sildenafil-citrate and Paraplegia

Multiple dramatic consequences follow medullary lesions. Not only are voluntary motor control and sensitivity of the body segment below the lesion lost, but it also becomes impossible to control erection and ejaculation as well as urinary and faecal continency. The first investigations into genito-sexual function in paraplegics have brought about the idea, commonly admitted in the medical world, that this kind of patient is impotent and sterile. Fortunately this idea is disappearing gradually and many data have demonstrated that appropriate treatment is required and some therapies efficient. This is particularly important in the case of the population concerned, namely young men in 70% of the cases, since the usual age bracket at trauma is between 25 and 35 years old. At this time of life, sexual activity is often at its peak, so that the fertility potential becomes erased.

Topics: Adult; Electric Stimulation Therapy; Erectile Dysfunction; Humans; Insemination, Artificial; Male; Papaverine; Paraplegia; Piperazines; Prostaglandins; Purines; Reflex, Abnormal; Sildenafil Citrate; Sperm Motility; Spinal Cord Injuries; Sulfones; Vibration

Double-blind, placebo-controlled, flexible-dose study.. To evaluate the efficacy, safety and tolerability of oral sildenafil in women with female sexual arousal disorder as a result of SCI (paraplegia/tetraplegia).. The study was conducted at clinical practice sites in North America (n =23), 11 European countries (n =23), Australia (n =4) and South Africa (n =2).. 129 women were randomized and treated with sildenafil or matching placebo. A 4-week baseline period was followed by 12 weeks of treatment, which could be increased from 50 to 100 mg or decreased to 25 mg once during the treatment period, depending on efficacy and tolerability. By use of an event log, sexual activity was monitored between screening and the end of treatment. The Sexual Function Questionnaire, the Sexual Quality of Life Questionnaire-Female, a global efficacy question and Sexual Distress Question were also assessed.. Sildenafil-treated women and placebo-treated women had an increase in their percentage of sexual activities throughout the course of the study, with no statistically significant difference between groups in the percentage of successful sexual activities at end of treatment versus baseline. There were also no statistically significant differences between sildenafil- and placebo-treated women on the aforementioned measures. The most common adverse events included headache and vasodilatation.. The results of this study are similar to other reports regarding a lack of clinically meaningful benefit of sildenafil in other populations of women.. This study was sponsored by Pfizer Inc.

Topics: Adult; Double-Blind Method; Female; Humans; Middle Aged; Paraplegia; Phosphodiesterase 5 Inhibitors; Piperazines; Placebo Effect; Purines; Quadriplegia; Sexual Dysfunctions, Psychological; Sildenafil Citrate; Spinal Cord Injuries; Sulfones; Young Adult

To evaluate the efficacy of sildenafil in the treatment of neurogenic erectile dysfunction (ED) secondary to upper motor neuron (UMN) and lower motor neuron (LMN) spinal cord injury (SCI). After taking consents 105 patients suffering from ED were enrolled in this prospective study. Seventy-two patients had signs and symptoms of UMN and 33 patients had signs and symptoms of LMN or mixed (UMN and LMN) spinal cord injuries. The patients took 50-100 mg sildenafil or placebo tablet at least 45 min before sexual intercourse. Based on a IIEF questionnaire, success in achieving erection adequate for sexual intercourse was compared between sildenafil and placebo groups in UMN and non-UMN spinal cord injuries. In patients with UMN disease, sildenafil was effective in 82% of patients and its efficacy was statistically higher than placebo (82 vs. 25%, p < 0.05). Twenty-eight per cent of patients with non-UMN disease had a favourable response to sildenafil that was not statistically different from placebo. Sildenafil seems more effective in the treatment of neurogenic ED secondary to UMN spinal cord injury compared with that secondary to LMN injury. Actually, its efficacy on LMN injuries does not seem different from placebo and administration of this treatment may not be effective in spinal cord injury which has caused LMN symptoms.

Topics: Adult; Erectile Dysfunction; Humans; Male; Middle Aged; Paraplegia; Phosphodiesterase Inhibitors; Piperazines; Purines; Sildenafil Citrate; Spinal Cord Injuries; Sulfones

Multicenter, open, prospective, before-after study.. To assess the efficacy and safety of sildenafil therapy for erectile dysfunction in patients with spinal cord injury, and the association between the response to sildenafil and factors such as causes and levels of spinal cord injury, grade of ASIA deficit, time since injury, orgasmic perception, and degree of baseline erection.. Homes of outpatients of 16 spinal cord injury units in Spain.. One hundred and seventy patients with erectile dysfunction secondary to spinal cord injury, from whom baseline data were collected on their sexual function, and who started treatment with sildenafil 50 mg. An efficacy assessment was made by the patient and his partner, and the score of the International Index of Erectile Function (IIEF) was recorded.. It was reported by 88.2% of the patients and 85.3% of their partners that treatment with sildenafil had improved their erections, regardless of the baseline characteristics of the spinal cord injury and erectile function. In responders, this improvement was confirmed by an increase from 12.5 to 24.8 points (P<0.001) of the Erectile Function Domain of IIEF. A significant improvement was also seen in patients' satisfaction with sexual activity and general satisfaction derived from sexual life. Preservation of orgasmic perception and a baseline degree of erection of 3 or 4 (P=0.006) were predictors of therapeutic success. No serious adverse events occurred.. Sildenafil is an effective, well-tolerated treatment for erectile dysfunction caused by spinal cord injury, regardless of the cause, neurological level, ASIA grade, and time since injury.. Spanish Society of Paraplegia.

Topics: Adult; Aged; Chi-Square Distribution; Drug Administration Schedule; Erectile Dysfunction; Follow-Up Studies; Humans; Logistic Models; Male; Middle Aged; Paraplegia; Piperazines; Predictive Value of Tests; Probability; Prospective Studies; Purines; Quadriplegia; Sildenafil Citrate; Spinal Cord Injuries; Statistics, Nonparametric; Sulfones; Treatment Outcome

The aim of the study was to determine which vasoactive agent was more efficacious for erectile dysfunction (ED), intracavernosal papaverine or oral sildenafil, in paraplegic men within the first year after injury by using a penile color Doppler ultrasound as a quantitative imaging method and to determine the association between responses to these two vasoactive agents and factors such as neurological lesion level and lesion severity. A total of 31 male in-patients with spinal cord injury, aged over 18 years, and with neurological lesions below the T6 level within the first year after injury with ED were included. Visual and auditory sexual stimulus (VASS) on day 1 (group 1), VASS with 25 mg intracavernosal papaverine (group 2) and after a wash-out period of papaverine on day 2, and VASS with 50 mg oral sildenafil on day 5 (group 3) were administered to each patient. Measurements of the peak systolic velocity and end diastolic velocity, which were used as vascular parameters during each procedure type, were taken using penile color Doppler ultrasound. Considering the severity of the lesion and the levels of the neurological lesion, there was a statistically significant difference between the PSV values of the group 1 and the other two groups (P<0.05). There was no statistically significant difference between the peak systolic velocity and end diastolic velocity values of groups 2 and 3 (P>0.05) in terms of both the severity and the levels of the lesion. Efficacies of intracavernosal papaverine hydrochloride or oral sildenafil citrate for ED were similar at all neurological lesion levels and lesion severity in paraplegic men within the first year after spinal cord injury.

Topics: Adult; Erectile Dysfunction; Humans; Male; Middle Aged; Papaverine; Paraplegia; Penis; Piperazines; Prospective Studies; Purines; Regional Blood Flow; Sildenafil Citrate; Sulfones; Treatment Outcome; Ultrasonography, Doppler; Vasodilator Agents