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43 Puech-Leao P, Chao S, Glina S Gravity cavernosometry simple diagnostic test for cavernosal incompetence Brit J Urol 1990;65:391 44 Ginesti IF, Romieu A, eds Radiologic exploration of impotence The Hague, Boston, London: Martinus Nijhoff Medical Division, 1978 45 McMahon CG Correlation of penile duplex ultrasonography, PBI, DICC and angiography in the diagnosis of impotence Int J Impot Res 1998;10(3):153 158 46 Ciampalini S, Savoca G, Buttazzi L, Gattuccio I, Mucelli FP, Bertolotto M, De Stefani S, Belgrano E High- ow priapism: treatment and long-term follow-up Urology 2002;59(1):110 113 47 Porst H, Tackmann W, van Ahlen H Bulbokavernosusre ex -Latenzzeitmessung (BCR) und somatosensorisch evozierte Potentiale (SSEP) in der Diagnostik der erektilen Dysfunktion Akt Urol 1987;18:198 202 48 Bemelmans BLH, Meuleman EJH, Anten BWM, et al Penile sensory disorders in erectile dysfunction Results of a comprehensive neuro-urophysiological diagnostic workup in 123 patients In: Meuleman, EJH, ed Recent progress in the diagnosis of erectile dysfunction Benda, Nijemegen, 1991, pp 81 94 49 Porst H, Tackmann W, van Ahlen H Neurophysiological investigations in potent and impotent men Brit J Urol 1998;61:445 450 50 Karacan J, Salis PJ, Thornby JI, et al The ontogeny of
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nocturnal penile tumescence Waking and Sleeping 1976;1:27 44 Marshall P, Morales A, Phillips P, et al Nocturnal penile tumescence with stamps: A comparative study under sleep laboratory conditions J Urol 1983;129:288 290 Ek A, Bradley WE, Krane RJ Nocturnal penile rigidity measured by snapgauge band J Urol 1983;129: 964 967 Jonas U Erektiometer: Ein einfacher und sicherer test in der diagnostik der erektilen impotenz Akt Urol 1982;13:324 327 Levine LA, Lenting EL Use of nocturnal penile tumescence and rigidity in the evaluation of male erectile dysfunction Urol Clin North Am 1995;22(4):775 788 Wagner G, Gerstenberg T Human in-vivo studies of electrical activity of corpus cavernosum J Urol 1988;139:Part 2, 327 A Stief CG, Bosch R, Diederichs W, et al Cavernous smooth muscle changes during penile erection and sympathetic stimulation Int J Impotence Res 1991; 3:15 20 Daffertshofer M, Linden D, Syren M, et al Assessment of local sympathetic function in patients with erectile dysfunction Int J Impotence Res 1994;6:213 225 Jost WH, Derouet H, Osterhage J, et al Elektrophysiologische diagnostik bei der erektilen dysfunktion Urologe 1996;A35:120 126
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Appendix A The abridged 5-item version (ED intensity scale) of the International Index of Erectile Dysfunction (IIEF-5) Over the past six months: 1 How do you rate your con dence that you could get and keep an erection
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Very low
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Moderate
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Very high
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1 2 When you had erections with sexual stimulation, how often were your erections hard enough for penetration Almost never/never
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2 A few times (much less than half the time)
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3 Sometimes (about half the time)
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5 Almost always/always
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1 3 During sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner Almost never/never
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2 A few times (much less than half the time)
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1 4 During sexual intercourse, how dif cult was it to maintain your erection to completion of intercourse Extremely dif cult
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2 Very dif cult
3 Dif cult
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1 5 When you attempted sexual intercourse, how often was it satisfactory for you Almost never/never
2 A few times (much less than half the time) 2
3 Sometimes (about half the time)
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5 Almost always/always
The IIEF-5 score is the sum of the ordinal responses to the ve items Thus, the score can range from 5 to 25 Severity categorization of ED: Score 5 10, severe ED; Score 11 15, moderate ED; Score 16 20, mild ED; Score 21 25, normal (no ED)
Oral Pharmacotherapy of Erectile Dysfunction
Hartmut Porst
Introduction
Up until a few years ago, pharmacologic treatment of erectile dysfunction (ED) was limited to a few substances, most of which had to be injected directly into the corpora cavernosa The oral substances available to treat ED included drugs containing yohimbine, and in some special cases the serotonin re-uptake inhibitor trazodone, of cially approved for the indication of depression, and occasionally administered in an off-label use for ED There was also a plethora of aphrodisiacs or sexual tonics available, which usually contained a mixture of various substances, such as testis sicca, testosterone, yohimbine, ginseng, caffeine, barbituric acid, saw palmetto, cayenne fruit, and many others, in one preparation Meanwhile many of these preparations disappeared from the market; some, however, are still available, in particular via the internet These include a range of drugs which contain yohimbine, vitamins (in particular vitamin E and vitamin B complex), dried extracts of muira-puama, gingseng and other herbal and plant extracts, or bamethan sulfate and benzyl nicotinate, respectively Common to all these aphrodisiacs, offered mostly by mail order sex companies or in sex shops, is the fact that their ef cacy was never proven in welldesigned placebo-controlled and double-blind clinical trials, and that only the belief in them may contribute to their promised ef cacy, but not the usual homeopathic doses of the various compounds contained in these aphrodisiacs This chapter on pharmacologic treatment deals
with all those substances, which have been clinically tested in a variety of ED studies and/or were nally approved in the indication of ED, at least in some countries of the world In addition to drugs of cially approved by the health authorities, this chapter also touches brie y on those medications/substances with which clinical studies in the indication of ED were conducted and reported in the literature, and which may be available in some countries, although not of cially be approved for ED treatment