[Effectiveness and safety of the treatment with sildenafil (Viagra) in patients with erectile dysfunction and arterial hypertension]. / Efectividad y seguridad del tratamiento con Sildenafilo (Viagra) en pacientes con disfunción eréctil e hipertensión arterial.

OBJECTIVES: To evaluate the efficacy and safety of sildenafil in the treatment of erectile dysfunction in hypertensive patients taking antihypertensive drugs, and to investigate factors associated to treatment failure. METHODS: Observational prospective study comparing two groups of patients suffering from erectile dysfunction with or without hypertension. Patients were evaluated by anamnesis, physical examination, blood tests, and the International Index of Erectile Function (IIEF). Blood pressure was measured before and after treatment with an automatic digital oscillometric device. RESULTS: Erections improved in 88.2% and 91.7% of the patients with an without hypertension respectively. On the initial visit 55.2% of all patients had severe dysfunction, which was reduced after sildenafil treatment to 4.7%. Diastolic arterial blood pressure, evaluated in random measures, was slightly reduced after starting treatment with Viagra. No significant adverse events were registered. CONCLUSIONS: Oral treatment with sildenafil in patients with erectile dysfunction and hypertension is effective, well-tolerated and does not produce pharmacologic interactions with antihypertensive drugs.

Efectividad y seguridad del tratamiento con Sildenafilo (Viagra®) en pacientes con disfunción eréctil e hipertensión arterial / Efficacy and safety of Sildenafil (Viagra®) in patients with erectile dysfunction and high blood pressure

OBJETIVO: Evaluar la efectividad y la seguridad de sildenafilo en el tratamiento de la disfunción eréctil (DE) en pacientes con hipertensión arterial (HTA) en tratamiento con antihipertensivos y analizar otros factores asociados al fracaso terapéutico. MÉTODOS: Se realizó un estudio prospectivo, observacional y comparativo incluyendo un grupo de pacientes (N=85) afectos de DE e HTA frente otro (N=85) con solo DE. Los pacientes han sido evaluados con anamnesis, examen físico, analítica de bioquímica y hemograma, a parte se realizó el cuestionario Indice Internacional de Función Eréctil (IIEF) para evaluar la respuesta al tratamiento con sildenafilo. En ambos grupos se han realizado tomas de la tensión arterial antes y después del tratamiento con Viagra. RESULTADOS: Después el tratamiento se observó mejoría de la erección en un 88,2 por ciento y 91,7 por ciento de pacientes con o sin HTA respectivamente. Según el IIEF en la visita basal el 55,2 por ciento de toda la muestra examinada presentaba DE severa que se ha reducido después de tratamiento con sildenafilo al 4,7 por ciento. La presión arterial diastólica (PAD), evaluada en tomas casual, se redujo levemente después de empezar el tratamiento con Viagra.No se determinaron efectos adversos importantes. CONCLUSIONES: El tratamiento oral con sildenafilo en pacientes con DE e HTA es eficaz, bien tolerado y no determina interacción farmacológica con la medicación antihipertensiva (AU)

Comparison of the efficacy and safety of 90 mg versus 20 mg fluoxetine in the treatment of premature ejaculation.

PURPOSE: We compare the efficacy and side effects of 90 mg fluoxetine once weekly versus 20 mg fluoxetine as single oral therapy for patients complaining of premature ejaculation without evident organic causes. MATERIALS AND METHODS: The study comprised 80 patients with a mean age of 36 years with premature ejaculation who presented to the urology clinic of 3 hospitals in Barcelona. Pretreatment evaluation included history and physical examination, International Index of Erectile Function (IIEF), Meares-Stamey test and ejaculatory latency time evaluation. The patients were randomized into treatment groups receiving 1 capsule of 90 mg fluoxetine a week (group 1) and 1 capsule of 20 mg fluoxetine a day (group 2) for 3 months. The 4-month followup included: ejaculatory latency time measurement, IIEF and partner sexual satisfaction. RESULTS: Mean pretreatment ejaculatory latency times for groups 1 and 2 were 0.48 minute (range 0 to 2.10) and 0.50 minute (0 to 2.04), respectively. After 3 months of treatment of weekly and daily administration of fluoxetine mean ejaculatory latency time was 3.57 and 3.37 minutes, respectively (p >0.01). Partner sexual satisfaction and IIEF rate were greater with 90 mg fluoxetine but no statistical difference was found. Nausea, insomnia and headache were reported side effects but no significant difference was noted between 90 and 20 mg fluoxetine. CONCLUSIONS: In men with premature ejaculation 90 mg fluoxetine weekly may be regarded as an effective and safe treatment.

Tadalafil, a further innovation in the treatment of sexual dysfunction.

In recognition of the large number of sufferers of sexual dysfunction worldwide, and the variety of etiologies of the condition, investigation into effective pharmacological agents has been expanded. One method of intervention is inhibition of the phosphodiesterase type 5 (PDE5) enzyme, which has already been exploited with a considerable degree--though not complete--success. A number of new agents that inhibit PDE5 are under development. Notable among these is tadalafil, which has demonstrated a high level of selectivity for PDE5 over the other phosphodiesterases and has shown efficacy in improving erectile function and sexual satisfaction in phase III trials. Throughout the clinical development program for tadalafil, the drug has been well tolerated and without serious side effects. The manufacturer, Lilly ICOS, received an approvable letter from the US Food and Drug Administration for use of the drug as a treatment for erectile dysfunction on April 30, 2002. Lilly ICOS hopes to market tadalafil, with the trade name Cialis, in the USA in 2003.

Clinical follow-up after subinguinal varicocele ligation to treat pain.

OBJECTIVE: To evaluate the usefulness of surgical treatment in patients with chronic orchialgia associated with varicocele and those for whom conservative treatment (jockstrap, non-steroidal anti-inflammatory drugs (NSAIDs) and restricted physical activity) was not effective. The response to spermatic vein ligation performed subinguinally with local anaesthesia was assessed in 25 patients with chronic testicular pain and varicocele as the only associated causal factor. Patient age, grade (according to Doppler study) and location of the varicocele, duration and degree of pain, response to treatment using an analogous pain scale pre- and post-surgery and complications pre- and post-surgery were recorded. Mean patient age was 28 years (range: 17-57) and time of pain evolution 14 months (range: 3-72). The varicocele was left-sided in 19 patients, bilateral in 4 and right-sided in 2, and grade III in 14 cases, grade II in 6 and grade I in 5. Subinguinal ligation of the spermatic vein was performed under local anaesthesia on an ambulatory basis in all cases. RESULTS: Twenty-two of the 25 patients (88%) reported resolution or evident improvement in their pain. The mean value on the pre-surgical pain scale was 64 (30-80). After a mean postoperative follow-up period of three months, the pain was reduced to a mean of 12. No perioperative complications were recorded; a post-operative hydrocele appeared in one case and the varicocele persisted in another. CONCLUSIONS: Ligation of the spermatic vein performed on an outpatient basis using a subinguinal approach and local anaesthesia is an effective treatment for chronic varicocele-associated testicular pain for patients in whom other therapeutic measures have failed.

Regulation of human penile smooth muscle tone by prostanoid receptors.

We have characterized the prostanoid receptors involved in the regulation of human penile arterial and trabecular smooth muscle tone. Arachidonic acid induced relaxation of human corpus cavernosum strips (HCCS) that was blocked by the cyclo-oxygenase inhibitor, indomethacin, and augmented by the thromboxane receptor (TP) antagonist, SQ29548, suggesting that endogenous production of prostanoids regulates penile smooth muscle tone. TP-receptors mediate contraction of HCCS and penile resistance arteries (HPRA), since the agonist of these receptors, U46619, potently contracted HCCS (EC50 8.3+/-2.8 nM) and HPRA (EC50 6.2+/-2.2 nM), and the contractions produced by prostaglandin F(2alpha) at high concentrations (EC50 6460+/-3220 nM in HCCS and 8900+/-6700 nM in HPRA) were inhibited by the selective TP-receptor antagonist, SQ29548 (0.02 microM). EP-receptors are responsible for prostanoid-induced relaxant effects in HCCS because only prostaglandin E1 (PGE1), prostaglandin E2 and the EP2/EP4-receptor agonist, butaprost, produced consistent relaxation of this tissue (EC50 93.8+/-31.5, 16.3+/-3.8 and 1820+/-1284 nM, respectively). In HPRA, both prostacyclin and PGE1 (EC50 60.1+/-18.4 and 109.0+/-30.9 nM, respectively) as well as the selective IP receptor agonist, cicaprost, and butaprost (EC50 25.2+/-15.2 and 7050+/-6020 nM, respectively) caused relaxation, suggesting co-existence of IP- and EP-receptors (EP2 and/or EP4). In summary, endogenous production of prostanoids may regulate penile smooth muscle contractility by way of specific receptors. TP-receptors mediate contraction in HCCS and HPRA, while the relaxant effects of prostanoids are mediated by EP2- and/or EP4-receptors in HCCS and by EP- and IP-receptors in HPRA.