Elsevier

Urology

Volume 53, Issue 1, January 1999, Pages 19-24
Urology

Rapid Communications
Treatment of erectile dysfunction with sildenafil

https://doi.org/10.1016/S0090-4295(98)00525-1Get rights and content

Abstract

Objectives. To determine the efficacy of sildenafil for the treatment of erectile dysfunction (ED) in a clinical practice setting; to evaluate the correlation between patient and partner perceptions of treatment outcomes; and to assess the relation between the severity of ED and response to treatment.

Methods. Among the first 100 men to receive sildenafil in a urology practice setting, 74 (mean ± SD age 64 ± 11 years) completed a validated sexual function questionnaire (International Index of Erectile Function [IIEF]) before and after a 4 to 6-week treatment period. A modified version of the same questionnaire was independently completed by partners. ED was categorized into a severity class of I to IV.

Results. Sildenafil treatment improved erections by 71% to 95%, according to responses in key IIEF questions 3 and 4. Overall, 57 (77%) of 74 patients desired to continue treatment after the test period. Patient score on the IIEF was correlated with partner score on the modified questionnaire before and after treatment (r = 0.67 to 0.81, P <0.01). IIEF scores were reflected in a simple severity classification system. Men with the best preservation of erections (severity class I) exhibited the best responses to sildenafil, whereas men with no erections (severity class IV) were much less likely to respond to the drug and desire continuation of treatment (P <0.01). Patients with a radical prostatectomy were relatively refractory to sildenafil, except for 2 of 5 who had undergone a nerve-sparing operation.

Conclusions. In clinical practice, sildenafil is an effective treatment of ED, according to partner-validated questionnaire responses; and the results of treatment are predictable with an ED severity classification system.

Section snippets

Patient screening and pretreatment evaluations

This was a prospective cohort study. The study included the first 100 men who elected to receive sildenafil therapy for the treatment of ED at a metropolitan Los Angeles urology practice, who met the study inclusion criteria, and who agreed to participate in a short-term, open-label, noncomparative trial (4 to 6 weeks in duration). Inclusion criteria were (1) a history of ED, as defined by the National Institutes of Health (NIH) Consensus Development Panel on Impotence,2 of at least 1 year in

Results

Of the first 100 patients electing to receive sildenafil, 74 completed the IIEF questionnaire both at baseline and at the follow-up visit. A summary of their baseline characteristics is shown in Table I. The mean ± SD age was 64 ± 11 years (range 29 to 80). The majority of patients (82%) had a history of concomitant medical conditions often associated with erectile dysfunction. Over the 4- to 6-week period, the mean number of tablets taken per patient was 4.5 ± 2.6. At the end of the study, 50

Comment

The advent of sildenafil has dramatically changed treatment of male ED. “Not surprisingly, patients are clamouring for the drug,”4 and, as noted earlier, physicians are responding positively to the demand. The safety and efficacy of sildenafil have been convincingly demonstrated in a large, rigorously controlled clinical trial.1 However, as with other treatments, major differences have been noted between results obtained in a clinical trial and those seen in a clinical practice setting. For

Conclusions

Sildenafil is an effective treatment of ED in a clinical practice setting. Previous data obtained from clinical trials are confirmed. The present findings, based largely on IIEF questionnaire responses, were substantiated by the responses of partners, who independently completed a modified version of the same questionnaire. Classifying the dysfunction according to severity appears to be a simple way to predict treatment response. Men who report some erectile function (severity class I or II)

References (7)

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Publication costs were supported in part by an unrestricted educational grant from Pfizer, Inc.

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