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In trying to determine if a particular drug causes erectile dysfunction, it is difficult to sort out the effects of the drug from those of the disease for which the drug is taken, Dr. R. Shiri and colleagues note in the Journal of Urology.
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"PDE-5 inhibitors have been considered the mainstay of treatment for erectile dysfunction in the general population for many years. Diabetics are prone to this complication, and the etiology of their erectile dysfunction is multifactorial, thus making their treatment a special challenge for physicians and other health care professionals," Vardi said.
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A number of specialized investigations exist for the evaluation of erectile dysfunction but need not be part of the routine evaluation. The penile brachial index involves measuring penile pressure and comparing it with arm pressure. It has limited clinical utility because the data are based on superficial and deep penile arterial pressure, whereas erectile function depends on the deep arteries exclusively. Duplex ultrasonography allows for refined assessment of the penile circulation. The information it provides, however, is operator dependent and rarely alters patient management. Selective pudendal arteriography combined with intracavernous injection of a vasoactive drug should be limited to the small group of patients who are candidates for penile revascularization surgery. These patients include nonsmoking men less than 40 years old with a history of pelvic trauma who have sustained a penile arterial disruption.30
"The mechanisms underlying the association between RLS and erectile dysfunction could be caused by hypofunctioning of dopamine in the central nervous system, which is associated with both conditions," said Gao.
The researchers stressed that the workers were exposed to BPA levels about 50 times higher than what most Chinese or Americans would be exposed to in everyday life.
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Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
THURSDAY, Feb. 1 (HealthDay News) -- More than 18 million men in the United States are affected by erectile dysfunction, a new study finds.
Gao agreed that the diagnosis of restless legs syndrome is not as straightforward as other diagnoses, and that some of the men who reported restless legs syndrome probably did not really have it.
Oral medications include neuropharmacologic agents that are adrenergic receptor antagonists (eg, phentolamine, yohimbine, delequamine), dopamine receptor antagonists (eg, apomorphine, bromocriptine), serotoninergic receptor activators (eg, trazodone), oxytocinergic receptor stimulators (eg, oxytocin), androgens, and PDE inhibitors.
Other adverse events associated with oral PDE-5 inhibitor therapy appear to be few (Table 4). In clinical trials the rates of discontinuation of the drug because of adverse events was low (< 5%) for all of 3 drugs, with few or no cases of priapism.37,53,55,56 Extra caution should be taken for patients who are expected to have reduced clearance of the drug. This group includes men who have severe hepatic or renal insufficiency, men over 65 years old and men taking drugs that inhibit the cytochrome P450 3A4 enzyme (e.g., cimetidine, erythromycin and ketoconazole).57 For these patients it is prudent to start with smaller doses of medication and build up gradually. For sildenafil, it is our experience that a starting dose of 50 mg is safe and effective for all men.
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