madman
Super Moderator
We believe that combination therapy with dual short- and long-acting PDE5 inhibitors may have an additive effect and should be considered, even as a first-line initial strategy in cases of more advanced ED. Tadalafil with its longer half-life, ability to be absorbed with a high-fat meal, and unique twin success in the treatment of benign prostatic enlargement, may be an ideal agent to prescribe daily along with an on-demand PDE5 inhibitor. To date, only 1 randomized clinical trial has investigated this combination.3
Because it appears that PDE5 inhibitors will remain the mainstay of ED management for the foreseeable future, an ideal complementary therapeutic strategy is one that will act in synergy with these drugs. New modalities, including Li-ESWT and plasma-rich platelet and stem cell therapies, are all worthy of evaluation but are still considered to be experimental because further large and well-designed prospective studies are required. With only a handful of small randomized clinical trials performed to date, Li-ESWT does appear to be associated with greater subjective improvements than other combinations, but the data are preliminary at best.4 Intuitively, the proposed mechanism of microtrauma that results in neoangiogenesis of vascular endothelial cells coupled with possible nerve regeneration and remodeling as well as the increase in local neuronal nitric oxide concentration may very well directly potentiate the activity of PDE5 inhibitors.
As the worldwide prevalence of ED continues to increase, it behooves those clinicians who treat men with ED to continue to try new complementary and synergistic treatment options. These new options should also be assessed in the appropriate prospective clinical settings.
Because it appears that PDE5 inhibitors will remain the mainstay of ED management for the foreseeable future, an ideal complementary therapeutic strategy is one that will act in synergy with these drugs. New modalities, including Li-ESWT and plasma-rich platelet and stem cell therapies, are all worthy of evaluation but are still considered to be experimental because further large and well-designed prospective studies are required. With only a handful of small randomized clinical trials performed to date, Li-ESWT does appear to be associated with greater subjective improvements than other combinations, but the data are preliminary at best.4 Intuitively, the proposed mechanism of microtrauma that results in neoangiogenesis of vascular endothelial cells coupled with possible nerve regeneration and remodeling as well as the increase in local neuronal nitric oxide concentration may very well directly potentiate the activity of PDE5 inhibitors.
As the worldwide prevalence of ED continues to increase, it behooves those clinicians who treat men with ED to continue to try new complementary and synergistic treatment options. These new options should also be assessed in the appropriate prospective clinical settings.
