Risk Factors in Predicting a Poor Response to Sildenafil Citrate in Elderly Men With ErectileDysfunction

K. PARK, J. H. KU, S. W. KIM AND J. S. PAICK, Department of Urology, Seoul National University Hospital,Seoul, Korea

BJU Int, 95: 366–370, 2005

OBJECTIVE: To assess the clinical efficacy of sildenafil and the potential predictors of poor response tosildenafil in elderly patients with erectile dysfunction (ED). PATIENTS AND METHODS: The studyincluded 162 patients (aged � or � 60 years) treated with sildenafil for at least 8 weeks; all patients wereevaluated with a history, physical examination, measurement of total testosterone and a pharmacologicalerection test. Sexual function before and 8 weeks after treatment was assessed using the self-administeredInternational Index of Erectile Function (IIEF). Treatment was considered successful when the patientattained a higher grade on the erectile function (EF) domain score, and an affirmative response to theoverall assessment question. Factors influencing treatment outcome were evaluated by univariate andmultivariate statistical analysis. RESULTS: The overall efficacy with sildenafil was 47% (76/162). Onunivariate analysis, uncontrolled diabetes, current smoking, hypogonadism (�3 microg/L testosterone) andlow pretreatment EF domain score (�17) were selected as predictors of a poor response. On multivariatelogistic regression, a low pretreatment EF domain score was the strongest independent prognostic factor fora poor response (odds ratio 2.25, 95% confidence interval, 1.45–7.33), and this was followed by hypogonad-ism (1.89, 1.12–3.16) and current smoking (1.34, 1.04–3.52). CONCLUSION: In a real clinical setting,sildenafil was effective for about half of the elderly men. The baseline EF domain score, hypogonadism andcurrent smoking were significantly associated with failure of sildenafil. These results suggest that modi-fying reversible risk factors, e.g. stopping smoking and replacing testosterone, would be beneficial inaugmenting the efficacy of sildenafil in elderly men.

Erectile Dysfunction is Strongly Linked With Decreased Libido in Diabetic Men

S. NAKANISHI, K. YAMANE, N. KAMEI, M. OKUBO AND N. KOHNO, Department of Molecular and InternalMedicine, Division of Clinical Medical Science, Programs for Applied Biomedicine, Graduate School ofBiomedical Sciences, Hiroshima University, Hiroshima, Japan

Aging Male, 7: 113–119, 2004

Erectile dysfunction frequently occurs with diabetes mellitus. A survey of diabetic men was conducted byanonymous questionnaire to investigate the associations of erectile dysfunction with various predictivefactors. A total of 112 diabetic males without an obvious history of erectile dysfunction were available foranalyses. The mean age and duration of diabetes were 53.7 �/� 12.2 years and 10.2 �/� 8.6 years (mean�/� standard deviation), respectively. The questionnaire included questions on the presence or absence ofsmoking, hypertension, libido and subjective symptoms of diabetic neuropathy that may be associated witherectile dysfunction. Analysis of the answers to the questionnaire revealed that 40% of the patientscomplained of erectile dysfunction (erection ‘always insufficient’). Erectile dysfunction was significantlycorrelated with age (p � 0.005), but not with duration of diabetes (p � 0.25), adjusted for age. Erectiledysfunction was also associated with sensory neuropathy and reduced libido, independently of age. Thelogistic regression analysis revealed that erectile dysfunction was positively associated with reduced libidoand age. The odds ratio of erectile dysfunction for reduced compared to unreduced libido was 18.21,suggesting that psychogenic factors have a marked influence on erectile dysfunction. It is concluded that thepresence of erectile dysfunction should be considered when symptoms related to diabetic neuropathy areobserved; psychological approaches, such as sexual counseling, could be applied for the treatment of erectiledysfunction.

Testosterone Regulates PDE5 Expression and In Vivo Responsiveness to Tadalafil in Rat CorpusCavernosum

X. H. ZHANG, A. MORELLI, M. LUCONI, L. VIGNOZZI, S. FILIPPI, M. MARINI, G. B. VANNELLI, R. MANCINA, G. FORTI

AND M. MAGGI, Andrology Unit, Department of Clinical Physiopathology, University of Florence, Florence,Italy

Eur Urol, 47: 409–416, 2005

OBJECTIVES: To investigate the effect of testosterone on PDE5 expression and PDE5 inhibitor tadalafilin vivo responsiveness in a rat model. METHODS: PDE5 expression was localized by immunohistochem-istry in the rat corpus cavernosum (CC) and quantified by both real-time RT-PCR and Western blot analysis

MALE AND FEMALE SEXUAL FUNCTION AND DYSFUNCTION; ANDROLOGY 657