Treatment for Erectile Dysfunction in Patients with Diabetes

In This ArticleAbstract and IntroductionPatients and MethodsResultsDiscussionTablesReferencesRelated Links

Results

Analysis of the IIEF scores before the treatment showed that 126 patients (44.4%) had severe ED, 106 (37.3%) moderate ED, and 52 (18.3%) mild-moderate ED. Five patients (1.8%) have had ED for 6 months to 1 y, 38 (13.4%) for 1-2 y, 117 (41.2%) for 2-5 y, 88 (31%) for 5-10 y, and 36 (12.7%) for 10-14 y. Mean duration was 2.5±0.9 y.Treatment

Phase 1. Of the 284 patients, eight were excluded from the sildenafil citrate phase as a precaution because of intensive laser treatment for severe retinopathy on the basis of ophtalmologist's request. Of the remaining 276 patients receiving sildenafil citrate, a positive response was noted in 147 (53.3%). In all, 25 patients (9.1%) had adverse effects, including facial flushing (n=12, 4.3%), headache (n=9, 3.3%), dizziness (n=3, 1.1%), and abnormal vision (n=1, 0.4%) and stopped sildenafil citrate after short time. Therefore 122 (44.2%) patients were able to continue this treatment.

See Table 2 .

Phase 2. Vacuum therapy with the VED was attempted in 162 patients: 129 who failed to respond to sildenafil citrate+25 with adverse effects to sildenafil+8 with retinopathy. After 2-3 sessions at intervals of 2-3 days, 114 patients (70.4%) showed a positive response. In all, 13 of them (8%), however, complained of severe pain from even the largest tension ring, and in 17 (10.5%) decreased penile rigidity to 1-2 min even with the smallest ring. Only 19 (11.7%) agreed to use the VED under domestic conditions.

Phase 3. A total of 143 patients were given ICI with vasoactive drugs: 48 patients who failed phase 2, 30 who had pain or rigidity during VED, 65 who refused the VED for home use despite a good response.

In all, 64 patients (44.8%) responded positively to the first ICI dose of papaverine 12 mg+phentolamine 1 mg+prostaglandin E1 10 µg. The duration of the response was 65.6±3.2 min. An additional 66 patients (46.2%) responded to the ICI, but had pain during erection. In these cases, the dose of prostaglandin E1 was reduced to 6 µg, and the doses of papaverine and phentolamine were increased to 17 and 1.5 mg, respectively. In the nonresponders to the first injection, the dose of prostaglandin E1 was increased as well, to 12.2±4.5 µg. There were 29/79 (36.7%) responders to the second injection, with a mean response duration of 50.4±2.5 min. The remaining 50 patients received a third injection of papaverine 25 mg+phentolamine 2 mg+prostaglandin E1 18.4±4.6 µg, and 10 (20%) responded. The duration of the positive response was 44.1±2.4 min. The total number of patients with a positive mean response at the end of phase 3 was 103 (72%).

Phase 4. In all, 40 patients received sildenafil 50 mg followed by ICI with papaverine 25 mg+ phentolamine 2 mg+prostaglandin E1 15.4±5 µg. In all, 17 (42.5%) patients responded, with a response duration of 48.5±5.5 min. A total of 23 nonresponders received sildenafil 100 mg followed by ICI at the same doses. In all, 10 patients (25%) responded to this increased dose with response duration of 31.4±1.2 min. Four patients (17.4%) complained of slight dizziness. A total of 13 patients were considered as nonresponders in this phase.

Phase 5. In all, 13 patients went on to receive papaverine 16 mg+phentolamine 1.5 mg+prostaglandin E1 15.2±3.4 µg followed by the VED. After two sessions at intervals of 3-5 days, nine (69.2%) showed a positive response.

Phase 6. The remaining four patients agreed to an inflatable two-piece (three patients) or three-piece (one patient) penile prosthesis. All performed successful coitus 8-10 weeks after surgery.

Of the 43 patients receiving insulin, 37 were eligible for sildenafil citrate treatment, and nine (24.3%) responded. In all, 22 (64.7%) of 34 responded to the ICI, 4/12 (33.3%) to sildenafil +the ICI, 2/8 (25%) to ICI+VED and the remaining four underwent a penile implant. Of the 17 patients (70.6%) in whom penile rigidity decreased after VED, 12 were receiving insulin.Follow-up

During the 2 y follow-up after 284 patients, the ED treatment was changed as necessary, according to the same 6-phase program. The reasons for transition from one treatment modality to another were different. In all, 11 patients were referred for penile implantation due to failure of other options during this period of time. Of the 19 patients (63.2%) who received the VED, 12 were asked to switch to another form of treatment during follow-up because their partner complained of a cold sensation during vaginal penetration. Examination of these patients in glands penis with an electrothermometer showed that at 1-2 min before vacuum therapy, penile temperature was 30.4±0.9°C, and after 10-12 min, it dropped to 24.4±0.4°C (P<0.05). After ICI in 6/113 patients (5.3%), small nodules appeared and treatment was stopped for 1.0-1.5 months, during which time vacuum therapy was used. The nodules disappeared within this period in all patients.

At the end of 2 y, 81 of 284 patients who entered the study (28.5%) were performing successful coitus with sildenafil citrate, seven (2.5%) with VED, 113 (39.8%) with ICI, 24 (8.5%) with sildenafil+ICI, two (0.7%) with ICI+VED and 15 (5.3%) with a penile prosthesis. In all, 17 (6%) patients reported spontaneous erections. A total of 14 (5%) patients had a negative response to all treatments. All of them had diabetic complications and comorbidities, including six (42.9%) receiving insulin, aged 70-78 y. In all, 11 (3.9%) patients stopped treatment despite an initial positive response: five were divorced, two were widowed, and four had an ill wife. In general, after 2 y, 259 (91.2%) were achieving coitus.

Total mean IIEF score before treatment was 16.48±6.41, and after 2 y of follow-up, 58.64± 11.78 (P<0.001). Comparison of the mean response to five domains of the IIEF between baseline and termination of the 2 y follow-up is shown in Table 3 .

Doppler ultrasound was performed in 17 patients with decreased rigidity with rings (VED). Peak systolic velocity (mean±s.d.) before ICI was 16.7± 1.5 cm/s, after 5 min 46.6±2.8 cm/s (P<0.001), after 15 min 24.3±1.6 cm/s (P<0.0001). Peak diastolic velocity before ICI was 3.5±0.2, after 5 min 8.9±0.3 (P<0.05) and after 15 min 4.2±0.4 cm/s (P<0.05). We assumed these patients had venous leakage. Accordingly, in the 12 patients who reported spousal complaints of cold sensation, electrothermometry revealed a significant drop from 30.4±0.9°C before vacuum therapy to 24.4±0.4°C at 10-12 min after cylinder removal but not when the rings were removed (P<0.05).Previous PageSection 3 of 4Next Page: Discussion
Int J Impot Res.  2005;17(5):431-436.  ©2005 Nature Publishing Group


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Essential oils ‘combat superbug’

Tests of new machine at a hospital have found it could be effective in the battle against the superbug MRSA.

Consultants at Wythenshawe Hospital found that using a vaporiser to spray essential oils into the atmosphere killed off micro-organisms.

Airborne bacterial counts dropped by 90% and infections were reduced in a nine-month trial at the burns unit.

The recipe of oils used in the machine was refined by microbiologists at Manchester Metropolitan University.

Scent Technologies, the Wigan-based company which makes the machine, developed the device to mask smells on wards but found it had a beneficial effect on infections.

The study was started after the recipe of oils was modified by the university team, in conjunction with Wythenshawe consultant Ken Dunn.

"Many people will be aware that there are decades of experience with the use of essential oils to control infection," said Mr Dunn.

"I think the novelty of this is putting the two researched technologies together and being able to affect a really surprisingly large area of the ward with a single machine."

There were no MRSA infections in the burns unit while the machine was being used with the recipe of oils.

In the final two months the natural essence blend was removed from the machines and MRSA levels in the air increased - and there was an MRSA outbreak in the ward.

More tests

But despite the apparent success of the trial, MRSA campaigners have urged healthcare professionals to continue with strict cleaning regimes.

Bev Hurst, whose mother Margaret died from an MRSA infection, said: "If this is something that is going to help then that's brilliant.

"But it has to be in conjunction with everything else - it can't just be a machine on a ward."

The National Audit Office estimates hospital-acquired infections contribute to some 5,000 deaths annually.

Further tests are now being carried out.
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‘Big Science’: Top Funding For EU Lung Research Project PULMOTENSION

Pulmonary hypertension (PH) describes a group of chronic, prolonged crippling and fatal vascular diseases. It is characterized by high blood pressure in the lung vessels leading to right heart failure. PH often affects young or middle-aged patients, who suffer from progressive loss of exercise capacity and dyspnoea. As a result, this serious lung disease represents a major burden on our healthcare systems.

With the formation of PULMOTENSION, European Top centers for scientific and technical competence in PH have taken a decisive step in tackling this large medical problem: Connected into a single project they aim to better understand and find a cure for this serious disease, because the large and complex tasks can only be addressed with the collected multidisciplinary competence and critical mass assembled. This pan-European "Big Science"- initiative allows the collaborating researchers to investigate basic science questions in terms of clinical applicability and provides a unique potential for scientific breakthroughs, technological advances and new treatments in the field of pulmonary hypertension.

"In this translational research concept the lung experts work "from bench to bedside" or "from the molecule to the patient": Over the next four years, we aim to uncover underlying molecular pathways of PH, identify distinct targets for anti-remodelling therapy, foster drug development based on these targets in alliance with industrial partners and exploitation facilities, and carefully test these new treatment options in preclinical and clinical trials", explains Werner Seeger, Head of the University of Giessen Lung Center (UGLC) of the Justus-Liebig-University of Giessen, Germany. "This is a huge but thrilling organizational challenge for all of us".

The combined expertise in PULMOTENSION extends from the initial discovery of gene mutations in PH to the establishment of new therapeutic regimen of PH. These include the discovery of BMPR2 mutations in PH, an effort led by Prof. Richard Trembath (King's College, London, United Kingdom) or the introduction of sildenafil (Viagra®) into the treatment of PH by a team of physicians led by Prof. Friedrich Grimminger (UGLC, Germany).

At the kick-off-meeting of PULMOTENSION in Giessen on February 9 and 10, 2006, the lung experts elected a central steering committee for this consortium and initiated research strategies, clinical trials and a European PH Tissue Bank and Registry.

For more information about PULMOTENSION and collaborating centers please visit: http://www.uglc.de/eu-six.html a European PH Tissue Bank and Registry.

Contact: Christiane Eickelberga European PH Tissue Bank and Registry.
christiane.eickelberg@uglc.de
University of Giessen Lung Center (UGLC)
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“Do It Yourself”: Patients Treating Themselves for UTIs

Return to Medscape coverage of: 41st Interscience Conference on Antimicrobial Agents and Chemotherapy  |  Daily Session Coverage

"Do It Yourself": Patients Treating Themselves for UTIs

Disclosures

Mary Beth Nierengarten, MA   

Chicago, Tuesday, December 18, 2001 — Escherichia coli bugs women, particularly their urinary tracts. Of all the pathogens that lead to urinary tract infections (UTIs), E coli is the main culprit. Two studies presented in a slide session at the 41st ICAAC focused on UTIs in 2 particular populations: women with recurrent infections, and those with diabetes.

Self-initiated Antibiotic Therapy for Recurrent UTIs

Self-initiated antibiotic therapy is an attractive option for controlling recurrent UTIs in women, and it can be safe and effective. One major drawback, however, is the potential risk for developing antibiotic resistance. Dr. Gupta from the University of Washington, and colleagues[2] conducted a study to evaluate the prevalence of antimicrobial resistance to E coli infections in women given either ofloxacin (OFL) or levofloxacin (LVX) to self-administer as needed. Of 172 women in the study, 144 had confirmed cases of UTI, primarily due to E coli (73% as sole pathogen, 12% as copathogen) during the study period. E coli isolates were resistant to trimethoprim-sulfamethoxazole (TMP/SMX) (12%), ampicillin (AMP) (31%), ampicillin/clavulanate (AMC) (10%), and cephalothin (CEP) (12%). None of the strains were resistant to cefotaxime, ciprofloxacin, ofloxacin, levofloxacin, or nitrofurantoin. These results are similar to those reported for sporadic uncomplicated cystitis.

The investigators also looked at resistance problems to different antibiotics in a subset of 103 women with 185 confirmed cultures, 85% of which were E coli. The report was encouraging, said Dr. Grupta, because of the finding that 62% of the E coli strains were not resistant to multidrug therapy; only 12% were resistant to 3 or more antimicrobials (ie, multidrug resistant).

Because an increased risk of antibiotic resistance is always a factor in managing UTIs, these data are encouraging for patients who wish to initiate their own therapy.

Women with Diabetes Mellitus

Can a vaccine prevent the high prevalence of bacteriuria in women with diabetes mellitus (DM)? Dr. Meiland, from the University Medical Center Utrecht, The Netherlands,[1] says it's time to clinically evaluate a vaccine that has shown promising results in the lab.

Due to an increased type of a particularly virulent strain of E coli (type 1-fimbriated), which binds to the uroepithelial cells of women with DM, the prevalence of bacteriuria is higher in these women than in women without this metabolic disorder. Developing a vaccine for these women is therefore highly attractive.

To clinically evaluate a vaccine to reduce and prevent E coli infections in diabetic women, Dr. Meiland and colleagues isolated 2 E coli strains — Ctr39 and NU14 — from uroepithelial cells of women with DM. After incubation with anti-FimCH antiserum diluted 1:50, 1:100, or 1:200, the investigators found that adherence of E coli to the uroepithelial cells of diabetic women was inhibited for both the Ctr39 (65%, 56%, and 41% by dilution ratios, respectively) and NU14 (23%, 8%, and 3% by dilution ratios, respectively) strains. These data show that a vaccine-induced anti-FimCH antiserum can inhibit adherence of E coli to uroepithelial cells of women with DM.

[A phase 2 clinical trial of a vaginal mucosal vaccine against 10 pathogenic strains of E coli and other organisms was presented on Monday (see Pushing the Envelope: A UTI Vaccine, Suppressive Herpes Therapy, and Linezolid Resistance).]

References

Meiland R, Geerlings SE, Brouwer EC, Coenjaerts FEJ, Langermann S, Hoepelman IM. Adherence of Escherichia coli to uroepithelial cells of women with diabetes mellitus (DM) can be inhibited by vaccine-induced anti-FimCH antiserum. Program and abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy; December 16-19, 2001; Chicago, Illinois. Abstract 1349.Gupta T, Hooton TM, Roberts PL, Stamm WE. Antimicrobial resistance in uropathogens from patients utilizing self-initiated therapy for recurrent UTI. Program and abstracts of the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy; December 16-19, 2001; Chicago, Illinois. Abstract 1352.

 
 
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