Sildenafil efficacy in erectile dysfunction secondary to spinal cord injury depends on the level of cord injuries

Abstract

To evaluate the efficacy of sildenafil in the treatment of neurogenic erectile dysfunction (ED) secondary to upper motor neuron (UMN) and lower motor neuron (LMN) spinal cord injury (SCI). After taking consents 105 patients suffering from ED were enrolled in this prospective study. Seventy-two patients had signs and symptoms of UMN and 33 patients had signs and symptoms of LMN or mixed (UMN and LMN) spinal cord injuries. The patients took 50-100 mg sildenafil or placebo tablet at least 45 min before sexual intercourse. Based on a IIEF questionnaire, success in achieving erection adequate for sexual intercourse was compared between sildenafil and placebo groups in UMN and non-UMN spinal cord injuries. In patients with UMN disease, sildenafil was effective in 82% of patients and its efficacy was statistically higher than placebo (82 vs. 25%, p < 0.05). Twenty-eight per cent of patients with non-UMN disease had a favourable response to sildenafil that was not statistically different from placebo. Sildenafil seems more effective in the treatment of neurogenic ED secondary to UMN spinal cord injury compared with that secondary to LMN injury. Actually, its efficacy on LMN injuries does not seem different from placebo and administration of this treatment may not be effective in spinal cord injury which has caused LMN symptoms.

Efficacy and safety of phosphodieterase-5 inhibitors for treatment of erectile dysfunction secondary to spinal cord injury: a systemic review and meta-analysis

“…[24][25][26]28,29 The reason why we did not analyze efficacy of PDE5 inhibitors with international index of erectile function was that they did not report values of standard deviation, although it has been deemed to have a high degree of sensitivity and specificity for extrapolating treatment-related changes in the erectile function. 40 The data in studies included in this meta-analysis all derived from randomized, double-blind, placebo-controlled trials.…”

“…Fifty-nine studies were excluded on account of duplicate, and 29 studies were excluded because they did not meet our inclusion criteria after reading full-text. In all, six articles [24][25][26][27][28][29] involving six RCTs were adopted for analysis: four RCTs that compared sildenafil with placebo, one RCT that compared vardenafil with placebo and one RCT that compared tadalafil with placebo. The baseline characteristics of the trials included in our meta-analysis are listed in Table 1.…”

An Unusual Case of Neurogenic Sexual Dysfunction Due to Lead Exposure

“…Men who suffer from erectile dysfunction should be investigated for an underlying suspected disease state. We present a rare case of erectile dysfunction secondary to neurogenic sexual dysfunction because of lead poisoning [3][4][5][6].…”

Editorial Comment from Dr Kanto to Testicular sperm extraction for patients with spinal cord injury‐related anejaculation: A single‐center experience

“…First, the degree of erectile dysfunction is usually not very severe in SCI men, because upper spinal cord injury is common in young SCI men. 3 SCI couples can have intercourse with some aids, even when phosphodiesterase type 5 inhibitors are ineffective, although the men can seldom ejaculate by themselves. 4 Second, C-TESE or micro-TESE does not require general anesthesia in SCI men, because they usually do not feel any pain during the procedure, and local anesthesia usually prevents convulsions.…”

“…nifedipine) and monitoring vital signs. 3 Surgical sperm retrieval is the last resort if PVS and electroejaculation fail to induce ejaculation. Although men with SCI have a normal sperm count, they present with low sperm motility and viability.…”