madman
Super Moderator
Abstract
Objective: To investigate the therapeutic effect of implanting a three-piece inflatable penile prosthesis (IPP) combined with the phosphodiesterase-5 inhibitor sildenafil in severe erectile dysfunction (ED) patients.
Methods: This randomized controlled study included 123 ED patients. Sixty-two patients received the IPP implantation and 61 patients received the IPP implantation and the phosphodiesterase-5 inhibitor sildenafil. Erectile function and sexual life quality were evaluated using the five-item International Index of Erectile Function (IIEF) and modified Sexual Life Quality Questionnaire–Quality of Life domain (mSLQQ-QoL), respectively. Serum interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-a, vascular cell adhesion molecule (VCAM)-1, and intercellular adhesion molecule (ICAM)-1 levels were assessed. Kaplan–Meier curves were used to assess the overall IPP survival.
Results: Implantation of the three-piece IPP with sildenafil improved erectile function and sexual life quality alleviated the inflammatory response, reduced the complication rate, and improved overall IPP survival.
Conclusion: Implantation of the three-piece IPP combined with a phosphodiesterase-5 inhibitor significantly improved clinical outcomes and the prognosis in ED patients.
Introduction
Erectile dysfunction (ED) is defined as a persistent inability to obtain or maintain an erection for satisfying sexual intercourse.1 Worldwide, up to 50% of men aged 40 to 70 years have ED.2 An increasing amount of evidence shows that ED is caused by the interaction of multiple physiologic systems, such as endocrine, neural, and vascular systems.3 Although ED is considered to be an age-related disease, it might have begun to occur in adolescence, especially for those who have risk factors, including cardiovascular diseases, metabolic syndrome, or diabetes.4
Currently, various methods are used to treat ED including seeking assistance from a mental health professional, lifestyle modifications, oral phosphodiesterase type 5 inhibitor (PDE5I), testosterone therapy, intracavernosal injection therapy, a vacuum erection device, and penile prosthesis implantation.5 PDE5Is including avanafil, lodenafil, mirodenafil, and sildenafil have been used clinically as first-line pharmaceuticals to treat ED.6 As previously reported, PDE5Is have a therapeutic effect on ED in patients with spinal cord trauma.7 Additionally, PDE5I administration was shown to be well-tolerated for ED in diabetic men, and it also showed excellent effectiveness.8 The anti-inflammatory effect of PDE5I was also reported in several studies. Kosutova et al.9 revealed that sildenafil treatment suppressed pro-inflammatory mediator release and attenuated oxidative damage in acute lung injury. Therefore, we hypothesized that PDE5I might play an anti-inflammatory role in patients with ED.
Implantation of an inflatable penile prosthesis (IPP) is an effective and safe treatment option for men who do not respond to conventional medical therapy.10 Although IPP implantation was reported to result in better sexual function and the patients had better feeling as well as higher satisfaction then with other treatment options, it also might result in a mechanical failure that requires prosthesis repair, explant, or replacement.11 Moreover, infections commonly result from bacterial implantation on the surface of the device during IPP implantation.12 The three-piece IPP was reported to be a safe and effective approach that has a high satisfaction rate, and its minimally invasive approach could decrease common postoperative complications.13 Therefore, more attention needs to be paid to decreasing the complication rate and alleviating inflammation.
In this study, we performed a randomized controlled trial to investigate the effect of implanting a three-piece IPP combined with a PDE5I in patients with severe ED.
Conclusion
We conducted a randomized controlled study to investigate the effect of three-piece IPP implantation combined with a PDE5I on erectile function and sexual life quality, inflammation, and the complication rate in severe ED patients.
We showed, for the first time, that implanting a three-piece IPP combined with PDE5I administration might significantly improve the clinical outcomes and patient prognosis.
Objective: To investigate the therapeutic effect of implanting a three-piece inflatable penile prosthesis (IPP) combined with the phosphodiesterase-5 inhibitor sildenafil in severe erectile dysfunction (ED) patients.
Methods: This randomized controlled study included 123 ED patients. Sixty-two patients received the IPP implantation and 61 patients received the IPP implantation and the phosphodiesterase-5 inhibitor sildenafil. Erectile function and sexual life quality were evaluated using the five-item International Index of Erectile Function (IIEF) and modified Sexual Life Quality Questionnaire–Quality of Life domain (mSLQQ-QoL), respectively. Serum interleukin (IL)-6, IL-8, tumor necrosis factor (TNF)-a, vascular cell adhesion molecule (VCAM)-1, and intercellular adhesion molecule (ICAM)-1 levels were assessed. Kaplan–Meier curves were used to assess the overall IPP survival.
Results: Implantation of the three-piece IPP with sildenafil improved erectile function and sexual life quality alleviated the inflammatory response, reduced the complication rate, and improved overall IPP survival.
Conclusion: Implantation of the three-piece IPP combined with a phosphodiesterase-5 inhibitor significantly improved clinical outcomes and the prognosis in ED patients.
Introduction
Erectile dysfunction (ED) is defined as a persistent inability to obtain or maintain an erection for satisfying sexual intercourse.1 Worldwide, up to 50% of men aged 40 to 70 years have ED.2 An increasing amount of evidence shows that ED is caused by the interaction of multiple physiologic systems, such as endocrine, neural, and vascular systems.3 Although ED is considered to be an age-related disease, it might have begun to occur in adolescence, especially for those who have risk factors, including cardiovascular diseases, metabolic syndrome, or diabetes.4
Currently, various methods are used to treat ED including seeking assistance from a mental health professional, lifestyle modifications, oral phosphodiesterase type 5 inhibitor (PDE5I), testosterone therapy, intracavernosal injection therapy, a vacuum erection device, and penile prosthesis implantation.5 PDE5Is including avanafil, lodenafil, mirodenafil, and sildenafil have been used clinically as first-line pharmaceuticals to treat ED.6 As previously reported, PDE5Is have a therapeutic effect on ED in patients with spinal cord trauma.7 Additionally, PDE5I administration was shown to be well-tolerated for ED in diabetic men, and it also showed excellent effectiveness.8 The anti-inflammatory effect of PDE5I was also reported in several studies. Kosutova et al.9 revealed that sildenafil treatment suppressed pro-inflammatory mediator release and attenuated oxidative damage in acute lung injury. Therefore, we hypothesized that PDE5I might play an anti-inflammatory role in patients with ED.
Implantation of an inflatable penile prosthesis (IPP) is an effective and safe treatment option for men who do not respond to conventional medical therapy.10 Although IPP implantation was reported to result in better sexual function and the patients had better feeling as well as higher satisfaction then with other treatment options, it also might result in a mechanical failure that requires prosthesis repair, explant, or replacement.11 Moreover, infections commonly result from bacterial implantation on the surface of the device during IPP implantation.12 The three-piece IPP was reported to be a safe and effective approach that has a high satisfaction rate, and its minimally invasive approach could decrease common postoperative complications.13 Therefore, more attention needs to be paid to decreasing the complication rate and alleviating inflammation.
In this study, we performed a randomized controlled trial to investigate the effect of implanting a three-piece IPP combined with a PDE5I in patients with severe ED.
Conclusion
We conducted a randomized controlled study to investigate the effect of three-piece IPP implantation combined with a PDE5I on erectile function and sexual life quality, inflammation, and the complication rate in severe ED patients.
We showed, for the first time, that implanting a three-piece IPP combined with PDE5I administration might significantly improve the clinical outcomes and patient prognosis.
