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Öğe Causes of sildenafil citrate treatment discontinuation in patients with erectile dysfunction(2005) Tu?lu, Devrim; Başar, M. Murad; Akbulut, Ziya; Güngör, Sefa; Tekdo?an, Ümit Y.; Atan, AliIntroduction: Although there are many methods in the treatment of erectile dysfunction, no one is successful and sufficient in all the patients. Sildenafil treatment has been found the most successful method among ED treatments. In spite of high efficacy of sildenafil, some patients still stop sildenafil treatment due to various reasons. The aim of the present study is to evaluate the causes of sildenafil citrate treatment discontinuation in the patients with erectile dysfunction. Materials and methods: A total of 217 patients who admitted to our outpatient clinic due to erectile dysfunction were included in the study. They were evaluated with a detailed medical and sexual history and physical examination. Erectile function was assessed with IIEF scores before and after the treatment. The patients' ages ranged from 22 to 74 years (52.3±11.7). They suffered from erectile dysfunction for 34.3±31.3 months (2-240 months). Sildenafil citrate 50 mg was given for a month. At the end of this period, patients were re-evaluated and questioned about the efficacy of sildenafil citrate, its' side effects and whether they wanted to continue the treatment or not. Later, sildenafil 100 mg was recommended to patients desiring to use higher dose of it, and they were questioned 4 week later. Finally, the efficacy and side effects of sildenafil was evaluated, and the causes of dropout were obtained from the patients who discontinued sildenafil treatment. Results: At the 4th week control, sufficient erection was observed in 163 patients (75.1%), no erection was encountered in 54 patients (24.9%). Out of 163 patients, 131 (80.4%) who had sufficient erection with sildenafil left the treatment. The causes of discontinuation in these patients were the high price of the drug in 86 patients (%65.6), improvement of erection problem in 26 (%19.8), fear of asparagus news appearing in the media in 12 patients (%9.2), and side effects of sildenafil in 7 patients (%5.3). Of sildenafil failed patients (n: 54), 12 (22.2%) accepted to try sildenafil 100 mg, 42 (77.8%) did not accept to try sildenafil 100 mg. The reasons not, to try sildenafil 100 mg for these patients were high prize in 20 patients (47.6%), consideration of penile prosthesis in 2 patients (3.2%), side effects of sildenafil 50 mg in 13 patients (30.9%), nothing for 7 patients (16.7%). At the end of the treatment period, only 35 (16.1%) patients continued to use sildenafil 50 or 100 mg, 182 patients (83.9%) left the treatment due to different causes. These causes were high prize in 108 patients (59.3%), improvement of erection quality in 26 patients (14.3%), side effects in 20 patients (10.9%), asparagus news in 12 patients (6.6%), inefficacy in 7 patients (3.8%), choosing other treatment alternatives in 2 patients (1.1%). The other 7 (3.8%) did not describe any cause. Side effects were headache in 15 patients (6.9%), sweating in 12 patients (5.5%), visual problems in 6 patients (2.8%) and chest pain in 4 patients (1.8%). Conclusion: Although Sildenafil treatment is found very effective with acceptable side effects in the treatment of ED regardless to the etiology, discontinuation of the drug is very high. In this study, 80.4% of the patients in whom sildenafil treatment was successful left the treatment. The most important factor of this low ratio is the difficulty of buying the drug due to economic problems.Öğe CAUSES OF SILDENAFIL CITRATE TREATMENT DISCONTINUATION IN PATIENTS WITH ERECTILE DYSFUNCTION(Aves, 2005) Tuglu, Devrim; Basar, M. Murad; Akbulut, Ziya; Gungor, Sefa; Tekdogan, Umit Y.; Atan, AliIntroduction: Although there are many methods in the treatment of erectile dysfunction, no one is successful and sufficient in all the patients. Sildenafil treatment has been found the most successful method among ED treatments. In spite of high efficacy of sildenafil, some patients still stop sildenafil treatment due to various reasons. The aim of the present study is to evaluate the causes of sildenafil citrate treatment discontinuation in the patients with erectile dysfunction. Materials and Methods: A total of 217 patients who admitted to our outpatient clinic due to erectile dysfunction were included in the study. They were evaluated with a detailed medical and sexual history and physical examination. Erectile function was assessed with IIEF scores before and after the treatment. The patients' ages ranged from 22 to 74 years (52.3 +/- 11.7). They suffered from erectile dysfunction for 34.3 +/- 31.3 months (2-240 months). Sildenafil citrate 50 mg was given for a month. At the end of this period, patients were re-evaluated and questioned about the efficacy of sildenafil citrate, its' side effects and whether they wanted to continue the treatment or not. Later, sildenafil 100 mg was recommended to patients desiring to use higher dose of it, and they were questioned 4 week later. Finally, the efficacy and side effects of sildenafil was evaluated, and the causes of dropout were obtained from the patients who discontinued sildenafil treatment. Results: At the 4th week control, sufficient erection was observed in 163 patients (75.1%), no erection was encountered in 54 patients (24.9%). Out of 163 patients, 131 (80.4%) who had sufficient erection with sildenafil left the treatment. The causes of discontinuation in these patients were the high price of the drug in 86 patients (% 65.6), improvement of erection problem in 26 (% 19.8), fear of asparagus news appearing in the media in 12 patients (% 9.2), and side effects of sildenafil in 7 patients (% 5.3). Of sildenafil failed patients (n: 54), 12 (22.2%) accepted to try sildenafil 100 mg, 42 (77.8%) did not accept to try sildenafil 100 mg. The reasons not to try sildenafil 100 mg for these patients were high prize in 20 patients (47.6%), consideration of penile prosthesis in 2 patients (3.2%), side effects of sildenafil 50 mg in 13 patients (30.9%), nothing for 7 patients (16.7%). At the end of the treatment period, only 35 (16.1%) patients continued to use sildenafil 50 or 100 mg, 182 patients (83.9%) left the treatment due to different causes. These causes were high prize in 108 patients (59.3%), improvement of erection quality in 26 patients (14.3%), side effects in 20 patients (10.9%), asparagus news in 12 patients (6.6%), inefficacy in 7 patients (3.8%), choosing other treatment alternatives in 2 patients (1.1%). The other 7 (3.8%) did not describe any cause. Side effects were headache in 15 patients (6.9%), sweating in 12 patients (5.5%), visual problems in 6 patients (2.8%) and chest pain in 4 patients (1.8%). Conclusion: Although Sildenafil treatment is found very effective with acceptable side effects in the treatment of ED regardless to the etiology, discontinuation of the drug is very high. In this study, 80.4% of the patients in whom sildenafil treatment was successful left the treatment. The most important factor of this low ratio is the difficulty of buying the drug due to economic problems.Öğe Common symptoms in men with prostatic inflammation(Springer, 2006) Tuncel, Altuğ; Akbulut, Ziya; Atan, Ali; Basar, M. MuradPurpose We evaluated 96 patients with prostatic inflammation in terms of their symptoms and aimed to find common types and frequencies of symptoms in these patients. Patients and methods The mean age of the patients was 38.0 +/- 8.7 (range 21-58) years. Physical examination, digital rectal examination, microscopic prostatic secretion assessment and urine cultures after taking a detailed medical history were performed. Urine samples before and after prostatic massage were collected for urine culture. Frequency and types of patients' symptoms were evaluated. All patients were asked about lower urinary tract symptoms, sexual dysfunction and other complaints. Results Lower urinary tract symptoms and lumbal pain were more prevalent in elder patients. Ejaculation disorder was the most common sexual problem (n = 65, 67.7%). Erectile dysfunction and decreased libido were observed in 29 (30.2%) and 22 (22.9%) of the patients. Other complaints were lumbal pain (n = 34, 35.4%), perineal fullness (n = 50, 52.1%), haemospermia (n = 20, 20.8%) and scrotal pain (n = 43, 44.8%). Conclusion Prostatic inflammation was usually seen in men of the third and fourth decade. Sexual dysfunction was the most common symptom in this particular group of patients.Öğe Comparison of efficacy of sildenafil-only, sildenafil plus topical EMLA cream, and topical EMLA-cream-only in treatment of premature ejaculation(Elsevier Science Inc, 2006) Atan, Ali; Basar, Murad M.; Tuncel, Altuğ; Ferhat, Mehmet; Agras, Koray; Tekdoğan, ÜmitObjectives. To compare the efficacy of sildenafil (Viagra) only, sildenafil plus topical anesthetic cream (EMLA), and topical EMLA-cream-only to that of placebo in treating premature ejaculation. Methods. A total of 84 patients were enrolled in this study. The duration of premature ejaculation in the patients ranged from 9 to 60 months (mean 32.5 +/- 14.6). Patients were randomized into four groups. Group 1 consisted of 20 patients who took placebo for 2 months. Groups 2 and 3 consisted of 20 and 22 patients, respectively, and they received 50 mg sildenafil 45 minutes before coitus for 2 months. In addition, patients in group 3 applied topical EMLA cream to the glans penis 15 minutes before coitus. The 22 patients in group 4 used topical EMLA-cream-only. After at least eight sexual attempts, the patients' clinical responses were assessed using the patient self-description method. Effectiveness was described as improvement plus cure. Results. The effectiveness was 40% in group 1, 55% in group 2, 86.4% in group 3, and 77.3% in group 4. Of the groups, a significant difference was found in the effectiveness of the treatments (Pearson chi-square = 0.00). No significant difference was found between groups 1 and 2 (P = 0.26). Efficacy was more successful in groups 3 and 4 than in the others (P = 0.00). The difference between groups 3 and 4 was not significant (Pearson chi-square = 0.42). Conclusions. Sildenafil-only was not superior to placebo or combination treatment. Topical EMLA-cream-only had equal effectiveness to that of sildenafil plus topical EMLA treatment. The use of topical EMLA-cream-only seems to be an effective treatment of premature ejaculation.Öğe Effect of sildenafil citrate treatment on serum dehydroepiandrosterone sulfate levels in patients with erectile dysfunction(Elsevier Science Inc, 2006) Tekdoğan, Ümit; Tuncel, Altuğ; Tuglu, Devrim; Basar, M. Murad; Atan, AliObjectives. To investigate the effect of sildenafil citrate treatment on serum dehydroepiandrosterone sulfate (DHEAS) levels in patients with erectile dysfunction (ED). Methods. A total of 124 men with a mean age of 45.9 years were included in the study. Group 1 consisted of 78 patients with ED, as determined by the Sexual Health Inventory of Male (SHIM) scale (score less than 2 1). Group 2 consisted of 46 healthy men with a SHIM score of 21 or greater. The 78 patients with ED took 100 mg sildenafil citrate at least eight times in 1 month. The SHIM scale was administered and serum DHEAS levels measured before and after treatment in the ED group. The serum DHEAS levels were also measured in the control group. The treatment response was defined as positive if the SHIM score was 21 or greater after sildenafil administration. Results. At the end of sildenafil citrate treatment, the serum DHEAS levels and SHIM scores had increased significantly in the ED group (P = 0.013 and P = 0.001, respectively). In groups 1 and 2, the mean pretreatment serum DHEAS level of the men younger than 50 years old was 200.1 +/- 77.9 and 279.4 +/- 125.4 mu g/dL, respectively (P = 0.013). The elevation of the serum DHEAS levels and SHIM scores was more significant in the sildenafil responders (P = 0.002 and P = 0.001), respectively. Conclusions. Serum DHEAS levels were significantly greater in the patients younger than 50 years old than in the older patients in the ED group. The serum DHEAS levels increased significantly after sildenafil citrate treatment in the ED group (especially in the younger men). Also, patient age was an important factor affecting the sildenafil citrate response.Öğe Efficacy of clomipramine, sertraline and terazosin treatments in premature ejaculation(Tubitak Scientific & Technical Research Council Turkey, 2008) Tuncel, Altug; Aslan, Yilmaz; Basar, M. Murad; Atan, AliAim: To compare the efficacy of oral domipramine, sertraline and terazosin to placebo in premature ejaculation. Materials and Methods: A total of 90 patients aged from 20 to 58 years were enrolled in this study. Patients were randomized into 4 groups. Group 1 (n: 22) took placebo and served as controls. Group 2 (n: 23) patients took 25 mg clomipramine HCl nightly; Group 3 (n: 20). 50 mg sertraline nightly; and Group 4 (n: 25) 5 mg terazosin nightly. The medications were used for two months. After 8 sexual attempts, the patients' clinical responses were assessed using the patient self-description method. Clinical responses were classified as "no change", "improvement" and "under control". Success was described as improvement + under control. Results: Success rates were 36.3% in Group 1, 91.3% in Group 2, 90% in Group 3 and 76% in Group 4. Although the efficacy of each medical treatment was superior to placebo (P = 0.001), no significant difference in efficacy was found between the medical treatment groups (P = 0.537). Conclusions: Clomipramine, sertraline and terazosin are more efficient than placebo. No significant difference was observed in terms of efficacy among these three medical treatments.Öğe The efficacy of sildenafil in different etiologies of erectile dysfunction(2001) Başar, Murat; Tekdoğan, Ümit Y.; Yılmaz, Erdal; Başar, Halil; Atan, Ali; Batislam, ErtanPurpose: The aim of this study was to evaluate the efficacy of sildenafil and success of treatment in particular etiological causes in erectile dysfunction lasting more than 3 months. Material and methods: A total of 141 patients between 27 and 78 years old without any cardiac compromise, despite controversial, which precludes sildenafil (Viagra®) treatment, were included in this study. All patients had only International Index of Erectile Capacity Form (IIEF) for pre-treatment evaluation and 50 mg sildenafil was started. Patients were assessed monthly for 6 months thereafter. Erectile capacity changes were questioned by IIEF on each follow-up and 100 mg sildenafil was given in patients without a response and monthly follow-up was scheduled. All patients had SMA-12, hormonal analyses and penile colour Doppler ultrasonography during the treatment course. The difference between IIEF score of each patient was displayed by Paired-t test and p-values less than 0.05 was applied as significant. Results: The average beginning IIEF score of 141 patients was 11.80 ± 0.47 [6-22], and increased to 20.70 ± 0.62 [6-30] after a month of 50 mg sildenafil treatment. The mean increase was 75.4% and found to be significant (p = 0.000, p < 0.05). The average IIEF scores were recorded as 22.57 ± 0.69 after 3, and 22.12 ± 0.24 after 6 months. There was no difference between these values and 2nd month controls (p3 month = 0.5675, p6 month month = 0.6138, p > 0.05). A positive response was recorded in 102 patients (72.3%) and 39 (27.7%) patients were unresponsive. Doubled doses of sildenafil (100 mg) was effective in additional 17 patients. After overall treatment, 119 (84.4%) patients had benefit from sildenafil. Penile Doppler ultrasonography displayed arterial insufficiency in 79 (56.03%), veno-occlusive dysfunction in 14 (9.93%), mixt vascular pathology in 14 (9.93%) patients. Normal ultrasonographic findings in 32 patients (22.7%) were classified as psychogenic dysfunction. Among the organic causes, sildenafil was found to be most effective in arterial insufficiency group. Conclusion: Sildenafil is a successful management modality in erectile dysfunction with minimal pre-treatment evaluation. As far as etiological causes concerned, sildenafil was found to be most effective in arterial insufficiency group and psychogenic group. The efficacy of sildenafil treatment has not been changed with the treatment time, since IIEF scores were stable during follow-up controls.Öğe Is there a relationship among age, international index of erectile function, international prostate symptom score, and aging males' symptoms score?(Springer, 2007) Atan, Ali; Murad Bşsar, M.; Tuncel, Altuğ; Mert, Cağatay; Aslan, YılmazPurpose To investigate the relationship among the International Index of Erectile Function (IIEF), International Prostate Symptom Score (IPSS), and Aging Males' Symptoms (AMS) scale scores in various age groups of males. Patients and methods A total of 307 male patients enrolled in the study. Mean age was 52.3 (range 21-77) years. Group 1 consisted of 51 (<= 39 years), Group 2 consisted of 160 (40-59 years), and Group 3 consisted of 96 (>= 60 years) patients. First five and 15th questions of the IIEF, IPSS, and AMS scale were replied by all the patients. The patients were assessed based on the IIEF for erectile dysfunction (ED), IPSS for lower urinary tract symptoms (LUTS), and AMS scale for Symptomatic Late-Onset Hypogonadism (SLOH). Results ED, LUTS, and SLOH symptoms were detected in 236 (76.8%), 162 (52.8%), and 184 (59.9%) patients. Except for total AMS scores, IIEF and IPSS scores were significantly different among the groups (p(AMS) = 0.320, p(IIEF) = 0.000, p(IPSS) = 0.000). In the comparisons of the IIEF scores between the each group, significant differences were observed (p(Group1-Group2) = 0.000, p(Group1-Group3) = 0.000, p(Group2-Group3) = 0.000). Nevertheless, IPSS score was significantly lower in the patients with age <= 39 years than the other age groups (p = 0.000). Conclusions In the present study, ED ratio and LUTS severity significantly increased in older men. We did not find significant relationship between aging and SLOH symptoms. In the light of our results, LUTS seems to be an important risk factor on erectile function.
