title: Initial results utilizing combination therapy for patients with a suboptimal response to either alprostadil or sildenafil monotherapy.
abstract: OBJECTIVE
  Intraurethral alprostadil and oral sildenafil are useful in selected patients. However, there continues to be a significant treatment failure rate. Since their mechanisms of action are different, we wanted to evaluate the effectiveness of combination therapy.
  
  
  METHODS
  Of 214 patients treated for erectile dysfunction (ED), 65 were not fully satisfied with the firmness of their erections via monotherapy. Responses were evaluated using the International Index for Erectile Function (IIEF) questionnaire before and after treatment. Group I consisted of 33 patients who tried maximal dose intraurethral alprostadil monotherapy initially, followed by the maximal dose of sildenafil monotherapy, and were still unsatisfied. Group II consisted of 32 patients who tried the maximal dose sildenafil monotherapy initially, followed by the maximal dose of alprostadil monotherapy, and were also unsatisfied. There 65 patients then underwent combination therapy.
  
  
  RESULTS
  60 out of the 65 patients stated they were satisfied with combination therapy. Questionnaire scores for erectile function were 23.1+/-2.0 (114%) for combination therapy vs. 19.2+/-1.8 (77%) and 15.2+/-1.6 (41%) for sildenafil and alprostadil monotherapies (p<0.05). There were no significant differences in responses between the two groups. The men also reported improvement in intercourse and overall satisfaction.
  
  
  CONCLUSIONS
  Combination therapy may be an option for motivated patients who have a suboptimal response from monotherapy.
authors.affiliation: Department of Urology, State University of New York Downstate Medical School, Brooklyn 11203, USA. mydloj06@hscbklyn.edu
authors.forename: J H
authors.initials: JH
authors.lastname: Mydlo
authors.forename: M A
authors.initials: MA
authors.lastname: Volpe
authors.forename: R J
authors.initials: RJ
authors.lastname: Macchia
mesh_terms: D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D007172:Erectile Dysfunction / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage*; D010879:Piperazines / Q000008:administration & dosage*; D011687:Purines; D012189:Retrospective Studies; D000068677:Sildenafil Citrate; D013450:Sulfones; D017211:Treatment Failure; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D000068677:Sildenafil Citrate; D000527:Alprostadil