The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform

Craig D Zippe - One of the best experts on this subject based on the ideXlab platform.

  • combination therapy medicated urethral system for erection enhances sexual satisfaction in Sildenafil Citrate failure following nerve sparing radical prostatectomy
    The Journal of Urology, 2006
    Co-Authors: Rupesh Raina, Ashok Agarwal, Kalyana C Nandipati, D Mansour, David C Kaelber, Craig D Zippe
    Abstract:

    The objective of our study was to assess the effec- tiveness of combining medicated urethral system for erection (MUSE) with Sildenafil Citrate in men unsatisfied with the Sildenafil alone. Baseline and follow-up data from 23 patients (mean age, 62.5 6 5.23 years) unsatisfied with the use of the Sildenafil Citrate alone for the treatment of erectile dysfunction following nerve-sparing rad- ical prostatectomy (mean use, 4 attempts/100-mg dose) was ob- tained. All patients started oral Sildenafil Citrate more than 6 months after radical prostatectomy. Combination therapy was initiated using 100 mg Sildenafil Citrate orally 1 hour prior to intercourse. Patients used combination therapy for a minimum of 4 attempts prior to as- sessment with the Sexual Health Inventory of Men (International In- dex for Erectile Function-5) and visual analog scale to gauge rigidity (0-100). The effect of therapy on the total International Index for Erectile Function (IIEF) score and penile rigidity score was as- sessed. Of the 23 patients, 4 (17%) had no improvement with the addition of medicated urethral system for erection and discontinued the drug, while 19 (83%) reported improvement with the penile rigid- ity and sexual satisfaction. The IIEF scores of these 19 patients showed significant improvements in each sexual domain, and the patients reported that erection was sufficient for vaginal penetration 80% of the time. Rigidity scores on a scale of 0-100 with Sildenafil alone averaged 38% (23-53) for men and 46% (26-67) for their partners. With the addition of MUSE, scores increased to 76% for men and 62% for their partners. We conclude that the addition of MUSE to Sildenafil improved sexual satisfaction and penile rigidity in patients unsatisfied with Sildenafil alone.

  • efficacy and factors associated with successful outcome of Sildenafil Citrate use for erectile dysfunction after radical prostatectomy
    Urology, 2004
    Co-Authors: Rupesh Raina, Ashok Agarwal, Eric A Klein, Milton M Lakin, Drogo K Montague, Edward J Mascha, Craig D Zippe
    Abstract:

    OBJECTIVES To assess the efficacy and factors associated with successful treatment of Sildenafil Citrate for erectile dysfunction after radical prostatectomy (RP). METHODS Of the 470 patients who underwent RP at our institution between July 1998 and January 2000, 227 (48%) sought treatment for erectile dysfunction, and 174 (37%) were prescribed Sildenafil Citrate. The starting dose was 50 mg, which was increased to 100 mg if the patient did not have a positive response. Of the 174 patients, 104 (59.8%) had undergone a bilateral nerve-sparing (NS) procedure, 28 (16.1%) had undergone a unilateral NS procedure, and 42 (24.1%) had undergone a non-NS procedure. Erectile function was assessed by the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory for Men (SHIM), at baseline and 1 year after Sildenafil use. The patients' charts were retrospectively reviewed to find factors associated with a successful outcome, which was defined as successful vaginal intercourse. Association with success was assessed by chi-square analysis and the Cochran Armitage test for trend. Bonferroni correction for multiple comparisons was used, with an overall significance level of 0.05 for each factor assessed. RESULTS The mean age was 60.1 +/- 6.25 years, and the mean interval from RP to drug use was 3 months. After treatment with Sildenafil, 100 (57%) of 174 patients responded to the drug: 79 (76%) of 104 in the bilateral NS group, 15 (53.5%) of 28 in the unilateral NS group, and 6 (14.2%) of 42 in the non-NS group. SHIM analysis showed that the magnitude of the improvement was greater in the bilateral NS group (19.97 +/- 1.12) than in the unilateral NS (15.89 +/- 3.38) or non-NS (10.06 +/- 2.0) groups (P <0.020). Four factors were significantly associated statistically with a successful outcome: the presence of at least one neurovascular bundle, a preoperative SHIM score of 15 or greater, age 65 years old or younger, and interval from RP to drug use of more than 6 months (P <0.001). CONCLUSIONS The efficacy of Sildenafil Citrate after RP correlated with the degree of neurovascular bundle preservation, preoperative erectile function status, age, and interval before starting treatment.

  • long term potency after iodine 125 radiotherapy for prostate cancer and role of Sildenafil Citrate
    Urology, 2003
    Co-Authors: Rupesh Raina, Ashok Agarwal, Kush K Goyal, Cheryl Jackson, James Ulchaker, Kenneth W Angermeier, Eric A Klein, Jay P Ciezki, Craig D Zippe
    Abstract:

    Abstract Objectives To assess the long-term sexual potency and attrition in sexual function after iodine-125 ( 125 I) seed radiotherapy and the effect of Sildenafil on radiation-induced erectile dysfunction (ED). Methods This prospective study consisted of 86 sexually active patients (mean age 63.5 ± 7.7 years) who underwent 125 I seed implantation from 1997 to 1999 to treat low-volume prostate cancer (prostate-specific antigen less than 10 ng/mL, Gleason score 6 or less, stage T1-T2). All patients were followed up every 6 to 8 months for 4 years. Patients prescribed Sildenafil Citrate for ED completed the abridged five-item version of the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires. Results The median follow-up was 49.7 months (range 36 to 66). Of 86 patients, 43 (50%) did not initiate drug therapy; and only 36 (83.7%) of the 43 were interviewed at 4 years. Twenty-three (63.8%) of the 36 patients had erections sufficient for vaginal penetration, with a total mean ± SD IIEF-5 score of 15.76 ± 1.13. The other 50% (43 of 86) initiated Sildenafil Citrate for treatment of ED after seed implantation, with a minimal follow-up of 6 months. At 4 years, 32 (74%) of the 43 were responding positively to Sildenafil Citrate, with a total IIEF-5 score of 18.3 ± 1.2. The mean EDITS ± SD score was 76.5 ± 3.2, and the spousal satisfaction rate was 72% (31 of 43). The dropout rate was 37% (16 of 43); 10 (63%) of the 16 discontinued because of a lack of efficacy, 3 (19%) because of a return of natural erections sufficient for vaginal penetration, and 3 (19%) discontinued because of side effects (headaches). Conclusions ED is a major long-term issue after 125 I seed radiotherapy, with a long-term potency rate of 29%. Sildenafil Citrate improves erections in most patients after 125 I seed implantation.

  • long term effect of Sildenafil Citrate on erectile dysfunction after radical prostatectomy 3 year follow up
    Urology, 2003
    Co-Authors: Rupesh Raina, Ashok Agarwal, Kush K Goyal, Eric A Klein, Milton M Lakin, Rakesh Sharma, Drogo K Montague, Craig D Zippe
    Abstract:

    Abstract Objectives To evaluate the long-term effect and safety of Sildenafil Citrate for the treatment of erectile dysfunction after radical prostatectomy (RP). Methods The study consisted of 91 patients with erectile dysfunction from our institution who received oral Sildenafil Citrate after RP. We surveyed these patients using a self-administered questionnaire during the first year of Sildenafil Citrate use to determine treatment satisfaction, patient compliance, and safety. Those who had responded positively to the drug were surveyed again 3 years later (n = 48). Sildenafil Citrate was prescribed at a dose of 50 mg and increased to 100 mg if needed. Data were collected from a self-administered questionnaire using the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory of Men, and the Erectile Dysfunction Inventory of Treatment Satisfaction. The patients were stratified according to the type of nerve-sparing (NS) RP procedure they underwent: bilateral NS, unilateral NS, and non-NS. Results At 3 years, 31 (71%) of the 43 patients who had returned the second surveys were still responding to Sildenafil. Of these 31 respondents, 10 (31%) had augmented their dose from 50 to 100 mg. The dropout rate was 27%; 6 of 12 had discontinued because of the return of natural erections, 5 because of a loss of efficacy, and 1 because his spouse had died. No differences were found in the 1-year and 3-year five-item International Index of Erectile Function (Sexual Health Inventory of Men) and Erectile Dysfunction Inventory of Treatment Satisfaction scores between the NS groups. The most common side effects at 3 years were headache (12%), flushing (10%), and blue or blurred vision (2%). No patient discontinued the drug at 3 years because of side effects. Conclusions The results of this study indicate that the vast majority of patients with erectile dysfunction after RP who initially respond to Sildenafil continue to do so at 3 years and are satisfied and compliant with the treatment regimen.

  • treatment of erectile dysfunction after radical prostatectomy with Sildenafil Citrate viagra
    Urology, 1999
    Co-Authors: Craig D Zippe, Anurag W Kedia, Kalish Kedia, David R Nelson, Ashok Agarwal
    Abstract:

    Objectives. To determine whether the response to the new oral medication, Sildenafil Citrate (Viagra), was influenced by the presence or absence of the neurovascular bundles, as recent reports on its success did not specify the efficacy of the drug in patients with erectile dysfunction after radical prostatectomy. Methods. Baseline and follow-up data from 28 healthy patients presenting with erectile dysfunction after radical prostatectomy were obtained. Patients receiving any neoadjuvant/adjuvant hormones or adjuvant radiation therapy were excluded. Patients reported what their erectile status was before surgery, before Sildenafil therapy, and after using a minimum of four doses of Sildenafil. Both the patients and their spouses were interviewed using the Cleveland Clinic post-prostatectomy questionnaire, which includes questions about response to therapy, duration of intercourse, spousal satisfaction, side effects, and related topics. The patients were compared on the basis of the type of surgical procedure they had undergone—nerve sparing or non-nerve sparing. A positive response to Sildenafil was defined as erection sufficient for vaginal penetration. Results. Of the 15 patients who had bilateral nerve-sparing procedures, 12 (80%) had a positive response to Sildenafil, with a mean duration of 6.92 minutes of vaginal intercourse. These 12 patients also reported a spousal satisfaction rate of 80%. All 12 of the responders had a positive response within the first three doses, and 10 of the 12 responded with the first or second dose. None of the 3 patients who had undergone a unilateral nerve-sparing procedure responded, nor did any of the 10 patients who had undergone a non-nerve-sparing procedure. The two most common side effects of the drug were transient headaches (39%) and abnormal color vision (11%). No patients discontinued the medication because of side effects. Conclusions. Successful treatment of erectile dysfunction in a patient after prostatectomy with Sildenafil Citrate may depend on the presence of bilateral neurovascular bundles. No patient who had undergone a non-nerve-sparing procedure responded. Whether patients who undergo unilateral nerve-sparing procedures will respond to Sildenafil is still unclear because of the small number of patients in our study. These findings should encourage urologists to continue to perform and perfect the nerve-sparing approach. The ability to restore potency with an oral medication after radical prostatectomy will impact our discussion with the patient on the surgical morbidity of radical prostatectomy. UROLOGY 52: 963‐966, 1998. © 1998,

Ashok Agarwal - One of the best experts on this subject based on the ideXlab platform.

  • combination therapy medicated urethral system for erection enhances sexual satisfaction in Sildenafil Citrate failure following nerve sparing radical prostatectomy
    The Journal of Urology, 2006
    Co-Authors: Rupesh Raina, Ashok Agarwal, Kalyana C Nandipati, D Mansour, David C Kaelber, Craig D Zippe
    Abstract:

    The objective of our study was to assess the effec- tiveness of combining medicated urethral system for erection (MUSE) with Sildenafil Citrate in men unsatisfied with the Sildenafil alone. Baseline and follow-up data from 23 patients (mean age, 62.5 6 5.23 years) unsatisfied with the use of the Sildenafil Citrate alone for the treatment of erectile dysfunction following nerve-sparing rad- ical prostatectomy (mean use, 4 attempts/100-mg dose) was ob- tained. All patients started oral Sildenafil Citrate more than 6 months after radical prostatectomy. Combination therapy was initiated using 100 mg Sildenafil Citrate orally 1 hour prior to intercourse. Patients used combination therapy for a minimum of 4 attempts prior to as- sessment with the Sexual Health Inventory of Men (International In- dex for Erectile Function-5) and visual analog scale to gauge rigidity (0-100). The effect of therapy on the total International Index for Erectile Function (IIEF) score and penile rigidity score was as- sessed. Of the 23 patients, 4 (17%) had no improvement with the addition of medicated urethral system for erection and discontinued the drug, while 19 (83%) reported improvement with the penile rigid- ity and sexual satisfaction. The IIEF scores of these 19 patients showed significant improvements in each sexual domain, and the patients reported that erection was sufficient for vaginal penetration 80% of the time. Rigidity scores on a scale of 0-100 with Sildenafil alone averaged 38% (23-53) for men and 46% (26-67) for their partners. With the addition of MUSE, scores increased to 76% for men and 62% for their partners. We conclude that the addition of MUSE to Sildenafil improved sexual satisfaction and penile rigidity in patients unsatisfied with Sildenafil alone.

  • efficacy and factors associated with successful outcome of Sildenafil Citrate use for erectile dysfunction after radical prostatectomy
    Urology, 2004
    Co-Authors: Rupesh Raina, Ashok Agarwal, Eric A Klein, Milton M Lakin, Drogo K Montague, Edward J Mascha, Craig D Zippe
    Abstract:

    OBJECTIVES To assess the efficacy and factors associated with successful treatment of Sildenafil Citrate for erectile dysfunction after radical prostatectomy (RP). METHODS Of the 470 patients who underwent RP at our institution between July 1998 and January 2000, 227 (48%) sought treatment for erectile dysfunction, and 174 (37%) were prescribed Sildenafil Citrate. The starting dose was 50 mg, which was increased to 100 mg if the patient did not have a positive response. Of the 174 patients, 104 (59.8%) had undergone a bilateral nerve-sparing (NS) procedure, 28 (16.1%) had undergone a unilateral NS procedure, and 42 (24.1%) had undergone a non-NS procedure. Erectile function was assessed by the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory for Men (SHIM), at baseline and 1 year after Sildenafil use. The patients' charts were retrospectively reviewed to find factors associated with a successful outcome, which was defined as successful vaginal intercourse. Association with success was assessed by chi-square analysis and the Cochran Armitage test for trend. Bonferroni correction for multiple comparisons was used, with an overall significance level of 0.05 for each factor assessed. RESULTS The mean age was 60.1 +/- 6.25 years, and the mean interval from RP to drug use was 3 months. After treatment with Sildenafil, 100 (57%) of 174 patients responded to the drug: 79 (76%) of 104 in the bilateral NS group, 15 (53.5%) of 28 in the unilateral NS group, and 6 (14.2%) of 42 in the non-NS group. SHIM analysis showed that the magnitude of the improvement was greater in the bilateral NS group (19.97 +/- 1.12) than in the unilateral NS (15.89 +/- 3.38) or non-NS (10.06 +/- 2.0) groups (P <0.020). Four factors were significantly associated statistically with a successful outcome: the presence of at least one neurovascular bundle, a preoperative SHIM score of 15 or greater, age 65 years old or younger, and interval from RP to drug use of more than 6 months (P <0.001). CONCLUSIONS The efficacy of Sildenafil Citrate after RP correlated with the degree of neurovascular bundle preservation, preoperative erectile function status, age, and interval before starting treatment.

  • long term potency after iodine 125 radiotherapy for prostate cancer and role of Sildenafil Citrate
    Urology, 2003
    Co-Authors: Rupesh Raina, Ashok Agarwal, Kush K Goyal, Cheryl Jackson, James Ulchaker, Kenneth W Angermeier, Eric A Klein, Jay P Ciezki, Craig D Zippe
    Abstract:

    Abstract Objectives To assess the long-term sexual potency and attrition in sexual function after iodine-125 ( 125 I) seed radiotherapy and the effect of Sildenafil on radiation-induced erectile dysfunction (ED). Methods This prospective study consisted of 86 sexually active patients (mean age 63.5 ± 7.7 years) who underwent 125 I seed implantation from 1997 to 1999 to treat low-volume prostate cancer (prostate-specific antigen less than 10 ng/mL, Gleason score 6 or less, stage T1-T2). All patients were followed up every 6 to 8 months for 4 years. Patients prescribed Sildenafil Citrate for ED completed the abridged five-item version of the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires. Results The median follow-up was 49.7 months (range 36 to 66). Of 86 patients, 43 (50%) did not initiate drug therapy; and only 36 (83.7%) of the 43 were interviewed at 4 years. Twenty-three (63.8%) of the 36 patients had erections sufficient for vaginal penetration, with a total mean ± SD IIEF-5 score of 15.76 ± 1.13. The other 50% (43 of 86) initiated Sildenafil Citrate for treatment of ED after seed implantation, with a minimal follow-up of 6 months. At 4 years, 32 (74%) of the 43 were responding positively to Sildenafil Citrate, with a total IIEF-5 score of 18.3 ± 1.2. The mean EDITS ± SD score was 76.5 ± 3.2, and the spousal satisfaction rate was 72% (31 of 43). The dropout rate was 37% (16 of 43); 10 (63%) of the 16 discontinued because of a lack of efficacy, 3 (19%) because of a return of natural erections sufficient for vaginal penetration, and 3 (19%) discontinued because of side effects (headaches). Conclusions ED is a major long-term issue after 125 I seed radiotherapy, with a long-term potency rate of 29%. Sildenafil Citrate improves erections in most patients after 125 I seed implantation.

  • long term effect of Sildenafil Citrate on erectile dysfunction after radical prostatectomy 3 year follow up
    Urology, 2003
    Co-Authors: Rupesh Raina, Ashok Agarwal, Kush K Goyal, Eric A Klein, Milton M Lakin, Rakesh Sharma, Drogo K Montague, Craig D Zippe
    Abstract:

    Abstract Objectives To evaluate the long-term effect and safety of Sildenafil Citrate for the treatment of erectile dysfunction after radical prostatectomy (RP). Methods The study consisted of 91 patients with erectile dysfunction from our institution who received oral Sildenafil Citrate after RP. We surveyed these patients using a self-administered questionnaire during the first year of Sildenafil Citrate use to determine treatment satisfaction, patient compliance, and safety. Those who had responded positively to the drug were surveyed again 3 years later (n = 48). Sildenafil Citrate was prescribed at a dose of 50 mg and increased to 100 mg if needed. Data were collected from a self-administered questionnaire using the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory of Men, and the Erectile Dysfunction Inventory of Treatment Satisfaction. The patients were stratified according to the type of nerve-sparing (NS) RP procedure they underwent: bilateral NS, unilateral NS, and non-NS. Results At 3 years, 31 (71%) of the 43 patients who had returned the second surveys were still responding to Sildenafil. Of these 31 respondents, 10 (31%) had augmented their dose from 50 to 100 mg. The dropout rate was 27%; 6 of 12 had discontinued because of the return of natural erections, 5 because of a loss of efficacy, and 1 because his spouse had died. No differences were found in the 1-year and 3-year five-item International Index of Erectile Function (Sexual Health Inventory of Men) and Erectile Dysfunction Inventory of Treatment Satisfaction scores between the NS groups. The most common side effects at 3 years were headache (12%), flushing (10%), and blue or blurred vision (2%). No patient discontinued the drug at 3 years because of side effects. Conclusions The results of this study indicate that the vast majority of patients with erectile dysfunction after RP who initially respond to Sildenafil continue to do so at 3 years and are satisfied and compliant with the treatment regimen.

  • treatment of erectile dysfunction after radical prostatectomy with Sildenafil Citrate viagra
    Urology, 1999
    Co-Authors: Craig D Zippe, Anurag W Kedia, Kalish Kedia, David R Nelson, Ashok Agarwal
    Abstract:

    Objectives. To determine whether the response to the new oral medication, Sildenafil Citrate (Viagra), was influenced by the presence or absence of the neurovascular bundles, as recent reports on its success did not specify the efficacy of the drug in patients with erectile dysfunction after radical prostatectomy. Methods. Baseline and follow-up data from 28 healthy patients presenting with erectile dysfunction after radical prostatectomy were obtained. Patients receiving any neoadjuvant/adjuvant hormones or adjuvant radiation therapy were excluded. Patients reported what their erectile status was before surgery, before Sildenafil therapy, and after using a minimum of four doses of Sildenafil. Both the patients and their spouses were interviewed using the Cleveland Clinic post-prostatectomy questionnaire, which includes questions about response to therapy, duration of intercourse, spousal satisfaction, side effects, and related topics. The patients were compared on the basis of the type of surgical procedure they had undergone—nerve sparing or non-nerve sparing. A positive response to Sildenafil was defined as erection sufficient for vaginal penetration. Results. Of the 15 patients who had bilateral nerve-sparing procedures, 12 (80%) had a positive response to Sildenafil, with a mean duration of 6.92 minutes of vaginal intercourse. These 12 patients also reported a spousal satisfaction rate of 80%. All 12 of the responders had a positive response within the first three doses, and 10 of the 12 responded with the first or second dose. None of the 3 patients who had undergone a unilateral nerve-sparing procedure responded, nor did any of the 10 patients who had undergone a non-nerve-sparing procedure. The two most common side effects of the drug were transient headaches (39%) and abnormal color vision (11%). No patients discontinued the medication because of side effects. Conclusions. Successful treatment of erectile dysfunction in a patient after prostatectomy with Sildenafil Citrate may depend on the presence of bilateral neurovascular bundles. No patient who had undergone a non-nerve-sparing procedure responded. Whether patients who undergo unilateral nerve-sparing procedures will respond to Sildenafil is still unclear because of the small number of patients in our study. These findings should encourage urologists to continue to perform and perfect the nerve-sparing approach. The ability to restore potency with an oral medication after radical prostatectomy will impact our discussion with the patient on the surgical morbidity of radical prostatectomy. UROLOGY 52: 963‐966, 1998. © 1998,

Rupesh Raina - One of the best experts on this subject based on the ideXlab platform.

  • combination therapy medicated urethral system for erection enhances sexual satisfaction in Sildenafil Citrate failure following nerve sparing radical prostatectomy
    The Journal of Urology, 2006
    Co-Authors: Rupesh Raina, Ashok Agarwal, Kalyana C Nandipati, D Mansour, David C Kaelber, Craig D Zippe
    Abstract:

    The objective of our study was to assess the effec- tiveness of combining medicated urethral system for erection (MUSE) with Sildenafil Citrate in men unsatisfied with the Sildenafil alone. Baseline and follow-up data from 23 patients (mean age, 62.5 6 5.23 years) unsatisfied with the use of the Sildenafil Citrate alone for the treatment of erectile dysfunction following nerve-sparing rad- ical prostatectomy (mean use, 4 attempts/100-mg dose) was ob- tained. All patients started oral Sildenafil Citrate more than 6 months after radical prostatectomy. Combination therapy was initiated using 100 mg Sildenafil Citrate orally 1 hour prior to intercourse. Patients used combination therapy for a minimum of 4 attempts prior to as- sessment with the Sexual Health Inventory of Men (International In- dex for Erectile Function-5) and visual analog scale to gauge rigidity (0-100). The effect of therapy on the total International Index for Erectile Function (IIEF) score and penile rigidity score was as- sessed. Of the 23 patients, 4 (17%) had no improvement with the addition of medicated urethral system for erection and discontinued the drug, while 19 (83%) reported improvement with the penile rigid- ity and sexual satisfaction. The IIEF scores of these 19 patients showed significant improvements in each sexual domain, and the patients reported that erection was sufficient for vaginal penetration 80% of the time. Rigidity scores on a scale of 0-100 with Sildenafil alone averaged 38% (23-53) for men and 46% (26-67) for their partners. With the addition of MUSE, scores increased to 76% for men and 62% for their partners. We conclude that the addition of MUSE to Sildenafil improved sexual satisfaction and penile rigidity in patients unsatisfied with Sildenafil alone.

  • efficacy and factors associated with successful outcome of Sildenafil Citrate use for erectile dysfunction after radical prostatectomy
    Urology, 2004
    Co-Authors: Rupesh Raina, Ashok Agarwal, Eric A Klein, Milton M Lakin, Drogo K Montague, Edward J Mascha, Craig D Zippe
    Abstract:

    OBJECTIVES To assess the efficacy and factors associated with successful treatment of Sildenafil Citrate for erectile dysfunction after radical prostatectomy (RP). METHODS Of the 470 patients who underwent RP at our institution between July 1998 and January 2000, 227 (48%) sought treatment for erectile dysfunction, and 174 (37%) were prescribed Sildenafil Citrate. The starting dose was 50 mg, which was increased to 100 mg if the patient did not have a positive response. Of the 174 patients, 104 (59.8%) had undergone a bilateral nerve-sparing (NS) procedure, 28 (16.1%) had undergone a unilateral NS procedure, and 42 (24.1%) had undergone a non-NS procedure. Erectile function was assessed by the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory for Men (SHIM), at baseline and 1 year after Sildenafil use. The patients' charts were retrospectively reviewed to find factors associated with a successful outcome, which was defined as successful vaginal intercourse. Association with success was assessed by chi-square analysis and the Cochran Armitage test for trend. Bonferroni correction for multiple comparisons was used, with an overall significance level of 0.05 for each factor assessed. RESULTS The mean age was 60.1 +/- 6.25 years, and the mean interval from RP to drug use was 3 months. After treatment with Sildenafil, 100 (57%) of 174 patients responded to the drug: 79 (76%) of 104 in the bilateral NS group, 15 (53.5%) of 28 in the unilateral NS group, and 6 (14.2%) of 42 in the non-NS group. SHIM analysis showed that the magnitude of the improvement was greater in the bilateral NS group (19.97 +/- 1.12) than in the unilateral NS (15.89 +/- 3.38) or non-NS (10.06 +/- 2.0) groups (P <0.020). Four factors were significantly associated statistically with a successful outcome: the presence of at least one neurovascular bundle, a preoperative SHIM score of 15 or greater, age 65 years old or younger, and interval from RP to drug use of more than 6 months (P <0.001). CONCLUSIONS The efficacy of Sildenafil Citrate after RP correlated with the degree of neurovascular bundle preservation, preoperative erectile function status, age, and interval before starting treatment.

  • long term potency after iodine 125 radiotherapy for prostate cancer and role of Sildenafil Citrate
    Urology, 2003
    Co-Authors: Rupesh Raina, Ashok Agarwal, Kush K Goyal, Cheryl Jackson, James Ulchaker, Kenneth W Angermeier, Eric A Klein, Jay P Ciezki, Craig D Zippe
    Abstract:

    Abstract Objectives To assess the long-term sexual potency and attrition in sexual function after iodine-125 ( 125 I) seed radiotherapy and the effect of Sildenafil on radiation-induced erectile dysfunction (ED). Methods This prospective study consisted of 86 sexually active patients (mean age 63.5 ± 7.7 years) who underwent 125 I seed implantation from 1997 to 1999 to treat low-volume prostate cancer (prostate-specific antigen less than 10 ng/mL, Gleason score 6 or less, stage T1-T2). All patients were followed up every 6 to 8 months for 4 years. Patients prescribed Sildenafil Citrate for ED completed the abridged five-item version of the International Index of Erectile Function (IIEF) and the Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaires. Results The median follow-up was 49.7 months (range 36 to 66). Of 86 patients, 43 (50%) did not initiate drug therapy; and only 36 (83.7%) of the 43 were interviewed at 4 years. Twenty-three (63.8%) of the 36 patients had erections sufficient for vaginal penetration, with a total mean ± SD IIEF-5 score of 15.76 ± 1.13. The other 50% (43 of 86) initiated Sildenafil Citrate for treatment of ED after seed implantation, with a minimal follow-up of 6 months. At 4 years, 32 (74%) of the 43 were responding positively to Sildenafil Citrate, with a total IIEF-5 score of 18.3 ± 1.2. The mean EDITS ± SD score was 76.5 ± 3.2, and the spousal satisfaction rate was 72% (31 of 43). The dropout rate was 37% (16 of 43); 10 (63%) of the 16 discontinued because of a lack of efficacy, 3 (19%) because of a return of natural erections sufficient for vaginal penetration, and 3 (19%) discontinued because of side effects (headaches). Conclusions ED is a major long-term issue after 125 I seed radiotherapy, with a long-term potency rate of 29%. Sildenafil Citrate improves erections in most patients after 125 I seed implantation.

  • long term effect of Sildenafil Citrate on erectile dysfunction after radical prostatectomy 3 year follow up
    Urology, 2003
    Co-Authors: Rupesh Raina, Ashok Agarwal, Kush K Goyal, Eric A Klein, Milton M Lakin, Rakesh Sharma, Drogo K Montague, Craig D Zippe
    Abstract:

    Abstract Objectives To evaluate the long-term effect and safety of Sildenafil Citrate for the treatment of erectile dysfunction after radical prostatectomy (RP). Methods The study consisted of 91 patients with erectile dysfunction from our institution who received oral Sildenafil Citrate after RP. We surveyed these patients using a self-administered questionnaire during the first year of Sildenafil Citrate use to determine treatment satisfaction, patient compliance, and safety. Those who had responded positively to the drug were surveyed again 3 years later (n = 48). Sildenafil Citrate was prescribed at a dose of 50 mg and increased to 100 mg if needed. Data were collected from a self-administered questionnaire using the abridged five-item version of the International Index of Erectile Function questionnaire, referred to as the Sexual Health Inventory of Men, and the Erectile Dysfunction Inventory of Treatment Satisfaction. The patients were stratified according to the type of nerve-sparing (NS) RP procedure they underwent: bilateral NS, unilateral NS, and non-NS. Results At 3 years, 31 (71%) of the 43 patients who had returned the second surveys were still responding to Sildenafil. Of these 31 respondents, 10 (31%) had augmented their dose from 50 to 100 mg. The dropout rate was 27%; 6 of 12 had discontinued because of the return of natural erections, 5 because of a loss of efficacy, and 1 because his spouse had died. No differences were found in the 1-year and 3-year five-item International Index of Erectile Function (Sexual Health Inventory of Men) and Erectile Dysfunction Inventory of Treatment Satisfaction scores between the NS groups. The most common side effects at 3 years were headache (12%), flushing (10%), and blue or blurred vision (2%). No patient discontinued the drug at 3 years because of side effects. Conclusions The results of this study indicate that the vast majority of patients with erectile dysfunction after RP who initially respond to Sildenafil continue to do so at 3 years and are satisfied and compliant with the treatment regimen.

John P Mulhall - One of the best experts on this subject based on the ideXlab platform.

  • prophylactic Sildenafil Citrate improves select aspects of sexual function in men treated with radiotherapy for prostate cancer
    The Journal of Urology, 2014
    Co-Authors: Michael J Zelefsky, Daniel Shasha, Rebekah Dunn Branco, Marisa A Kollmeier, Raymond E Baser, Xin Pei, Ronald D Ennis, Richard G Stock, Natan Barchama, John P Mulhall
    Abstract:

    Purpose: We studied adjuvant daily Sildenafil Citrate during and after radiotherapy for prostate cancer for erectile function preservation.Materials and Methods: We performed a randomized, prospective trial of 279 patients with localized prostate cancer treated with radiotherapy who received Sildenafil Citrate (50 mg daily) or placebo (2:1 randomization). Medication/placebo was initiated 3 days before treatment and continued daily for 6 months. Before therapy and 3, 6, 9, 12, 18 and 24 months after radiotherapy patients completed the IIEF questionnaire, including the erectile function domain, the I-PSS questionnaire and the RAND SF-36®. All IIEF domains were scored.Results: At 12 months erectile function scores were better for Sildenafil Citrate than placebo (p = 0.018), 73% of patients on Sildenafil Citrate vs 50% on placebo had mild/no erectile dysfunction (p = 0.024) and the Sildenafil Citrate arm had superior overall satisfaction (p = 0.027) and IIEF total scores (p = 0.043). At 24 months erectile fun...

  • predictors of response to Sildenafil Citrate following radiation therapy for prostate cancer
    The Journal of Sexual Medicine, 2009
    Co-Authors: Patrick E Teloken, Marilyn Parker, Najeeb Mohideen, John P Mulhall
    Abstract:

    ABSTRACT Introduction Phosphodiesterase type 5 inhibitor (PDE5) use is a treatment strategy for prostate cancer patients with post-radiation therapy (RT) erectile dysfunction (ED). Aim To define the predictors of Sildenafil response in men treated with RT for prostate cancer. Main Outcome Measures International Index of Erectile Function (IIEF). Methods Patients were enrolled prospectively if they met the following criteria: (i) either a three-dimensional conformal external beam (EBRT) or brachytherapy (BT) with or without androgen deprivation (AD) for prostate cancer; (ii) self-reported ability to have sexual intercourse prior to RT; (iii) experienced onset of ED following RT; (iv) candidates for Sildenafil Citrate use; (v) followed-up periodically; and (vi) completed the IIEF at least 12 months after RT. Failure to respond to Sildenafil was defined as IIEF-erectile function (EF) domain score of Results One hundred fifty-two patients met all the criteria: 110 in the EBRT group and 42 in the BT group. Mean age was 62 years. The mean follow-up was 38 months. Mean radiation dose for EBRT was 78 Gy and for BT was 101 Gy. Thirty-five patients received AD, 25% of EBRT, and 62% of BT patients. Sixty-one percent of the patients receiving AD had exposure only pre-RT, whereas 39% had pre- and post-RT AD exposure. The mean duration of AD was 4.6 months. Post-RT IIEF-EF domain score at >24 months was 17. Successful response to Sildenafil occurred in 68% of men at 12 months after RT, 50% at 24 months, and 36% at 36 months. On multivariable analysis, predictors of failure to respond to Sildenafil were: older age, longer time after RT, AD > 4 months duration, and RT dose > 85 Gy. Modality of radiation delivery was not predictive of Sildenafil failure. Conclusions A steady decrease in Sildenafil response was seen with increasing duration after RT. Several factors were predictive of Sildenafil failure. Teloken PE, Parker M, Mohideen N, and Mulhall JP. Predictors of response to Sildenafil Citrate following radiation therapy for prostate cancer. J Sex Med **;**:**–**.

  • assessment of the impact of Sildenafil Citrate on lower urinary tract symptoms in men with erectile dysfunction
    The Journal of Sexual Medicine, 2006
    Co-Authors: John P Mulhall, Marilyn Parker, Patricia Guhring, Carin V Hopps
    Abstract:

    ABSTRACT Introduction Sildenafil Citrate is an effective and well‐tolerated oral erectogenic medication. Through phosphodiesterase type 5 (PDE5) inhibition, it induces relaxation in penile smooth muscle, resulting in erection. Due to its mild affinity for other PDE enzymes, it may cause smooth muscle relaxation in a number of other organs. Recent data suggest an association between erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Anecdotally some patients cite improvement in LUTS while using Sildenafil. Aim This study was conducted to assess the impact of Viagra on LUTS, using the International Prostate Symptom Score (IPSS) questionnaire. Main Outcome Measure International Index of Erectile Function (IIEF) and IPSS inventories. Methods Men presenting to a sexual dysfunction clinic who were candidates and opted for treatment with Sildenafil completed the IIEF and IPSS. Men with the IPSS scores greater than 10 were enrolled and completed the IPSS and IIEF questionnaires at least 3 months after the commencement of Sildenafil. Comparisons were made between pre‐ and posttreatment scores in the IPSS and erectile function (EF) domain of the IIEF. Results Forty‐eight men were enrolled, with a mean age of 62 ± 11 years. The mean improvement in the EF domain score was 7 points ( P  = 0.01). The mean improvement in the IPSS score was 4.6 points ( P  = 0.013) and in quality of life (QOL) score was 1.4 points ( P  = 0.025). In total, 60% of men improved their IPSS score, and 35% had at least a 4‐point improvement in their score. The mean number of uses of Sildenafil per week was 2.0 ± 0.6. No significant correlation was seen between the degree of the IPSS improvement and baseline IPSS, baseline EF domain score, or magnitude of improvement in EF domain score. Conclusions These data indicate a positive impact of Viagra on men with mild to moderate LUTS. It is presumed, although unproven, that the medication's effect is mediated through bladder neck/prostatic smooth muscle relaxation. Mulhall JP, Guhring P, Parker M, and Hopps C. Assessment of the impact of Sildenafil Citrate on lower urinary tract symptoms in men with erectile dysfunction. J Sex Med 2006;3:662–667.

Andrew Mccullough - One of the best experts on this subject based on the ideXlab platform.

  • recovery of erectile function after nerve sparing radical prostatectomy and penile rehabilitation with nightly intraurethral alprostadil versus Sildenafil Citrate
    The Journal of Urology, 2010
    Co-Authors: Andrew Mccullough, Herbert Lepor, Run Wang, Wayne G Hellstrom, Kristofer R Wagner, Jason D Engel
    Abstract:

    Purpose: To our knowledge we report the first large, randomized, prospective penile rehabilitation clinical trial to compare the effectiveness of nightly intraurethral alprostadil vs Sildenafil Citrate after nerve sparing prostatectomy.Materials and Methods: We performed a prospective, randomized, open label, multicenter American study in men with normal erectile function who underwent bilateral nerve sparing radical prostatectomy. The International Index of Erectile Function erectile function domain was the primary end point. Subjects initiated nightly treatment within 1 month of surgery with intraurethral alprostadil or oral Sildenafil Citrate (50 mg) for 9 months. After 1-month washout and before sexual activity subjects self-administered Sildenafil Citrate (100 mg) for a total of 6 attempts in 1 month. Secondary end points were the global assessment question, sexual encounter profile, Erectile Dysfunction Inventory of Treatment Satisfaction and measured stretched penile length.Results: Of 139 men who ...

  • original research pharmacotherapy efficacy of Sildenafil Citrate in men with erectile dysfunction following radical prostatectomy a systematic review of clinical data
    The Journal of Sexual Medicine, 2005
    Co-Authors: Francesco Montorsi, Andrew Mccullough
    Abstract:

    ABSTRACT Introduction Radical prostatectomy is a frequently used treatment option for prostate cancer; however, prostatectomy is often associated with significant morbidity, including erectile dysfunction (ED). Aim To analyze the efficacy of Sildenafil Citrate in treating ED after radical prostatectomy. Materials and Methods MEDLINE and CANCERLIT (1998 to January 2004) were searched for English language articles using the key words prostatectomy , Sildenafil , and phosphodiesterase inhibitors . Eleven studies fulfilled the inclusion criteria: primary, discrete data sets of postprostatectomy patients with ED treated with Sildenafil monotherapy. Results Sample sizes ranged from 13 to 198 (mean age, 61 ± 3 years). Treatment durations were 4 weeks (or more than four doses) to 1 year, and Sildenafil dosing was in the recommended range (25–100 mg). Seven studies reported a response rate (range, 14%−53%) for an end point consistent with the primary analysis outcome (erection sufficient for vaginal intercourse); the combined estimate of probability of response was 35% (95% confidence interval [CI], 24%−48%). There was strong evidence for a lower response rate after non–nerve‐sparing (range, 0%−15%) versus nerve‐sparing surgery (range, 35%−75%; combined odds ratio [OR] = 12.1; 95% CI, 5.5–26.6) but not after unilateral (range, 10%−80%) versus bilateral nerve‐sparing surgery (range, 46%−72%; combined OR = 2.21; 95% CI, 0.75–6.54). Conclusions The results of these studies demonstrate that with Sildenafil, more than one third of patients with postprostatectomy ED achieved erection sufficient for intercourse. The odds of responding improved 12‐fold with preservation of at least one neurovascular bundle. Early treatment failure does not necessarily imply lack of efficacy in the future, and patients should be encouraged to continue trying Sildenafil, titrating up to 100 mg as needed. Montorsi F, and McCullough A. Efficacy of Sildenafil Citrate in men with erectile dysfunction following radical prostatectomy: a systematic review of clinical data. J Sex Med 2005;2:658–667.