Buyang Huanwu Decoction Ameliorates Damage of Erectile Tissue and Function Following Bilateral Cavernous Nerve Injury / 中国结合医学杂志

OBJECTIVE@#To verify the effect of Buyang Huanwu Decoction (BHD) in ameliorating erectile dysfunction (ED) after radical prostatectomy (RP).@*METHODS@#The composition of BHD was verified by ultra-performance liquid chromatography quadrupole time-of-flight mass spectrometry (UPLC-QTOF-MS/MS) analysis. Bilateral cavernous nerve crush injury (BCNI) in rats was used to mimic the neurovascular injury occurring after RP. By the envelope method, forty rats were randomly divided into 4 groups as follows: sham (cavernous nerves exposed only), model (BCNI), low-dosage BHD [LBHD, 12.8 g/(kg·d)], and high-dosage BHD [HBHD, 51.2 g/(kg·d)] groups, 10 rats in each group, feeding for 3 weeks respectively. Erectile function was evaluated by measuring intracavernosal pressure (ICP). Changes in the histopathology of corpus cavernosum (CC) were examined by hematoxylin-eosin staining. Meanwhile, the fibrosis of CC was measured by Masson's trichrome staining and Western blot was used to detect the expressions of collagen I, transforming growth factor beta 1 (TGF- β 1) and α-smooth muscle actin (α-SMA). Apoptosis index was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL) and Western blot for determining the expressions of B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X (Bax). The oxidative stress in the CC were assessed by the superoxide dismutase (SOD), malondialdehyde (MDA) and reactive oxygen species (ROS) levels. The proteins expression of c-Jun N-terminal kinase (JNK) and c-Jun were detected by Western blot. In addition, the expression of α-SMA and p-c-Jun in the CC was observed by double immunofluorescence staining.@*RESULTS@#The UPLC-QTOF-MS/MS analysis showed that BHD contained calycosin-7-O- β -D-glucoside, ononin, calycosin and formononetin. Compared with the model group, LBHD and HBHD treatment improved the ICP and the circumference, area, and weight of CC (P<0.05 or P<0.01). Furthermore, LBHD and HBHD treatments increased CC smooth muscle content and decreased apoptosis index (P<0.05 or P<0.01). LBHD and HBHD also elevated SOD and expression level of α -SMA and Bcl-2, and reduced MDA and ROS levels, as well as expression of TGF- β 1, collagen I, Bax, p-c-JNK, p-JNK in the CC compared with the model group (P<0.05 or P<0.01). The double immunofluorescence staining showed that the fluorescence degree of p-c-Jun in both LBHD and HBHD treatment groups was significantly reduced, whereas the α -SMA expression increased (P<0.05 or P<0.01).@*CONCLUSIONS@#BHD can improve ED of rats with BCNI, which is related to inhibiting fibrosis, apoptosis, and oxidative stress of CC. The ROS/JNK/c-Jun signaling pathway may play an important role in the process.

Effect of Shanhaidan Granules combined with tadalafil on erectile dysfunction: A multi-center clinical trial / 中华男科学杂志

Objective@#To observe the clinical effect and safety of Shanhaidan Granules (SHDG) combined with tadalafil tablets (TT) in the treatment of ED.@*METHODS@#In this open multi-center case-control clinical trial, we enrolled 247 ED patients according to the designed criteria, and treated them orally with SHDG at 10 g per time tid (n = 74), TT at 5 mg per time bid (n = 52), or SHDG + TT at the above doses (n = 121), all for 8 weeks. Before and after medication, we recorded the IIEF-6, erection hardness scores (EHS), traditional Chinese medicine syndromes (TCMS) scores, penile cavernous blood flow parameters and adverse reactions, and compared them between the 3 groups of patients.@*RESULTS@#After 8 weeks of treatment, all the patients showed significantly increased IIEF-6, EHS and TCMS scores in comparison with the baseline (P < 0.05). The total effectiveness rates in the SHDG, TT and SHDG + TT groups were 60.8%, 67.3% and 69.4% respectively based on the IIEF-6 scores, remarkably higher in the TT and SHDG + TT groups than in the SHDG group (P < 0.05), and 40.5%, 32.7% and 63.6% respectively according to the TCMS scores, markedly higher in the SHDG and SHDG + TT groups than in the TT group (P < 0.05). Single-center data manifested significantly increased peak systolic velocity (PSV) of the penile artery in the SHDG + TT and TT groups (P < 0.05). The improvement values of relevant parameters were remarkably higher in the SHDG + TT group than in the TT and SHDG groups, so were IIEF-6 scores in the TT than in the SHDG group, and TCM syndromes in the SHDG than in the TT group. No medication-related adverse events were found in any of patients after treatment, except for some mild side effects including muscle soreness and gastrointestinal reactions in a few cases, all soon relieved, none with abnormalities in blood and urine routine tests or hepatic and renal function indicators.@*CONCLUSIONS@#Shanhaidan Granules combined with tadalafil can significantly improve the erectile function and reduce TCM syndromes in ED patients, and therefore can be applied effectively and safely in clinical practice./.

Evaluation of relaxant responses properties of cinnamon essential oil and its major component, cinnamaldehyde on human and rat corpus cavernosum

ABSTRACT Cinnamomum cassia (Cinnamon) is a well-known traditional medicine with therapeutic benefits for centuries. We evaluated the effects of cinnamon essential oil (CEO) and its main component cinnamaldehyde (CA) on human corpus cavernosum (HCC) and rat CC. The essential oil of cinnamon was analyzed for the confirmation of the oil profile. HCC specimens from patients undergoing penile prosthesis surgery (age 48-69 years) were utilized for functional studies. In addition, erectile responses in anesthetized control and diabetic rats were evaluated in vivo after intracavernosal injection of CEO and CA, and rat CC strips were placed in organ baths. After precontraction with phenylephrine (10µM), relaxant responses to CEO and CA were investigated. CA (96.9%) was found as the major component. The maximum relaxation responses to CEO and CA were 96.4±3.5% and 96.0±5.0% in HCC and 97.5±5.5% and 96.8±4.8% in rat CC, respectively. There was no difference between control and diabetic rats in relaxation responses to CEO and CA. The relaxant responses obtained with essential oil and CA were not attenuated in the presence of nitric oxide synthase (NOS) inhibitor, and soluble guanylate cyclase inhibitor (sGS) in CC. In vivo, erectile responses in diabetic rats were lower than in control rats, which was restored after intracavernosal injection of CEO and CA. CEO and CA improved erectile function and relaxation of isolated strips of rat CC and HCC by a NO/cGMP-independent mechanism. Further investigations are warranted to fully elucidate the restorative effects of CEO and CA on diabetic erectile dysfunction.

Transient global amnesia associated with sildenafil use: report of one case / Amnesia global transitoria asociada al uso de sildenafil: informe de un caso

ABSTRACT A 69 years old male with erectile dysfunction lasting 2 years, took 50 mg of sildenafil for having sex with his wife at about 6 o'clock in the morning. One hour later his wife detected that he had an anterograde memory impairment: this was interpreted as a confusional state. The neurological examination suggested a transient global amnesia (TGA). EEG and cerebral magnetic resonance imaging were non-informative and memory deficits resolved within 24 h. Therefore, a TGA was diagnosed. Since no other trigger was detectable, sildenafil was deemed responsible for its occurrence,

Se reporta el caso de un individuo de sexo masculino de 69 años con disfunción eréctil, que ingiere 50 mg de sildenafil con objetivo de facilitar el mantener relaciones sexuales con su esposa. Una hora después, su esposa nota que su marido presenta una alteración de su memoria anterógrada, lo que fue interpretado como un estado confusional. Evaluado clínicamente su examen neurológico es sugerente de una amnesia transitoria anterógrada. El EEG y las imágenes por resonancia magnética no muestran hallazgos significativos y el déficit de memoria remite dentro de 24 h. en vista de su evolución, se diagnostica una amnesia global transitoria. Como no se identifica otro gatillante, se consideró que el cuadro fue causado por sildenafil..

Efectividad del sildenafil en la disfunción sexual eréctil en pacientes con cáncer de próstata / Eficácia do sildenafil na disfunção sexual erétil em pacientes com câncer de próstata / Effectiveness of sildenafil in erectile sexual dysfunction in patients with prostate cancer

Introducción: el cáncer de próstata es la primera causa de muerte por cáncer en los hombres cubanos y afecta la calidad de su vida sexual. Objetivo: caracterizar los resultados del uso del sildenafil para el manejo de la disfunción sexual eréctil en pacientes con cáncer de próstata tratados con hormonas o radioterapia. Método: se realizó un estudio observacional, ambispectivo y transversal, en el Servicio de Urología del Hospital "Dr. Agostinho Neto" de Guantánamo durante el periodo 2014-2018, que se aprobó por el comité de ética médica. El universo de estudio se conformó por 70 pacientes con diagnóstico de cáncer de próstata, tratados con hormonas o radioterapia, y que presentaron disfunción eréctil. En cada paciente se estudió la edad, tratamiento que se aplicó para el cáncer, tiempo de aparición de la disfunción luego de este, y la respuesta de la función eréctil del pene al uso de sildenafil. Resultados: el 37,2 por ciento de los pacientes tenían entre 70 y 79 años de edad y el 79,1 por ciento se trató con hormonas; la mayor proporción presentó disfunción eréctil de 1 a 2 años después del tratamiento (48,8 por ciento); el 81,4 por ciento respondió adecuadamente al tratamiento con sildenafil, lo que fue independiente del tratamiento del cáncer con hormonas o radioterapia. Conclusiones: los pacientes con cáncer de próstata tratados con hormonas y/o radioterapia se benefician de los efectos del sildenafil(AU)

Introduction: the prostate cancer is the first cause of death for cancer in the Cuban men and it affects the sexual quality of life. Objective: to characterize the results of the use of the sildenafil for the management of the erectile sexual dysfunction in patient with prostate cancer tried with hormones or radiotherapy. Method: was an observational, ambispective and traverse study, in the Service of Urology of the Hospital "Dr. Agostinho Neto" of Guantánamo during the period 2014-2018 that it was approved by the committee of medical ethics. The study universe conformed to for 70 patients with diagnostic of prostate cancer, treaties with hormones and/or radiotherapy, and that they presented erectile dysfunction. In each patient was studied the age, treatment that was applied for the cancer, time of appearance of the dysfunction after this, and the answer of the erectile function of the penis to the sildenafil use. Results: The 37.2 percent of the patients had between 70 and 79 years of age and 79.1 percent were talked with hormones. The biggest proportion presented erectile dysfunction 1 to 2 years after the treatment (48.8 percent). The 81.4 percent responded appropriately to the treatment with sildenafil, what was independent of the treatment of the cancer with hormones or radiotherapy. Conclusion: The patients with prostate cancer tried with hormones and/or radiotherapy benefitted with the use of the sildenafil(AU)

Introdução: em Cuba, o câncer de próstata é a principal causa de morte por câncer em homens. Objetivo: sistematizar as bases teóricas essenciais que sustentam a autopreparação do estudante de medicina e do clínico geral para sua participação na prevenção, diagnóstico precoce e manejo do paciente com câncer de próstata. Método: na Faculdade de Medicina de Guantánamo, entre setembro e dezembro de 2018; foi realizada uma busca nas bases de dados eletrônicas por meio do mecanismo de metabusca do Google Acadêmico. Resultados: elaborouse uma monografia sobre as atuais considerações sobre o câncer de próstata em nível de estudantes de medicina e clínico geral que continhaos seguintes núcleos de conhecimento: definição, fisiopatologia, etiologia, diagnóstico e tratamento. Conclusões: A expressão clínica desse tipo de câncer é diversa e ainda não tem biomarcadores precisos para o diagnóstico, o que torna inevitável permitindo que clínicos gerais para contribuir de forma eficaz na prevenção e no diagnóstico clínico precoce em termos de assegurar ao paciente um maior chance de cura e sobrevivencia(AU)

IcarisideII facilitates the differentiation of ADSCs to SCs via let-7i/STAT3 axis to preserve erectile function

BACKGROUND: IcarisideII (ICAII) could promote the differentiation of adipose tissue-derived stem cells (ADSCs) to Schwann cells (SCs), leading to improvement of erectile function (EF) and providing a realistic therapeutic option for the treatment of erectile dysfunction (ED). However, the underlying molecular mechanisms of ADSCs and ICAII in this process remain largely unclear. METHODS: ADSCs were treated with different concentrations of ICAII. Cell proliferation was determined by MTT assay. qRT-PCR and western blot were performed to detect expressions of SCs markers, signal transducer and activator of transcription-3 (STAT3), and microRNA-let-7i (let-7i). Luciferase reporter assay was conducted to verify the regulatory relationship between let-7i and STAT3. The detection of intracavernosal pressure (ICP) and the ratio of ICP/mean arterial pressure (MAP) were used to evaluate the EF in bilateral cavernous nerve injury (BCNI) rat models. RESULTS: ICAII promoted cell proliferation of ADSCs in a dose-dependent manner. The mRNA and protein levels of SCs markers were increased by ICAII treatment in a dose-dependent manner in ADSCs. Moreover, let-7i was significantly decreased in ICAII-treated ADSCs and upregulation of let-7i attenuated ICAII-induced promotion of SCs markers. In addition, STAT3 was a direct target of let-7i and upregulated in ICAII-treated ADSCs. Interestingly, overexpression of STAT3 abated the let-7i-mediated inhibition effect on differentiation of ADSCs to SCs and rescued the ICAII-mediated promotion effect on it. Besides, combination treatment of ADSCs and ICAII preserved the EF of BCNI rat models, which was undermined by let-7i overexpression. CONCLUSION: ICAII was effective for preserving EF by promoting the differentiation of ADSCs to SCs via modulating let-7i/STAT3 pathway.

Evaluation of the long-term safety and effectiveness of tadalafil once daily in Chinese men with erectile dysfunction: interim results of a multicenter, randomized, open-label trial / 亚洲男科学杂志(英文版)

Once-daily tadalafil administration has been well established; however, studies about tadalafil once-daily treatment in the Chinese population are lacking. In this phase 4, postmarketing study, we ascertained the long-term safety and effectiveness of tadalafil 2.5 mg and 5.0 mg once daily in Chinese men with erectile dysfunction (n = 635). The primary endpoint of the study was safety at 12 months as assessed by the proportion of patients experiencing at least one treatment-emergent adverse event (serious or nonserious). The secondary endpoints included safety and effectiveness, measured by the International Index of Erectile Function-Erectile Function (IIEF-EF) domain scores. Similar adverse events to the known safety profile of tadalafil, such as nasopharyngitis, upper respiratory tract infection, headache, and dizziness, were detected. No new cardiovascular safety concerns were observed. After 3 months of treatment, significant increases in IIEF-EF domain scores were detected for both 2.5-mg (least squares [LS] mean change: 6.3; 95% confidence interval [CI]: 5.4-7.1; P < 0.001) and 5.0-mg (LS mean change: 7.4; 95% CI: 6.8-7.9; P < 0.001) tadalafil doses, and significance was maintained up to 12 months. In addition, approximately 40% of patients regained normal erectile function (IIEF-EF ≥26) following 1 year of tadalafil once-daily treatment. The findings in this study provide evidence for the extended effectiveness and tolerability of tadalafil, demonstrating no new safety concerns, in a Chinese population and make once-daily tadalafil administration a viable option for improving sexual performance and satisfaction in Chinese men with erectile dysfunction.

Dipyridamole reduces penile apoptosis in a rat model of post-prostatectomy erectile dysfunction

ABSTRACT Purpose: Despite the nerve-sparing technique, many patients suffer from erectile dysfunction after radical prostatectomy (RP) due to cavernous nerve injury. The aim of this study was to evaluate dipyridamole as a potential treatment agent of post-radical prostatectomy erectile dysfunction. Material and methods: A total of 18 male Sprague-Dawley rats were randomized into three experimental Groups (SHAM+DMSO, BCNI+DMSO and BCNI+DIP). An animal model of bilateral cavernous nerve crush injury (BCNI) was established to mimic the partial nerve damage during nerve-sparing RP. After creating of BCNI, dimethyl sulphoxide (DMSO) was administered transperitoneally as a vehicle to SHAM+DMSO and BCNI+DMSO Groups. BCNI+DIP Group received dipyiridamole (10mg/kg/day) as a solution in DMSO for 15 days. Afterwards, rats were evaluated for in vivo erectile response to cavernous nerve stimulation. Penile tissues were also analyzed biochemically for transforming growth factor-β1 (TGF-β1) level. Penile corporal apoptosis was determined by TUNEL method. Results: Erectile response was decreased in rats with BCNI and there was no significant improvement with dipyridamole treatment. TGF-β1 levels were increased in rats with BCNI and decreased with dipyridamole treatment. Dipyridamole led to reduced penile apoptosis in rats with BCNI and there was no significant difference when compared to sham operated rats. Conclusions: Although fifteen-day dipyridamole treatment has failed to improve erectile function in rats with BCNI, the decline in both TGF-β1 levels and apoptotic indices with treatment may be helpful in protecting penile morphology after cavernous nerve injury.

Prevalence of erectile dysfunction oral drugs use in a city of southern Brazil / Prevalência do uso de drogas orais para disfunção erétil em uma cidade do sul do Brasil

Abstract The last decade has seen a breakthrough in the treatment of erectile dysfunction (ED) with the advent of phosphodiesterase-5 inhibitors. There are few population-based observational studies on the prevalence of use of these drugs. We conducted a cross-sectional population-based study in the city of Pelotas (Brazil). Our sample comprised 1,082 men aged 20 years or older who answered a confidential and self-administered questionnaire. Prevalence of EDD use was 5% (IC95% = 4%;7%). ED and advanced age were strongly associated with a higher prevalence of EDD use. ED prevalence in men who used EDD was 68%, which was much higher than the one found in the entire sample (27%). The use of EDD was more frequently reported among separated men, respondents with higher level of education and those without ED. A high proportion of respondents (68%) did not seek medical advice on the use of EDD. Sildenafil was the most commonly used drug (38%) but non-regulated and non-evidence-based drugs were also frequently used (14%). Prevalence of EDD use is higher among individuals with ED, opposing to the notion of recreational use of EDD.

Resumo Na última década houve um grande avanço no tratamento da disfunção erétil (DE), com o advento dos inibidores da fosfodiesterase-5. Existem poucos trabalhos sobre a prevalência de uso destas drogas. Foi realizado um estudo transversal de base populacional na cidade de Pelotas. A amostra foi composta por 1.082 homens com 20 anos ou mais de idade que responderam um questionário confidencial e auto-aplicado. A prevalência do uso de medicamentos estimulantes da ereção (MEE) foi de 5%(IC95% = 4%-7%). Idade avançada e DE foram fortemente associados a uma maior prevalência de uso de MEE. A prevalência foi também maior em indivíduos com ensino superior e aqueles separados. A prevalência de DE em homens que usaram MEE foi de 68%, sendo maior do que a prevalência encontrada em toda a amostra (27%). A maioria dos indivíduos não teve aconselhamento médico para o uso de MEE (68%). Sildenafil foi a droga mais utilizada (38%), seguida por aquelas não regulamentadas (14%). A prevalência do uso de MEE é maior em indivíduos com disfunção erétil, opondo-se à noção de uso "recreativo" de EDD.

Effect of tadalafil 5mg daily treatment on the ejaculatory times, lower urinary tract symptoms and erectile function in patients with erectile dysfunction

ABSTRACT Objective To investigate the effect of a 5mg daily tadalafil treatment on the ejaculation time, erectile function and lower urinary tract symptoms (LUTS) in patients with erectile dysfunction. Materials and Methods A total of 60 patients diagnosed with erectile dysfunction were retrospectively evaluated using the international index of erectile function questionnaire-5 (IIEF-5), intravaginal ejaculatory latency time (IELT) and international prostate symptoms scores (IPSS). After the patients were treated with 5mg tadalafil once a day for three months, their erection, ejaculation and LUTS were assessed again. The fasting levels of blood glucose, total testosterone, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and total cholesterol were measured. The independent-samples t-test was used to compare the pre- and post-treatment scores of the patients. Results The mean age of the 60 participants was 50.4±7.9 and the mean baseline serum total testosterone, total cholesterol, and fasting blood sugar were 444.6±178.6ng dL-1, 188.7±29.6mg/dL-1,104 (80-360) mg dL-1, respectively. The mean baseline scores were 2.2±1.4 min for IELT, 9.5±3.7 for IIEF-5 and 14.1±4.5 for IPSS. Following the three-month daily 5mg tadalafil treatment, the scores were found to be 3.4±1.9 min, 16.1±4.7, and 10.4±3.8 for IELT, IIEF and IPSS, respectively. When the baseline and post-treatment scores were compared, a statistically significant increase was observed in the IELTs and IIEF-5 values whereas there was a significant decrease in IPSS (p<0.01). Conclusion A daily dose of 5mg tadalafil can be safely used in the treatment of erectile dysfunction and LUTS, that prolongs the ejaculatory latency time.

Phytochemical and biological assessments on Lipidium meyenii [maca] and Epimidium sagittatum [horny goat weed]

The effects of Lipidium meyenii [maca, LM] and Epimidium sagittatum [horny goat weed, ES] have been investigated due to their involvement in fertilization. Both of the drugs showed good results before, during and after fertilization in male and female mice. The results revealed that the crude extract of Lipidium meyenii caused a significant decrease in the no. of writhes at 300 and 500mg/kg [p<0.05] as compare to control, Epimidium sagittatum and standard drug. The gross behavioral, open field, exploratory behaviour, forced swimming test for stress, diuretic activity, chronic toxicity with the effect on reproduction of both male and female and change in body weight were also studied. The phytochemical study showed the presence of tannin, alkaloid, carbohydrate, rich protein and absence of sterol in LM, whereas ES shows presence of sterol and less protein. LS improve in muscle activity and exploratory behaviours without any toxic effects on mice and their pups. It does not have diuretic effect for first two hour but act normally after initial phase of drug therapy. Epimidium sagittatum has dual action that is at low dose it has slight stimulation action and at high dose little depressive effect. ES also has some diuretic effect. Overall these results suggest that LM is highly effective remedy for treatment of impotency and reduces stress and depression, because of dual effect ES not only suggested as an anxiolytic medicine but also effective in female hormonal disorder

Improvement of erectile dysfunction by the active pepide from urechis unicinctus by high temperature/pressure and ultra - wave assisted lysis in streptozotocin induced diabetic rats

ABSTRACT Introduction: We investigate the effect of active peptide from Urechis unicinctus (UU) by high temperature/pressure and ultra-wave assisted lysis on erectile dysfunction in streptozotocin-induced diabetic rats. Materials and Methods: Forty 12-week-old Sprague-Dawley rats were used in this study. Diabetes was induced by a one-time intraperitoneal injection of streptozotocin (50mg/kg). One week later, the diabetic rats were randomly divided into four groups: normal control, untreated diabetes control, and groups treated with 100 or 500mg/kg/d UU peptide. Rats were fed with UU peptide by intragastric administration for 8 weeks. After 8 weeks, penile hemodynamic function was evaluated in all groups by measuring the intracavernosal pressure after electrostimulating the cavernous nerve. Nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) activities were measured and endothelial nitric oxide synthase (eNOS) and neuronal NOS (nNOS) protein expression was determined by Western blot. Results: Maximum intracavernosal pressure in diabetic control rats decreased significantly compared to normal control rats, and was increased significantly compared to untreated diabetic rats after UU peptide supplementation. Treatment with the higher dose of UU peptide significantly increased the NO and cGMP levels compared with the diabetic control group. Decreased activity and expression eNOS and nNOS were found in the diabetic rats compared with the normal control group. Decreased eNOS and nNOS in diabetic rats were improved by UU peptide administration. Conclusions: Active peptide from UU ameliorates erectile function in a streptozotocin induced diabetic rat model of erectile dysfunction.

Short hairpin RNA targeting insulin-like growth factor binding protein-3 restores the bioavailability of insulin-like growth factor-1 in diabetic rats

ABSTRACT Purpose To investigate whether intracavernosal injection of short hairpin RNA for IGFBP-3 could improve erectile function in streptozotocin-induced diabetic rats. Materials and methods After 12 weeks of IGFBP-3 short hairpin RNA injection treatment, intracavernous pressure responses to electrical stimulation of cavernous nerves were evaluated. The expression of IGFBP-3 and IGF-1 at mRNA and protein levels were detected by quantitative real-time PCR analysis and Western blot, respectively. The concentration of cavernous cyclic guanosine monophosphate was detected by enzyme-linked immunosorbent assay. Results At 12 weeks after intracavernous administration of IGFBP-3 shRNA, the cavernosal pressure was significantly increased in response to the cavernous nerves stimulation compared to the diabetic group (P<0.05). Cavernous IGFBP-3 expression at both mRNA and protein levels was significantly inhibited. At the same time, cavernous IGF-1 expression was significantly increased in the IGFBP-3 shRNA treatment group compared to the diabetic group (P<0.01). Cavernous cyclic guanosine monophosphate concentration was significantly increased in the IGFBP-3 shRNA treatment group compared to the diabetic group (P<0.01). Conclusions Gene transfer of IGFBP-3 shRNA could improve erectile function via the restoration of cavernous IGF-1 bioavailability and an increase of cavernous cGMP concentration in the pathogenesis of erectile dysfunction in streptozotocin-induced diabetic rats.

Viagra y juventud / Viagra and youth

Usando como disparadores dos viñetas clínicas de sendos pacientes, el autor de este artículo polemiza sobre la difundida opinión en contra de que los jóvenes sin disfunción sexual aparente utilicen sildenafil y sobre el concepto de adicción psicológica. Aprovecha esta polémica para introducir al lector el concepto de "alétheia" o "alizia", rescatado por Heidegger de la filosofía griega pre-socrática, y que representa la "unicidad del ocultamiento y el desocultamiento"; y el de "extraverdad", adaptado por el autor de este artículo desde el de "no-verdad" propuesto por Nietzsche, que permite situarse más allá de la dicotomía respecto de si un concepto o un hecho es verdadero o falso para operar con mayor soltura en la práctica clínica. (AU)

Based upon two clinical vignettes, the author of this article argues about the widespread opinion that young people with-out sexual dysfunction should not use sildenafil and about the concept of psychological addiction. He also introduces the concept of " aletheia " or " alizia " that Heidegger rescued from pre-Socratic Greek philosophy, and that represents the "unicity of concealment and unconcealment"; and "extratruth", adapted by the author of this article from the concept of"no- truth" proposed by Nietzsche, that allows us to stay beyond the dichotomy of the concepts of true or false, and to operate more proficiently in clinical practice. (AU)

PDE5 Inhibitor Treatment Persistence and Adherence in Brazilian Men: Post-hoc Analyses from a 6-Month, Prospective, Observational Study

Purpose Characterize persistence and adherence to phosphodiesterase type - 5 inhibitor (PDE5I) on-demand therapy over 6 months among Brazilian men in an observational, non-interventional study of Latin American men naïve to PDE5Is with erectile dysfunction (ED). Materials and Methods Men were prescribed PDE5Is per routine clinical practice. Persistence was defined as using ≥ 1 dose during the previous 4 - weeks, and adherence as following dosing instructions for the most recent dose, assessed using the Persistence and Adherence Questionnaire. Other measures included the Self - Esteem and Relationship (SEAR) Questionnaire, and International Index of Erectile Function (IIEF). Multivariate logistic regression was used to identify factors associated with persistence/adherence. Results 104 Brazilian men were enrolled; mean age by treatment was 53 to 59 years, and most presented with moderate ED (61.7%). The prescribed PDE5I was sildenafil citrate for 50 (48.1%), tadalafil for 36 (34.6%), vardenafil for 15 (14.4%), and lodenafil for 3 patients (2.9%). Overall treatment persistence was 69.2% and adherence was 70.2%; both were numerically higher with tadalafil (75.0%) versus sildenafil or vardenafil (range 60.0% to 68.0%). Potential associations of persistence and/or adherence were observed with education level, ED etiology, employment status, and coronary artery disease. Improvements in all IIEF domain scores, and both SEAR domain scores were observed for all treatments. Study limitations included the observational design, brief duration, dependence on patient self - reporting, and limited sample size. Conclusion Approximately two-thirds of PDE5I-naive, Brazilian men with ED were treatment persistent and adherent after 6 months. Further study is warranted to improve long-term outcomes of ED treatment. .

Effect of Improvement in Lower Urinary Tract Symptoms on Sexual Function in Men: Tamsulosin Monotherapy vs. Combination Therapy of Tamsulosin and Solifenacin

PURPOSE: To evaluate how much the improvement of lower urinary tract symptoms (LUTS) affects sexual function and which storage symptoms or voiding symptoms have the greatest effect on sexual function. MATERIALS AND METHODS: A total of 187 patients were enrolled in this study. Patients were randomly assigned to receive either tamsulosin 0.2 mg (group A) or tamsulosin 0.2 mg and solifenacin 5 mg (group B). At 4 weeks and 12 weeks, the LUTS and sexual function of the patients were evaluated by use of the International Index of Erectile Function-5 (IIEF5), International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) questionnaire, uroflowmetry, and bladder scan. RESULTS: Both groups A and B showed statistically significant improvements in IPSS, OABSS, and quality of life (QoL). Group A showed improved maximum flow rate, mean flow rate, and residual urine volume by time. Group B did not show an improvement in flow rate or residual urine volume but total voiding volume increased with time. The IIEF5 score was not improved in either group. In group A, the IIEF5 score dropped from 13.66+/-4.97 to 11.93+/-6.14 after 12 weeks (p=0.072). Group B showed a decline in the IIEF5 score from 13.19+/-5.91 to 12.45+/-6.38 (p=0.299). Although group B showed a relatively smaller decrease in the IIEF5 score, the difference between the two groups was not significant (p=0.696). CONCLUSIONS: Tamsulosin monotherapy and combination therapy with solifenacin did not improve erectile function despite improvements in voiding symptoms and QoL. The improvement in storage symptoms did not affect erectile function.

Effect of Improvement in Lower Urinary Tract Symptoms on Sexual Function in Men: Tamsulosin Monotherapy vs. Combination Therapy of Tamsulosin and Solifenacin

PURPOSE: To evaluate how much the improvement of lower urinary tract symptoms (LUTS) affects sexual function and which storage symptoms or voiding symptoms have the greatest effect on sexual function. MATERIALS AND METHODS: A total of 187 patients were enrolled in this study. Patients were randomly assigned to receive either tamsulosin 0.2 mg (group A) or tamsulosin 0.2 mg and solifenacin 5 mg (group B). At 4 weeks and 12 weeks, the LUTS and sexual function of the patients were evaluated by use of the International Index of Erectile Function-5 (IIEF5), International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS) questionnaire, uroflowmetry, and bladder scan. RESULTS: Both groups A and B showed statistically significant improvements in IPSS, OABSS, and quality of life (QoL). Group A showed improved maximum flow rate, mean flow rate, and residual urine volume by time. Group B did not show an improvement in flow rate or residual urine volume but total voiding volume increased with time. The IIEF5 score was not improved in either group. In group A, the IIEF5 score dropped from 13.66+/-4.97 to 11.93+/-6.14 after 12 weeks (p=0.072). Group B showed a decline in the IIEF5 score from 13.19+/-5.91 to 12.45+/-6.38 (p=0.299). Although group B showed a relatively smaller decrease in the IIEF5 score, the difference between the two groups was not significant (p=0.696). CONCLUSIONS: Tamsulosin monotherapy and combination therapy with solifenacin did not improve erectile function despite improvements in voiding symptoms and QoL. The improvement in storage symptoms did not affect erectile function.

Efectividad y satisfacción del tratamiento con dosis diaria de Tadalafilo 5 mg para la disfunción eréctil / Effectiveness and satisfaction of the treatment with daily dose of Tadalafil 5 mg for erectile dysfunction

La base del tratamiento de la disfunción eréctil (DE) son los inhibidores de la fosfodiesterasa 5, disponibles mayoritariamente para dosificación a demanda. En 2008 la FDA aprobó el Tadalafilo 5 mg de uso diario. OBJETIVO: Evaluar la efectividad del Tadalafilo 5 mg de uso diario para el tratamiento de la DE y la satisfacción de los pacientes frente a su uso. PACIENTES Y METODOS: Se reclutaron pacientes con DE entre Junio de 2011 y Mayo de 2012. Se registraron datos sociodemográficos, clínicos y andrológicos. La DE se clasificó según el puntaje del cuestionario IIEF. Todos los pacientes iniciaron tratamiento diario con Tadalafilo 5 mg y fueron reevaluados luego de un mes. La satisfacción y calidad de vida se evaluó con cuestionarios validados (EDITS, SEAR y GAQ). Para el análisis estadístico se consideró significativo un P<0.05.RESULTADOS: Se reclutaron 49 pacientes con edad promedio de 59,9 +/- 8,8 años. Un 14,3 por ciento presentaba DE severa, 36,7 por ciento moderada, 36,7por ciento leve-moderada y 12,2 por ciento leve. Al mes de tratamiento, el puntaje IIEF aumentó significativamente (P<0.0005), encontrándose un 18,4 por ciento sin DE, 53,1 por ciento con DE leve, 28,6 por ciento con DE leve-moderada y ninguno con DE moderada o grave. El 87,7 por ciento de los pacientes refirió mejores erecciones y el 81,6 por ciento una mejor capacidad para mantener la relación sexual. La satisfacción global con el tratamiento fue de 64,1 por ciento. CONCLUSIÓN: El tratamiento diario con Tadalafilo 5 mg es efectivo para el manejo de la DE y se asocia a niveles adecuados de satisfacción y confianza al cabo de un mes de tratamiento.

The base of the treatment of erectile dysfunction (ED) are the phosphodiesterase-5 inhibitors, mostly available for “on demand” dosing. In 2008, the FDA approved Tadalafil 5mg for daily use. OBJECTIVE: To evaluate the effectiveness of Tadalafil 5 mg daily dose for the treatment of ED and the patient’s satisfaction with its use. PATIENTS AND METHODS: Patients with ED were enrolled between June 2011 and May 2012. Sociodemographic, clinical and andrologic data was recorded. The severity of ED was classified according to the score of the IIEF questionnaire. All patients started daily treatment with Tadalafil 5 mg and were reevaluated after one month. Satisfaction and quality of life was assessed using validated questionnaires (EDITS, SEAR and GAQ). A P<0.05 was considered significant in all statistical analysis. RESULTS: A total of 49 patients were enrolled, with mean age of 59.9 +/- 8.8 years. A 14.3 ´percent suffered severe ED, 36.7 percent moderate, 36.7 percent mild-moderate and 12.2 percent mild. After one month, the IIEF score significantly increased (P<0.0005), finding a 18.4 percent of patients without ED, 53.1 percent with mild ED, 28.6 percent with mild-moderate ED and no cases with moderate or severe ED. 87.7 percent of patients reported better erections and 81.6 percent stated a better capacity to maintain erections during. The global satisfaction rate with the treatment was of 64.1 percent. CONCLUSION: The treatment with daily dose of Tadalafil 5 mg is effective for the management of ED and is associated with adequate levels of satisfaction and confidence after one month of use.