶囊(口服,2粒/次,3次/日)和万艾可50 mg(性生活前1 h口服)口服;对照组单纯口服万艾可100 mg(性生活前1 h口服)。两组性生活频率1～2次/周,观察期2个月,对用药前后患者国际勃起功能评分(IIEF-5)及TSS伴侣评分进行对比分析。结果:两组每次使用万艾可对勃起功能改善的有效率比较,治疗组总有效率94.44%,对照组88.89%,两组对比差异无显著性意义(P>0.05)。IIEF-5评分治疗组治疗前后分别为(13.166 7±3.601 5)和(20.888 9±3.833 1),而对照组治疗前后分别为(13.055 6±2775 4)和(18.777 8±4.008 2),每组治疗前后对比差异有显著性意义(P<0.05);治疗后两组IIEF-5评分及TSS伴侣评分比较,治疗组的效果均比对照组好,且差异具有显著性意义(P<0.05)。结论:复方玄驹胶囊联合万艾可治疗万艾可渐进性失效ED疗效显著。     

Sildenafil citrate treatment for erectile dysfunction after kidney transplantation

OBJECTIVE: Our goal was to analyze the morbidity of organic erectile dysfunction (ED) in kidney-transplant patients and to evaluate the efficacy and reliability of sildenafil citrate treatment. METHOD: Sixty-five ED patients with normal graft function for 3 to 12 months after kidney transplantation were involved in our study. Erectile dysfunction was diagnosed in all the patients by the International Index of Erectile Dysfunction (IIEF). Among them, 10 patients were in light degree; 32 patients in moderate degree, and 23 patients in severe degree according to IIEF score. All of the patients underwent medical history, physical and chemical examinations. In each patient, the IIEF score, blood urea nitrogen, creatinine, and trough concentrations of cyclosporine were compared before and after taking sildenafil citrate at an initial dose of 50 mg every night. RESULTS: Twenty-six patients without ED before transplantation suffered ED after the operation, and 32 patients with ED before transplantation noticed worsening. Taking sildenafil citrate was effective in 53 patients (81.54%). There were no statistical differences in blood urea nitrogen, creatinine, or trough concentrations of cyclosporine in patients before and after sildenafil treatment. CONCLUSIONS: The morbidity of organic erectile dysfunction increased after transplantation. Sildenafil citrate treatment for ED in kidney-transplant patients was effective and safe. Graft function and trough concentrations of cyclosporine were not affected by sildenafil citrate.     

Addition of metformin to sildenafil treatment for erectile dysfunction in eugonadal nondiabetic men with insulin resistance. A prospective, randomized, double-blind pilot study

Erection depends largely on the release of nitric oxide (NO) by vascular endothelial cells. Insulin resistance (IR) is a metabolic abnormality that produces endothelial dysfunction characterized by decreased synthesis and release of NO. The aim of this paper is to evaluate the effect of treatment with metformin on the response to sildenafil in patients with erectile dysfunction (ED) and IR enrolled in a prospective, randomized, controlled, double-blind placebo study. We included 30 male patients with ED, IR, and poor response to sildenafil. Exclusion criteria included pharmacologic, anatomic, or endocrine ED; diabetes; prostatic surgery; or chronic illnesses. Erectile function was rated according to the International Index of Erectile Function 5 (IIEF-5); IR was measured by homeostasis model assessment (HOMA; IR = HOMA ≥ 3). Patients were randomized to receive metformin (n = 17) or placebo (n = 13). After treatment with metformin, patients with ED showed a significant increase in IIEF-5 score and a significant decrease in HOMA, both occurring at month 2 (IIEF-5: 17.0 ± 6.0 vs 14.3 ± 3.9, P = .01; HOMA: 3.9 ± 1.6 vs 5.5 ± 2.4, P = .01) to 4 of treatment (IIEF-5: 19.8 ± 3.8 vs 14.3 ± 3.9, P = .005; HOMA: 4.5 ± 1.9 vs 5.5 ± 2.4, P = .04), with no changes in these parameters in patients with ED receiving placebo. Patients treated with metformin had more adverse events than those who received placebo: 61.5% compared with 7.7%, P = .03, respectively. Adverse events were mild, mainly gastrointestinal, and did not cause discontinuation of treatment. Treatment with metformin in patients with ED and poor response to sildenafil reduced the IR and improved erectile function.     

Daily use of sildenafil improves endothelial function in men with type 2 diabetes

Diminished vascular endothelial function results in decreased vasodilator capacity and is associated with erectile dysfunction (ED) in patients afflicted with type 2 diabetes. The current study was designed to evaluate whether daily use of sildenafil could alter endothelial function and improve penile rigidity in a group of patients with diabetic ED. A double-blind, placebo-controlled, prospective trial was conducted with 24 men with type 2 diabetes who were randomized into 2 groups: one receiving daily sildenafil (50 mg, n = 12) and the other placebo (n = 12) for 10 weeks. Erectile function was captured subjectively using the International Index of Erectile Function (IIEF-5), and endothelial function was objectively monitored via brachial artery flow-mediated dilation. Among the placebo and sildenafil groups, there were no significant differences in average patient age, time from type 2 diabetes diagnosis, duration of ED, or baseline IIEF-5 scores. Past medical histories, including smoking, alcohol consumption, hypertension, and hyperlipidemia, were also similar. At the conclusion of the 10-week trial, patients who received daily sildenafil had significantly improved erectile rigidity as captured by IIEF-5 (P < .001) and increased endothelial function via brachial artery flow-mediated dilation (P < .01). Endothelial function in men with type 2 diabetes was enhanced with daily sildenafil. Improved erectile rigidity and enhanced vascular circulation was noted after 10 weeks of daily sildenafil use.     

Patient-reported validated functional outcome after extraperitoneal robotic-assisted nerve-sparing radical prostatectomy.

BACKGROUND AND OBJECTIVES: Erectile function after prostate surgery is an important criterion for patients when they are choosing a treatment modality for prostate cancer. Improved visualization, dexterity, and precision afforded by the da Vinci robot allow a precise dissection of the neurovascular bundles. We objectively assessed erectile function after robot-assisted extraperitoneal prostatectomy by using the SHIM (IIEF-5) validated questionnaire. METHODS: Between July 2003 and September 2004, 150 consecutive men underwent da Vinci robot-assisted extraperitoneal radical prostatectomy for clinically localized prostate cancer. The IIEF-5 questionnaire was used to assess postoperative potency in 67 patients who were at least 6 months postsurgery. Erectile function was classified as impotent (<11), moderate dysfunction (11 to 15), mild dysfunction (16 to 21), and potent (22 to 25). All patients used oral pharmacological assistance postprocedure. RESULTS: Sixty-seven patients were available to complete the IIEF-5 questionnaire 6 months to 1 year postprostatectomy. Twelve patients were excluded from the study who abstained from all sexual activity after surgery for emotional or social reasons. Of the 55 patients evaluated, 22 (40%) were impotent, 3 (5.5%) had moderate erectile dysfunction (ED), 12 (21.8%) had mild ED, and 18 (32.7%) were fully potent. The table compares IIEF-5 scores with nerve-sparing status. Of patients who had bilateral nerve sparing, 28/45 (62.2%) had mild or no ED within 6 to 12 months postsurgery, and all expressed satisfaction with their current sexual function or rate of improvement after robotic prostatectomy. CONCLUSION: Robot-assisted extraperitoneal prostatectomy provides comparable outcomes to those of open surgery with regards to erectile function. Assessment of the ultimate maximal erectile function will require continued analysis, as this is likely to further improve beyond 6 to 12 months.     

Early experience with sildenafil for the treatment of erectile dysfunction in renal transplant recipients.

BACKGROUND: Erectile dysfunction (ED) is common in men with renal failure, but is not always alleviated following kidney transplant. The objective of the present study was to assess the feasibility in renal transplant patients of sildenafil citrate treatment, an agent with proven efficacy in the management of ED. METHODS: This was a phase IV, open, multicentre, 3 month, dose-escalation study. All patients meeting the inclusion criteria were prescribed a dose of 50 mg sildenafil at the first visit. Thereafter the dose could be increased to 100 mg or reduced to 25 mg based on efficacy or tolerability. The primary efficacy parameter assessed the ability of patients to achieve erections sufficient for intercourse and to maintain erections after penetration. Secondary endpoints assessed patient satisfaction with sildenafil and the effect of sildenafil on their quality of life. Patients were carefully monitored throughout the study for adverse events, interactions with immunosuppressive therapy and effect on graft function. RESULTS: The study included 50 patients in the intent-to-treat population. Sildenafil significantly improved patient's erection ability and the frequency of their erection maintenance. Analysis of the secondary efficacy parameters revealed that 66% of patients believed treatment had improved their erections. Patients reported improvements in their sexual life and partner relationships and a high level of satisfaction with treatment. There were no interactions between sildenafil and the immunosuppressive drugs and there was no significant adverse effect of sildenafil on graft function. CONCLUSIONS: Sildenafil is an effective and well-tolerated agent for the treatment of ED in renal transplant recipients.