title: Positive effect of counseling and dose adjustment in patients with erectile dysfunction who failed treatment with sildenafil.
abstract: OBJECTIVE
  Many patients with erectile dysfunction (ED) stop using sildenafil due to subjective failure. This study examined whether counseling and maximal dosing (100 mg) could achieve better treatment compliance and could possibly improve treatment outcome.
  
  
  METHODS
  Patients were recruited by newspaper advertisements and referred to 5 ED centers throughout the country. Details about their previous experiences with sildenafil were recorded and following an explicit explanation about the nature and action of the drug, were offered to enter the study. Instructions on drug use were provided during each visit in which four 100 mg Sildenafil tablets were provided. Treatment outcomes were assessed by the international index of erectile function (IIEF) questionnaire after taking 4 and 8 tablets. In 2 ED centers a short video with sexual counseling content was added in between visits.
  
  
  RESULTS
  The study cohort was comprised of 220 patients aged 27-88 years. The majority reported having received limited or no instructions on drug use when sildenafil was first prescribed. A significant increase in IIEF erectile function domain scores (EFDS) between visits 1, 2 and 3 was observed (10.96+/-0.40, 16.73+/-0.51 and 17.82+/-0.55 mean+/-SE, respectively), with 23.6% of the study patients achieving normal erectile function at the end of the study. The parameters of age and initial severity of ED most influenced treatment success.
  
  
  CONCLUSIONS
  Counseling and dose adjustment were directly influential in achieving an excellent response to a second trial of sildenafil in patients with ED who had previously failed treatment with the drug, and obviated their needing to seek more invasive measures.
authors.affiliation: Neuro-urology Unit, Rambam Medical Center, Haifa, Israel. i_gruenwald@rambam.health.gov.il
authors.forename: Ilan
authors.initials: I
authors.lastname: Gruenwald
authors.forename: Ofer
authors.initials: O
authors.lastname: Shenfeld
authors.forename: Juza
authors.initials: J
authors.lastname: Chen
authors.forename: Gil
authors.initials: G
authors.lastname: Raviv
authors.forename: Santiago
authors.initials: S
authors.lastname: Richter
authors.forename: Ayala
authors.initials: A
authors.lastname: Cohen
authors.forename: Yoram
authors.initials: Y
authors.lastname: Vardi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003376:Counseling; D004305:Dose-Response Relationship, Drug; D007172:Erectile Dysfunction / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010726:Phosphodiesterase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D011687:Purines; D000068677:Sildenafil Citrate; D013450:Sulfones
chemical_list: D010726:Phosphodiesterase Inhibitors; D010879:Piperazines; D011687:Purines; D013450:Sulfones; D000068677:Sildenafil Citrate