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The aim of this study was to investigate the effects of sildenafil on ocular hemodynamics by color Doppler ultrasonography (CDU). In all, 38 patients with erectile dysfunction diagnosed by International Index of Erectile Function (IIEF) and Sexual Health Inventory of Men (SHIM) scores were included into the study. After taking 100 mg of oral sildenafil citrate, all patients underwent CDU examination of central retinal artery at 60 and 75 min and CDU examination of cavernosal artery at 20, 60 and 75 min. All of the side effects during and after the test were also recorded. The mean cavernous artery peak systolic flow velocity increased significantly after sildenafil. However, no significant change was determined in central retinal artery flow parameters including peak systolic flow velocity, end-diastolic flow velocity, resistive index, pulsatility index, volume and diameter. Five patients experienced ocular side effects. No significant change was observed in retinal artery CDU measurements of patients having ocular side effects. Sildenafil has no effect on ocular hemodynamics on the basis of CDU. Ocular side effects may be the result of other changes in retinal photoreceptors rather than the ocular circulation.

In this study we determine the sexual problems and the prevalence of erectile dysfunction (ED) in male hemodialysis patients by means of the International Index of Erectile Function (IIEF). A total of 187 male patients were included in the study. All of the patients who underwent hemodialysis were asked to complete the IIEF questionnaire. The IIEF domain scores were calculated and erectile dysfunction grading was determined on erectile function domain. Patients were also asked to report whether they had disclosed their sexual problems to physicians or not.The mean age was 49.3+/-13.2 y and the duration of hemodialysis was 38.1+/-8.4 months. By means of the IIEF, the prevalence of erectile dysfunction of any degree was 80.7%. The prevalence of any ED for the patients <50 y and >or=50 y was 74.5% and 86.6%, respectively. The prevalence and the severity of ED was significantly higher in patients >or=50 y. The frequency of intercourse attempts during the last four weeks was 1-2 in 130 (69.5%) of patients. Only 1% of patients disclosed their erectile problems and sought medical assistance prior to our study.Erectile dysfunction is highly prevalent in hemodialysis patients. The prevalence and the severity of ED increased with age. Evaluations for ED should be included in routine assessment of hemodialysis patients.

Objective: To assess the efficacy of sildenafil for erectile dysfunction (ED) in patients on haemodialysis (HD) or peritoneal dialysis (PD), as men with end-stage renal disease (ESRD) often have sexual dysfunction (up to 82% among those on chronic dialysis)., Patients and Methods: Forty-one patients with ED and in ESRD participated in an open-label prospective study. Thirty patients on HD and 11 on PD were asked to complete the International Index of Erectile Function (IIEF) and Fugl-Meyer life-satisfaction scale before and after sildenafil treatment. A total score in the erectile function domain of < or = 25 was accepted as indicating ED. All patients were started on a 25-mg dose, which was increased to 50 mg if there was no response after two trials. In addition, the overall efficacy question was used to evaluate satisfaction, and patients reported any side-effects during treatment., Results: The erectile function and intercourse satisfaction domains improved significantly in both groups (P < 0.01). After sildenafil treatment, two-thirds of those on HD (20/30) and nine of the 11 on PD recovered their erectile function. The pretreatment scores on the IIEF and four domains (except sexual desire) of those responding were significantly higher than in those not responding (P < 0.05). The satisfaction rate on the overall efficacy question was 80% and 82% for the HD and PD groups, respectively. At least one side-effect was seen in 17 patients (43%); one had severe hypotension in the PD group. Overall, mild headache (seven patients, 18%) and flushing (12, 30%) were reported most often., Conclusions: Sildenafil is a safe and satisfactory drug for improving erectile function in patients with ESRD. Patients were satisfied whether treated by HD or PD. Pretreatment scores on the IIEF may be useful for predicting the success of treatment.

Purpose: Of the various methods of hemodynamic studies performed to evaluate erectile dysfunction penile color Doppler ultrasound is currently considered the best. However, intracavernous injection is invasive and has adverse effects, such as prolonged erection. We evaluated whether sildenafil may be used as a substitute for intracavernous agents when assessing impotence on color Doppler ultrasound., Materials and Methods: A total of 42 patients with erectile dysfunction underwent color Doppler ultrasound before and after intracavernous injection of 60 mg. papaverine with genital and audiovisual sexual stimulation. Peak flow and end diastolic velocity were measured in the recorded waveforms obtained 0, 1, 5, 10 and 20 minutes after injection. The patients also underwent color Doppler ultrasound after a 50 mg. oral dose of sildenafil with genital and audiovisual sexual stimulation not before 3 days after the papaverine study. The same parameters were measured at 30, 45, 60, 75 and 90 minutes, and compared with the values obtained after papaverine injection., Results: Mean peak flow velocity significantly increased after oral sildenafil starting at 30 minutes and achieving a maximum value at 60 minutes. There were no significant differences in the 2 methods in mean peak velocity 1, 5, 10 and 20 minutes after papaverine injection, and 30, 45, 60, 75 and 90 minutes after oral sildenafil administration. Penile color Doppler ultrasound with intracavernous papaverine injection is accepted as the gold standard but color Doppler ultrasound with sildenafil has 90% sensitivity and 100% selectivity for demonstrating arterial insufficiency. Due to prolonged erection 5 patients (11.9%) in the papaverine group required pharmacological detumescence by intracavernous injection. No adverse effects of sildenafil were observed., Conclusions: Sildenafil administration achieved increased peak flow velocity comparable to that after intracavernous papaverine injection. With no prolonged erection sildenafil emerges as a safer alternative compared to more invasive intracavernous injection.

Forty-four patients with impotence were evaluated by intracavernous papaverine injection, penile brachial index (PBI) determination and dynamic cavernosography. The correlation between these diagnostic procedures and their diagnostic value were investigated. It was concluded that the papaverine test is an efficient diagnostic procedure and can be used as the first step for the routine work-up of impotent patients.