title: Treatment program for erectile dysfunction in patients with cardiovascular diseases.
abstract: The present study assesses the effectiveness of our progressive treatment program for erectile dysfunction in patients with cardiovascular diseases. The study sample included 453 patients aged 36 to 91 years. Therapy in all patients was begun with sildenafil citrate 25 to 100 mg. Those with contraindications, drug adverse effects, or a negative response (erection insufficient for vaginal penetration) were given intracavernous injections of a cocktail of vasoactive drugs (dimix, trimix, or quadmix), followed by the addition of sildenafil citrate to the trimix in case of failure, and then a penile prosthesis. Patients were followed for 2 years; in cases of treatment ineffectiveness during follow-up, drug dosages were increased or a penile prosthesis was suggested. Sildenafil citrate was offered to 417 patients of whom 205 (49.2%) responded positively. The remaining 248 patients received intracavernous injections: 135 (54.4%) had a positive response to the dimix, 85 (75.2%) to the trimix, and 16 (57.1%) to the quadmix. Four of the other 12 patients (0.9%) responded to sildanefil citrate + trimix, and 2 (0.4%) agreed to a penile prosthesis. At the 2-year follow-up of 447 patients, 131 (29.3%) were successfully treated with sildanefil citrate, 92 (20.6%) with dimix, 122 (27.3%) with trimix, 12 (2.7%) with quadmix, and 2 (0.4%) with sildanefil citrate + trimix; 5 patients (1.1%) had a penile implant. Forty-eight patients (10.7%) achieved spontaneous erection, of whom 46 were taking aspirin. Twenty-six patients (5.8%) stopped treatment because of health and family reasons and 9 (2%) had a negative response. Our progressive treatment program for erectile dysfunction has a high success rate in patients with cardiovascular disease: Overall, 98.7% achieved an erection sufficient for vaginal penetration immediately after the trial and 92.2% on follow-up; 10.7% achieved spontaneous erections.
authors.affiliation: Institute of Urology, Rabin Medical Center, Beilinson Campus, Tetah Tiqva, Israel. Shmueli@zahav.net.il
authors.forename: Solomon
authors.initials: S
authors.lastname: Israilov
authors.forename: Jack
authors.initials: J
authors.lastname: Baniel
authors.forename: Joseph
authors.initials: J
authors.lastname: Shmueli
authors.forename: Eva
authors.initials: E
authors.lastname: Niv
authors.forename: Dov
authors.initials: D
authors.lastname: Engelstein
authors.forename: Ephraim
authors.initials: E
authors.lastname: Segenreich
authors.forename: Pinhas M
authors.initials: PM
authors.lastname: Livne
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications*; D004334:Drug Administration Schedule; D007172:Erectile Dysfunction / Q000150:complications / Q000473:pathology / Q000628:therapy*; D006371:Helium / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000008:administration & dosage / Q000627:therapeutic use; D010100:Oxygen / Q000008:administration & dosage / Q000627:therapeutic use; D015917:Penile Prosthesis; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D011687:Purines; D012720:Severity of Illness Index; D000068677:Sildenafil Citrate; D013450:Sulfones; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D010879:Piperazines; D011687:Purines; D013450:Sulfones; D014665:Vasodilator Agents; D006371:Helium; C045257:trimix; D000068677:Sildenafil Citrate; D009584:Nitrogen; D010100:Oxygen