sildenafil-citrate and Postoperative-Complications

With the wide use of sildenafil in kidney-transplanted patients, it is vital to recognize the effectiveness and safety in clinical practice.. Full-text articles involving the application of sildenafil after renal transplantation searched out in multiple databases were reviewed. All the meta-analyses were performed with Review Manager 5.0 software and bias analysis of the studies were conducted to examine the quality of articles. In addition, to estimate possible publication bias, funnel plot and the Egger's test were used.. Finally 7 articles eventually satisfied the inclusion criteria. The penetration ability and maintenance frequency in sildenafil group were much larger than those of control group. Except orgasmic function, domains of the International Index of Erectile Function have showed larger scores in sildenafil group than those of control group. No significant difference of the concentration of cyclosporine was observed between sildenafil and control group.. In conclusion, this study showed that treatment with sildenafil in renal allograft recipients with erectile dysfunction is a valid and safe option.

Topics: Cyclosporine; Erectile Dysfunction; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Penile Erection; Postoperative Complications; Sildenafil Citrate; Treatment Outcome; Vasodilator Agents

We carried out a systematic review and meta-analysis to assess the efficacy and safety of phosphodiesterase type 5 (PDE5) inhibitors for treating erectile dysfunction (ED) after bilateral nerve-sparing radical prostatectomy (BNSRP). A literature review was performed to identify all published randomised double-blind, placebo-controlled trials of PDE5 inhibitors for the treatment of ED after BNSRP. The search included the following databases: MEDLINE, EMBASE and the Cochrane Controlled Trials Register. The reference lists of the retrieved studies were also investigated. Six publications involving a total of 1678 patients were used in the analysis, including six RCTs that compared PDE5 inhibitors (tadalafil, sildenafil, avanafil and vardenafil) with placebo. Co-primary efficacy end points: International Index of Erectile Function-Erectile Function (IIEF-EF) domain score [the standardised mean difference (SMD) = 4.04, 95% confidence interval (CI) = 2.87-5.22, P < 0.00001]; successful vaginal penetration (SEP2) [the odds ratio (OR) = 14.87, 95%CI = 4.57-48.37, P < 0.00001]; and successful intercourse (SEP3) (OR = 47, 95%CI = 3-13.98, P < 0.00001) indicated that PDE5 inhibitors was more effective than the placebo. Specific adverse events with PDE5 inhibitors included headache (12.08%), dyspepsia (6.76%) and flushing (6.52%), which were significantly less likely to occur with placebo. This meta-analysis indicates that PDE5 inhibitors to be an effective and well-tolerated treatment for ED after BNSRP.

Topics: Erectile Dysfunction; Humans; Male; Organ Sparing Treatments; Peripheral Nerves; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Prostatectomy; Pyrimidines; Sildenafil Citrate; Tadalafil; Treatment Outcome; Vardenafil Dihydrochloride

The Fontan operation is the final step of palliation for patients with a functionally single ventricle. Since its introduction in the 1970s, the Fontan surgery has become part of a successful surgical strategy that has improved single ventricle mortality. In recent years, we have become more aware of the limitations and long-term consequences of the Fontan physiology. Pulmonary vascular resistance plays an important role in total cavopulmonary circulation, and has been identified as a potential therapeutic target to mitigate Fontan sequelae. In this review, we will discuss the results of different pulmonary vasodilator trials and the use of pulmonary vasodilators as a treatment strategy for Fontan patients.

Topics: Bosentan; Cardiac Output; Endothelin Receptor Antagonists; Fontan Procedure; Heart Defects, Congenital; Heart Failure; Humans; Phenylpropionates; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Pulmonary Circulation; Pyridazines; Sildenafil Citrate; Sulfonamides; Vascular Resistance; Vasodilator Agents

Topics: Adolescent; Budesonide; Fontan Procedure; Glucocorticoids; Humans; Hypoplastic Left Heart Syndrome; Male; Piperazines; Postoperative Complications; Purines; Sildenafil Citrate; Sulfones; Vasodilator Agents

Stem cells (SCs) have been investigated for the treatment of erectile dysfunction (ED).. This review covers key disease targets and all 33 preclinical studies, including their use of SC types, animal models, transplantation routes, and outcome assessment methods.. In the past one and half years there have been more stem-cell-for-erectile-dysfunction studies than the prior 8 years combined. These new studies tend to use combinatory treatment approaches by modifying or supplementing SCs with angiogenic or neurotrophic genes or proteins. However, when considering all risks and benefits, these combinatory approaches do not seem more advantageous than single-SC approaches. Another trend is the choice of transplantation routes other than the standard intracavernous (IC) injection. However, with the exception of intravenous injection, these new transplantation approaches are more cumbersome than IC injection and yet offer no evidence of producing better outcomes. In contrast to these variations, a consensus among these studies is the suggestion that paracrine action, as opposed to cellular differentiation, is the principal therapeutic mechanism. In conclusion, IC injection of a single SC type should be the choice protocol for initial clinical trials, and this is clearly the case with two clinical trials that are currently recruiting patients.

Topics: Animals; Clinical Trials as Topic; Diabetes Complications; Disease Models, Animal; Erectile Dysfunction; Evaluation Studies as Topic; Humans; Injections, Intravenous; Male; Myocytes, Smooth Muscle; Organ Specificity; Paracrine Communication; Penile Induration; Piperazines; Postoperative Complications; Prevalence; Prostatectomy; Purines; Radiotherapy; Rats; Sildenafil Citrate; Stem Cell Transplantation; Sulfones; Treatment Outcome

The Fontan procedure is the final common pathway in the surgical palliation of many single ventricle heart defects. Mortality has improved but morbidity remains significant. Pleural effusions continue to present challenges after this operation and account for increased length of stay and increased time with draining tube thoracostomies. This review examines recent publications addressing this problem.. Four papers in 2008-2009 addressed effusions after the Fontan procedure. Off-pump Fontan procedures did not decrease time until chest tube removal. Pulmonary vascular compliance, derived from an electrical circuit model, predicted chest tube indwelling time. A retrospective study identified mean pulmonary artery pressure as a risk factor for effusions lasting more than 14 days after the Fontan procedure. One prospective, randomized trial evaluated the effects of lisinopril on pleural effusions after the Fontan procedure. There was no difference in the length of pleural drainage between the two groups.. Pleural effusions after the Fontan procedure continue to be a challenge. The cause is likely multifactorial and could explain why the literature has no clear message. One randomized, prospective trial suggests that fenestration reduces effusions. Many other reviews report no benefit to fenestration. Sildenafil after the Fontan procedure should be studied in a randomized, prospective fashion.

Topics: Antihypertensive Agents; Chest Tubes; Drainage; Fontan Procedure; Heart Defects, Congenital; Humans; Hypertension, Pulmonary; Lisinopril; Piperazines; Pleural Effusion; Postoperative Complications; Purines; Sildenafil Citrate; Sulfones; Vasodilator Agents

Treatment of postoperative pulmonary hypertension with intravenous (IV) pulmonary vasodilators is hampered by the lack of selectivity. Inhaled nitric oxide produces selective pulmonary vasodilation; however, it requires a special device, and weaning can cause rebound. Oral sildenafil is a phosphodiesterase type V inhibitor. Sildenafil can produce sustained pulmonary vasodilatation in patients with hypoxic or primary pulmonary hypertension; however, experience with postoperative pulmonary hypertension is limited. We report our initial experience with eight patients who received oral sildenafil as adjunctive therapy for postoperative pulmonary hypertension. We reviewed the charts of eight adult patients with postoperative pulmonary hypertension who received oral sildenafil (25 to 50 mg) to facilitate weaning of IV (milrinone, nitroglycerine, and sodium nitroprusside) and inhaled (nitric oxide) pulmonary vasodilators. Hemodynamic data were recorded before and 30 and 60 minutes after the initial dose of sildenafil.. After the initial dose of sildenafil, mean pulmonary artery pressure was reduced by 20% and 22% at 30 and 60 minutes, respectively (p < 0.05). Pulmonary vascular resistance index decreased by 49% and 44% at 30 and 60 minutes, respectively (p < 0.05). Sildenafil had no clinically significant effects on cardiac index, mean arterial pressure, or systemic vascular resistance. Subsequent doses of sildenafil were administered at regular intervals, allowing successful weaning of concomitant pulmonary vasodilators.. Oral sildenafil is an effective agent for treatment of postoperative pulmonary hypertension and can be used to facilitate weaning of inhaled and IV pulmonary vasodilators.

Topics: Adult; Aged; Cardiac Surgical Procedures; Drug Evaluation; Drug Resistance; Female; Hemodynamics; Humans; Hypertension, Pulmonary; Male; Middle Aged; Milrinone; Nitric Oxide; Nitroglycerin; Nitroprusside; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Purines; Retrospective Studies; Sildenafil Citrate; Sulfones; Vascular Resistance; Vasodilator Agents

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Administration, Oral; Alprostadil; Clinical Trials as Topic; Cohort Studies; Cyclic Nucleotide Phosphodiesterases, Type 5; Double-Blind Method; Erectile Dysfunction; Humans; Injections; Male; Penis; Phosphodiesterase Inhibitors; Phosphoric Diester Hydrolases; Piperazines; Postoperative Complications; Prospective Studies; Prostatectomy; Purines; Randomized Controlled Trials as Topic; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

Radical prostatectomy is a frequently used treatment option for prostate cancer; however, prostatectomy is often associated with significant morbidity, including erectile dysfunction (ED).. To analyze the efficacy of sildenafil citrate in treating ED after radical prostatectomy.. MEDLINE and CANCERLIT (1998 to January 2004) were searched for English language articles using the key words prostatectomy, sildenafil, and phosphodiesterase inhibitors. Eleven studies fulfilled the inclusion criteria: primary, discrete data sets of postprostatectomy patients with ED treated with sildenafil monotherapy.. Sample sizes ranged from 13 to 198 (mean age, 61 +/- 3 years). Treatment durations were 4 weeks (or more than four doses) to 1 year, and sildenafil dosing was in the recommended range (25-100 mg). Seven studies reported a response rate (range, 14%-53%) for an end point consistent with the primary analysis outcome (erection sufficient for vaginal intercourse); the combined estimate of probability of response was 35% (95% confidence interval [CI], 24%-48%). There was strong evidence for a lower response rate after non-nerve-sparing (range, 0%-15%) versus nerve-sparing surgery (range, 35%-75%; combined odds ratio [OR] = 12.1; 95% CI, 5.5-26.6) but not after unilateral (range, 10%-80%) versus bilateral nerve-sparing surgery (range, 46%-72%; combined OR = 2.21; 95% CI, 0.75-6.54).. The results of these studies demonstrate that with sildenafil, more than one third of patients with postprostatectomy ED achieved erection sufficient for intercourse. The odds of responding improved 12-fold with preservation of at least one neurovascular bundle. Early treatment failure does not necessarily imply lack of efficacy in the future, and patients should be encouraged to continue trying sildenafil, titrating up to 100 mg as needed.

Topics: Erectile Dysfunction; Humans; Male; Middle Aged; Piperazines; Postoperative Complications; Prostatectomy; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

Although the high rate of erectile dysfunction (ED) following prostatectomy is well recognised, the aetiology and pathophysiology have not yet been fully elucidated. We examined the current literature as to aetiology, treatment and possible prevention of ED following prostatectomy.. Review of the literature by a Medline search.. The most important predictors of erectile function are pre-operative erectile function and the nerve sparing nature of the procedure. The former is determined by age and vascular risk-factors whereas the latter is decided by the stage of the tumour and the skill of the surgeon. The value of intraoperative nerve mapping seems limited and the importance of nerve grafting is uncertain. Natural recovery of erection can take as long as 24 months. Patients complain about a lack of professional support. Symptomatic therapy may be applied according to the current general standards of treatment in men with ED.

Topics: Alprostadil; Erectile Dysfunction; Humans; Male; Penile Erection; Penile Prosthesis; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Prostatectomy; Prostatic Neoplasms; Purines; Quality of Life; Risk Factors; Sildenafil Citrate; Sulfones; Vacuum; Vasodilator Agents

Despite the revolutionary introduction of oral erectogenic agents for the treatment of erectile dysfunction, there will always be patients who do not respond to conservative therapy. Penile prosthetic surgery remains an important option for these patients. Mechanical reliability and patient satisfaction have improved significantly throughout the years. This review focuses on the most recent and important updates regarding product enhancements, patient satisfaction studies, and management of intra- and postoperative problems.

Topics: Erectile Dysfunction; Forecasting; Humans; Intraoperative Complications; Male; Patient Satisfaction; Patient Selection; Penile Induration; Penile Prosthesis; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Preoperative Care; Purines; Reproducibility of Results; Sildenafil Citrate; Sulfones; Time Factors; Treatment Outcome

Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long-term follow-up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32-44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18-26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow-up of 4.5 years, 91 deaths accounted for 4.21 higher-than-expected mortality in the age-matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance-either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six-month changes in the composite clinical score and in the 6-minute walk test distance were related to survival. Conclusions Persistent valvular heart disease-pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.

Topics: Diabetes Mellitus; Double-Blind Method; Female; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Heart Valves; Humans; Hypertension, Pulmonary; Long Term Adverse Effects; Male; Middle Aged; Organ Size; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Pulmonary Wedge Pressure; Risk Factors; Sildenafil Citrate; Vascular Resistance

This study assessed whether i.v. sildenafil citrate prevented acute kidney injury in at-risk patients undergoing cardiac surgery with cardiopulmonary bypass.. In a double-blind RCT, adults at increased risk of acute kidney injury undergoing cardiac surgery in a single UK tertiary centre were randomised to receive sildenafil citrate 12.5 mg kg. The analysis population comprised eligible randomised patients that underwent valve surgery or combined coronary artery bypass graft and valve surgery, with cardiopulmonary bypass, between May 2015 and June 2018. There were 60 subjects in the sildenafil group and 69 in the placebo control group. The difference between groups in creatinine concentration was not statistically significant (MD: 0.88 μmol L. These results do not support the use of i.v. sildenafil citrate for kidney protection in adult cardiac surgery.. ISRCTN18386427.

Topics: Acute Kidney Injury; Administration, Intravenous; Aged; Aged, 80 and over; Cardiac Surgical Procedures; Double-Blind Method; Female; Glucose; Humans; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Sildenafil Citrate; United Kingdom

It has not been clearly proved in real practice whether early rehabilitation with phosphodiesterase type 5 inhibitors starting immediately after radical prostatectomy improves erectile function recovery more effectively than delayed treatment with the same regimen. We performed a prospective randomized trial to identify this.. Patients with prostate cancer and an IIEF-5 (International Index of Erectile Function-5) preoperative score of 17 or greater were randomly assigned to receive sildenafil 100 mg regularly twice per week for 3 months immediately after urethral catheter removal as the early group or only 3 months after nerve sparing robot-assisted laparoscopic radical prostatectomy as the delayed group. The study primary end point was the full erectile function recovery rate, defined as an IIEF-5 score of 17 or greater, during the 12 months.. Of the 120 randomized patients the proportion who achieved full recovery was significantly higher during the 12 months in the early group than in the delayed group (β = 0.356, p <0.001, generalized estimating equation). After 9 months postoperatively the proportion of patients who achieved full recovery steadily increased to 41.4% at 12 months in the early group while patients in the delayed group showed no further improvement. Thus, full recovery was achieved in only 17.7% of patients at 12 months. Only early sildenafil treatment independently improved full recovery at 12 months (HR 2.943, p = 0.034).. Our trial provides clinical data to suggest that earlier rehabilitation with phosphodiesterase type 5 inhibitors can contribute to the recovery of erectile function after radical prostatectomy in the clinical setting.

Topics: Erectile Dysfunction; Follow-Up Studies; Humans; Laparoscopy; Male; Middle Aged; Penile Erection; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Recovery of Function; Robotic Surgical Procedures; Sildenafil Citrate; Time Factors; Treatment Outcome

To evaluate the role of sildenafil in relieving ureteral stent symptoms.. A randomized controlled trial was conducted between March 2014 and November 2016. It included adult men who underwent unilateral ureteric stent after ureteroscopy. Patients who were taking PDE5-Is, alpha-blockers or anticholinergics, had contraindication to sildenafil or developed postoperative complications were not included. Eligible patients were randomized using sealed closed envelops to one of two groups (S and C). Patients in group S received sildenafil citrate 50 mg tablet once daily. Patients in group C were the control. All patients answered the ureteral stent symptom questionnaire (USSQ) after 2 weeks of stenting. Primary outcome was the difference in total USSQ score between both groups. Secondary outcomes were tolerability of the treatment and the difference in each domain of USSQ score.. After randomization, four patients (7.3%) in group C withdraw their consent because of severe symptoms and two patients (3.6%) in group S discontinued treatment because of headache and dizziness. Final analysis was performed for 46 and 48 patients in groups C and S, respectively. Total USSQ score and all domains (except work performance) were significantly lower in group S (P < 0.001). Dysuria and urgency were significantly more in group C (P = 0.012 and 0.007, respectively). Three patients in groups S (6.25%) experienced transient mild adverse effects (dyspepsia, flushing and rhinitis in one patient for each) but they continued sildenafil.. Sildenafil is an effective and well-tolerated treatment option for relieving ureteral stent-related symptoms in men. CLINICALTRIAL.. NCT02345980.

Topics: Adult; Dysuria; Hematuria; Humans; Lower Urinary Tract Symptoms; Male; Middle Aged; Nocturia; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Quality of Life; Sildenafil Citrate; Stents; Surveys and Questionnaires; Treatment Outcome; Ureter; Ureteral Calculi; Ureteroscopy; Urinary Incontinence, Urge

Acute kidney injury (AKI) is a common and severe complication of cardiac surgery. There is no effective prevention or treatment. Sildenafil citrate (Revatio. We conducted an open label, dose escalation study with six patients per dose level. The six doses were 2.5 mg, 5 mg or 10 mg as a bolus, either alone or followed by an additional 2 h infusion of 2.5 mg sildenafil.. Thirty-six patients entered the trial, of which 33 completed it. The mean age was 69.9 years. One patient died during surgery, two others were removed from the trial before dosing (all at dose level 5 mg + 2.5 mg). The pharmacokinetic profile of sildenafil was similar to previously published studies. For a dose of 10 mg administered as a bolus followed by 2.5 mg administered over 2 h the results were AUC. Pharmacokinetics of sildenafil during cardiopulmonary bypass were comparable to those of other patient groups. The drug was well tolerated at therapeutic plasma levels. These results support the further evaluation of sildenafil for the prevention of AKI in cardiac surgery.

Topics: Acute Kidney Injury; Administration, Intravenous; Aged; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Nitric Oxide; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Sildenafil Citrate

High pulmonary vascular resistance (PVR) may be a risk factor for early and late mortality in both Glen shunt and Fontan operation patients. Furthermore, PVR may increase long after the Fontan operation. Whether pulmonary vasodilators such as phosphodiesterase 5 inhibitors can decrease PVR in patients with single ventricular physiology remains undetermined.. This was a prospective, multicenter study. Patients with single ventricular physiology who have a PVR index higher than 2.5 Wood units·㎡ (WU) were enrolled. Cardiac catheterization was performed before and after administration of sildenafil in all patients. After the Fontan operation, a six minute walk test (6MWT) was also performed. A total of 42 patients were enrolled. PVR was significantly decreased in each stage of single ventricular physiology after sildenafil administration: from 4.3±1.5WU to 2.1±0.6WU (p<0.01) in patients before a Glenn shunt, from 3.2±0.5WU to 1.6±0.6WU (p<0.001) in patients after a Glenn shunt, and from 3.9±1.7WU to 2.3±0.8WU (p<0.001) in patients after Fontan. In patients after Fontan, the 6MWT increased from 416±74m to 485±72m (p<0.01), and NYHA functional class improved significantly (p<0.05) after sildenafil administration. No major side effects were observed in any patients.. Sildenafil reduced PVR in patients with single ventricle physiology. Sildenafil increased exercise capacity and improved NYHA functional class in patients after a Fontan operation. This implies that pulmonary vasodilation is a potential therapeutic target in selected patients with elevated PVR with single ventricle physiology. Long-term clinical significance warrants further study.

Topics: Adolescent; Child, Preschool; Female; Fontan Procedure; Heart Defects, Congenital; Heart Ventricles; Hemodynamics; Humans; Hypertension, Pulmonary; Infant, Newborn; Japan; Male; Outcome and Process Assessment, Health Care; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Sildenafil Citrate; Vascular Resistance; Vasodilator Agents

To perform a randomized control trial (RCT) assessing the effect of phosphodiesterase 5 inhibitor (PDE5i) used prior to hilar clamping during robot assisted partial nephrectomy (RAPN) for renoprotection.. We performed an institutional review board approved, placebo controlled, double blinded RCT evaluating a single 100 mg oral dose of sildenafil immediately prior to RAPN. Primary end point was accrual, participation and retention of patients with secondary endpoints assessing post-operative renal functional outcomes and safety. Exclusion criteria included history of coronary artery disease, solitary kidney, suspected benign pathology, PDE5i intolerance or pregnant females.. Of 40 eligible consecutive patients undergoing RPN between 9/2013 and 12/2014, 30 (75%) were randomized to treatment and there was 100% participation and retention. The groups were well matched for all measured comorbidities. Intraoperative outcomes including warm ischemia time (median 15 vs. 16.5 min, P = 0.29) were similar. Change in eGFR demonstrated similar decrease between sildenafil versus placebo at 1 day (-8% vs. -10%, P = 0.53), 2 days (-9% vs. -9%, P = 0.77), and 1 month (-4% vs. -6%, P = 0.31) following RAPN. Intermediate follow up (median 183 days) demonstrated similar results (-8% vs. -1%, P = 0.16) between the two cohorts. Safety profiles were similar between the two cohorts without any adverse reactions to the sildenafil.. Successful retention of patients was achieved in this RCT. The secondary outcome of renoprotection was not identified. J. Surg. Oncol. 2016;114:785-788. © 2016 2016 Wiley Periodicals, Inc.

Topics: Acute Kidney Injury; Administration, Oral; Adult; Aged; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Hemostasis, Surgical; Humans; Laparoscopy; Male; Middle Aged; Nephrectomy; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Preoperative Care; Prospective Studies; Protective Agents; Reperfusion Injury; Robotic Surgical Procedures; Sildenafil Citrate; Treatment Outcome

To evaluate the efficacy and safety of intravenous sildenafil for immediate postoperative pulmonary hypertension (PH) in pediatric patients undergoing congenital heart surgery.. A double-blind, multicenter, placebo-controlled, dose-ranging, parallel-group trial was conducted. Patients were randomized to one of three doses of intravenous sildenafil, or placebo, for a minimum of 24 h.. The study was heavily underpowered. Whereas enrollment of 228 patients (57 per treatment arm) was required to achieve the sample size estimate to detect difference between arms, the sponsor terminated the study after 15 months owing to slow patient accrual. Seventeen patients (median age 5 months) experiencing postoperative PH were randomized and treated, five with placebo and four each with low-, medium-, and high-dose sildenafil. In the first 24 h, 40% of placebo and 17% of sildenafil patients required additional therapy (p = 0.330). Median time to extubation (3 versus 8 days, p = 0.023) and intensive care unit stay (6 versus 15 days, p = 0.008) were shorter for sildenafil patients. Mean ± standard deviation systolic pulmonary artery pressure was reduced with sildenafil (46 ± 11 to 35 ± 6 mmHg, p = 0.027 versus placebo). No adverse events or systemic hypotension were attributed to sildenafil.. Intravenous sildenafil reduced pulmonary artery pressure and shortened time to extubation and intensive care unit stay in children with postoperative PH.

Topics: Adolescent; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug-Related Side Effects and Adverse Reactions; Female; Heart Defects, Congenital; Humans; Hypertension, Pulmonary; Infant; Infusions, Intravenous; Male; Piperazines; Postoperative Complications; Purines; Sildenafil Citrate; Sulfones; Vasodilation; Vasodilator Agents

Sildenafil is a strong pulmonary vasodilator that increases the intracellular cyclic guanosine monophosphate concentration through inhibition of phosphodiesterase-5. We assessed the benefit of oral sildenafil for persistent pulmonary hypertension early after congenital cardiac surgery in paediatric patients.. Sildenafil was administered at a starting dose of 0.5 mg kg(-1) following admission to the intensive care unit. With careful monitoring of haemodynamics, the dose was increased stepwise by 0.5 mg kg(-1) every 4-6 h up to a maximum of 2 mg kg(-1). After successful weaning from a ventilator and from other vasodilators, sildenafil was gradually discontinued over the next 5-7 days.. A retrospective review of medical records showed an age distribution of <1 month (n=26), > or = 1-<6 months (n=36), > or = 6-<12 months (n=19), 1-3 years (n=8), 4-9 years (n=9) and >10 years (n=2) at the time of surgery. The surgeries were performed for ventricular septal defect closure (n=17), arterial switch (n=30), truncus arteriosus repair (n=10), complete atrioventricular septal defect repair (n=12), total anomalous venous drainage repair (n=9), and other open-heart surgery (n=22). The aforementioned concomitant inhaled nitrous oxide treatment was performed in 66 patients. Pulmonary arterial pressure decreased in 28, was unchanged in five and elevated in one patient out of the total of 34 cases for which data from continuous pressure monitoring were available. Bosentan was added in three cases with persistent symptoms due to pulmonary hypertension despite sildenafil treatment. After sildenafil administration, modest oxygen desaturation occurred in seven cases, but no 'rebound' pulmonary hypertension occurred. There were no significant adverse events during sildenafil treatment.. Our results suggest that oral sildenafil is a safe and effective alternate for persistent pulmonary hypertension following congenital heart surgery in children.

Topics: Administration, Oral; Age Distribution; Child; Child, Preschool; Drug Administration Schedule; Heart Defects, Congenital; Hemodynamics; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Oxygen Consumption; Phosphodiesterase 5 Inhibitors; Piperazines; Postoperative Care; Postoperative Complications; Pulmonary Circulation; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome; Vasodilator Agents

We prospectively investigated whether postoperative statin use would contribute to earlier recovery of erectile function in men who underwent bilateral nerve sparing radical retropubic prostatectomy for clinically localized prostate cancer.. A total of 50 potent men without hypercholesterolemia undergoing bilateral nerve sparing radical retropubic prostatectomy for clinically localized prostate cancer were prospectively randomized into 2 equal groups. Group 1 patients were instructed to ingest only 50 mg sildenafil per day if needed following hospital discharge after radical retropubic prostatectomy. Group 2 patients were prescribed atorvastatin at a dose of 10 mg daily from postoperative days 1 to 90 and they were also instructed to ingest sildenafil, as in group 1. Patient status regarding potency and adverse events were assessed 6 months after surgery.. The 2 groups demonstrated no significant differences regarding various baseline factors, including International Index of Erectile Function-5 scores. Group 2 had a significantly higher postoperative International Index of Erectile Function-5 score than group 1 at 6 months postoperatively (p = 0.003). Meanwhile, as judged by a preset definition, the incidence of potent patients 6 months after prostatectomy was 26.1% in group 1 and 55% in group 2 (p = 0.068). Also, 17.4% and 40% of the men reported achieving intercourse by vaginal penetration without a phosphodiesterase 5 inhibitor in groups 1 and 2, respectively (p = 0.172). No serious adverse events associated with medication were reported.. Postoperative treatment with atorvastatin in men who report normal erectile function preoperatively may contribute to earlier recovery of erectile function after nerve sparing radical retropubic prostatectomy.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Aged; Atorvastatin; Cyclic Nucleotide Phosphodiesterases, Type 5; Denervation; Drug Therapy, Combination; Erectile Dysfunction; Follow-Up Studies; Heptanoic Acids; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Male; Microsurgery; Middle Aged; Penile Erection; Peripheral Nerves; Piperazines; Postoperative Complications; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Purines; Pyrroles; Sildenafil Citrate; Sulfones; Vasodilator Agents

To assess the effectiveness of combining sildenafil citrate with a vacuum constriction device (VCD) in men (after radical prostatectomy) unsatisfied with the results of the VCD alone.. A total of 31 patients unsatisfied with the early use of VCD alone after radical prostatectomy (mean follow-up of 4.5 months) were instructed to take 100 mg of sildenafil 1 to 2 hours before VCD use for sexual intercourse. Patients used combination therapy for a minimum of five attempts before assessment with the abridged International Index of Erectile Function (IIEF) questionnaire and a visual analogue scale to gauge rigidity. The effect of combination therapy on the total IIEF-5 score and penile rigidity score were assessed.. Of the 31 patients, 7 (22%) had no improvement with the addition of sildenafil with VCD and discontinued the drug, and 24 (77%) reported improved penile rigidity and sexual satisfaction. The IIEF-5 score revealed statistically significant improvement in each domain, and patients reported that sildenafil enhanced their erections 100% of the time. The penile rigidity scores on a scale of 0 to 100 with the VCD alone averaged 55% (range 23% to 85%) for the men and 59% (range 26% to 90%) for their partners. With the addition of sildenafil, it increased to 76% for the men and 82% for their partners. Of the 24 men, 7 (30%) reported a return of natural erections at 18 months using combination therapy, with 5 of 7 reporting erections sufficient for vaginal penetration.. In this study, the addition of sildenafil with VCD improved sexual satisfaction and penile rigidity in patients unsatisfied with VCD alone after radical prostatectomy.

Topics: Coitus; Combined Modality Therapy; Constriction; Erectile Dysfunction; Humans; Male; Middle Aged; Penis; Personal Satisfaction; Piperazines; Postoperative Complications; Prostatectomy; Purines; Sexual Partners; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Treatment Outcome; Vacuum

To evaluate the effect of sildenafil on the response of glans penis during sexual intercourse in patients with penile prosthesis who show cold glans syndrome symptoms.. Fourteen patients who had undergone three-piece inflatable penile prosthesis implantation were evaluated. In spite of the normal functioning of the device all of them complained of a degree of dissatisfaction during SI due to a lack of engorgement in the glans penis. The patients were advised to have a dose of 100 mg VO sildenafil about 45 minutes before activating the PP and starting SI. All of them followed this scheme at least three times. They ticked questions 7, 8, 13 and 14 of the International Index of Erectile Function (IIEF) questionnaire with/without having had sildenafil.. Twelve out of thirteen patients (85.7%) indicated a more pleasant SI on sildenafil. It was related to an increase in penile glans engorgement and sensitivity. The scores obtained in the IIEF questions showed a significant increase on taking sildenafil. The partners also talked of a more comfortable SI that they related to a less painful penetration. Sildenafil-related morbidity was not found.. Sildenafil could be used to improve functional results of the penile prosthesis in those patients with CGS and seems to increase satisfaction during SI.

Topics: Body Temperature; Cold Temperature; Humans; Male; Penile Prosthesis; Penis; Piperazines; Postoperative Complications; Prospective Studies; Purines; Sildenafil Citrate; Sulfones; Syndrome; Vasodilator Agents

To investigate the acute effects of intravenous sildenafil on haemodynamics and oxygenation, and its interaction with inhaled nitric oxide (iNO) in infants at risk of pulmonary hypertension early after cardiac surgery.. Prospective, randomised trial.. Paediatric intensive care unit of a children's hospital.. Sixteen ventilated infants early after closure of ventricular or atrioventricular septal defects, were randomly assigned to one of two groups. The study was completed in 15 infants.. Studies were commenced within 7 h of separation from bypass. Seven infants received iNO (20 ppm) first, with the addition of intravenous sildenafil (0.35 mg/kg over 20 min) after 20 min. Eight infants received sildenafil first, iNO was added after 20 min. Vascular pressures, cardiac output and a blood gas were recorded at 0, 20 and 40 min.. In infants receiving iNO first, iNO lowered the pulmonary vascular resistance index (PVRI) from 3.45 to 2.95 units (p=0.01); sildenafil further reduced PVRI to 2.45 units p<0.05). In those receiving sildenafil first, PVRI was reduced from 2.84 to 2.35 units (p<0.05) with sildenafil, and fell to 2.15 units (p=0.01) with the addition of iNO. In both groups, sildenafil reduced the systemic blood pressure and systemic vascular resistance (p<0.01) and worsened arterial oxygenation and the alveolar-arterial gradient (p<0.05).. Intravenous sildenafil augmented the pulmonary vasodilator effects of iNO in infants early after cardiac surgery. However, sildenafil produced systemic hypotension and impaired oxygenation, which was not improved by iNO.

Topics: Administration, Inhalation; Blood Pressure; Bronchodilator Agents; Cardiac Output; Drug Synergism; Drug Therapy, Combination; Female; Heart Septal Defects, Atrial; Heart Septal Defects, Ventricular; Humans; Hypertension, Pulmonary; Infant; Infant, Newborn; Infusions, Intravenous; Male; Nitric Oxide; Piperazines; Postoperative Complications; Prospective Studies; Pulmonary Circulation; Purines; Risk Factors; Sildenafil Citrate; Sulfones; Treatment Outcome; Vascular Resistance; Vasodilator Agents

Topics: Adult; Erectile Dysfunction; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Piperazines; Postoperative Complications; Prevalence; Purines; Safety; Sildenafil Citrate; Sulfones; Time Factors; Vasodilator Agents

Controlled trials have demonstrated the efficacy of sildenafil for "mixed etiology" erectile dysfunction, but this may not be the case if there is underlying pelvic parasympathetic nerve damage. We aimed to determine the efficacy of sildenafil after rectal excision for rectal cancer and inflammatory bowel disease.. Patients with erectile dysfunction after rectal excision were randomly assigned in a double-blind manner to sildenafil or placebo groups. After unblinding, placebo patients crossed over to open sildenafil. Primary end points were improvement in erectile function on a global efficacy question and erectile function questionnaire scores. Secondary end points were frequency and severity of side effects.. Thirty-two patients were randomly assigned, and two dropped out before randomization. Fourteen received sildenafil, and 18 received placebo. Eleven (79 percent) of 14 responded to sildenafil, on global efficacy assessment, compared with 3 (17 percent) of 18 taking placebo (mean difference, 61.9 percent; 95 percent confidence interval, 34.4 to 89.4 percent; P = 0.0009). Sildenafil improved both erectile function domain scores (mean difference, 13.3; 95 percent confidence interval, 7.9 to 18.7; P = 0.0001) and total International Index of Erectile Function scores (mean difference, 30.6; 95 percent confidence interval, 18.7 to 42.6; P < 0.0001) from pretreatment baseline scores. Placebo did not produce improvement in either erectile function (mean difference, 1.7; 95 percent confidence interval, -0.8 to 4.2; P = 0.16) or total International Index of Erectile Function scores (mean difference, 5; 95 percent confidence interval, -1.1 to 11.1; P = 0.1). Ten (100 percent) of 10 crossover patients not responding to placebo did respond to sildenafil (difference, 100 percent; P < 0.0001). Sildenafil improved both erectile function domain scores (mean difference, 16.8; 95 percent confidence interval, 9.7 to 24; P = 0.002) and total International Index of Erectile Function scores (mean difference, 29.5; 95 percent confidence interval, 15.8 to 43.2; P = 0.003) from precrossover baseline scores. Seven (50 percent) of 14 patients on sildenafil compared with 4 (22 percent) of 18 on placebo experienced side effects (difference, 28 percent; 95 percent confidence interval, -4.4 to 60.4 percent; P = 0.14), 91 percent of which were mild and well tolerated.. Sildenafil completely reverses or satisfactorily improves postproctectomy erectile dysfunction in 79 percent of patients. Side effects are usually mild and well tolerated. The damage incurred by the pelvic nerves after proctectomy, less profound than after prostatectomy, is likely to result in a partial parasympathetic nerve lesion.

Topics: Adult; Aged; Aged, 80 and over; Cross-Over Studies; Double-Blind Method; Erectile Dysfunction; Humans; Inflammatory Bowel Diseases; Male; Middle Aged; Parasympathetic Nervous System; Patient Satisfaction; Pelvis; Piperazines; Placebos; Postoperative Complications; Purines; Rectal Neoplasms; Rectum; Sildenafil Citrate; Sulfones; Vasodilator Agents

Patients undergoing radical pelvic floor surgery are often find that sexual function is impaired. In this research hypothesis, we evaluated the efficacy of alternative therapy to conventional PGE 1 injections, such as the association of Sildenafil and L-Arginine. This association is based on the principle that L-Arginine, the precursor of nitric oxide, improves the effect of Sildenafil, which is effective in the presence of nitric oxide.. The experimental plan was to make a comparative study between 2 random groups of patients selected from those undergoing radical cystectomies and prostatectomies over the past three years. 116 patients were eligible (64 prostatectomies and 52 cystectomies). The first random group was treated with Sildenafil alone and the second with Sildenafil and L-Arginine. The efficacy of treatment was evaluated using the Buckling test (pressure threshold of cavernous flexation at penile axial rigidity) once after ambulatorial administration and then by telephone interview (subjective evaluation) after administration at domicile.. The starter dose was 50 mg and was inefficient in both groups (Buckling test between 0 and 250). 100-mg doses gave significant results (Buckling test >500) in both groups, especially the second. Cardiopathic patients, diabetics and patients with retinal disorders or who were unmotivated were excluded from the study. The mean age of patients was 65.. The resumption of relatively satisfactory sexual activity was demonstrated using non-invasive pharmacological treatment.

Topics: Aged; Arginine; Erectile Dysfunction; Humans; Male; Pelvic Floor; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Purines; Sildenafil Citrate; Sulfones

Phosphodiesterase type 5 inhibitors represent the standard treatment of erectile dysfunction after nerve-sparing prostatectomy. Avanafil is a second-generation phosphodiesterase type 5 inhibitor with a high selectivity for phosphodiesterase type 5 isoform. To date, there are no studies comparing the outcomes of avanafil versus sildenafil in this scenario. In this study, we evaluated the efficacy and safety of avanafil versus sildenafil as a drug for post-prostatectomy rehabilitation. Overall, 160 patients submitted to robot-assisted nerve-sparing prostatectomy for localized prostate cancer at three hospitals were enrolled for the present study. After 6 months of treatment, patients in the two groups showed no significantly different sexual function scores, except for the Erection Hardness Score and Sexual Encounter Profile-Q2 that were higher in the Sildenafil group. Adverse events in the Avanafil group occurred in four (5%) patients and in 16 (20%) patients in the Sildenafil group. According to our experience, in patients undergoing nerve-sparing prostatectomy, penile rehabilitation with avanafil compared to sildenafil showed a lower ability to produce a valid erection in the initial phase of sexual intercourse, a difference that disappears in the continuation of the same. Avanafil showed a greater tolerance profile with a lower rate of AEs and discontinuation of therapy due to AEs.

Topics: Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Organ Sparing Treatments; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Prospective Studies; Prostate; Prostatectomy; Prostatic Neoplasms; Pyrimidines; Robotic Surgical Procedures; Sildenafil Citrate; Treatment Outcome

Low-level hemolysis (LLH) after left ventricular assist device implantation contributes to thromboembolic events (TE). Free plasma hemoglobin (fHb) scavenges nitric oxide (NO), which causes endothelial dysfunction and activates platelets. fHb also interacts with von Willebrand factor (vWF). We hypothesized that improved hemodynamic and enhanced NO signaling in HeartMate II (HMII) patients with LLH taking the phosphodiesterase-5 inhibitor sildenafil may reduce the risk of TE.From 2011 to 2015, 83 patients underwent HMII implantation. Patients with LLH as defined by elevated lactate dehydrogenase (400 < LDH ≤ 700 U/L) at hospital discharge were identified. Patients were categorized into 4 groups: 1) LLH + sildenafil, 2) LLH no sildenafil, 3) no LLH + sildenafil, and 4) no LLH no sildenafil. Adverse event-free survival was compared between the groups.Thirty-four patients (40.9%) were discharged with LLH and 22 (64.7%) of them took sildenafil. LDH and fHb remained significantly elevated in both LLH groups compared to the no LLH patients (P < 0.0001). Overall incidence of pump thrombosis (PT) was 4.8% and of ischemic stroke (IS) was 8.4%. HMII patients with LLH not on sildenafil had higher risk of TE (hazard ratio (HR): 14.4, 95%-CI: 1.8-117.1, P = 0.001). vWF activity and bleeding incidence did not differ between the LLH and no LLH patients. Mean pulmonary artery pressure and pulmonary vascular resistance decreased significantly in HMII taking sildenafil (P < 0.0001) while cardiac index increased (P < 0.0001).Sildenafil treatment among HMII patients with LLH reduced the risk of thromboembolic events and significantly improved and decompressed the pulmonary circulation during HMII support.

Topics: Aged; Case-Control Studies; Female; Follow-Up Studies; Heart-Assist Devices; Hemolysis; Humans; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Postoperative Complications; Pulmonary Circulation; Retrospective Studies; Sildenafil Citrate; Thromboembolism; Treatment Outcome

Although mortality is low after the modified Fontan procedure, there is a significant percentage of patients with prolonged postoperative recovery. The objective of this study is to evaluate the usefulness of postoperative administration of oral sildenafil and inhaled nitric oxide on early postoperative outcome. A prospective interventional and comparison study with a historical cohort was conducted. Between January, 2010 and March, 2013, 16 patients received oral sildenafil during immediate modified Fontan postoperative period. Inhaled nitric oxide was also administered if the patient was kept intubated 12 hours after surgery. Early postoperative outcome was compared with a historical cohort of 32 patients on whom the modified Fontan procedure was performed between March, 2000 and December, 2009. Postoperative administration of sildenafil and nitric oxide had no influence on early postoperative outcome after the modified Fontan procedure in terms of duration of pleural effusions, mechanical ventilation time, length of stay in the ICU, and length of hospital stay.

Topics: Child; Child, Preschool; Female; Fontan Procedure; Heart Defects, Congenital; Humans; Male; Nitric Oxide; Postoperative Complications; Postoperative Period; Prospective Studies; Risk Factors; Sildenafil Citrate; Treatment Outcome; Vasodilator Agents

This exploratory study examines the experience of three gay couples managing sexual dysfunction as a result of undergoing a radical prostatectomy. Semi-structured interviews were conducted as part of a larger study at an urban hospital in Toronto, Ontario, Canada. Interview transcripts were transcribed verbatim, and analyzed using interpretative phenomenological analysis. The authors clustered 18 subordinate themes under 3 superordinate themes: (a) acknowledging change in sexual experience (libido, erectile function, sexual activity, orgasmic function); (b) accommodating change in sexual experience (strategies: emphasizing intimacy, embracing plan B, focus on the other; barriers: side-effect concerns, loss of naturalness, communication breakdown, failure to initiate, trial and failure, partner confounds); and (c) accepting change in sexual experience (indicators: emphasizing health, age attributions, finding a new normal; barriers: uncertain outcomes, treatment regrets). Although gay couples and heterosexual couples share many similar challenges, we discovered that gay men have particular sexual roles and can engage in novel accommodation practices, such as open relationships, that have not been noted in heterosexual couples. All couples, regardless of their level of sexual functioning, highlighted the need for more extensive programming related to sexual rehabilitation. Equitable rehabilitative support is critical to assist homosexual couples manage distress associated with prostatectomy-related sexual dysfunction.

Topics: Adaptation, Psychological; Adult; Communication; Erectile Dysfunction; Gender Identity; Homosexuality, Male; Humans; Interpersonal Relations; Interview, Psychological; Libido; Male; Middle Aged; Orgasm; Penile Prosthesis; Piperazines; Postoperative Complications; Prostatectomy; Purines; Sexual Behavior; Sexual Dysfunction, Physiological; Sildenafil Citrate; Sulfones; Urinary Incontinence

High pulmonary vascular resistance index (PVRI) can lead to right ventricular dysfunction and failure of the donor heart early after pediatric heart transplantation. Oral pulmonary vasodilators such as sildenafil have been shown to be effective modifiers of pulmonary vascular tone. We performed a retrospective, observational study comparing patients treated with sildenafil ("sildenafil group") to those not treated with sildenafil ("nonsildenafil group") after heart transplantation from 2007 to 2012. Pre- and posttransplant data were obtained, including hemodynamic data from right heart catheterizations. Twenty-four of 97 (25%) transplant recipients were transitioned to sildenafil from other systemic vasodilators. Pretransplant PVRI was higher in the sildenafil group (6.8 ± 3.9 indexed Woods units [WU]) as compared to the nonsildenafil group (2.5 ± 1.7 WU, p=0.002). In the sildenafil group posttransplant, there were significant decreases in systolic pulmonary artery pressure, mean pulmonary artery pressure, transpulmonary gradient and PVRI (4.7 ± 2.9 WU before sildenafil initiation to 2.7 ± 1 WU on sildenafil, p=0.0007). While intubation time, length of inotrope use and time to hospital discharge were longer in the sildenafil group, survival was similar between both groups. Oral sildenafil was associated with a significant improvement in right ventricular dysfunction and invasive hemodynamic measurements in pediatric heart transplant recipients with high PVRI early after transplant.

Topics: Adolescent; Adult; Cardiac Catheterization; Child; Child, Preschool; Female; Follow-Up Studies; Heart Transplantation; Humans; Infant; Male; Piperazines; Postoperative Complications; Prognosis; Purines; Retrospective Studies; Sildenafil Citrate; Sulfones; Vasodilator Agents; Ventricular Dysfunction, Right; Young Adult

Pulmonary hypertension (PHT) and the resulting right ventricle dysfunction are important risk factors in patients who undergo cardiac surgery. The treatment of PHT and right ventricle dysfunction should be focused on maintaining the correct right ventricle after load, improving right ventricle function and reducing the right ventricle pre-load and therefore reducing pulmonary vascular resistance by means of vasodilators. A combined therapy of vasodilators and medicines which have different mechanisms of action, is becoming an option for the treatment of PHT. We present a 65 year old woman that suffered from mitral regurgitation, aortic valve disease, tricuspid and ascending aortic dilation with 115mmHg of pulmonary artery pressure (by ultrasound evaluation). The patient was operated on of mitral, aortic valve and tricuspid plastia and proximal aortic artery plastia as well. Previosly to surgery the patient suffered right ventricle dysfunction and PHT and was treated with nitric oxide, intravenous sildenafil and levosimendan. Subsequent evolution was satisfactory, PHT being controlled, without arterial hypotension nor respiratory alterations.

Topics: Aged; Aorta; Dobutamine; Drug Synergism; Drug Therapy, Combination; Female; Heart Valve Prosthesis Implantation; Humans; Hydrazones; Hypertension, Pulmonary; Nitric Oxide; Norepinephrine; Postoperative Complications; Pyridazines; Sildenafil Citrate; Simendan; Treatment Outcome; Vasodilator Agents; Ventricular Dysfunction, Right

Thrombosis of vascular anastomosis in the field of reconstructive microsurgery is a clinical problem of extraordinary importance for the devastating consequences for affected patients. Sildenafil has been shown to be relaxing vascular action on the peripheral vascular system in vivo and have an ability to reduce platelet aggregation. There is no study up to date on the effect of sildenafil on microvascular anastomosis, neither experimental studies nor clinical settings.. A purposeful thrombotic back-wall stitch was performed in the groin flap pedicle to obtain an anastomosis with thrombotic potential where the drug effect was studied.. Data in the experimental group treated with papaverine or sildenafil indicate a considerable decrease in the percentage of necrotic flaps (20% necrotic flaps in papaverine group versus 30% necrotic flaps in sildenafil group) in comparison with control group (60% necrotic flaps). In papaverine group, in 100% cases, flap necrosis was established in the first 24 h, but in sildenafil group, 66% flap necrosis was established between the second and the seventh postoperative days.. The study did not demonstrate significant differences between the groups, but it does suggest a benefit in applying papaverine and sildenafil in the anastomosis with already thrombogenetic disease, compared to the nonapplication of antithrombotic drugs. The establishment of thrombosis in the necrotic flaps in the group treated with sildenafil was later than in the group treated with papaverine, with a statistical trend but without becoming significant.

Topics: Anastomosis, Surgical; Animals; Disease Models, Animal; Free Tissue Flaps; Humans; Male; Microsurgery; Necrosis; Piperazines; Postoperative Complications; Purines; Rats; Rats, Sprague-Dawley; Sildenafil Citrate; Sulfonamides; Sutures; Thrombosis; Vasodilator Agents

Portopulmonary hypertension (PoPH) refers to pulmonary arterial hypertension associated with portal hypertension with or without evidence of an underlying liver disease. Despite the potential for curing PoPH with liver transplantation, the presence of moderate or severe PoPH is associated with increased morbidity and mortality and is, therefore, a contraindication to transplantation. Previous studies have predominantly used intravenous epoprostenol for treatment in order to qualify patients for liver transplantation. In this retrospective case series, we describe the clinical course of 11 patients whom we successfully treated (predominantly with oral sildenafil and subcutaneous treprostinil) in order to qualify them for liver transplantation. The mean pulmonary artery pressure significantly improved from 44 to 32.9 mm Hg, and the pulmonary vascular resistance decreased from 431 to 173 dyn second cm(-5) . There were significant improvements in the cardiac output and the transpulmonary gradient with these therapies as well. All 11 patients subsequently received liver transplants with a 0% mortality rate to date; the duration of follow-up ranged from 7 to 60 months. After transplantation, 7 of the 11 patients (64%) were off all pulmonary vasodilators, and only 2 patients required transiently increased doses of prostacyclins. In conclusion, an aggressive approach to the treatment of PoPH with sildenafil and/or treprostinil and subsequent liver transplantation may be curative for PoPH in some patients.

Topics: Adult; Antihypertensive Agents; Epoprostenol; Female; Follow-Up Studies; Humans; Hypertension, Portal; Length of Stay; Liver Failure; Liver Transplantation; Male; Middle Aged; Phosphodiesterase 5 Inhibitors; Piperazines; Postoperative Complications; Pulmonary Circulation; Purines; Retrospective Studies; Severity of Illness Index; Sildenafil Citrate; Sulfones

Therapy (case series).. 4.. To evaluate factors that affect compliance in men who enroll in a phosphodiesterase type 5 inhibitor (PDE5I) protocol after nerve-sparing robot-assisted prostatectomy (RAP), and report on short-term outcomes, as PDE5Is may help restore erectile function after RAP and patient adherence to the regimen is a factor that potentially can affect outcome.. We prospectively followed 77 men who had nerve-sparing RAP and enrolled in a postoperative penile rehabilitation protocol. The men received either sildenafil citrate or tadalafil three times weekly. The minimum follow-up was 8 weeks. Potency was defined as erection adequate for penetration and complete intercourse. Compliance was defined as men adhering to the regimen for > or =2 months.. The mean age of the cohort was 57.8 years and the median follow-up was 8 months. In all, 32% of the men discontinued the therapy <2 months after RAP and were deemed noncompliant with an additional 39% discontinuing therapy by 6 months, with the high cost of medication being the primary reason (65%). Long-term compliance and preoperative erectile dysfunction were independent predictors of potency return after adjusting for age and nerve sparing.. The high cost of medication remains a significant barrier to maintaining therapy. Noncompliance to PDE5I therapy in a tertiary care centre was much higher than reported in clinical trial settings. With longer-term follow-up, we need to further define the factors that improve overall recovery of sexual function after RAP.

Topics: Carbolines; Erectile Dysfunction; Humans; Male; Medication Adherence; Middle Aged; Patient Satisfaction; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Purines; Robotics; Sildenafil Citrate; Sulfones; Tadalafil; Trauma, Nervous System; Treatment Outcome

Common complications after surgery for transposition of the great arteries (TGA) include systemic ventricular dysfunction and arrhythmia after atrial baffle repair (AB) and outflow tract stenosis or regurgitation after the arterial switch (AS). Severe pulmonary hypertension (PHT) is a rarely reported problem after AB and AS. In this study we sought to evaluate the frequency of late onset severe PHT following surgical repair for TGA. We report 3 cases, 2 after AB and 1 after AS, describe the frequency of this complication and treatment response, by comparing the response to pulmonary vasodilators in this group of patients to that of idiopathic or connective tissue disease (CTD) related PHT. We currently follow 85 patients >or=17 years of age with repaired TGA; 77 after AB and 8 after AS. 3.5% of our adult congenital heart disease patients with TGA have developed late severe PHT. None of these patients demonstrated clinical improvement with Bosentan at 6 months, however 2 of 3 were stabilised with the addition of Sildenafil to initial therapy. The third patient died 4 months after the diagnosis of severe PHT, whilst waiting for heart-lung transplantation, despite Bosentan, Sildenafil and inotropic support. By contrast, of 37 patients with idiopathic or CTD related PHT commenced on Bosentan as initial therapy, 32 (86.5%) demonstrated a clinical response at 6 months; the other patients had Sildenafil as added therapy after 6 months. Our data suggest that patients with TGA and late onset PHT are less likely to achieve a clinical response on pulmonary vasodilator monotherapy (P = 0.006). Whilst more investigation is needed, our experience suggests an aggressive clinical course, often requiring combination PHT treatment.

Topics: Adolescent; Adult; Antihypertensive Agents; Cardiac Surgical Procedures; Cardiotonic Agents; Drug Therapy, Combination; Echocardiography, Doppler; Humans; Hypertension, Pulmonary; New South Wales; Piperazines; Postoperative Complications; Purines; Risk Factors; Sildenafil Citrate; Sulfones; Transposition of Great Vessels; Vasodilator Agents

We sought to determine the efficacy of postoperative oral sildenafil therapy (OST) in pediatric patients with congenital heart disease (CHD). A retrospective review of 45 postoperative patients with CHD who received OST was performed. Patients were categorized into three groups according to clinical indications: (1) to stabilize pulmonary vascular reactivity after biventricular repair (group 1 [n = 15]), (2) to lower pulmonary vascular resistance after bidirectional cavopulmonary shunt (group 2 [n = 12]), and (3) to improve post-Fontan hemodynamics (group 3 [n = 18]). Thirty-four patients (34 of 45 [75.6%]) had received inhaled nitric oxide (iNO) while on OST. Mean pulmonary arterial pressure (mPAP), mean systemic blood pressure (mSBP), and peripheral oxygen saturation (SpO(2)) were recorded during the first 24 hours after the initiation of OST. In group 1, the baseline mPAP/mSBP ratio (0.60 +/- 0.17) decreased significantly after the second (0.46 +/- 0.14, p = 0.004) and fourth (0.50 +/- 0.18, p = 0.025) doses of OST. In group 2, baseline SpO(2) (71.0 +/- 12.3%) increased after the fourth dose (75.1 +/- 12.3%, p = 0.04) of OST, without significant changes in mPAP. In group 3, baseline mPAP (14.8 +/- 3.3 mmHg) decreased significantly after the first (13.9 +/- 2.8 mmHg, p = 0.025) and second (13.3 +/- 1.9 mmHg, p = 0.016) doses of OST, without changes in SpO(2). In thirty-one (31 of 34 [92%]) subjects, iNO was discontinued within a median of 2 days after the initiation of OST, without rebound phenomena. There were no OST-related complications. Sildenafil citrate can be used safely in postoperative pediatric patients with CHD. Benefits from OST may be manifested differently in various clinical settings.

Topics: Administration, Inhalation; Administration, Oral; Adolescent; Blood Pressure; Child; Child, Preschool; Drug Therapy, Combination; Female; Heart Defects, Congenital; Hemodynamics; Humans; Infant; Infant, Newborn; Male; Nitric Oxide; Oxygen; Piperazines; Postoperative Complications; Pulmonary Artery; Pulmonary Wedge Pressure; Purines; Retrospective Studies; Sildenafil Citrate; Sulfones; Treatment Outcome; Vascular Resistance; Vasodilator Agents

Sildenafil is increasingly being used in the management of pulmonary arterial hypertension in the newborn. Its role in patients with congenital cardiac disease is less well defined and as yet has only been reported sporadically.. Present our experience with sildenafil treatment in patients with a failing Fontan circulation.. Retrospective review of 13 symptomatic patients after Fontan palliation who received treatment with sildenafil between January, 2006 and July, 2008.. Three patients suffered from protein-losing enteropathy, four patients presented with bronchial casts, two had severe cyanosis after fenestrated Fontan procedure, two had prolonged chylous effusions, one had a previous failure of Fontan and take-down, and one patient had arrhythmias and end-stage cardiac failure requiring conversion to an extra-cardiac Fontan. Sildenafil was used in the dosage of 1-2 milligrams per kilogram 3-4 times per day. Protein-losing enteropathy and alpha-1-antitrypsin levels improved in all three patients on sildenafil treatment. One of these patients had a concomitant catheter creation of a fenestration, as did two patients presenting with bronchial casts and both patients with persistent chylous effusions. All four patients with bronchial casts and two patients with cyanosis improved significantly on sildenafil treatment. Chylous effusions decreased after sildenafil and stent enlargement of a fenestration. There were no significant side effects requiring sildenafil withdrawal over a treatment period ranging from 2 months to 2 years.. Sildenafil can be used safely and effectively in the treatment of patients with a failing Fontan circulation.

Topics: Child; Child, Preschool; Female; Follow-Up Studies; Fontan Procedure; Heart Failure; Humans; Hypertension, Pulmonary; Male; Piperazines; Postoperative Complications; Protein-Losing Enteropathies; Purines; Retrospective Studies; Shock; Sildenafil Citrate; Sulfones; Time Factors; Treatment Outcome; Vasodilator Agents

OBJECTIVE To evaluate the indications for penile prosthesis implantation in the treatment of erectile dysfunction (ED) before and after the introduction of sildenafil. PATIENTS AND METHODS Penile prosthesis implantation was indicated in 144 men with ED at our institution between 1992 and 2007; 83 (55.6%) accepted the procedure, 55 (38.2%) refused it and six (4.2%) accepted but eventually had no surgery. Sixty-seven patients were operated primarily, and the remainder were referred cases with complications after or dissatisfaction with primary operations done elsewhere. Thirty-two were operated before the introduction of sildenafil (BS) and 35 after (AS). RESULTS In the BS group the most frequent aetiology was vascular disease, with 11(34%) vs two (6%) in the AS group. The most frequent aetiology in the AS group was previous radical pelvic surgery (radical prostatectomy, sigmoidectomy, etc.) with 17 (49%) vs none in the BS group. There were no significant differences in complication rates in both groups. Satisfaction rates in patients with malleable and inflatable devices were 36 (86%) and 17 (85%), respectively. CONCLUSIONS After the introduction of oral therapy for ED there were some changes in the aetiology of refractory ED; ED after radical prostatectomy is gaining acceptance as the main reason for a penile implant.

Topics: Erectile Dysfunction; Humans; Male; Patient Satisfaction; Penile Implantation; Penile Prosthesis; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Prostatectomy; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome

Radical pelvic surgery is a major cause of erectile dysfunction due to iatrogenic cavernous nerve damage. Endothelial nitric oxide synthase, which generates nitric oxide (NO) in the cavernosal tissues, localizes to specialized plasma membrane invaginations known as caveolae. Growing evidence suggests that caveolae are major components of signal trafficking and that stimuli that affect the concentration of the main structural protein of caveolae, caveolin-1 influence NO signaling.. To evaluate caveolin-1 expression as a marker of cavernous tissue damage and determine the impact of early sildenafil administration on caveolin-1 expression in animal models of partial and total surgical penile denervation.. Thirty-six rats were divided into six groups (N = 6 per group) that received bilateral or unilateral penile denervation or sham surgery, with and without sildenafil 10 mg daily for 7 weeks.. Sections were taken from the proximal middle portion of the penis of all animals. Cavernous tissue was delineated by the tunica albuginea, then the extent of immunostaining for the following parameters was quantitated to determine (i) cavernous smooth muscle layer in the cavernous space expressed as the percentage of alpha-smooth muscle actin (alpha-SMA) positive immunostaining per area and (ii) caveolin-1 expressed as a percentage of area.. A marked decrease in both caveolin-1 and alpha-SMA expression in cavernous smooth muscle tissue and in the endothelium of rats was noted after a bilateral and unilateral neurotomy. Specimens from animals receiving sildenafil exhibited higher mean immunostaining values for both proteins in cavernous tissue. The differences were statistically significant compared with groups receiving the same surgical treatment without sildenafil.. Caveolin-1 and alpha-SMA expression in cavernous tissue is significantly reduced by pelvic nerve injury, and the loss is related to the extent of the neural damage. Early administration of sildenafil elicits caveolin-1 expression, which appears to preserve cavernous tissue.

Topics: Actins; Animals; Caveolin 1; Erectile Dysfunction; Iatrogenic Disease; Male; Muscle, Smooth; Pelvis; Penis; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Purines; Rats; Rats, Sprague-Dawley; Sildenafil Citrate; Sulfones; Sympathectomy

Topics: Amputation, Surgical; Female; Fingers; Hand Dermatoses; Humans; Ischemia; Microcirculation; Middle Aged; Piperazines; Postoperative Complications; Purines; Scleroderma, Systemic; Sildenafil Citrate; Skin Ulcer; Sulfones; Vasodilator Agents

Assess acceptance of and discontinuation rate from erectile dysfunction (ED) treatment in patients after bilateral nerve-sparing radical retropubic prostatectomy (BNSRRP).. We analyzed acceptance and discontinuation data of 100 consecutive, age-comparable, preoperatively self-reported potent BNSRRP patients who at the discharge from the hospital received a phosphodiesterase type 5 inhibitor (PDE5-I) prescription. Patients were informed of the pharmacokinetic properties of the available compounds and the option of on-demand versus rehabilitative therapy. Thereafter, patients did not receive any specific counseling throughout the entire follow-up period and freely decided to use or not use any ED therapy. Complete preoperative data were obtained on hospital admission and included a medical and sexual history and the International Index of Erectile Function (IIEF). The IIEF was completed every 6 mo postoperatively, and patients participated in a semi-structured interview about the treatment adherence at the 18-mo follow-up.. Forty-nine (49%) patients freely decided not to start any ED therapy (group 1). Of the remaining patients, 36 (36%) opted for an as-needed PDE5-I (group 2), whereas 15 (15%) decided to use a daily PDE5-I (group 3). At the 18-mo follow-up, the overall discontinuation rate from both treatment modalities was 72.6% (eg, 72.2% vs. 73.3% in group 2 vs. group 3; p=0.79). Treatment effect below expectations was the main reason for treatment discontinuation, followed by loss of interest in sex due to partner's causes.. Almost 50% of BNSRRP patients freely decided not to start any ED treatment postoperatively. Roughly 73% of patients who started therapy eventually discontinued it.

Topics: Carbolines; Erectile Dysfunction; Follow-Up Studies; Humans; Imidazoles; Male; Middle Aged; Patient Compliance; Phosphodiesterase 5 Inhibitors; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Prostate; Prostatectomy; Prostatic Neoplasms; Purines; Quality of Life; Sildenafil Citrate; Sulfones; Surveys and Questionnaires; Tadalafil; Time Factors; Treatment Outcome; Treatment Refusal; Triazines; Vardenafil Dihydrochloride

Topics: Abnormalities, Multiple; Arteriovenous Fistula; Cardiac Catheterization; Child, Preschool; Endothelium-Dependent Relaxing Factors; Female; Follow-Up Studies; Heart Bypass, Right; Heart Defects, Congenital; Humans; Hypoxia; Nitric Oxide; Piperazines; Postoperative Complications; Pulmonary Artery; Purines; Radiography; Risk Assessment; Sildenafil Citrate; Sulfones; Treatment Outcome; Vascular Resistance; Vasodilator Agents

Since the launch in 1998 of the anti-impotence drug sildenafil (viagra), the American food and drug administration has identified 50 cases of drug-related blindness, the so-called nonarteritic anterior ischemic optic neuropathy. This, very serious, side effect frequently leads to sudden, mostly irreversible loss of vision, and there is no proven effective treatment to cure patients or to prevent recurrence. The mechanism of ischemic optic neuropathy is not clear, but it could be related to the fact that the ophthalmic and central retinal arteries have an autoregulation of their own blood flow without any autonomic nerve supply; vasoreactivity could be lower albeit efficient, and therefore more vulnerable to systemic modifications of the circulation. But decreased visual acuity and loss of visual ability also are, although uncommon, anesthesiological and surgical complications. These data are consistent with the hypothesis that sildenafil, surgery and anesthesia, taken together, could be a potentially dangerous cocktail of risk factors for sudden irreversible loss of vision. To reduce the risk, sildenafil use should be avoided at least one week before surgical operations, since the reported cases of blindness developed 36h after drug ingestion.

Topics: Anesthesia; Blindness; Carbon Dioxide; Humans; Hypertension; Ischemia; Male; Optic Nerve; Optic Nerve Diseases; Optic Neuropathy, Ischemic; Piperazines; Postoperative Complications; Purines; Risk; Risk Factors; Sildenafil Citrate; Sulfones; Vasodilator Agents

We report on the management of Candida endocarditis in a 5-month old infant. The orifice of the tricuspid valve was totally obstructed, and the tension apparatus of the valve destroyed. Excision of the valve led to severe failure of the right heart. The combined use of anti-failure treatment, and reduction of right ventricular afterload with oxygen, nitric oxide and sildenafil, proved successful.

Topics: Antifungal Agents; Candidiasis; Endocarditis; Female; Fluconazole; Heart Failure; Humans; Infant; Nitric Oxide; Oxygen Inhalation Therapy; Piperazines; Postoperative Complications; Purines; Sildenafil Citrate; Sulfones; Tricuspid Valve; Vasodilator Agents

We describe successful use of enteral sildenafil following surgery for congenital heart disease in three cases. One infant after repair of ventricular septal defect and aortic coarctation had pulmonary hypertension non-responsive to nitric oxide, another infant and 3.5 year child following palliative surgery for congenital heart disease with univentricular physiology were treated with inhaled nitric oxide and had severe systemic desaturations associated with endotracheal suctioning. Therapy with sildenafil reduced pulmonary arterial pressure, prevented episodes of arterial desaturations and allowed weaning from nitric oxide (Ref. 7). Full Text (Free, PDF) www.bmj.sk

Topics: Female; Heart Defects, Congenital; Humans; Hypertension, Pulmonary; Infant; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Purines; Sildenafil Citrate; Sulfones; Vascular Resistance; Vasodilator Agents

To assess the response rate to different erectile aids in a consecutive series of patients treated with non-nerve sparing radical prostatectomy (NNSRP).. Ninety-four potent men were counselled about the different treatment options to restore an assisted erection before they had NNSRP. They were invited to participate in a multiphase protocol involving the sequential use of different erectile aids which aimed at restoring erectile function after surgery. The first proposed treatment was oral apomorphine sublingual. Patients with a positive response to the 1-item overall efficacy question and a minimum score of 3 in both question 3 and 4 of the International Index of Erectile Function were considered responders to oral pharmacotherapy. Treatment with sildenafil was then suggested to those not responding. If patients did not respond to oral pharmacotherapy a trial with a vacuum erectile device was offered; those not responding to this were then offered intracavernosal injection therapy with prostaglandin-E alone as the first option, followed by a mixture of vasoactive agents if needed. In those in whom injections also failed, a penile implant was recommended. At the 1-year follow-up visit all patients were offered a second trial with oral therapy regardless of the treatment currently in use.. Seventy-six patients entered the protocol; there was no response to apomorphine. Five of 59 (8%) patients responded to sildenafil when they first used it at a mean of 7 months after NNSRP, while there were three additional responders in 22 patients who tried it for a second time a year later. Of patients achieving at least a complete tumescence sufficient for vaginal penetration, 52% and 60% were considered responders to the vacuum device and intracavernosal injections, respectively. Overall, 44% of patients enrolled in the protocol chose to use an erectile aid for at-home use. At the 1-year follow-up, only 20% of patients were still using an erectile aid, including two who had had a penile implant.. Up to 10% of patients may achieve a clinically significant erection with sildenafil after NNSRP, but 80% will not be using any erectile aid at 1 year after surgery. In the present study protocol the proposed erectile aids were largely inadequate for treating the permanent erectile dysfunction that follows NNSRP.

Topics: Administration, Sublingual; Aged; Algorithms; Apomorphine; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Patient Compliance; Penile Prosthesis; Piperazines; Postoperative Complications; Prospective Studies; Prostaglandins E; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome; Vacuum; Vasodilator Agents

Sildenafil is a cyclic guanosine-specific phosphodiesterase type 5 (PD-5) inhibitor that is widely used for erectile dysfunction. Potent and competitive inhibition of PD-5 enhances levels of cyclic guanosine monophosphate (cGMP). Fibrin glue-apart from tissue fixation-has been used for slow release of drugs. In this study, local delivery of Sildenafil citrate with fibrin glue was accomplished to improve random flap survival. Fifty Wistar rats were randomized into 5 groups, and a standardized dorsal random-pattern skin flap was elevated in each rat. In Group I (n = 10), the base of the flap was divided, making it a "graft" control to study the graft effect. In Group II (n = 10), a thin Silastic sheet was used to separate the flap from the underlying vascular bed, and no pharmacologic treatment was given. In Group III (n = 10), only 0.5 mL of fibrin glue was applied to the flap donor site. In Group IV (n = 10), 2.5 mg of sildenafil citrate mixed in 0.5 mL of fibrin glue was applied to donor site of the flap, whereas 10 mg of sildenafil citrate mixed in 0.5 mL of fibrin glue was applied in Group V (n = 10). Area of flap survival was evaluated on postoperative seventh day. Total necrosis of all of the flaps was observed in "graft" control group (Group I). Sildenafil and fibrin glue groups (Group IV and V) resulted in a statistically significant decrease in flap necrosis compared with Groups II and III (P < 0.0001). A statistically significant difference could not be documented between Group II and Group III (P > 0.0001). The decrease in skin necrosis was statistically significant in Group V compared with Group IV (P < 0.0001). Histologic examination revealed significantly increased vascular density in Groups IV and V compared with Groups II and III (P < 0.0001), whereas a significant difference could not be documented between Groups IV and V (P > 0.0001) and between Groups II and III (P > 0.0001). In view of these results, topical sildenafil application seems to improve flap survival in random-pattern skin flaps in dose-dependent manner.

Topics: Animals; Fibrin Tissue Adhesive; Necrosis; Piperazines; Postoperative Complications; Purines; Random Allocation; Rats; Rats, Wistar; Sildenafil Citrate; Sulfones; Surgical Flaps; Tissue Survival

Peyronie's disease (PD) is correctable by several surgical approaches including plaque incision with grafting. While the best choice of graft material remains controversial, the risk of postoperative erectile dysfunction (ED) is apparent across previous reports.. We attempt to provide guidelines as to which patients may be at increased risk for developing postoperative ED after this procedure, as well as examine the role of sildenafil citrate (SC) in the postoperative period for prevention of this complication.. A retrospective review was performed on 37 patients who underwent surgical correction of PD with pericardial grafting after plaque incision. Mean follow-up was 24 months. We evaluated patient age, duration of disease, defect size, plaque location, degree of curvature, shaft narrowing, preoperative coital activity, vascular risk factors for ED, as well as preoperative erection grade and duplex ultrasound parameters. Twenty-six of these patients underwent a postoperative rehabilitation protocol of SC to enhance recovery of unassisted erections.. Overall, 11 patients (29%) noted diminished postoperative rigidity, that compromised unassisted coitus, compared to preoperative status. Comparison of rates of ED among those with or without vascular risk factors yielded no statistically significant results. Peyronie's disease duration, patient age, defect size, plaque location, degree of curvature, and narrowing were also insignificant predictors of which patients developed ED. An increased percentage of patients who developed ED were not sexually active preoperatively compared to those that did not develop ED (58% vs. 80%). When patients were compared based on preoperative erection grade, those patients with compromised erectile function were more likely to develop postoperative ED vs. those with full erections (P < 0.05). No significant differences were found in preoperative duplex ultrasound parameters between both sets of patients. For those undergoing SC rehabilitation, 7 out of 26 (26%) developed ED in comparison to 4 out of 11 patients (36%) developing diminished rigidity when not subjected to the protocol.. No single parameter was found that predicted the occurrence of postoperative ED with the exception of preoperative erectile status. The surgeon must carefully assess and consult each patient when considering grafting as well as consider the possible role of SC in attempting to prevent this complication.

Topics: 3',5'-Cyclic-GMP Phosphodiesterases; Erectile Dysfunction; Humans; Male; Middle Aged; Penile Induration; Pericardium; Phosphodiesterase Inhibitors; Pilot Projects; Piperazines; Postoperative Complications; Purines; Retrospective Studies; Risk Factors; Sexual Behavior; Sildenafil Citrate; Sulfones

To assess the penile vascular system in men long-term after surgical treatment of penile fractures.. During a 15-year period, 36 cases of penile fracture underwent immediate surgical repair at the University of Istanbul, Turkey. At least 1 year after operation, all patients were invited for penile vascular evaluation. 15 patients accepted our call and were enrolled in our study. They were evaluated with detailed medical and sexual history, a serial of serum analyses, and penile color Doppler ultrasonography.. By history, 6 of the 36 (16.6%) patients who had undergone surgical repair had erectile dysfunction (ED). The mean interval between surgical intervention for penile fracture and penile vascular evaluation was 3.6 +/- 1.9 (range 1.5-8) years. Evaluation of the penile vascular system of 15 men (mean age 35.7 +/- 17.3, range 21-63 years) revealed normal vascular system in seven (46.7%), while cavernosal insufficiency was observed in four (26.7%) and arterial insufficiency in three (20%) men. The remaining case (6.7%) was diagnosed to have mixed arterial and cavernous insufficiency. Erectile dysfunction in two cases was considered to be in psychogenic origin and vascular in the remaining four.. Although immediate repair is reported to be the treatment of choice in penile fractures, ED of either a physiological or vascular origin can be encountered as a long-term sequel and deserves to be evaluated in detail.

Topics: Adult; Erectile Dysfunction; Humans; Male; Middle Aged; Papaverine; Penis; Piperazines; Postoperative Complications; Purines; Rupture; Sildenafil Citrate; Sulfones; Ultrasonography, Doppler, Color; Vasodilator Agents

Our institution previously described a surgical technique for preservation of accessory pudendal arteries at radical retropubic prostatectomy. Since then, we have expanded our experience. We now report our refinements in the surgical technique, illustrated with video, and the influence of accessory artery preservation on the recovery of sexual function after radical retropubic prostatectomy (RRP).. Between 1987 and 2003, 2399 potent men underwent RRP. Of the 2399 men, 84 (4%) were identified with accessory pudendal arteries. Of the 84 men, 52, who underwent bilateral nerve-sparing surgery, were available for evaluation. We identified a control population, without accessory pudendal arteries, who were matched for age, stage, and neurovascular bundle status. Potency was defined as the ability to achieve unassisted intercourse with or without the use of sildenafil. In a Cox proportional hazards model, the effect of artery preservation increased the likelihood of potency more than twofold (relative risk 2.65; 95% confidence interval 1.11 to 6.32; P = 0.028). Kaplan-Meier analysis showed a significantly shorter median time to regain potency among those with artery preservation, 6 versus 12 months (P = 0.020).. Preservation of accessory pudendal arteries may favorably influence the recovery of sexual function and interval to recovery after RRP.

Topics: Adenocarcinoma; Arteries; Cohort Studies; Erectile Dysfunction; Humans; Life Tables; Male; Middle Aged; Penis; Piperazines; Postoperative Complications; Proportional Hazards Models; Prostatectomy; Prostatic Neoplasms; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome

A five-month-old girl of Down syndrome underwent a corrective surgery for complete atrioventricular septal defect. Her postoperative course was complicated with pulmonary hypertensive (PH) crises despite nitroglycerin (NTG) infusion and inhaled nitric oxide (NO). Sildenafil citrate, a phosphodiesterase 5 inhibitor, was administered through a nasogastric tube at a starting dose of 0.3 mg/kg by stepwise increment to the maximum dose of 2 mg/kg 4 hourly. Sildenafil citrate dramatically lowered pulmonary arterial pressure and the patient was weaned from NTG and NO without PH crisis. There was no side effect after sildenafil citrate administration. Oral sildenafil citrate is a safe and potent adjunct to the existing therapies for postoperative PH in infants after open heart surgery.

Topics: Administration, Inhalation; Administration, Oral; Cardiac Surgical Procedures; Down Syndrome; Female; Heart Septal Defects; Humans; Hypertension, Pulmonary; Infant; Nitric Oxide; Piperazines; Postoperative Complications; Purines; Sildenafil Citrate; Sulfones; Vasodilator Agents

Pulmonary hypertension remains a major cause of morbidity after cardiac surgery, although inhaled nitric oxide (iNO) was shown to have clinical benefit. Some patients are dependent on iNO, increasing the length of hospital stay. The authors report a case of a girl, nine years old (17 kg), with mitral insufficiency, atrial septal defect and pulmonary hypertension (80% of systemic pressure). Following cardiac surgery, pulmonary hypertension persisted and iNO could not be withdrawn. Sildenafil was administered orally (1,5mg x kg(-1), every 4 h) at the 15th postoperative day and iNO could be withdrawn within 24h with clinical improvement.

Topics: Administration, Inhalation; Cardiac Surgical Procedures; Child; Female; Heart Septal Defects, Atrial; Humans; Hypertension, Pulmonary; Mitral Valve Insufficiency; Nitric Oxide; Piperazines; Postoperative Complications; Purines; Sildenafil Citrate; Sulfones; Vasodilator Agents

Topics: Acenocoumarol; Administration, Oral; Aged; Anticoagulants; Blood Proteins; Drug Administration Schedule; Drug Synergism; Erectile Dysfunction; Gingival Hemorrhage; Half-Life; Heart Valve Diseases; Humans; International Normalized Ratio; Male; Piperazines; Postoperative Complications; Protein Binding; Purines; Ranitidine; Sildenafil Citrate; Sulfones; Thrombosis; Warfarin

Topics: Administration, Inhalation; Drug Synergism; Heart Valve Prosthesis Implantation; Humans; Hypertension, Pulmonary; Infant; Male; Mitral Valve Stenosis; Nitric Oxide; Piperazines; Postoperative Complications; Purines; Sildenafil Citrate; Sulfones; Treatment Outcome

We determined the effect of incision and saphenous vein grafting on penile length, erectile function and overall sexual satisfaction in men with Peyronie's disease.. A total of 24 consecutive men underwent plaque incision and saphenous vein grafting with postoperative daily use of a vacuum erection device. Erect penile length, pain, curvature and erectile function were assessed before and after surgery, and overall sexual satisfaction was scored from 1 to 5 by a validated instrument.. Of the 22 patients in whom adequate followup data were available mean penile length was increased 2.1 cm. as a result of surgery (p <0.001). Median score of overall satisfaction with sex life was 4 or moderately satisfied. Of the 86% of men who achieved sexual intercourse after surgery 54% used no erectile aids and 32% required sildenafil or intracavernous injection. Complete erectile dysfunction was present in 14% of cases. Patients who reported erectile difficulty preoperatively were significantly more likely to have erectile dysfunction postoperatively that required erectile aids. Arterial insufficiency on duplex Doppler ultrasound was associated with a higher likelihood of complete erectile dysfunction. Complications in 33% of patients included complete erectile dysfunction in 3 and significant persistent penile curvature in 1.. Incision and venous grafting of plaque leads to statistically and clinically significant increases in penile length in men with Peyronie's disease. Preoperative erectile dysfunction and cavernous arterial insufficiency were associated with a higher risk of postoperative erectile dysfunction. Nevertheless, patients reported a high degree of satisfaction with their overall sex life.

Topics: Adult; Aged; Erectile Dysfunction; Humans; Male; Middle Aged; Penile Erection; Penile Induration; Penis; Phosphodiesterase Inhibitors; Piperazines; Postoperative Complications; Purines; Saphenous Vein; Sexual Behavior; Sildenafil Citrate; Sulfones