The aim of this study is to evaluate the effectiveness of short-term sildenafil use in the management of unconsummated marriages diagnosed to be mainly psychogenic in origin. This retrospective study included 35 patients evaluated within an Andrology clinic. Patients underwent a complete medical and sexual history as well as a focused physical examination. Investigations were ordered as necessary following a goal-directed approach. Education about the male and female genital anatomy and the sexual response cycle was carried out, as well as a detailed explanation about the concepts of performance anxiety, vaginismus and the mode of action of sildenafil. Sildenafil on demand therapy was initiated for 1 month and the duration extended as needed. Of 35 patients included in our study, 32 (91%) were able to achieve vaginal intromission and perform sexually. In all, 23 patients needed the sildenafil (66%) for less than 1 month, five (14%) for up to 3 months and four (11%) for more than 3 months. Three patients (9%) were unsuccessful. Treatment failures were managed by intracavernous injection therapy, combined with psychosexual therapy, depending on the cause. We conclude sildenafil use is effective as a short-term treatment option in the management of unconsummated marriages.
Introduction: Among the reasons for patient dissatisfaction following penile prosthesis implantation (PPI) is decreased length, possibly due to implantation as per the flaccid stretched length, which is shorter than the erect length. Aim of Study: To examine safety of sizing implant length as per the erect state, and its efficacy in enhancing patient satisfaction, by evaluating outcome of implantation in patients with refractory ischemic priapism operated upon early enough before fibrosis sets in. Patients and Methods: Patients for the study were recruited in the past 2 years. Nineteen post-priapism patients comprised the study group (SG), and 21 non-priabitic cases comprised the control group (CG) who were treated for ED refractory to oral medication and intr-cavernosal injection. PPI was performed as per the erect length for the SG and the flaccid stretched length for the CG. At final follow up (46 ± 12.4 months), subjective patient's impression of length compared to his recall of erect pre-ED/pre-priapism length was recorded as either "almost the same", "shorter" or "longer", and patient's satisfaction with length was recorded on a 5-point Lickert scale. Complications were reported. Results: In the CG all patients reported a shorter length (100%), in contrast to 5.3% in the SG .Satisfaction with length was 57.1 % higher in the SG compared to CG (mean satisfaction 5, and 2.1 ± 0.96 respectively, p=0.048). None of the cases in either groups encountered anterior or posterior perforation/extrusion) or persistent pain beyond 2 months postoperatively. Clinical Implications : Penile prosthesis implantation as per the erect length and not the flaccid stretched length may be safe and effective in preserving length. Conclusion: Penile prosthesis implantation in the erect state post-priapism was safe and offered higher satisfaction with length, and it is therefore safe and favorable to implant prostheses as per the erect length in other cases.
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