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Medical treatment of erectile dysfunction: Other treatments

ORAL AGENTS

Trazodone
The antidepressant trazodone was noted to occasionally induce priapism and therefore interest developed in its possible role in treatment of erectile dysfunction. There are reports of good erectogenic activity with trazodone, although no significant benefit was found in a placebo-controlled trial. There are also troublesome side-effects, including drowsiness, orthostatic hypotension, nausea and vomiting.

Sildenafil (Viagra®)
Sildenafil is a novel oral therapy currently under active investigation. It is a specific inhibitor of type 5 cGMP phosphodiesterase, which is the predominate isoenzyme in the cavernosal tissue of the penis. Its inhibition leads to increased local levels of the secondary messenger cGMP, leading to relaxation of smooth muscle in the cavernosal tissue. This in turn increases blood flow into the corpora cavernosa, an essential stage in the erectile process. In a double-blind cross-over study of 12 patients with erectile dysfunction of no established organic cause, an objective dose-dependent increase in erectile activity as determined by plethysmography (RigiScan, Dacomed Corporation, MN, USA) was demonstrated. Ten of 12 patients reported improved erectile activity in the sildenafil group compared with two of 12 taking placebo. In another double-blind placebo-controlled study of 351 men with erectile dysfunction, outcome by patient and partner questionnaire confirmed a significant dose-dependent improvement on erectile activity. Side-effects such as facial flushing, headaches and dyspepsia were rare and mild. Sildenafil seems to be efficacious and safe and will undoubtedly play a major role in the treatment of erectile dysfunction in the future. Buy Viagra Professional

Apomorphine
Dopamine receptors situated in midbrain nuclei are known to have a role in the initiation of penile erection. Apomorphine is a short-acting dopamine agonist known to cause nausea, bouts of yawning, and erections, when given by subcutaneous injection. Conventional oral administration of apomorphine tablets is associated with nausea as a side-effect. A new controlled-release tablet for sublingual administration has been found to be associated with a significant increase in erectile activity in two placebo-controlled double-blind variable-dose studies of men with psychogenic erectile dysfunction. Moreover, 70% of patients achieved successful sexual intercourse at home more than 50% of the time. Apomorphine, especially in the sublingual form, therefore seems to be a promising oral treatment for psychogenic erectile dysfunction. Order Cialis Super Active

Phentolamine and prazosin
Alpha-adrenergic antagonists such as phentolamine and prazosin have been reported to have erectogenic activity by reducing the tone of the cavernosal smooth muscle. Erectile response rates of 30-40% were reported with buccal administration of phentolamine, compared with 15-20% with placebo. Although some improvement in erectile activity compared with placebo was noted in men over 50 years of age, this increase did not reach statistical significance. Oral prazosin was found to be significantly more effective than placebo in 65 men with psychogenic erectile dysfunction (response rate 70% vs 26% on placebo). Alpha-adrenergic antagonists, of which yohimbine is also one, can be effective in the treatment of psychogenic erectile dysfunction but their role in organic erectile dysfunction is very limited. Patients may also be troubled by retrograde ejaculation as a side-effect of alpha-blocking medication. Levitra Professional 20mg

Red ginseng
Ginseng has been associated with increased vitality and potency for many years. In two placebo-controlled studies in men with psychogenic erectile dysfunction, no increase in objective parameters of erectile function with RigiScan® monitoring or haemodynamic measurements were shown with Korean red ginseng. Both studies, however, showed significantly increased patient-perceived duration and rigidity of erections, and overall satisfaction with ginseng administration (effectivity 60% vs 30% on placebo). Levitra Plus Online

PGEl: ALTERNATIVE ROUTES OF ADMINISTRATION
PGEl can be given not only as an intracavernosal injection but also transurethrally, known as MUSE (medicated urethral system for erection, figure 2), and topically as a gel. Information regarding the effectiveness of topical PGEl is limited but in one placebo-controlled study significant increases in cavernosal artery blood flow was noted, although only two of the nine men attained an erection.60 The MUSE system involves the placement of a PGEl pellet into the urethra by an applicator after the man has urinated. Up to 80% of the PGEl is absorbed by the urethral mucosa within 10 minutes of administration and significant increases in cavernosal artery blood flow have been shown. The evidence of the safety and efficacy of the MUSE system comes from a double-blind placebo-controlled prospective study of 1511 men aged between 27 and 88 years with erectile dysfunction of varying aetiology. On clinic testing, an erection adequate for sexual intercourse was attained in 65.9% of administrations. In the home treatment phase of the study administration of PGEl transurethrally was followed by sexual intercourse in 50.4% compared with 10.4% in the placebo group. The MUSE was effective regardless of age or the aetiology of the erectile dysfunction. Penile pain was noted in 10.8% of administrations of transurethral PGEl and affected 32.7% of men. However, only 2.4% discontinued because of the pain. Other adverse effects such as dizziness, hypotension and urethral trauma occurred very rarely. In the 3 months of the study there was no evidence of penile fibrosis or any episode of priapism. It would seem that transurethral PGEl is not only an attractive treatment option but is safe and effective. A study comparing MUSE with intracavernosal PGEl is now required. Viagra Jelly 100 mg

TOPICAL AGENTS

Glycerol trinitrate
A glycerol trinitrate cream has been shown to cause marked dilatation of the cavernosal arteries when applied to the penis; however, only tumescence occurred, with inadequate rigidity for penetration. Not only is efficacy poor but side-effects, including hypotension and headache, are a problem. Buy cheap Men’s Health drugs

Triple vasodilator combination
A topically applied cream containing three vasodilators (3% aminophylline, 0.25% isosorbide dinitrate and 0.05% co-dergocrine mesylate) was studied in a randomised double-blind placebo-controlled cross-over trial in 36 men with erectile dysfunction of mixed aetiology. Overall, the results were encouraging, with 58% of men attaining an erection adequate for sexual intercourse with the active cream compared to 8% using the placebo. The cream was particularly effective in men with psychogenic erectile dysfunction, with eight of nine men responding fully. However, only two of seven men with arteriogenic erectile dysfunction responded adequately. In laboratory testing with duplex scanning, a significant increase in penile arterial flow was noted on application of the active cream compared to the placebo. Levitra oral drug

Conclusions

Erectile dysfunction is common, and its morbidity is significant, underdiagnosed and under-treated. Hackett reported that only 10% of a control group with erectile dysfunction had consulted their general practitioners, although 80% said they would like to discuss it if an effective treatment existed. More disappointing is that of those that were treated only 10% found it useful.

Effective medical treatment for erectile dysfunction does exist, intracavernosal injections and vacuum devices reportedly giving satisfactory treatment in more than 70% of cases. Although these techniques may seem unspontaneous or cumbersome, they are well tolerated by the patient and partner, especially if they are in a stable relationship.

Yohimbine has very few side-effects and can have a positive response; it is therefore worth trying in selected patients. Testosterone supplementation will have an effect on many systems and the risks and benefits are not known; there is no evidence that it is beneficial in the treatment of erectile dysfunction in patients with normal testosterone levels. Canadian Pharmacy

Although there are currently available treatments for erectile dysfunction which are safe and effective, what everyone would wish for is a convenient tablet that could be taken when sexual intercourse is desired. Although not yet available, the specific cGMP phosphodiesterase inhibitors such as sildenafil are a significant hope for the future.