Sildenafil Citrate Response Correlates with the Nature and the Severity of Penile Vascular Insufficiency

Abstract

Introduction Sildenafil citrate is a highly effective erectogenic agent. However, predicting which patients will respond to this agent is often difficult. While the patient response to this agent is dependent on the nitric oxide–guanylate cyclase–cyclic guanosine monophosphate cascade, the integrity of penile arterial flow and venocclusive mechanism is also important. Duplex Doppler penile ultrasonography can reliably document penile hemodynamics. This study aimed at defining response rates based on degree of penile vascular sufficiency. Methods This study enrolled patients who met strict criteria for sildenafil citrate response who had also undergone penile ultrasound. Correlation was drawn between the nature and the severity of the vascular insufficiency and the response rate to sildenafil citrate. Results The distribution of vascular diagnoses was arteriogenic 64%, venogenic 6%, mixed vascular insufficiency 18%, and normal 12%. The best response was seen in those men with normal vascular studies, 80% responding. Fifty-three percent of all men with any abnormality on penile ultrasound responded; 65% of men with arteriogenic erectile dysfunction (ED), 25% of patients with venogenic ED, and 6% of men with a mixed vascular insufficiency were responders. There was a correlation between the degree of vascular impairment and the response rate. All men with venogenic ED who responded had mild leak. Conclusion These data demonstrate a correlation between the nature and severity of penile vascular disease and the ability to respond to sildenafil citrate. These data may be useful to the sexual medicine practitioner when counseling patients regarding oral erectogenic therapy.

Is there a role for bilateral peak systolic velocity readings in a penile duplex ultrasound?

“…Moreover, there was neither a right or left preference nor a difference in the right or left penile blood-flow haemodynamics. However, our study presented a similar correlation between PSV, EDF and RI and the clinical efficacy questionnaires in previous studies (Mulhall et al, 2005), which reduces the possibility of a type 1 error. Our research clearly shows that when the highest bilateral and lowest bilateral PSV are considered, the lowest bilateral PSV clearly has a higher correlation with the clinical efficacy, penile rigidity and patient-reported treatment satisfaction (Table 5) When assessing the same variables as predictors of improvement, cure and satisfaction, the lowest PSV shows a fair-to-good ability to predict all three events, while RI on any of the four combinations was a fair predictor of cure and satisfaction, although it was a poor predictor of improvement ( Area under the receiver operating characteristic curve (AUC) are displayed.…”

“…All the studied penile blood-flow parameters were correlated with clinical efficacy, as already shown in the past by other groups (Mulhall et al, 2005;Xuan et al, 2016), and with treatment satisfaction as assessed by the EDITS questionnaire and VAS. Although correlation was expected (Cappelleri, Tseng, Stecher, & Goldstein, 2018), it had not been demonstrated until now.…”

ORIGINAL RESEARCH—ED PHARMACOTHERAPY: Flexible‐Dose Vardenafil in a Community‐Based Population of Men Affected by Erectile Dysfunction: A 12‐Week Open‐Label, Multicenter Trial

“…In most trials on PDE5 inhibitors, a higher efficacy is usually reported using higher doses of the drug [12]. However, although vardenafil has shown to be overall effective in ED patients independently of baseline severity and etiology [13], the responsivity to PDE5 inhibitors is variable and correlates with nature and severity of penile vascular impairment [14]. In the present study, the apparently surprising result that, at the endpoint, the highest efficacy occurred in patients taking the lowest dose of the drug can be explained bearing in mind that a dose‐titration strategy has been adopted in the study.…”

Combined intracavernous vasoactive drugs and sildenafil citrate in treatment of severe erectile dysfunction not responding to on-demand monotherapy

“…The common underlying vascular abnormalities were corporal VOD alone or combined with arterial insufficiency. These abnormalities were the causes of failure, and are very difficult to treat, as those cases were predicted to be non-responders according to Mullhall et al [19]; they stated that the presence of any degree of venous leak resulted in reduced efficacy of sildenafil, with only five of 46 (11%) patients responding to sildenafil. Also, corporeal VOD alone or combined with arterial disease is the specific haemodynamic abnormality causing no response to intracavernous pharmacotherapy [18].…”