Clinical assessment of sildenafil in the treatment of neurogenic male sexual dysfunction: After the hype.
Objective: To evaluate the efficacy and safety of sildenafil over a two-year period in patients with erectile dysfunction caused by spinal cord injury and multiple sclerosis in a clinical practice following FDA approval and release of the medication to the general healthcare community. Study design: 40 patients including 33 SCI (13 quadriplegics, 20 paraplegics; 14 complete, 19 incomplete) and 7 MS patients were prescribed sildenafil in varying dosages. The patients were asked to return to the clinic for additional prescriptions so that we could assess their clinical response and their incidence of side effects. They were then followed for a period of up to two years either by follow up clinic visits or telephone interviews to determine whether they continued to use sildenafil as an ongoing solution to their erectile dysfunction. Results: Mean erectile response went from 4.9 to 7.8 (scale 1--10). Non-responders went from 9 to 4. 36 of the 40 were able to achieve erections sufficient for sexual intercourse. At the 2-year interval 13 of the 40 were no longer using sildenafil but only six discontinued due to lack of response. Adverse effects were minimal and mimicked those seen in the able-bodied studies. Conclusion: Sildenafil is a safe and effective first line treatment for the treatment of male neurogenic erectile dysfunction. However close clinical surveillance is necessary so that patients can avail themselves of other options should sildenafil not be effective.
Green
Bruce G.
BG
Shepherd Center, Atlanta, GA, USA.
Martin
Sherri
S