daily use of L-arginine, tadalafil and combined L-arginine with tadalafil in the treatment of elderly patients with ED

[madman]

Comparison of the clinical efficacy of daily use of L-arginine, tadalafil and combined L-arginine with tadalafil in the treatment of elderly patients with erectile dysfunction.


Abstract

This study aimed to evaluate the efficacy of the daily oral administrations of L-arginine, tadalafil and combined L-arginine with tadalafil in treatments of elderly patients with erectile dysfunction (ED). It was designed as a single-blind placebo-controlled clinical trial. It was conducted on 120 male patients aged ≥60 years old with ED. Patients were randomized classified into four groups (n = 30 each). Oral daily use of L-arginine (5 g), tadalafil (5 mg), combined L-arginine (5 g) with tadalafil (5 mg) and placebo were taken for 6 weeks in each group of patients respectively. Patients were assessed before and after treatments using the Sexual Health Inventory for Men (SHIM) questionnaire and total serum testosterone. The means of Q1–5, total scores of SHIM and total testosterone, in L-arginine, tadalafil and combined L-arginine with tadalafil groups were significantly higher after treatments (p = .001). Combined L-arginine with tadalafil group had the highest SHIM scores and levels of total testosterone. This clinical trial deduced that the combined daily use of L-arginine with tadalafil therapy for elderly male patients with ED could significantly increase the SHIM scores and levels of total testosterone in comparison to L-arginine, or tadalafil alone.




1 | INTRODUCTION

Erectile dysfunction (ED) is defined as a persistent or recurrent inability to obtain and/or maintain sufficient penile erection for satisfactory sexual intercourse. The prevalence of ED is enhanced by aging, and in general, ED is less than 10% among males aged <40 years, less than 15% among males aged 40–49 years, 20%–30% among males aged 50–69 years, 20%–40% among males aged 60–69 years, and 50%–100% among males aged ≥70 years (McCabe et al., 2016).

The risk factors for ED may be classified into four categories, including (a) cardiovascular and metabolic disorders (such as diabetes mellitus, hypertension, hyperlipaemia and obesity), (b) andrological or urological diseases (such as lower urinary tract symptoms), (c) psychosomatic and psychiatric disorders (such as depression, psychological stress and antidepressants) and (d) lifestyle factors (such as smokers and sedentary lifestyle) (Beutel, Weidner, & Brahler, 2006; McMahon, 2019; Nguyen, Gabrielson, & Hellstrom, 2017).

Penile erection is a complex phenomenon that denotes a delicate organized balance among vascular, neurological and tissue compartments. It comprises penile arterial dilation, smooth muscle relaxation of trabecular tissues with stimulation of the mechanism of corporeal veno-occlusion (Gratzke et al., 2010).








This clinical study concluded that the combined daily use of L-arginine with tadalafil therapy for elderly male patients with ED for 6 weeks could significantly increase the SHIM scores and total testosterone levels in comparison to L-arginine alone, or tadalafil alone.

 

[madman]

This study reported that the means of total testosterone before treatments among the study groups were insignificant (p ˃ .05). (Table 3).

The means of total testosterone, in L-arginine, tadalafil and combined L-arginine with tadalafil groups were significantly improved after six weeks of treatments in comparison with the baseline values (p = .0001), while the mean of total testosterone, in the placebo group, was insignificant after treatment (p ˃ .05).

After six weeks of treatments, the means of total testosterone among L-arginine, tadalafil, combined L-arginine with tadalafil and placebo groups were significant (p = 0.0001), and the highest mean values of total testosterone were presented in combined L-arginine with tadalafil group. (Table 3).