Prostaglandin E1 Versus Mixture of Prostaglandin E1, Papaverine and Phentolamine in Nonresponders to High Papaverine Plus Phentolamine Doses

Bechara, Amado; Casabé, A.; Chéliz, G.; Romano, Salomón Víctor; Fredotovich, N.

doi:10.1016/s0022-5347(01)66344-4

Cited by 42 publications

(11 citation statements)

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“…The majority of published reports in this area concern the evaluation of specific diagnostic and therapeutic strategies. [1][2][3][4][5][6] Indeed, the field has advanced significantly in recent years with the advent of intracavernosal injection 7-10 and intraurethral therapy. 11 As health care increasingly moves to the primary care setting, generalists must be more attuned to the pathophysiology, treatments, and psychosocial impacts of erectile dysfunction in their patients.…”

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confidence: 99%

Health-related quality of life in men with erectile dysfunction

1998

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OBJECTIVE:To assess health-related quality of life (HRQOL) in men with erectile dysfunction. DESIGN:Descriptive survey with general and disease-specific measures. The instrument contained three established, validated HRQOL measures, a validated comorbidity checklist, and sociodemographics. The RAND 36-Item Health Survey 1.0 (SF-36) was used to assess general HRQOL. Sexual function and sexual bother were assessed using the UCLA Prostate Cancer Index. The marital interaction scale from the Cancer Rehabilitation Evaluation System Short Form (CARES-SF) was used to assess each patient's relationship with his sexual partner. SETTING:Urology clinics at a university medical center and the affiliated Veterans Affairs (VA) Medical Center. PARTICIPANTS:Thirty-five (67%) of 54 consecutive university patients presenting for erectile dysfunction and 22 (42%) of 52 VA patients who were awaiting a previously prescribed vacuum erection device participated. MAIN RESULTS:The university respondents scored slightly lower than population normals in social function, role limitations due to emotional problems, and emotional well-being. The VA respondents scored lower than expected in all eight domains. Scores for the VA population were significantly lower than those for the university population in physical function, role limitations due to physical problems, bodily pain, and social function. A significant correlation was seen between marital interaction and sexual function ( r ‫؍‬ ؊ .33, p ‫؍‬ .01) but not between marital interaction and sexual bother ( r ‫؍‬ ؊ .15, p ‫؍‬ .26) in the total sample. Sexual function also correlated significantly with general health perceptions ( r ‫؍‬ .34, p ‫؍‬ .01), role limitations due to physical problems ( r ‫؍‬ .29, p ‫؍‬ .03), and role limitations due to emotional problems ( r ‫؍‬ .30, p ‫؍‬ .03). Sexual bother did not correlate with any of the general HRQOL domains. Affluent men reported better sexual function ( p ‫؍‬ .03). CONCLUSIONS:The emotional domains of the SF-36 are associated with more profound impairment than are the physical domains in men with erectile dysfunction. Erectile dysfunction and the bother it causes are discrete domains of HRQOL and distinct from each other in these patients. With increased attention to patient-centered medical outcomes, greater emphasis has been placed on such variables as HRQOL. This should be particularly true for a patient-driven symptom, such as erectile dysfunction.KEY WORDS: erectile dysfunction; impotence; health-related quality of life; medical outcomes. J GEN INTERN MED 1998;13:159-166.

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confidence: 99%

Health-related quality of life in men with erectile dysfunction

1998

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“…285 In a randomized comparison carried out in men with long-term (>6 months) ED, the tri-mix (papaverine 17.64 mg þ phentolamine 0.58 mg þ PGE 1 5.8 mg) was twice as effective as PGE 1 (40 mg) monotherapy (50% vs 22%), with minimal pain (12.5% vs 41%). 286 It appears that the combination effectively tapped the various pathways of erectile mechanism, as mentioned earlier. It also is noteworthy that when poor responders to PDE5 inhibitors were switched to IC injections, 65% satisfactorily continued with selfinjection at the end of a long-term follow-up (25 months), of whom 85% were tri-mix candidates.…”

Section: Papaverine-phentolamine-pge 1 Combination (Tri-mix)mentioning

confidence: 61%

Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)

Hatzimouratidis

Salonia

Adaikan

et al. 2016

The Journal of Sexual Medicine

178

199

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Introduction Treatment of erectile dysfunction is based on pharmacotherapy for most patients. Aim To review the current data on pharmacotherapy for erectile dysfunction based on efficacy, psychosocial outcomes, and safety outcomes. Methods A review of the literature was undertaken by the committee members. All related articles were critically analyzed and discussed. Main Outcome Measures Levels of evidence (LEs) and grades of recommendations (GRs) are provided based on a thorough analysis of the literature and committee consensus. Results Ten recommendations are provided. (i) Phosphodiesterase type 5 (PDE5) inhibitors are effective, safe, and well-tolerated therapies for the treatment of men with erectile dysfunction (LE = 1, GR = A). (ii) There are no significant differences in efficacy, safety, and tolerability among PDE5 inhibitors (LE = 1, GR = A). (iii) PDE5 inhibitors are first-line therapy for most men with erectile dysfunction who do not have a specific contraindication to their use (LE = 3, GR = C). (iv) Intracavernosal injection therapy with alprostadil is an effective and well-tolerated treatment for men with erectile dysfunction (LE = 1, GR = A). (v) Intracavernosal injection therapy with alprostadil should be offered to patients as second-line therapy for erectile dysfunction (LE = 3, GR = C). (vi) Intraurethral and topical alprostadil are effective and well-tolerated treatments for men with erectile dysfunction (LE = 1, GR = A). (vii) Intraurethral and topical alprostadil should be considered second-line therapy for erectile dysfunction if available (LE = 3, GR = C). (viii) Dose titration of PDE5 inhibitors to the maximum tolerated dose is strongly recommended because it increases efficacy and satisfaction from treatment (LE = 2, GR = A). (ix) Treatment selection and follow-up should address the psychosocial profile and the needs and expectations of a patient for his sexual life. Shared decision making with the patient (and his partner) is strongly recommended (LE = 2, GR = A). (x) Counterfeit medicines are potentially dangerous. It is strongly recommended that physicians educate their patients to avoid taking any medication from unauthorized sources (LE = 2, GR = A). The first seven recommendations are the same as those from the Third International Consultation for Sexual Medicine and the last three are new recommendations. Conclusion PDE5 inhibitors remain a first-line treatment option because of their excellent efficacy and safety profile. This class of drugs is continually developed with new molecules and new formulations. Intracavernosal injections continue to be an established treatment modality, and intraurethral and topical alprostadil provide an alternative, less invasive treatment option.

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“…These factors could play a major role in the observed increased need for stronger remedies (higher doses of PGE1 or more effective mixtures of PGE1 and PAP). It is well established that the combination of low or reasonable doses of vasoactive drugs are more effective than high doses of PGE1 to achieve an erection suitable for penetration, with a lower incidence of pain [19].…”

Section: Discussionmentioning

confidence: 99%

Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction

et al. 2006

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Prostaglandin E1 Versus Mixture of Prostaglandin E1, Papaverine and Phentolamine in Nonresponders to High Papaverine Plus Phentolamine Doses

Abstract: The 3-drug mixture may be regarded as more effective than prostaglandin E1 alone in inducing an erectile response with a decreased incidence of pain.

Cited by 42 publications

References 11 publications

Health-related quality of life in men with erectile dysfunction

Health-related quality of life in men with erectile dysfunction

Pharmacotherapy for Erectile Dysfunction: Recommendations From the Fourth International Consultation for Sexual Medicine (ICSM 2015)

Long-term treatment with intracavernosal injections in diabetic men with erectile dysfunction

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