Treatment of Male Erectile Dysfunction Following Spinal Cord Injuries Using PDE5 Inhibitors

Česká verzia

Authors: T. Šrámková ^1,2; M. Sutorý ¹
Authors place of work: Klinika traumatologie LF MU Brno, Úrazová nemocnice – Traumacentrum přednosta: prof. MUDr. P. Wendsche, CSc., ředitel: doc. MUDr. Svoboda, CSc., FRCS (T) ¹; Ústav psychologie LF MU Brno, přednostka: doc. PhDr. M. Bendová, CSc. ²
Published in the journal: Rozhl. Chir., 2008, roč. 87, č. 5, s. 250-254.
Category: Monothematic special - Original

Summary

The authors present results of a clinical study examining therapeutic effects of PDE5 inhibitors in the management of male erectile dysfunction following spinal cord injuries. The study was prospective, non-invasive, observational.

Aim:
The aim of the study was to determine efficacy and safety of tadalafil in the treatment of male erectile dysfunction following spinal cord injuries and to assess one- year treatment results.

Material and Methods:
16 males, the mean age of 33 years, participated in a four-week assessment of tadalafil efficacy and safety. A paraplegic couple received 8 tablets of tadalafil 20 mg and recommendation of sexual intercourse twice a week. The males recorded the tablet intake in a „Diary“. The following questionnaire scores were used in the assessment prior and after the four- week treatment period: IIEF-5 (International Index of Erectile Function), GAO (Global Assessment Question), SEP 2 a 3 (Sexual Encountner Profile, questions 2,3). A non- parametric test was used for statistical evaluation.

Results:
In 94% of the males, the treatment resulted in improved erection quality (GAQ) and there was statistically significant improvement in ability for penis imission to vagina (SEP 2, p = 0.005). In 69% of the young disabled males, tadalafil –mediated erection was sufficient to perform a satisfactory intercourse (SEP3, p = 0.001). Based on the IIEF-5 questionnaire data, the erectile function score improvement was statistically significant, compared to that prior to therapy (p = 0.001). 75% of the paralyzed used the benefit of the long-acting PDE5 inhibitor and repeated the sexual intercourse within 36 hours of its intake. Undesirable effects were reported in 3 out of the 16 subjects and a single patient discontinued the treatment due to the side effects.

8 out of the 16 males (50%) continued the tadalafil treatment after one year of medication.

The authors conclude that tadalafil treatment of male erectile dysfunction following spinal cord injuries is safe and effective and is well tolerated for over a year.

Key words:
erectile dysfunction – spinal cord injury – tadalafil

Zdroje

1. Wendsche, P. Současný trend stabilizace úrazů thorakolumbální páteře. Úraz. Chir., 1995, 3, s. 1–15.

2. Wendsche, P., Kříž, J. Doporučené postupy péče v akutní fázi po poškození míchy. Vydal svaz paraplegiků s podporou MZ ČR, Praha, 2006, 23 s.

3. Beneš, V. Poranění míchy. Praha, Avicenum. 3. vydání, 1987, 190 s.

4. Šrámková, T. Sexuologicko-andrologické aspekty traumatických míšních lézí. Kandidátská dizertační práce. Brno, 1998, 135 s.

5. McMahon, Ch. Efficacy and safety of daily tadalafil in men with erectile dysfunction previously unresponsive to on-demand tadalafil. J. Sex. Med., 2004, 1, s. 292–300.

6. Derry, F., Hultling, C., Seftel A. D., Sipski, M. L. Efficacy and safety of sildenafil citrate (Viagra) in men with erectile dysfunction and spinal cord injury:a review. Urology, 2002, 60, Suppl. 2, s. 49–57.

7. Ramos, A. S., Samso, J. V. Specific aspects of erectile dysfunction in spinal cord injury. Int. J. Impot. Res., 2004, 16, Suppl. 2, s. 42–45.

8. Šrámková, T., Dragomirecká, E., Wendsche, P., Cpinová, P., Sutorý, M. Kvalita života mužů s posttraumatickou transverzální míšní lézí. Prakt. Lék., 79, 1999, 5, s. 263–268.

9. Carson, C. C. Oral and injectable medications for the treatment of erectile dysfunction. Curr. Urol. Rep., 2000, 1, s. 307–312.

10. Gao, C. G., Ge, J. P., Chen, L. S. The situation of sildenafil in the treatment of men with erectile dysfunction. Zhonghua nan ke xue = National journal of andrology, 2002, 8, s. 302–308.

11. Šrámková, T., Mechl, M. Prostaglandin E1 Caverject v terapii erektilní dysfunkce. Prakt. Lék. 77, 1999, 6, s. 296–301.

12. Bodner, D. R., Haas, C. A., Krueger, B., Seftel, A. D. Intraurethral alprostadil for treatment of erectile dysfunction in patients with spinal cord injury. Urology, 1999, 53, s. 199–202.

13. Gresser, U., Gleiter, CH. Erectile dysfunction: comparison of efficacy and side effects of the PDE-5 inhibitors sildenafil, vardenafil, tadalafil. Eur. Med. Res., 2002, 7, s. 435–446.

14. Sanchez, R. A., Vidal, J., Jáuregui, M. L., Barrera, M., Giner, M. Efficacy, safety and predictive factors of therapeutic succes with sildenafil for erectile dysfunction in patients with different spinal cord injuries. Spinal Cord, 2001, 39, s. 637–643.

15. McMaytom, M. C., Derry, F. A., Dinsmore, W. W., Glass, C. A., Smith, M. D., et al. A two part pilot study of sildenafil (Viagra) in men with erectile dysfunction caused by spinal cord injury. Spinal Cord, 1999, 37, s. 110–116.

16. Giuliano, F., Hultling, C., El Masry, W. S., et al. Randomized trial of sildenafil for the treatment of erectile dysfunction in spinal cord injury. Ann. Neurol., 1999, 46, s. 15–21.

17. Del Popolo, G., Li Marzi, V., Mondaini, N., Lombardi, G. Time/duration effectivennes of sildenafil versus tadalafil in the treatment of erectile dysfunction in male spinal cord-injured patients. Spinal Cord, 2004, 42, s. 643–648.

18. Porst, H., Giuliano, F., Glina, S., Ralph, D., Casabé, A. R., et al. Evaluation of the efficacy and safety of once-a-day dosing of tadalafil 5 mg and 10 mg in the treatment of erectile dysfunction: results of a multicenter, randomized, double blind, placebo-controlled trial. European Urology, 2006, 50, s. 351–359.

19. Gans, W. H., Zaslau, S., Wheeler, S., Galea, G., Vpenk, J. M. Efficacy and safety of oral sildenafil in men with erectile dysfunction and spinal cord injury. J. Spinal Cord, 2001, 24, s. 35–40.

20. Hutling, C., Giuliano, F., Quirk, F., Pena, B., Misghra, A., Smith, M. D. Quality of life in patients with spinal cord injury receiving Viagra (sidlenafil citrate) for the treatment of erectile dysfunction. Spinal Cord, 2000, 38, s. 363–370.