The use of the simplified International Index of Erectile Function (IIEF-5) as a diagnostic tool to study the prevalence of erectile dysfunction.

The purpose of this research was to determine the prevalence of erectile dysfunction (ED) in a non-selected population using the abridged 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool. In a non-institutionalized population and during a free screening program for prostate cancer (Prostate Cancer Awareness Week of Santa Casa Hospital, Porto Alegre, Brazil), from 26 to 30 July 1998, all men who were attending were invited to complete a sexual activity questionnaire (the abridged 5-item version of the International Index of Erectile Function-IIEF-5) as a diagnostic tool for ED. The possible scores for the IIEF-5 range from 5 to 25, and ED was classified into five categories based on the scores: severe (5-7), moderate (8-11), mild to moderate (12-16), mild (17-21), and no ED (22-25). Of the 1071 men who participated in the program, 965 (90.1%) were included in this study. Of the responding men 850 were Caucasian (88%) and 115 were black (12%). The mean age of the men was 60.7 y, ranging from 40 to 90 y old. In this sample the prevalence of all degrees of ED was estimated as 53.9%. In this group of men, the degree of ED was mild in 21.5%, mild to moderate in 14.1%, moderate in 6.3%, and severe in 11.9%. According to age the rates of ED were: 40-49 (36.4%); 50-59 (42.5%); 60-69 (58.1%); 70-79 (79.4%), and over 80 y (100%) showed ED (P<0.05). The Pearson coefficients between the variables age and IIEF-5 showed a statistically significant inverse (negative) relation (r=-0.3449; P<0.05). ED is highly prevalent in men over 40 and this condition showed a clear relationship to aging, as demonstrated in other studies published. The simplified IIEF-5, as a diagnostic tool, showed to be an easy method, which can be used to evaluate this condition in studies with a great number of men.

Long-term results of penile vein ligation for erectile dysfunction due to cavernovenous disease.

PURPOSE: We now know that outflow restriction is essential for maintaining a rigid erection, which can be achieved after satisfactory smooth muscle relaxation. The aim of this study was to assess retrospectively the efficacy of penile vein surgical ligation in patients with a follow-up of at least 3 years. MATERIALS AND METHODS: Thirty-two men with impotence due to cavernovenous occlusive disease underwent penile vein ligation for management of organic erectile dysfunction. Cavernovenous occlusive disease was diagnosed by gravity cavernosometry. RESULTS: Long-term evaluation revealed sustained potency without adjunctive therapy in only 7 patients (21.87%). Twenty-five patients (78.12%) did not show any improvement in the erectile mechanism. Associated complications included penile shortening in 4 (12.5%), hypoesthesia of the glans area in 2 (6.25%), and Peyronie's disease in 1 (3.2%). CONCLUSION: Based on these data, we conclude that the long-term success of penile vein ligation is poor.

Tamoxifen versus placebo in the treatment of Peyronie's disease.

PURPOSE: We evaluated the effects of oral tamoxifen and placebo in patients with Peyronie's disease. MATERIALS AND METHODS: We selected 25 patients with Peyronie's disease who did not have calcified plaque for treatment in the andrology outpatient clinic. A medical history was obtained, and physical examination, penile x-ray, penile ultrasound and pharmacologically induced erection with prostaglandin E1 were performed. Patients were randomly divided into group 1--those who received 20 mg. tamoxifen twice daily for 3 months and group 2--those who received placebo for the same period. The same evaluations were done 4 months later and results were compared. Qualitative (chi-square test) and quantitative (Student's t test) results were analyzed using the Yates correction factor with p <0.05 considered significant. RESULTS: Pain subsided in 66.6 and 75% of the patients treated with tamoxifen and placebo, respectively (p >0.05). In groups 1 and 2 a reduction in the penile deformity was noticed by 46.1 and 41.7% of the patients (p >0.05), and a decrease in plaque size was noticed by 30.7 and 25%, respectively. On the other hand, objective measurements did not reveal any difference in plaque area or curvature angle. CONCLUSIONS: This study did not show significant improvement in pain, curvature or plaque size in patients with Peyronie's disease who were treated with tamoxifen compared with those treated with placebo.

Endoscopic suspension of the prolapsed vaginal dome.

Complete prolapse of the vaginal dome post hysterectomy is uncommon. However, complications such as urinary incontinence, recurrent urinary infections, and ureteral obstruction leading to anuria and loss of renal function may result. A modified technique for endoscopic suspension of the bladder neck and vaginal prolapse, performed in six patients, is presented. The positive results achieved after a 64-month of follow-up suggest that this procedure is another safe alternative to correct vaginal prolapse and its complications.

Therapeutic effects of high dose yohimbine hydrochloride on organic erectile dysfunction.

PURPOSE: We evaluated men with organic erectile dysfunction treated with placebo and high dose oral yohimbine hydrochloride. MATERIALS AND METHODS: We selected 22 patients with organic erectile dysfunction (mean age 58 years) for treatment in the andrology outpatient clinic. These patients had been previously undergone neurological, vascular, hormonal and psychological testing, and were treated during an equal period of 30 days with placebo and daily single dose oral 100 mg. yohimbine. The response to treatment was evaluated via a questionnaire that comprised the outcome items of complete--normal penile rigidity enabling vaginal penetration, partial--erection improved but not sufficiently for appropriate vaginal penetration, none--no improvement and worse--erection deteriorated. The patients consented to treatment after being told of the severe adverse effects that might occur. RESULTS: The most common side effects were anxiety, increase in cardiac frequency, increased urinary output and headache but in no case was treatment discontinued. Of the patients 3 (13.6%) and 12 (54.5%) reported complete or partial response to treatment, respectively. However, statistical analysis disclosed no significant difference when yohimbine was compared to placebo (p < 0.05). CONCLUSIONS: Oral 100 mg. single dose daily yohimbine promotes no improvement in patients with organic erectile dysfunction.

Atropine role in the pharmacological erection test: study of 228 patients.

PURPOSE: We determined the efficacy of atropine sulfate combined with papaverine hydrochloride, prostaglandin E1 and phentolamine mesylate in the pharmacological erection test. MATERIALS AND METHODS: A total of 230 consecutive patients with erectile dysfunction was randomized for pharmacological erection test and received an intracorporeal combination of 50 mg. papaverine hydrochloride, 10 micrograms. prostaglandin E1, 0.2 mg. phentolamine mesylate and 0.075 mg. of atropine sulfate (group 1), or the same combination without atropine sulfate (group 2). Erectile response was evaluated subjectively and by intracorporeal pressure measurement. RESULTS: In group 1, 40 patients (35.1%) showed only tumescence, and 22 (19.3%) had poor erection. In group 2, 45 patients (39.5%) had tumescence and 17 (14.9%) poor erection. In both groups 52 patients (45.6%) had rigid erection. There was no statistically significant difference regarding erectile response and intracorporeal pressure. CONCLUSIONS: The addition of atropine sulfate did not improve results of the pharmacological erection test when combined with 50 mg. papverine hydrochloride, 10 micrograms, prostaglandin E1, and 0.2 mg. phentolamine mesylate.