The corporeal blood gas changes in accordance with the duration of the prolonged erection which developed after intracorporeal pharmacotherapy with papaverine and phentolamine were investigated in 62 impotence patients. The picture of the corporeal blood taken from 15 psychogenic impotence patients (a control group) at 10 minutes after intracavernous injection when they showed full erections was arterial but there was pCO2 rise and pH drop compared to femoral artery blood taken simultaneously. As the erection lasted longer, significant gas changes of the cavernous blood began to appear (p<0.0001): increase in pCO2 and decrease in pO2 from 4 hours, decrease in pH from 5 hours, decrease in O2 saturation from 6 hours. Erections lasting for more than 16 hours showed significantly worse hypoxia (p<0.05). Therefore, to prevent hypoxia and metabolic acidosis, drug-induced prolonged erection would be better decompressed before it lasts for more than 4 hours.
Adult ; Carbon Dioxide/*blood ; Erectile Dysfunction/*blood/drug therapy ; Femoral Artery ; Humans ; Hydrogen-Ion Concentration ; Male ; Middle Aged ; Oxygen/*blood ; Papaverine/administration & dosage/therapeutic use ; Penile Erection/*drug effects ; Phentolamine/administration & dosage/therapeutic use ; Time Factors

AIMTo examine the treatment efficacy of Korean Red Ginseng (KRG) in impotent men with erectile dysfunction (ED).

METHODSA total of 60 patients presenting mild or mild to moderate ED were enrolled in a double-blind, placebo-controlled study in which the efficacies of KRG and a placebo were compared. The patients received either 1,000 mg (3 times daily) of KRG or a placebo.

RESULTSThe five-item version of the International Index of Erectile Function (IIEF-5) score after the treatment was significantly higher in the KRG group compared with that before the treatment (from 16.4 +/- 2.9 to 21.0 +/- 6.3, P < 0.0001). In contrast, there was no difference before and after the treatment in the placebo group (from 17.0 +/- 3.1 to 17.7 +/- 5.6, P > 0.05). In the KRG group, 20 patients (66.6%), reported improved erection, significant in the global efficacy question (P < 0.01); in the placebo group there was no significance. Scores on questions 2 (rigidity), 3 (penetration), 4 and 5 (maintenance), were significantly higher for KRG than those for the placebo when those questions were answered after 12 weeks of each treatment (P < 0.01). When the score in the KRG group was compared to the placebo group after the treatment, there was a significant improvement in total score (IIEF-5 score) in questions 3 and 5 for the KRG-treated group (P < 0.001 and P < 0.0001, respectively). The levels of serum testosterone, prolactine and cholesterol after the treatment were not statistically significant different between the KRG and the placebo group (P > 0.05).

CONCLUSIONOur data show that KRG can be an effective alternative to the invasive approaches for treating male ED.

Adult ; Aged ; Cholesterol ; blood ; Double-Blind Method ; Erectile Dysfunction ; drug therapy ; Humans ; Lipoproteins, HDL ; blood ; Lipoproteins, LDL ; Male ; Middle Aged ; Panax ; Patient Satisfaction ; Phytotherapy ; Plant Extracts ; therapeutic use ; Prolactin ; blood ; Testosterone ; blood

OBJECTIVETo observe the efficacy and safety of Jingui Shengqi Pill in treating partial androgen deficiency in aging males (PADAM), and to explore the new approach in improving the quality of life in PADAM patients.

METHODSForty patients with PADAM were treated with JSP, the efficacy was evaluated with international index of erectile function (IIEF) scoring, PADAM questionnaire scoring, hormone, prostatic specific antigen (PSA), etc., and the data before treatment were compared with those after treatment in the same group.

RESULTSAfter 3 months of treatment, PADAM scoring and IIEF scoring were all significantly improved. Symptoms regarding physical ability, vasomotion, and psychical and mental condition all got improved more markedly than symptoms regarding sexual hypofunction. The serum level of testosterone was 3.85 +/- 0.36 before treatment and 5.02 +/- 0.83 after treatment (P < 0.05); luteinizing hormone of 7.33 +/- 2.14 and 4.84 +/- 1.43 (P < 0.01), follicle-stimulating hormone of 10.22 +/- 4.48 and 6.47 +/- 3.28 (P < 0.01), respectively. The level of PSA failed to change significantly (1.94 +/- 0.55 and 2.06 +/- 0.47, P > 0.05).

CONCLUSIONJSP is effective and safe in treating PADAM, the mechanism of it is different from supplementing extrinsic androgen. It may have produced the effect by means of favorably regulating the condition of sex hormone to improve the balance of pituitary-sex gland axis, so it has more extensive clinical application.

Aged ; Androgens ; deficiency ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Erectile Dysfunction ; drug therapy ; Follicle Stimulating Hormone ; blood ; Humans ; Luteinizing Hormone ; blood ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Testosterone ; blood

The vacuum erectile device (VED) uses negative pressure to increase blood inflow into the corpora cavernosum, with a ring at the base of the penis to maintain erection for intercourse or without a ring for penile rehabilitation. Owing to the limitation of phosphodiesterase 5 inhibitors (PDE5I) shown in the treatment of refractory erectile dysfunction (ED), the use of VED has resurged and is becoming the first line therapy in the treatment of ED following radical prostatectomy (RP). Currently, the combination therapy of VED with PDE5I and that of VED with intracavernous injection are advocated for post-RP ED. Hereby, we review the role of VED in penile rehabilitation, its underlying mechanisms, and the combination therapies for it.
Coitus ; Combined Modality Therapy ; methods ; Erectile Dysfunction ; drug therapy ; etiology ; rehabilitation ; Humans ; Male ; Penile Prosthesis ; Penis ; blood supply ; Phosphodiesterase 5 Inhibitors ; therapeutic use ; Prostatectomy ; adverse effects ; Regional Blood Flow ; Vacuum

Testosterone (T) as a compound for treatment of T deficiency has been available for almost 70 years, but the pharmaceutical formulations have been less than ideal. Traditionally, injectable T esters have been used for treatment, but they generate supranormal T levels shortly after the 2-3 weekly injection interval. T levels then decline very rapidly, becoming subnormal during the days preceding the next injection. The rapid fluctuations in plasma T are subjectively experienced as disagreeable. T undecanoate (TU) is a new injectable T preparation with a considerably better pharmacokinetic profile. After two initial injections separated by a 6-week interval, the following intervals between two injections are generally 12 weeks, eventually amounting to a total of four injections per year. Plasma T levels with this preparation are nearly always in the range of normal men, as are its metabolic products estradiol and dihydrotestosterone (DHT). It reverses the effects of hypogonadism on bone and muscle and metabolic parameters, and on sex functions. It is suitable for male contraception. Its safety profile is excellent because of the continuous normalcy of plasma T levels. No polycythemia has been observed and no adverse effects on lipid profiles. Prostate safety parameters are well within reference limits. TU is a valuable treatment option of androgen deficiency.
Contraceptive Agents, Male ; pharmacokinetics ; therapeutic use ; Erectile Dysfunction ; drug therapy ; Humans ; Hypogonadism ; drug therapy ; Injections, Intramuscular ; Male ; Testosterone ; analogs & derivatives ; blood ; pharmacokinetics ; therapeutic use ; Testosterone Congeners ; pharmacokinetics ; therapeutic use

UNLABELLEDOCTOBER: To explore the effects of the glucagon-like peptide 1 (GLP-1) liraglutide on the penile erectile function of rats with diabetic erectile dysfunction (DED) by observing the impact of liraglutide on the expression of eNOS in the corpus cavernosum of diabetic rats.

METHODSWe randomly divided 30 six-week-old male SD rats into a normal control (n = 10) and an experimental group (n = 20) , established models of diabetes mellitus (DM) in the experimental rats, and subdivided them into a DM (n = 8) and a GLP-1 group (n = 8) to receive intramuscular injection of normal saline and liraglutide at 5 mg per kg of the body weight per day, respectively. After 12 weeks of intervention, we obtained the levels of FPG, FINS, TG, TC, HDL-C, LDL-C, testosterone, and IL-6 and the indexes of Homa-IR and Homa-β, detected the expressions of Akt/p-Akt and eNOS/p-eNOS in the corpus cavernosum by Western blot, and compared the erectile function between different groups.

RESULTSThe frequency and rate of penile erection were significantly lower in the DM group than in the GLP-1 and normal control groups (P < 0.05) and also lower in the GLP-1 group than in the normal controls (P < 0.05). Immunofluorescence staining showed the expression of eNOS mainly in the cytoplasm of the cavernosal vessels and sinusoidal endothelial cells, markedly lower in the DM and GLP-1 groups than in the normal rats (P < 0.05), but higher in the GLP-1 than in the DM group (P < 0.05). The level of eNOS/p-eNOS in the penile tissue was significantly decreased in the DM and GLP-1 groups in comparison with the normal controls (P < 0.01 or P < 0.05), while that of p-eNOS was markedly increased in the GLP-1 group as compared with the DM group (P < 0.05). No statistically significant differences were observed in the Akt level among the three groups of animals (P > 0.05). The expression of p-Akt was remarkably reduced in the DM and GLP-1 groups in comparison with the control rats (P < 0.01 or P < 0.05), but higher in the GLP-1 than in the DM group (P < 0.05).

CONCLUSIONGLP-1 can protect the function of endothelial cells in the corpus cavernosum and improve the erectile function of DED rats by regulating the Akt/ eNOS signaling pathway, which indicates that GLP-1 could be an important option for the treatment and prevention of DED.

Animals ; Blotting, Western ; Diabetes Mellitus, Experimental ; Erectile Dysfunction ; drug therapy ; enzymology ; Hypoglycemic Agents ; pharmacology ; Liraglutide ; pharmacology ; Male ; Nitric Oxide Synthase Type III ; metabolism ; Penile Erection ; drug effects ; Penis ; drug effects ; enzymology ; physiopathology ; Random Allocation ; Rats ; Rats, Sprague-Dawley ; Testosterone ; blood

AIMTo investigate the influence of an extract obtained from five Chinese medicinal plants on sexual behavior of adult male rats.

METHODSThe extract was administered at doses of 30, 60 and 120 mg/kg by oral gavage, acutely (one time, 45 min before mating test) or subchronically (daily for 10 days) in sexually potent and sexually sluggish/impotent rats. Sexual behavior, serum levels of luteinizing hormone (LH) and testosterone (T) were evaluated in treated rats and compared with controls receiving vehicle. The effect of the extract on central dopaminergic neurotransmission was assessed in the nucleus accumbens using a microdialysis technique.

RESULTSIn sexually potent rats, both acute and subchronic treatment with the extract dosed at 30 and 60 mg/kg reduced mount latency and intromission latency. In sluggish/impotent rats, the acutely administered extract at the dose of 60 mg/kg shortened ejaculation latency, whereas subchronically administered at the doses of 30 and 60 mg/kg, reduced mount, intromission and ejaculation latencies, increasing also the percentage of mounting and ejaculating rats. The extract dosed at 60 mg/kg significantly increased LH and T following acute and subchronic administration and increased 3,4-dihydroxyphenylacetic acid levels in the nucleus accumbens, 30 min after the acute administration.

CONCLUSIONThe improvement in both appetitive and consummatory components of sexual behavior observed in male rats treated with the extract could be ascribed to increased serum T level in parallel with the activation of the central dopaminergic system.

Animals ; Brain Chemistry ; drug effects ; Central Nervous System ; drug effects ; Copulation ; drug effects ; Dopamine ; physiology ; Drugs, Chinese Herbal ; pharmacology ; Ejaculation ; drug effects ; Erectile Dysfunction ; drug therapy ; psychology ; Female ; Gonadal Steroid Hormones ; blood ; Luteinizing Hormone ; blood ; Male ; Microdialysis ; Motivation ; Plant Extracts ; pharmacology ; Plants, Medicinal ; chemistry ; Rats ; Rats, Sprague-Dawley ; Sexual Behavior, Animal ; drug effects ; Stimulation, Chemical ; Synaptic Transmission ; drug effects ; Testosterone ; blood

AIMTo evaluate whether the response to sildenafil administration in patients with arterial erectile dysfunction (ED) was related to their peak systolic velocity (PSV), peripheral atherosclerosis, cardiovascular risk factors (RF) and/or comorbidities at low cardiovascular risk.

METHODSWe enrolled 97 patients with 1-2 RF and comorbidities, combined with arterial ED alone (group A, n = 27), ED plus atherosclerotic carotid artery (group B, n = 23), ED plus lower limb artery abnormalities (group C, n = 25), and ED plus carotid and lower limb artery abnormalities (group D, n = 22). Sildenafil efficacy (100 mg twice a week for 12 weeks) was also examined in patients with =or>3 RF, peripheral atherosclerosis and no cardiovascular comorbidities (group E, n = 20).

RESULTSMedian PSV was 24.1, 21.0, 19.3, 14.5 and 17.5 cm/s in groups A, B, C, D and E, respectively. Sildenafil response was higher in group A patients (77.8%), intermediate in groups B and C (65.2% and 56%) and lowest in groups D (45.4%) and E (50%), and the response in latter two groups was significantly lower than in the other three groups. In addition, sildenafil response was negatively influenced by: =or>3 RF, peripheral atherosclerosis and no systemic comorbidity, or presence of 1-2 RF associated with extended atherosclerosis and comorbidities. The number of comorbidities was positively related to atherosclerosis localization or extension (25, 35, 38 and 47 in groups A, B, C and D, respectively).

CONCLUSIONLow sildenafil efficacy in patients with arterial ED was associated with extended atherosclerosis. These patients should undergo extensive ultrasonography and a full cardiovascular examination.

Aged ; Arterial Occlusive Diseases ; complications ; drug therapy ; physiopathology ; Atherosclerosis ; complications ; Cardiovascular Diseases ; complications ; drug therapy ; Erectile Dysfunction ; drug therapy ; etiology ; physiopathology ; Humans ; Lower Extremity ; blood supply ; Male ; Middle Aged ; Physical Examination ; Piperazines ; therapeutic use ; Purines ; therapeutic use ; Regional Blood Flow ; physiology ; Retrospective Studies ; Risk Factors ; Sildenafil Citrate ; Sulfones ; therapeutic use ; Treatment Outcome ; Vasodilator Agents ; therapeutic use

AIMErectile dysfunction may be observed in up to 80% of patients with Peyronie's disease. An objective evaluation of the erectile function is attempted to work out in patients with Peyronie's disease.

METHODSPenile deformity, sexual function and penile vascular status were analyzed in 123 patients with Peyronie's disease, who had not received any pertinent treatment.

RESULTSPenile deformity, palpable plaque and pain on erection were seen in 112 (91%), 97 (78.8%) and 27 (21.9%) of the 123 patients, respectively. Of the 76 patients evaluated by color Doppler ultrasounography, veno-occlusive dysfunction as the vascular component for erectile dysfunction was found in 17 (22.3%), arterial insufficiency in 10 (13.1%) and a mixed picture in 23 (30.2%).

CONCLUSIONThe documentation of penile erectile function and the determination of the vascular status using color Doppler ultrasonography can guide the appropriate therapeutic choice.

Adult ; Aged ; Antioxidants ; therapeutic use ; Colchicine ; therapeutic use ; Erectile Dysfunction ; diagnostic imaging ; drug therapy ; physiopathology ; Gout Suppressants ; therapeutic use ; Humans ; Male ; Middle Aged ; Penile Induration ; diagnostic imaging ; drug therapy ; physiopathology ; Penis ; blood supply ; pathology ; physiopathology ; Ultrasonography, Doppler, Color ; Vitamin E ; therapeutic use

Vardenafil is a new type of PDE5 inhibitor (PDE5I) with great inhibiting potential on PDE5 (IC50: 0.01 nmol/L) for enhancing erectile function. International and domestic clinical studies showed it to be safe and effective in treating ED with mild temporary side effects such as headache, dizziness, flushing and rhinitis. In this paper we reviewed the cardiovascular safety of vardenafil. Studies showed that clinical dosage of vardenafil could decrease the systematic arterial blood pressure mildly (< 10 mmHg) , however, it did not interact in a potentially hazardous way with antihypertensive or antianginal therapy, with the exception of organic nitrates. Vardenafil slightly prolonged the QT interval (QTc) in cardiac repolarization, but with no evidence to prove that it could cause arrhythmia in clinical studies. The rates and categories of cardiovascular adverse events of vardenafil therapy were not significantly different from placebo in 5 clinical trials. Present studies demonstrated that clinical dosage of vardenafil appeared generally well tolerated in most patients with chronic and stable cardiovascular disease and it was an ideal drug for the first line treatment of ED.
Adult ; Blood Pressure ; drug effects ; Erectile Dysfunction ; drug therapy ; Heart ; drug effects ; Humans ; Imidazoles ; adverse effects ; therapeutic use ; Male ; Middle Aged ; Phosphodiesterase Inhibitors ; adverse effects ; therapeutic use ; Piperazines ; adverse effects ; therapeutic use ; Safety ; Sulfones ; adverse effects ; therapeutic use ; Triazines ; adverse effects ; therapeutic use ; Vardenafil Dihydrochloride