sildenafil-citrate and Trauma--Nervous-System

There is no consensus on the best oral phosphodiesterase type 5 inhibitor (PDE5I) for patients undergoing penile rehabilitation after surgical nerve injury.. To determine the mechanism of PDE5I on cultured neuronal cells and the effectiveness of local drug delivery using nanospheres (NSPs) to sites of nerve injury in a rat model of bilateral cavernous nerve injury (BCNI).. The effects of sildenafil, tadalafil, and vardenafil on cyclic adenosine monophosphate, cyclic guanosine monophosphate, and cell survival after exposure to hypoxia and H. Viability of neuronal cells was measured. Intracavernous pressure changes after cavernous nerve electrostimulation and expression of neurofilament, nitric oxide synthase, and actin in mid-shaft of penis were analyzed 14 days after injury.. Sildenafil and rolipram significantly decreased cell death after exposure to H. Sildenafil showed the most profound neuroprotective effect compared with tadalafil and vardenafil. Sildenafil- or rolipram-loaded NSP delivery to the site of nerve injury prevented erectile dysfunction and led to increased neurofilament, nitric oxide synthase, smooth muscle content in rat penile tissue after BCNI.

Topics: Animals; Cyclic GMP; Erectile Dysfunction; Humans; Hydrogen Peroxide; Male; Muscle, Smooth; Nitric Oxide Synthase; Penile Erection; Penis; Phosphodiesterase 5 Inhibitors; Prostatectomy; Rats; Rats, Sprague-Dawley; Sildenafil Citrate; Trauma, Nervous System

The aim of this study was to compare the effects of sildenafil and trimetazidine on bilateral cavernosal nerve injury-induced oxidative damage and fibrotic changes in cavernosal tissue in rat model.. A total of 32 male Sprague-Dawley rats were randomly divided into 4 groups; each group consist 8 rats (control, BCI, BCI + TMZ, and BCI + sildenafil groups). Tissue superoxide dismutase (SOD), malondialdehyde (MDA), and protein carbonyl (PC) levels were determined biochemically and distribution of cavernosal fibrosis density among groups was performed histopathologically.. Tissue SOD levels in BCI group were significantly lower than the control group (P < 0.05). Tissue MDA and PC levels in BCI group were significantly higher than the control group (P < 0.05). TMZ and sildenafil administration significantly increased tissue SOD levels (P < 0.05) and reduced tissue MDA and PC levels (P < 0.05). Histologically, the degree of cavernosal fibrosis and collagen density was higher in BCI group in comparison to control, TMZ-treated, and sildenafil-treated groups.. BCI caused oxidative damage and increased cavernosal fibrosis in rat penis. TMZ and sildenafil treatment decreased oxidative damage and reduced the degree of fibrosis in penile tissue due to BCI.

Topics: Animals; Fibrosis; Male; Malondialdehyde; Oxidative Stress; Penis; Piperazines; Purines; Random Allocation; Rats, Sprague-Dawley; Sildenafil Citrate; Sulfones; Superoxide Dismutase; Trauma, Nervous System; Treatment Outcome; Trimetazidine; Vasodilator Agents

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

In this study, prophylactic penile rehabilitation (PR) with sildenafil before and after a cavernosal nerve (CN) injury was analyzed in an animal model.. Thirty-six animals were divided into six groups as follows: (1) those with no CN injury (i.e., sham), (2) those with a bilateral CN injury (i.e., control), (3, 4) those with a bilateral CN injury treated with 10-20 mg/kg of sildenafil subcutaneously (SC) on a daily basis commencing 1 month prior to and after nerve injuries, respectively, (5, 6) those with a bilateral CN injury treated daily with 10-20 mg/kg of sildenafil SC after the nerve injuries, respectively. Mean arterial pressure (MAP) and intracavernosal pressure (ICP) were measured in response to CN stimulation to assess erectile function (EF). Neuronal nitric oxide synthase (nNOS) immunohistochemical analysis and real-time polymerase chain reaction (RT-PCR) were performed.. The maximal ICP/MAP ratio was 60 ± 18% in the sham, 22 ± 5% in the control, 28 ± 9% in Group III, 45 ± 16% in Group IV, 45 ± 17% in Group V, and 49 ± 21% in Group VI. Although EF was improved with sildenafil treatment in a dose-dependent fashion, no statistically significant difference was observed between the preemptive and standard rehabilitation groups. Again, nNOS immunoreactivity and RT-PCR results showed the beneficial effect of sildenafil, but the study did not support the efficacy of preemptive rehabilitation when compared to the standard rehabilitation group.. Although, a dose-response relationship was observed for PR treatment with sildenafil; i.e., outcomes improved at higher doses of sildenafil for PR, preemptive PR should not be pursued as an alternative rehabilitation modality.

Topics: Animals; Dose-Response Relationship, Drug; Erectile Dysfunction; Male; Models, Animal; Penis; Piperazines; Purines; Rats; Rats, Sprague-Dawley; Sildenafil Citrate; Sulfones; Trauma, Nervous System; Treatment Outcome; Vasodilator Agents